,,ii ,calendar ,no4 #gaf #aadth ,,congress #b;d ,session ,s4 #dbe ,report ,no4 #aad-cie ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,february #aj1 #bjae,mr4 ,boozman 7for himself1 ,mr4 ,tester1 ,mr4 ,inhofe1 and ,mr4 ,schumer7 introduced the following bill2 which was read twice and referred to the ,committee on ,veterans' ,affairs ,december #g1 #bjaf,reported by ,mr4 ,isakson1 with an amendment and an amendment to the title,strike out all after the enacting clause and insert the part printed in italic ,a ,,bill ,to amend title #ch1 ,united ,states ,code1 to provide for a five-year extension to the homeless veterans reintegration programs and to provide clarification regarding eligibility for services under such programs4 #a4 ,short title ,this ,act may be cited as the ,homeless ,veterans' ,reintegration ,programs ,reauthorization ,act of #bjae4 #b4 ,reauthorization of ,department of ,veterans ,affairs homeless veterans reintegration programs 7a7 ,five-,year extension of homeless veterans reintegration programs ,section #bjba7;e77,f7 of title #ch1 ,united ,states ,code1 is amended by striking #bjae and inserting #bjbj4 7b7 ,five-,year extension of homeless women veterans and homeless veterans with children reintegration grant program ,section #bjba;,a7f77#a7 of such title is amended by striking #bjae and inserting #bjbj4 7c7 ,clarification of eligibility for services under homeless veterans reintegration programs ,section #bjba7;a7 of such title is amended by striking reintegration of homeless veterans into the labor force4 and inserting the following3 reintegration into the labor force of-- 7#a7 homeless veterans2 7#b7 veterans participating in the ,department of ,veterans ,affairs supported housing program for which rental assistance is provided pursuant to section #h7o77#ai7 of the ,united ,states ,housing ,act of #aicg 7#db ,u4,s4,c4 #adcg;f7o77#ai772 7#c7 ,indians who are veterans and receiving assistance under the ,native ,american ,housing ,assistance and ,self ,determination ,act of #aiif 7#be ,u4,s4,c4 #daja et seq472 and 7#d7 veterans who are transitioning from being incarcerated4 4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,veterans ,homeless ,programs1 ,caregiver ,services1 and ,other ,improvements ,act of #bjae4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,,title ,i--,benefits ,sec4 #aja4 ,expedited payment of survivors benefits4 ,sec4 #ajb4 ,increase in special pension for ,medal of ,honor recipients4 ,,title ,,ii--,education matters ,sec4 #bja4 ,restoration of entitlement to ,post-#i_/aa ,educational ,assistance for veterans affected by closures of educational institutions4 ,sec4 #bjb4 ,modification and improvement of transfer of unused ,post-#i_/aa ,educational ,assistance to family members4 ,sec4 #bjc4 ,codification and improvement of election process for ,post-#i_/aa ,educational ,assistance4 ,sec4 #bjd4 ,centralized reporting of veteran enrollment by certain groups1 districts1 and consortiums of educational institutions4 ,sec4 #bje4 ,improved role of ,state approving agencies in administration of veterans educational benefits4 ,sec4 #bjf4 ,modification of criteria used to approve courses for purposes of veterans educational benefits4 ,sec4 #bjg4 ,surveys for compliance of educational institutions and training establishments with requirements relating to administration of veterans educational benefits4 ,sec4 #bjh4 ,modification of requirements for approval for purposes of educational assistance provided by ,department of ,veterans ,affairs of programs designed to prepare individuals for licensure or certification4 ,sec4 #bji4 ,expansion of ,yellow ,ribbon ,g4,i4 ,education ,enhancement ,program4 ,sec4 #baj4 ,consideration of certain time spent receiving medical care from ,secretary of ,defense as active duty for purposes of eligibility for ,post-#i_/aa ,educational ,assistance4 ,,title ,,iii--,homeless veterans matters ,sec4 #cja4 ,expansion of definition of homeless veteran for purposes of benefits under the laws administered by the ,secretary of ,veterans ,affairs4 ,sec4 #cjb4 ,increased per diem payments for transitional housing assistance that becomes permanent housing for homeless veterans4 ,sec4 #cjc4 ,expansion of ,department of ,veterans ,affairs authority to provide dental care to homeless veterans4 ,sec4 #cjd4 ,clarification of eligibility for services under homeless veterans reintegration programs4 ,sec4 #cje4 ,program to improve retention of housing by formerly homeless veterans and veterans at risk of becoming homeless4 ,sec4 #cjf4 ,pilot program on provision of intensive case management interventions to homeless veterans who receive the most health care from the ,department of ,veterans ,affairs4 ,sec4 #cjg4 ,establishment of ,national ,center on ,homelessness ,among ,veterans4 ,sec4 #cjh4 ,partnerships with public and private entities to provide legal services to homeless veterans and veterans at risk of homelessness4 ,sec4 #cji4 ,administrative improvements to grant and per diem programs of ,department of ,veterans ,affairs4 ,sec4 #caj4 ,repeal of requirement for annual reports on assistance to homeless veterans4 ,sec4 #caa4 ,comptroller ,general of the ,united ,states study on homeless veterans programs of ,department of ,veterans ,affairs4 ,sec4 #cab4 ,requirement for ,department of ,veterans ,affairs to assess comprehensive service programs for homeless veterans4 ,sec4 #cac4 ,report on outreach relating to increasing the amount of housing available to veterans4 ,,title ,,iv--,health care matters ,sec4 #dja4 ,short title4 ,subtitle ,a--,employment of directors and health care providers ,sec4 #daa4 ,extension of period for increase in graduate medical education residency positions at medical facilities of the ,department of ,veterans ,affairs4 ,sec4 #dab4 ,modification of hours of employment for physicians and physician assistants employed by the ,department of ,veterans ,affairs4 ,sec4 #dac4 ,requirement that physician assistants employed by the ,department of ,veterans ,affairs receive competitive pay4 ,sec4 #dad4 ,establishment of positions of ,directors of ,veterans ,integrated ,service ,networks in ,office of ,under ,secretary for ,health of ,department of ,veterans ,affairs and modification of qualifications for ,medical ,directors4 ,sec4 #dae4 ,pay for ,medical ,directors and ,directors of ,veterans ,integrated ,service ,networks4 ,sec4 #daf4 ,additional requirements for hiring of health care providers by ,department of ,veterans ,affairs4 ,sec4 #dag4 ,provision of information on health care providers of ,department of ,veterans ,affairs to ,state medical boards4 ,sec4 #dah4 ,report on compliance by ,department of ,veterans ,affairs with reviews of health care providers leaving the ,department or transferring to other facilities4 ,subtitle ,b--,opioid therapy and pain management ,sec4 #dba4 ,guidelines on management of opioid therapy by ,department of ,veterans ,affairs and ,department of ,defense and implementation of such guidelines by ,department of ,veterans ,affairs4 ,sec4 #dbb4 ,improvement of opioid safety measures by ,department of ,veterans ,affairs4 ,sec4 #dbc4 ,enhancement of joint working group on pain management of the ,department of ,veterans ,affairs and the ,department of ,defense4 ,sec4 #dbd4 ,establishment of pain management boards of ,department of ,veterans ,affairs4 ,sec4 #dbe4 ,review1 investigation1 and report on use of opioids in treatment by ,department of ,veterans ,affairs4 ,subtitle ,c--,patient advocacy ,sec4 #dca4 ,establishment of ,office of ,patient ,advocacy of the ,department of ,veterans ,affairs4 ,sec4 #dcb4 ,community meetings on improving care from ,department of ,veterans ,affairs4 ,sec4 #dcc4 ,improvement of awareness of patient advocacy program and patient bill of rights of ,department of ,veterans ,affairs4 ,sec4 #dcd4 ,comptroller ,general ,report on ,patient ,advocacy ,program of ,department of ,veterans ,affairs4 ,subtitle ,d--,complementary and integrative health ,sec4 #dda4 ,expansion of research and education on and delivery of complementary and integrative health to veterans4 ,sec4 #ddb4 ,pilot program on integration of complementary and integrative health within ,department of ,veterans ,affairs medical centers4 ,subtitle ,e--,family caregivers ,sec4 #dea4 ,expansion of family caregiver program of ,department of ,veterans ,affairs4 ,sec4 #deb4 ,implementation of information technology system of ,department of ,veterans ,affairs to assess and improve the family caregiver program4 ,sec4 #dec4 ,modifications to annual evaluation report on caregiver program of ,department of ,veterans ,affairs4 ,sec4 #ded4 ,advisory committee on caregiver policy4 ,sec4 #dee4 ,comprehensive study on seriously injured veterans and their caregivers4 ,subtitle ,f--,health care agreements ,sec4 #dfa4 ,authorization of agreements between the ,department of ,veterans ,affairs and non-,department extended care providers4 ,sec4 #dfb4 ,modification of authority to enter into agreements with ,state homes to provide nursing home care4 ,,title ,v--,other matters ,sec4 #eja4 ,extension of temporary increase in number of judges on ,united ,states ,court of ,appeals for ,veterans ,claims4 ,sec4 #ejb4 ,repeal inapplicability of modification of basic allowance for housing to benefits under laws administered by ,secretary of ,veterans ,affairs4 ,sec4 #ejc4 ,department of ,veterans ,affairs program of internal audits4 ,sec4 #ejd4 ,improvement of training for managers4 ,i ,benefits #aja4 ,expedited payment of survivors benefits 7a7 ,in general ,section #eaja7;a77#a7 of title #ch1 ,united ,states ,code1 is amended-- 7#a7 by striking ,a specific and inserting 7,a7 ,except as provided in subparagraph 7,b71 a specific2 and 7#b7 by adding at the end the following new subparagraph3 7,b7 7i7 ,the ,secretary may pay benefits under chapters #ac and #ae and sections #bcjb1 #bcjg1 and #eaba of this title to a survivor of a veteran who has not filed a formal claim if the ,secretary determines that the record contains sufficient evidence to establish the entitlement of the survivor to such benefits4 7ii7 ,for purposes of this subparagraph and section #eaaj of this title1 the date on which the ,secretary is notified of the death of the veteran shall be treated as the date of the receipt of the survivor's application for benefits described in clause 7i74 4 7b7 ,effective date ,the amendments made by subsection 7a7 shall apply with respect to claims for benefits based on a death occurring on or after the date of the enactment of this ,act4 #ajb4 ,increase in special pension for ,medal of ,honor recipients 7a7 ,in general ,section #aefb7;a7 of title #ch1 ,united ,states ,code1 is amended by striking #a1jjj and inserting #c1jjj4 7b7 ,effective date 7#a7 ,in general ,the amendment made by subsection 7a7 shall take effect on the date that is-- 7,a7 except as provided in subparagraph 7,b71 one year after the date of the enactment of this ,act2 and 7,b7 in the case that the date that is one year after the date of the enactment of this ,act is not the first day of a month1 the first day of the first month beginning after the date that is one year after the date of the enactment of this ,act4 7#b7 ,delay of annual cost of living adjustment 7,a7 ,in general ,the ,secretary shall not make an increase pursuant to section #aefb7;e7 of such title effective ,december #a1 #bjaf1 if the amendment made by subsection 7a7 takes effect before such date4 7,b7 ,resumption ,in the case that the ,secretary1 pursuant to subparagraph 7,a71 does not make an increase pursuant to section #aefb7;e7 of such title effective ,december #a1 #bjaf1 the ,secretary shall resume making increases pursuant to such section with the first such increase effective ,december #a1 #bjag4 ,,ii ,education matters #bja4 ,restoration of entitlement to ,post-#i_/aa ,educational ,assistance for veterans affected by closures of educational institutions 7a7 ,educational assistance 7#a7 ,in general ,section #ccab of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new subsection3 7d7 ,discontinuation of education due to closure of educational institution 7#a7 ,in general ,any payment of educational assistance described in paragraph 7#b7 shall not-- 7,a7 be charged against any entitlement to educational assistance of the individual concerned under this chapter2 or 7,b7 be counted against the aggregate period for which section #cfie of this title limits the individual's receipt of educational assistance under this chapter4 7#b7 ,description of payment of educational assistance ,subject to paragraph 7#c71 the payment of educational assistance described in this paragraph is the payment of such assistance to an individual for pursuit of a course or courses under this chapter if the ,secretary finds that the individual-- 7,a7 was forced to discontinue such course pursuit as a result of a permanent closure of an educational institution2 and 7,b7 did not receive credit1 or lost training time1 toward completion of the program of education being pursued at the time of such closure4 7#c7 ,period for which payment not charged ,the period for which1 by reason of this subsection1 educational assistance is not charged against entitlement or counted toward the applicable aggregate period under section #cfie of this title shall not exceed the aggregate of-- 7,a7 the portion of the period of enrollment in the course or courses from which the individual failed to receive credit or with respect to which the individual lost training time1 as determined under paragraph 7#b77;,b71 and 7,b7 the period by which a monthly stipend is extended under section #cfhj7;a77#b77;,b7 of this title4 4 7#b7 ,applicability ,subsection 7d7 of such section1 as added by paragraph 7#a71 shall apply with respect to courses and programs of education discontinued as described in paragraph 7#b7 of such subsection in fiscal year #bjae or any fiscal year thereafter4 7b7 ,monthly housing stipend 7#a7 ,in general ,section #cfhj7;a7 of such title is amended-- 7,a7 by striking the matter after paragraph 7#c77;,b72 7,b7 in paragraph 7#c71 by redesignating subparagraphs 7,a7 and 7,b7 as clauses 7i7 and 7ii71 respectively2 7,c7 by redesignating paragraphs 7#a7 through 7#c7 as subparagraphs 7,a7 through 7,c71 respectively2 7,d7 in the matter before subparagraph 7,a71 as redesignated1 in the first sentence1 by striking ,payment of and inserting 7#a7 ,except as provided in paragraph 7#b71 payment of2 and 7,e7 by adding at the end the following new paragraph 7#b73 7#b7 ,notwithstanding paragraph 7#a71 the ,secretary may1 pursuant to such regulations as the ,secretary shall prescribe1 continue to pay allowances to eligible veterans and eligible persons enrolled in courses set forth in paragraph 7#a77;,a7-- 7,a7 during periods when schools are temporarily closed under an established policy based on an ,executive order of the ,president or due to an emergency situation1 except that the total number of weeks for which allowances may continue to be so payable in any #ab-month period may not exceed four weeks2 or 7,b7 solely for the purpose of awarding a monthly housing stipend described in section #ccac of this title1 during periods following a permanent school closure1 except that payment of such a stipend may only be continued until the earlier of-- 7i7 the date of the end of the term1 quarter1 or semester during which the school closure occurred2 and 7ii7 the date that is #d months after the date of the school closure4 4 7#b7 ,conforming amendment ,paragraph 7#a77;,c77ii7 of such section1 as redesignated1 is amended by striking described in subclause 7,a7 of this clause and inserting described in clause 7i74 #bjb4 ,modification and improvement of transfer of unused ,post-#i_/aa ,educational ,assistance to family members 7a7 ,eligibility requirements ,subsection 7b77#a7 of section #ccai of title #ch1 ,united ,states ,code1 is amended-- 7#a7 by striking six years and inserting ten years2 and 7#b7 by striking four more years and inserting two more years4 7b7 ,commencement of use ,subsection 7g77#a77;,a7 of such section is amended by striking six years and inserting ten years4 7c7 ,rate of payment ,subsection 7h77#c77;,b7 of such section is amended by inserting before the period at the end the following3 1 except that the amount of the monthly stipend described in subsection 7c77#a77;,b7 or 7g77#c77;,a77ii7 of section #ccac1 as the case may be1 shall be payable in an amount equal to #ej percent of the amount of such stipend that would otherwise be payable under this chapter to the individual making the transfer4 7d7 ,technical correction ,such section is further amended by striking armed forces each place it appears and inserting ,armed ,forces4 7e7 ,applicability ,the amendments made by subsections 7a7 through 7c7 shall apply with respect to an election to transfer entitlement under section #ccai of title #ch1 ,united ,states ,code1 that is made on or after the date that is #ahj days after the date of the enactment of this ,act4 #bjc4 ,codification and improvement of election process for ,post-#i_/aa ,educational ,assistance 7a7 ,in general ,subchapter ,,iii of chapter #cc of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new section3 #ccbf4 ,election to receive educational assistance 7a7 ,individuals eligible to elect participation in post-#i_/aa educational assistance ,an individual may elect to receive educational assistance under this chapter if such individual-- 7#a7 as of ,august #a1 #bjji-- 7,a7 is entitled to basic educational assistance under chapter #cj of this title and has used1 but retains unused1 entitlement under that chapter2 7,b7 is entitled to educational assistance under chapter #ajg1 #afjf1 or #afjg of title #aj and has used1 but retains unused1 entitlement under the applicable chapter2 7,c7 is entitled to basic educational assistance under chapter #cj of this title but has not used any entitlement under that chapter2 7,d7 is entitled to educational assistance under chapter #ajg1 #afjf1 or #afjg of title #aj but has not used any entitlement under such chapter2 7,e7 is a member of the ,armed ,forces who is eligible for receipt of basic educational assistance under chapter #cj of this title and is making contributions toward such assistance under section #cjaa7;b7 or #cjab7;c7 of this title2 or 7,f7 is a member of the ,armed ,forces who is not entitled to basic educational assistance under chapter #cj of this title by reason of an election under section #cjaa7;c77#a7 or #cjab7;d77#a7 of this title2 and 7#b7 as of the date of the individual's election under this paragraph1 meets the requirements for entitlement to educational assistance under this chapter4 7b7 ,cessation of contributions toward ,,gi bill ,effective as of the first month beginning on or after the date of an election under subsection 7a7 of an individual described by paragraph 7#a77;,e7 of that subsection1 the obligation of the individual to make contributions under section #cjaa7;b7 or #cjab7;c7 of this title1 as applicable1 shall cease1 and the requirements of such section shall be deemed to be no longer applicable to the individual4 7c7 ,revocation of remaining transferred entitlement 7#a7 ,election to revoke ,if1 on the date an individual described in paragraph 7#a77;,a7 or 7#a77;,c7 of subsection 7a7 makes an election under that subsection1 a transfer of the entitlement of the individual to basic educational assistance under section #cjbj of this title is in effect and a number of months of the entitlement so transferred remain unutilized1 the individual may elect to revoke all or a portion of the entitlement so transferred that remains unutilized4 7#b7 ,availability of revoked entitlement ,any entitlement revoked by an individual under this paragraph shall no longer be available to the dependent to whom transferred1 but shall be available to the individual instead for educational assistance under chapter #cc of this title in accordance with the provisions of this section4 7#c7 ,availability of unrevoked entitlement ,any entitlement described in paragraph 7#a7 that is not revoked by an individual in accordance with that paragraph shall remain available to the dependent or dependents concerned in accordance with the current transfer of such entitlement under section #cjbj of this title4 7d7 ,post-#i_/aa educational assistance 7#a7 ,in general ,subject to paragraph 7#b7 and except as provided in subsection 7e71 an individual making an election under subsection 7a7 shall be entitled to educational assistance under this chapter in accordance with the provisions of this chapter1 instead of basic educational assistance under chapter #cj of this title1 or educational assistance under chapter #ajg1 #afjf1 or #afjg of title #aj1 as applicable4 7#b7 ,limitation on entitlement for certain individuals ,in the case of an individual making an election under subsection 7a7 who is described by paragraph 7#a77;,a7 of that subsection1 the number of months of entitlement of the individual to educational assistance under this chapter shall be the number of months equal to-- 7,a7 the number of months of unused entitlement of the individual under chapter #cj of this title1 as of the date of the election1 plus 7,b7 the number of months1 if any1 of entitlement revoked by the individual under subsection 7c77#a74 7e7 ,continuing entitlement to educational assistance not available under #i_/aa assistance program 7#a7 ,in general ,in the event educational assistance to which an individual making an election under subsection 7a7 would be entitled under chapter #cj of this title1 or chapter #ajg1 #afjf1 or #afjg of title #aj1 as applicable1 is not authorized to be available to the individual under the provisions of this chapter the individual shall remain entitled to such educational assistance in accordance with the provisions of the applicable chapter4 7#b7 ,charge for use of entitlement ,the utilization by an individual of entitlement under paragraph 7#a7 shall be chargeable against the entitlement of the individual to educational assistance under this chapter at the rate of one month of entitlement under this chapter for each month of entitlement utilized by the individual under paragraph 7#a7 7as determined as if such entitlement were utilized under the provisions of chapter #cj of this title1 or chapter #ajg1 #afjf1 or #afjg of title #aj1 as applicable74 7f7 ,additional post-#i_/aa assistance for members having made contributions toward ,,gi bill 7#a7 ,additional assistance ,in the case of an individual making an election under subsection 7a7 who is described by subparagraph 7,a71 7,c71 or 7,e7 of paragraph 7#a7 of that subsection1 the amount of educational assistance payable to the individual under this chapter as a monthly stipend payable under paragraph 7#a77;,b7 of section #ccac7;c7 of this title1 or under paragraphs 7#b7 through 7#g7 of that section 7as applicable71 shall be the amount otherwise payable as a monthly stipend under the applicable paragraph increased by the amount equal to-- 7,a7 the total amount of contributions toward basic educational assistance made by the individual under section #cjaa7;b7 or #cjab7;c7 of this title1 as of the date of the election1 multiplied by 7,b7 the fraction-- 7i7 the numerator of which is-- 7,i7 the number of months of entitlement to basic educational assistance under chapter #cj of this title remaining to the individual at the time of the election2 plus 7,,ii7 the number of months1 if any1 of entitlement under chapter #cj revoked by the individual under subsection 7c77#a72 and 7ii7 the denominator of which is #cf months4 7#b7 ,months of remaining entitlement for certain individuals ,in the case of an individual covered by paragraph 7#a7 who is described by subsection 7a77#a77;,e71 the number of months of entitlement to basic educational assistance remaining to the individual for purposes of paragraph 7#a77;,b77i77,,ii7 shall be #cf months4 7#c7 ,timing of payment ,the amount payable with respect to an individual under paragraph 7#a7 shall be paid to the individual together with the last payment of the monthly stipend payable to the individual under paragraph 7#a77;,b7 of section #ccac7;c7 of this title1 or under paragraphs 7#b7 through 7#g7 of that section 7as applicable71 before the exhaustion of the individual's entitlement to educational assistance under this chapter4 7g7 ,continuing entitlement to additional assistance for critical skills or speciality and additional service ,an individual making an election under subsection 7a77#a7 who1 at the time of the election1 is entitled to increased educational assistance under section #cjae7;d7 of this title1 or section #afaca7;i7 of title #aj1 or supplemental educational assistance under subchapter ,,iii of chapter #cj of this title1 shall remain entitled to such increased educational assistance or supplemental educational assistance in the utilization of entitlement to educational assistance under this chapter1 in an amount equal to the quarter1 semester1 or term1 as applicable1 equivalent of the monthly amount of such increased educational assistance or supplemental educational assistance payable with respect to the individual at the time of the election4 7h7 ,alternative election by ,secretary 7#a7 ,in general ,in the case of an individual who1 on or after ,january #a1 #bjaf1 submits to the ,secretary an election under this section that the ,secretary determines is clearly against the interests of the individual1 or who fails to make an election under this section1 the ,secretary may make an alternative election on behalf of the individual that the ,secretary determines is in the best interests of the individual4 7#b7 ,notice ,if the ,secretary makes an election on behalf of an individual under this subsection1 the ,secretary shall notify the individual by not later than seven days after making such election and shall provide the individual with a #cj-;day period1 beginning on the date of the individual's receipt of such notice1 during which the individual may modify or revoke the election made by the ,secretary on the individual's behalf4 ,the ,secretary shall include1 as part of such notice1 a clear statement of why the alternative election made by the ,secretary is in the best interests of the individual as compared to the election submitted by the individual4 ,the ,secretary shall provide the notice required under this paragraph by electronic means whenever possible4 7i7 ,irrevocability of elections ,an election under subsection 7a7 or 7c77#a7 is irrevocable4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by adding at the end the following new item3 #ccbf4 ,election to receive educational assistance4 4 7c7 ,conforming repeal ,subsection 7c7 of section #ejjc of the ,post-#i_/aa ,veterans ,educational ,assistance ,act of #bjjh 7,public ,law #aaj-beb2 #ch ,u4,s4,c4 #ccja note7 is hereby repealed4 #bjd4 ,centralized reporting of veteran enrollment by certain groups1 districts1 and consortiums of educational institutions 7a7 ,in general ,section #cfhd7;a7 of title #ch1 ,united ,states ,code1 is amended-- 7#a7 in paragraph 7#a71 by inserting #cb1 #cc1 after #ca12 and 7#b7 by adding at the end the following new paragraph3 7#d7 ,for purposes of this subsection1 the term educational institution may include a group1 district1 or consortium of separately accredited educational institutions located in the same ,state that are organized in a manner that facilitates the centralized reporting of the enrollments in such group1 district1 or consortium of institutions4 4 7b7 ,effective date ,the amendments made by subsection 7a7 shall apply with respect to reports submitted on or after the date of the enactment of this ,act4 #bje4 ,improved role of ,state approving agencies in administration of veterans educational benefits 7a7 ,approval of certain courses ,section #cfgb7;b77#b77;,a7 of title #ch1 ,united ,states ,code1 is amended by striking the following and all that follows through the colon and inserting the following3 a program of education is deemed to be approved for purposes of this chapter if a ,state approving agency determines that the program is one of the following programs34 7b7 ,approval of other courses ,section #cfge of such title amended-- 7#a7 in subsection 7a77#a7-- 7,a7 by striking ,the ,secretary or a ,state approving agency and inserting ,a ,state approving agency1 or the ,secretary when acting in the role of a ,state approving agency12 and 7,b7 by striking offered by proprietary for-profit educational institutions and inserting not covered by section #cfgb of this title2 and 7#b7 in subsection 7b7-- 7,a7 in the matter before paragraph 7#a71 by striking the ,secretary or the ,state approving agency and inserting the ,state approving agency1 or the ,secretary when acting in the role of a ,state approving agency12 and 7,b7 in paragraph 7#a71 by striking the ,secretary or the ,state approving agency and inserting the ,state approving agency1 or the ,secretary when acting in the role of a ,state approving agency4 #bjf4 ,modification of criteria used to approve courses for purposes of veterans educational benefits 7a7 ,nonaccredited courses ,section #cfgf7;c77#ad7 of title #ch1 ,united ,states ,code1 is amended by inserting before the period the following3 if the ,secretary1 in consultation with the ,state approving agency and pursuant to regulations prescribed to carry out this paragraph1 determines such criteria are necessary and treat public1 private1 and proprietary for-profit educational institutions equitably4 7b7 ,accredited courses ,section #cfge7;b77#c7 of such title is amended by striking and 7#c7 and inserting 7#c71 and 7#ad74 7c7 ,application ,the amendment made by subsection 7a7 shall apply with respect to-- 7#a7 criteria developed pursuant to paragraph 7#ad7 of subsection 7c7 of section #cfgf of title #ch1 ,united ,states ,code1 on or after ,january #a1 #bjac2 and 7#b7 an investigation conducted under such subsection that is covered by a reimbursement of expenses paid by the ,secretary of ,veterans ,affairs to a ,state pursuant to section #cfgd of such title on or after ,october #a1 #bjae4 #bjg4 ,surveys for compliance of educational institutions and training establishments with requirements relating to administration of veterans educational benefits 7a7 ,in general ,section #cfic of title #ch1 ,united ,states ,code1 is amended-- 7#a7 by striking subsection 7a7 and inserting the following new subsection 7a73 7a7 7#a7 7,a7 ,except as provided in subsection 7b71 the ,secretary shall conduct an annual compliance survey of educational institutions and training establishments offering one or more courses approved for the enrollment of eligible veterans or persons if at least #bj such veterans or persons are enrolled in any such course4 7,b7 ,the ,secretary shall-- 7i7 design the compliance surveys to ensure that such institutions or establishments1 as the case may be1 and approved courses are in compliance with all applicable provisions of chapters #cj through #cf of this title2 7ii7 survey each such educational institution and training establishment not less than once during every two-year period2 and 7iii7 assign not fewer than one education compliance specialist to work on compliance surveys in any year for each #dj compliance surveys required to be made under this section for such year4 7#b7 ,the ,secretary1 in consultation with the ,state approving agencies1 shall-- 7,a7 annually determine the parameters of the surveys required under paragraph 7#a72 and 7,b7 not later than ,september #a of each year1 make available to the ,state approving agencies a list of the educational institutions and training establishments that will be surveyed during the fiscal year following the date of making such list available4 2 and 7#b7 by adding at the end the following new subsection3 7c7 ,in this section1 the terms educational institution and training establishment have the meaning given such terms in section #cdeb of this title4 4 7b7 ,conforming amendments ,subsection 7b7 of such section is amended-- 7#a7 by striking subsection 7a7 of this section for an annual compliance survey and inserting subsection 7a77#a7 for a compliance survey2 7#b7 by striking institution and inserting educational institution or training establishment2 and 7#c7 by striking institution's demonstrated record of compliance and inserting record of compliance of such institution or establishment4 #bjh4 ,modification of requirements for approval for purposes of educational assistance provided by ,department of ,veterans ,affairs of programs designed to prepare individuals for licensure or certification 7a7 ,approval of non-,accredited courses ,subsection 7c7 of section #cfgf of title #ch1 ,united ,states ,code1 as amended by section #bjf1 is further amended-- 7#a7 by redesignating paragraph 7#ad7 as paragraph 7#af72 and 7#b7 by inserting after paragraph 7#ac7 the following new paragraphs3 7#ad7 ,in the case of a course designed to prepare an individual for licensure or certification in a ,state1 the course-- 7,a7 meets any instructional curriculum licensure or certification requirements of such ,state2 and 7,b7 in the case of a course designed to prepare an individual for licensure to practice law in a ,state1 is accredited by an accrediting agency or association recognized by the ,secretary of ,education under subpart #b of part ,h of title ,,iv of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajii;b74 7#ae7 ,in the case of a course designed to prepare an individual for employment pursuant to standards developed by a board or agency of a ,state in an occupation that requires approval1 licensure1 or certification1 the course-- 7,a7 meets such standards2 and 7,b7 in the case of a course designed to prepare an individual for licensure to practice law in a ,state1 is accredited by an accrediting agency or association recognized by the ,secretary of ,education under subpart #b of part ,h of title ,,iv of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajii;b74 4 7b7 ,exceptions ,such section is further amended by adding at the end the following new subsection3 7f7 7#a7 ,the ,secretary may waive the requirements of paragraph 7#ad7 or 7#ae7 of subsection 7c7 in the case of a course of education offered by an educational institution 7either accredited or not accredited7 if the ,secretary determines all of the following3 7,a7 ,the course did not meet the requirements of such paragraph at any time during the two-year period preceding the date of the waiver4 7,b7 ,the waiver furthers the purposes of the educational assistance programs administered by the ,secretary or would further the education interests of individuals eligible for assistance under such programs4 7,c7 ,the educational institution does not provide any commission1 bonus1 or other incentive payment based directly or indirectly on success in securing enrollments or financial aid to any persons or entities engaged in any student recruiting or admission activities or in making decisions regarding the award of student financial assistance1 except for the recruitment of foreign students residing in foreign countries who are not eligible to receive ,federal student assistance4 7#b7 ,not later than #cj days after the date on which the ,secretary issues a waiver under paragraph 7#a71 the ,secretary shall submit to ,congress notice of such waiver and a justification for issuing such waiver4 4 7c7 ,approval of accredited courses ,section #cfge7;b77#c7 of such title1 as amended by section #bjf1 is further amended-- 7#a7 by striking and 7#ad7 and inserting 7#ad71 7#ae71 and 7#af72 and 7#b7 by inserting before the period at the end the following3 7or1 with respect to such paragraphs 7#ad7 and 7#ae71 the requirements under such paragraphs are waived pursuant to subsection 7f77#a7 of section #cfgf of this title74 7d7 ,approval of accredited standard college degree programs offered at public or not-for-profit educational institutions ,section #cfgb7;b77#b7 of such title is amended-- 7#a7 in subparagraph 7,a77i71 by striking ,an accredited and inserting ,except as provided in subparagraph 7,c71 an accredited2 and 7#b7 by adding at the end the following new subparagraph3 7,c7 ,a course that is described in both subparagraph 7,a77i7 of this paragraph and in paragraph 7#ad7 or 7#ae7 of section #cfgf7;c7 of this title shall not be deemed to be approved for purposes of this chapter unless-- 7i7 a ,state approving agency1 or the ,secretary when acting in the role of a ,state approving agency1 determines that the course meets the applicable criteria in such paragraphs2 or 7ii7 the ,secretary issues a waiver for such course under section #cfgf7;f77#a7 of this title4 4 7e7 ,disapproval of courses ,section #cfgi of such title is amended by adding at the end the following new subsection3 7d7 ,notwithstanding any other provision of this chapter1 the ,secretary or the applicable ,state approving agency shall disapprove a course of education described in paragraph 7#ad7 or 7#ae7 of section #cfgf7;c7 of this title unless the educational institution providing the course of education-- 7#a7 publicly discloses any conditions or additional requirements1 including training1 experience1 or examinations1 required to obtain the license1 certification1 or approval for which the course of education is designed to provide preparation2 and 7#b7 makes each disclosure required by paragraph 7#a7 in a manner that the ,secretary considers prominent4 4 7f7 ,applicability ,if after enrollment in a course of education that is subject to disapproval by reason of an amendment made by this ,act1 an individual pursues one or more courses of education at the same educational institution while remaining continuously enrolled 7other than during regularly scheduled breaks between courses1 semesters1 or terms7 at that institution1 any course so pursued by the individual at that institution while so continuously enrolled shall not be subject to disapproval by reason of such amendment4 #bji4 ,expansion of ,yellow ,ribbon ,g4,i4 ,education ,enhancement ,program 7a7 ,in general ,section #ccag7;a7 of title #ch1 ,united ,states ,code1 is amended by striking in paragraphs 7#a7 and 7#b7 and inserting in paragraphs 7#a71 7#b71 and 7#i74 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply with respect to academic years beginning after the date that is one year after the date of the enactment of this ,act4 #baj4 ,consideration of certain time spent receiving medical care from ,secretary of ,defense as active duty for purposes of eligibility for ,post-#i_/aa ,educational ,assistance 7a7 ,in general ,section #ccja7a77;,b7 of title #ch1 ,united ,states ,code1 is amended by inserting #abcja7;h71 after #abcja7;g714 7b7 ,effective date ,the amendment made by subsection 7a7 shall take effect on the date that is one year after the date of the enactment of this ,act and shall apply with respect to assistance provided under chapter #cc of such title on and after the date that is one year after the date of the enactment of this ,act4 ,,iii ,homeless veterans matters #cja4 ,expansion of definition of homeless veteran for purposes of benefits under the laws administered by the ,secretary of ,veterans ,affairs ,section #bjjb7a7 of title #ch1 ,united ,states ,code1 is amended by striking in section #ajc7;a7 of the ,mc,kinney-,vento ,homeless ,assistance ,act 7#db ,u4,s4,c4 #aacjb7;a77 and inserting in subsection 7a7 or 7b7 of section #ajc of the ,mc,kinney-,vento ,homeless ,assistance ,act 7#db ,u4,s4,c4 #aacjb74 #cjb4 ,increased per diem payments for transitional housing assistance that becomes permanent housing for homeless veterans ,section #bjab7;a77#b7 of title #ch1 ,united ,states ,code1 is amended-- 7#a7 by redesignating subparagraphs 7,b7 through 7,d7 as subparagraphs 7,c7 through 7,e71 respectively2 7#b7 in subparagraph 7,c71 as redesignated1 by striking in subparagraph 7,d7 and inserting in subparagraph 7,e72 7#c7 in subparagraph 7,d71 as redesignated1 by striking under subparagraph 7,b7 and inserting under subparagraph 7,c72 7#d7 in subparagraph 7,e71 as redesignated1 by striking in subparagraphs 7,b7 and 7,c7 and inserting in subparagraphs 7,c7 and 7,d72 and 7#e7 in subparagraph 7,a7-- 7,a7 by striking ,the rate and inserting ,except as otherwise provided in subparagraph 7,b71 the rate2 and 7,b7 by striking under subparagraph 7,b7 and all that follows through the end and inserting the following3 8under subparagraph 7,c74 7,b7 7i7 ,except as provided in clause 7ii71 in no case may the rate determined under this paragraph exceed the rate authorized for ,state homes for domiciliary care under subsection 7a77#a77;,a7 of section #agda of this title1 as the ,secretary may increase from time to time under subsection 7c7 of that section4 7ii7 ,in the case of services furnished to a homeless veteran who is placed in housing that will become permanent housing for the veteran upon termination of the furnishing of such services to such veteran1 the maximum rate of per diem authorized under this section is #aej percent of the rate described in clause 7i74 4 #cjc4 ,expansion of ,department of ,veterans ,affairs authority to provide dental care to homeless veterans 7a7 ,in general ,subsection 7b7 of section #bjfb of title #ch1 ,united ,states ,code1 is amended to read as follows3 7b7 ,eligible veterans 7#a7 ,subsection 7a7 applies to a veteran who-- 7,a7 is enrolled for care under section #agje7;a7 of this title2 and 7,b7 for a period of #fj consecutive days1 is receiving-- 7i7 assistance under section #h7o7 of the ,united ,states ,housing ,act of #aicg 7#db ,u4,s4,c4 #adcg;f7o772 or 7ii7 care 7directly or by contract7 in any of the following settings3 7,i7 ,a domiciliary under section #agaj of this title4 7,,ii7 ,a therapeutic residence under section #bjcb of this title4 7,,iii7 ,community residential care coordinated by the ,secretary under section #agcj of this title4 7,,iv7 ,a setting for which the ,secretary provides funds for a grant and per diem provider4 7#b7 ,for purposes of paragraph 7#a71 in determining whether a veteran has received assistance or care for a period of #fj consecutive days1 the ,secretary may disregard breaks in the continuity of assistance or care for which the veteran is not responsible4 4 7b7 ,effective date ,subsection 7a7 shall take effect on the date that is one year after the date of the enactment of this ,act4 #cjd4 ,clarification of eligibility for services under homeless veterans reintegration programs ,section #bjba7;a7 of title #ch1 ,united ,states ,code1 is amended by striking reintegration of homeless veterans into the labor force4 and inserting the following3 reintegration into the labor force of-- 7#a7 homeless veterans2 7#b7 veterans participating in the ,department of ,veterans ,affairs supported housing program for which rental assistance is provided pursuant to section #h7o77#ai7 of the ,united ,states ,housing ,act of #aicg 7#db ,u4,s4,c4 #adcg;f7o77#ai772 7#c7 ,indians who are veterans and receiving assistance under the ,native ,american ,housing ,assistance and ,self ,determination ,act of #aiif 7#be ,u4,s4,c4 #daja et seq472 and 7#d7 veterans who are transitioning from being incarcerated4 4 #cje4 ,program to improve retention of housing by formerly homeless veterans and veterans at risk of becoming homeless 7a7 ,program required 7#a7 ,in general ,subchapter ,,ii of chapter #bj of title #ch1 ,united ,states ,code1 is amended-- 7,a7 by redesignating section #bjac as section #bjad2 and 7,b7 by inserting after section #bjab the following new section #bjac3 #bjac4 ,program to improve retention of housing by formerly homeless veterans and veterans at risk of becoming homeless 7a7 ,program required ,the ,secretary shall carry out a program under which the ,secretary shall provide case management services to improve the retention of housing by veterans who were previously homeless and are transitioning to permanent housing and veterans who are at risk of becoming homeless4 7b7 ,grants 7#a7 ,the ,secretary shall carry out the program through the award of grants4 7#b7 7,a7 ,in awarding grants under paragraph 7#a71 the ,secretary shall give priority to organizations that demonstrate a capability to provide case management services as described in subsection 7a71 particularly organizations that are successfully providing or have successfully provided transitional housing services using amounts provided by the ,secretary under sections #bjab and #bjfa of this title4 7,b7 ,in giving priority under subparagraph 7,a71 the ,secretary shall give extra priority to an organization described in such subparagraph that-- 7i7 voluntarily stops receiving amounts provided by the ,secretary under sections #bjab and #bjfa of this title2 and 7ii7 converts a facility that the organization used to provide transitional housing services into a facility that the organization uses to provide permanent housing that meets housing quality standards established under section #h7o77#h77;,b7 of the ,united ,states ,housing ,act of #aicg 7#db ,u4,s4,c4 #adcg;f7o77#h77;,b774 7,c7 ,in any case in which a facility1 with respect to which a person received a grant for construction1 rehabilitation1 or acquisition under section #bjaa of this title1 is converted as described in subparagraph 7,b77ii71 such conversion shall be considered to have been carried out pursuant to the needs of the ,department and such person shall not be considered in non-compliance with the terms of such grant by reason of such conversion4 4 7#b7 ,clerical amendment ,the table of sections at the beginning of chapter #bj of such title is amended by striking the item relating to section #bjac and inserting the following new items3 #bjac4 ,program to improve retention of housing by formerly homeless veterans and veterans at risk of becoming homeless4#bjad4 ,authorization of appropriations4 4 7b7 ,regulations ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall prescribe regulations to carry out section #bjac of such title1 as added by subsection 7a77#a77;,b74 7c7 ,report 7#a7 ,in general ,not later than ,june #a1 #bjai1 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 program required by section #bjac of such title1 as added by subsection 7a77#a77;,b74 7#b7 ,contents ,the report submitted under paragraph 7#a7 shall include assessments of the following3 7,a7 ,the percentage of veterans who received case management services under the program who were able to retain permanent housing by the end of the program1 disaggregated by each recipient of a grant under such section4 7,b7 ,the percentage of veterans who received case management services under the program who were not in permanent housing at the end of the program1 disaggregated by housing status and reason for failing to retain permanent housing under the program4 7,c7 ,the use by veterans who received case management services under the program of housing assistance furnished by the ,department of ,veterans ,affairs1 including a comparison of the use of such assistance by such veterans before and after receiving such services4 7,d7 ,an assessment of the employment status of veterans who received case management services under the program1 including a comparison of the employment status of such veterans before and after receiving such services4 #cjf4 ,pilot program on provision of intensive case management interventions to homeless veterans who receive the most health care from the ,department of ,veterans ,affairs 7a7 ,pilot program required ,not later than ,september #a1 #bjaf1 the ,secretary of ,veterans ,affairs shall commence a pilot program to assess the feasibility and advisability of providing intensive case management interventions to covered veterans4 7b7 ,covered veterans ,for purposes of the pilot program1 a covered veteran is a veteran who is enrolled in-- 7#a7 the homeless registry of the ,department2 and 7#b7 the system of annual patient enrollment established and operated by the ,secretary under section #agje7;a7 of title #ch1 ,united ,states ,code4 7c7 ,location 7#a7 ,in general ,the ,secretary shall carry out the pilot program at not fewer than six locations selected by the ,secretary for purposes of the pilot program as follows3 7,a7 ,not fewer than three locations in cities that have the largest populations of homeless veterans in the ,united ,states4 7,b7 ,not fewer than three locations in suburban or rural settings4 7#b7 ,interaction and coordination with community organizations ,in selecting locations under paragraph 7#a71 the ,secretary shall only select locations in areas in which the ,secretary determines that there is a high degree of interaction and coordination between the ,department and community organizations that provide housing and social services for veterans1 such as outreach1 employment1 and financial assistance for homeless veterans1 veterans at risk of becoming homeless1 and low-income veterans4 7d7 ,provision of intensive case management interventions 7#a7 ,minimum number of veterans to receive interventions ,in carrying out the program at each location selected under subsection 7c71 the ,secretary shall provide intensive case management interventions to not fewer than #bj covered veterans at each such location who the ,secretary determines are the covered veterans at such location who receive the most health care and related services furnished by the ,department of ,veterans ,affairs4 7#b7 ,nature of interventions ,the intensive case management interventions provided to covered veterans under paragraph 7#a7 shall include assistance with gaining and maintaining access to such housing and services1 including benefits and services to which covered veterans may be entitled or eligible under the laws administered by the ,secretary1 as may be necessary to improve the stability of their housing and the appropriateness of the health care that they receive4 7e7 ,report 7#a7 ,in general ,not later than ,december #a1 #bjah1 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 pilot program carried out under this section4 7#b7 ,contents ,the report submitted under paragraph 7#a7 shall include assessments of the following3 7,a7 ,the types and frequencies of intensive case management interventions provided under the pilot program4 7,b7 ,the housing status of each veteran who received an intensive case management intervention under the pilot program4 7,c7 ,the employment status of each veteran who received an intensive case management intervention under the pilot program1 including a comparison of the employment status of such veteran before and after receiving such intervention4 7,d7 ,the use by veterans who received intensive case management interventions under the pilot program of health care and related services furnished by the ,department of ,veterans ,affairs and the costs incurred by the ,department in furnishing such care and services1 including a comparison of the use by such veterans of such care and services and the costs incurred from furnishing such care and services before and after receiving such interventions4 7,e7 ,the number of veterans who received intensive case management interventions under the pilot program1 disaggregated by whether the intensive case management intervention was provided in a location described in subparagraph 7,a7 or 7,b7 of subsection 7c77#a74 7,f7 ,the costs incurred by the ,department in carrying out the pilot program1 disaggregated by provision of intensive case management interventions in locations described in subparagraphs 7,a7 and 7,b7 of such subsection4 7,g7 ,an estimate of the costs the ,department would have incurred for the provision of health care and associated services to covered veterans but for the provision of intensive case management interventions under the pilot program1 disaggregated by provision of intensive case management interventions in locations described in subparagraphs 7,a7 and 7,b7 of subsection 7c77#a74 #cjg4 ,establishment of ,national ,center on ,homelessness ,among ,veterans 7a7 ,in general ,subchapter ,,vii of chapter #bj of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new section3 #bjfg4 ,national ,center on ,homelessness ,among ,veterans 7a7 ,in general 7#a7 ,the ,secretary shall establish and operate a center to carry out the functions described in subsection 7b74 7#b7 ,the center established under paragraph 7#a7 shall be known as the ,national ,center on ,homelessness ,among ,veterans4 7#c7 ,to the degree practicable1 the ,secretary shall operate the center established under paragraph 7#a7 independently of the other programs of the ,department that address homelessness among veterans4 7b7 ,functions ,the functions described in this subsection are as follows3 7#a7 ,to carry out and promote research into the causes and contributing factors to veteran homelessness4 7#b7 ,to assess the effectiveness of programs of the ,department to meet the needs of homeless veterans4 7#c7 ,to identify and disseminate best practices with regard to housing stabilization1 income support1 employment assistance1 community partnerships1 and such other matters as the ,secretary considers appropriate with respect to addressing veteran homelessness4 7#d7 ,to integrate evidence-based and best practices1 policies1 and programs into programs of the ,department for homeless veterans and veterans at risk of homelessness and to ensure that the staff of the ,department and community partners can implement such practices1 policies1 and programs4 7#e7 ,to serve as a resource center for1 and promote and seek to coordinate the exchange of information regarding1 all research and training activities carried out by the ,department and by other ,federal and non-,federal entities with respect to veteran homelessness4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #bj of such title is amended by inserting after the item relating to section #bjff the following new item3 #bjfg4 ,national ,center on ,homelessness ,among ,veterans4 4 #cjh4 ,partnerships with public and private entities to provide legal services to homeless veterans and veterans at risk of homelessness 7a7 ,in general ,chapter #bj of title #ch1 ,united ,states ,code1 is amended by inserting after section #bjbb the following new section3 #bjbb;,a4 ,partnerships with public and private entities to provide legal services to homeless veterans and veterans at risk of homelessness 7a7 ,partnerships authorized ,subject to the availability of funds for that purpose1 the ,secretary may enter into partnerships with public or private entities to fund a portion of the general legal services specified in subsection 7c7 that are provided by such entities to homeless veterans and veterans at risk of homelessness4 7b7 ,locations 7#a7 ,the ,secretary shall ensure that1 to the extent practicable1 partnerships under this section are made with entities equitably distributed across the geographic regions of the ,united ,states1 including rural communities1 tribal lands of the ,united ,states1 ,native ,americans1 and tribal organizations4 7#b7 ,in this subsection1 the terms ,native ,american and tribal organization have the meanings given such terms in section #cgfe of this title4 7c7 ,legal services ,legal services specified in this subsection include legal services provided by public or private entities that address the needs of homeless veterans and veterans at risk of homelessness1 such as the following3 7#a7 ,legal services related to housing1 including eviction defense and representation in landlord-tenant cases4 7#b7 ,legal services related to family law1 including assistance in court proceedings for child support1 divorce1 and estate planning4 7#c7 ,legal services related to income support1 including assistance in obtaining public benefits4 7#d7 ,legal services related to criminal defense1 including defense in matters symptomatic of homelessness1 such as outstanding warrants1 fines1 and driver's license revocation1 to reduce recidivism and facilitate the overcoming of reentry obstacles in employment or housing4 7d7 ,consultation ,in developing and carrying out partnerships under this section1 the ,secretary shall1 to the extent practicable1 consult with public and private entities-- 7#a7 for assistance in identifying and contacting organizations described in subsection 7c72 and 7#b7 to coordinate appropriate outreach relationships with such organizations4 7e7 ,reports ,the ,secretary may require entities that have entered into partnerships under this section to submit to the ,secretary periodic reports on legal services provided to homeless veterans and veterans at risk of homelessness pursuant to such partnerships4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #bj of such title is amended by adding after the item relating to section #bjbb the following new item3 #bjbb;,a4 ,partnerships with public and private entities to provide legal services to homeless veterans and veterans at risk of homelessness4 4 #cji4 ,administrative improvements to grant and per diem programs of ,department of ,veterans ,affairs ,section #bjab of title #ch1 ,united ,states ,code1 is amended-- 7#a7 in subsection 7a77#a71 in the matter before subparagraph 7,a71 by inserting and except as otherwise provided in this section after such purpose2 and 7#b7 by adding at the end the following new subsection3 7e7 ,review and conditional renewal 7#a7 ,each year1 the ,secretary shall review each grant recipient and eligible entity that received a per diem payment under this section for a service furnished to a veteran during the one-year period preceding the review to evaluate the performance of the grant recipient or eligible entity during that period with respect to-- 7,a7 the success of the grant recipient or eligible entity in assisting veterans to obtain1 transition into1 and retain permanent housing2 and 7,b7 increasing the income of veterans1 whether by helping veterans obtain employment or by helping veterans obtain income-related benefits to which such veterans may be eligible or entitled4 7#b7 ,for any grant recipient or eligible entity whose performance was evaluated for a year under paragraph 7#a71 the ,secretary may only provide per diem under this section to that grant recipient or eligible entity in the following year if the ,secretary determines that such performance merits continued receipt of per diem under this section4 7#c7 ,the ,secretary shall establish uniform performance targets throughout the ,united ,states for all grant recipients and eligible entities that receive per diem payments under this section for purposes of evaluating the performance of each such grant recipient and eligible entity under this subsection4 4 #caj4 ,repeal of requirement for annual reports on assistance to homeless veterans 7a7 ,in general ,section #bjfe of title #ch1 ,united ,states ,code1 is hereby repealed4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #bj of such title is amended by striking the item relating to section #bjfe4 #caa4 ,comptroller ,general of the ,united ,states study on homeless veterans programs of ,department of ,veterans ,affairs 7a7 ,in general ,not later than #bgj days after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall complete a study of programs of the ,department of ,veterans ,affairs that provide assistance to homeless veterans4 7b7 ,elements ,the study required by subsection 7a7 shall include the following3 7#a7 ,an assessment of whether programs described in subsection 7a7 are meeting the needs of veterans who are eligible for assistance provided by such programs1 including any gaps or duplication in the provision of services4 7#b7 ,a review of recent efforts of the ,secretary of ,veterans ,affairs to improve the privacy1 safety1 and security of female veterans receiving assistance from such programs4 #cab4 ,requirement for ,department of ,veterans ,affairs to assess comprehensive service programs for homeless veterans 7a7 ,in general ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall-- 7#a7 assess and measure the capacity of programs for which entities receive grants under section #bjaa of title #ch1 ,united ,states ,code1 or per diem payments under section #bjab or #bjfa of such title2 and 7#b7 assess such programs with respect to-- 7,a7 how well they achieve their stated goals at a national level2 7,b7 placements in permanent housing2 7,c7 placements in employment2 and 7,d7 increases in the regular income of participants in the programs4 7b7 ,assessment at national and local levels ,in assessing and measuring under subsection 7a77#a71 the ,secretary shall develop and use tools to examine the capacity of programs described in such subsection at both the national and local level in order to assess the following3 7#a7 ,whether sufficient capacity exists to meet the needs of homeless veterans in each geographic area4 7#b7 ,whether existing capacity meets the needs of the subpopulations of homeless veterans located in each geographic area4 7#c7 ,the amount of capacity that recipients of grants under sections #bjaa and #bjfa and per diem payments under section #bjab of such title have to provide services for which the recipients are eligible to receive per diem under section #bjab7;a77#b77;,b77ii7 of title #ch1 ,united ,states ,code1 as added by section #cjb7e77;,b74 7c7 ,consideration of other resources ,in assessing and measuring programs under subsection 7a77#a71 the ,secretary shall consider the availability to such programs of resources made available to such programs and to homeless veterans1 including resources provided by the ,department of ,veterans ,affairs and by entities other than the ,department4 7d7 ,use of information ,the ,secretary shall use the information collected under this section as follows3 7#a7 ,to set specific goals to ensure that programs described in subsection 7a7 are effectively serving the needs of homeless veterans4 7#b7 ,to assess whether programs described in subsection 7a7 are meeting goals set under paragraph 7#a74 7#c7 ,to inform funding allocations for programs described in subsection 7a74 7#d7 ,to improve the referral of homeless veterans to programs described in subsection 7a74 7e7 ,report ,not later than #ahj days after the date on which the assessment required by subsection 7a7 is completed1 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 such assessment and such recommendations for legislative and administrative action as the ,secretary may have to improve the programs and per diem payments described in subsection 7a74 #cac4 ,report on outreach relating to increasing the amount of housing available to veterans ,not later than one year after the date of the enactment of this ,act1 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 describing and assessing the outreach conducted by the ,secretary to realtors1 landlords1 property management companies1 and developers to educate them about the housing needs of veterans and the benefits of having veterans as tenants4 ,,iv ,health care matters #dja4 ,short title ,this title may be cited as the ,jason ,simcakoski ,memorial ,act4 ,a ,employment of directors and health care providers #daa4 ,extension of period for increase in graduate medical education residency positions at medical facilities of the ,department of ,veterans ,affairs 7a7 ,in general ,paragraph 7#b7 of section #cja7;b7 of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #gcjb note7 is amended-- 7#a7 in the paragraph heading1 by striking ,five-year and inserting ,ten-year2 and 7#b7 in subparagraph 7,a71 by striking #e-year period and inserting #aj-year period4 7b7 ,report ,paragraph 7#c77;,a7 of such section is amended by striking until #bjai and inserting until #bjbd4 #dab4 ,modification of hours of employment for physicians and physician assistants employed by the ,department of ,veterans ,affairs ,section #gdbc7;a7 of title #ch1 ,united ,states ,code1 is amended-- 7#a7 by striking 7a7 ,the hours and inserting 7a77#a7 ,except as provided in paragraph 7#b71 the hours2 and 7#b7 by adding at the end the following new paragraph3 7#b7 ,the ,secretary may modify the hours of employment for a physician or physician assistant appointed in the ,administration under any provision of this chapter on a full-time basis to be more than or less than #hj hours in a biweekly pay period if the total hours of employment for such employee in a calendar year does not exceed #b1jhj hours4 4 #dac4 ,requirement that physician assistants employed by the ,department of ,veterans ,affairs receive competitive pay 7a7 ,in general ,section #gdea7;a77#b7 of title #ch1 ,united ,states ,code1 is amended-- 7#a7 by redesignating subparagraph 7,b7 as subparagraph 7,c72 7#b7 by inserting after subparagraph 7,a7 the following new subparagraph 7,b73 7,b7 ,physician assistant4 2 and 7#c7 in subparagraph 7,c71 as redesignated by paragraph 7#a71 by striking and registered nurse and inserting registered nurse1 and physician assistant4 7b7 ,effective date ,the amendments made by subsection 7a7 shall take effect on the date that is one year after the date of the enactment of this ,act4 #dad4 ,establishment of positions of ,directors of ,veterans ,integrated ,service ,networks in ,office of ,under ,secretary for ,health of ,department of ,veterans ,affairs and modification of qualifications for ,medical ,directors ,section #gcjf7;a77#d7 of title #ch1 ,united ,states ,code1 is amended-- 7#a7 by inserting and ,directors of ,veterans ,integrated ,service ,networks after ,such ,medical ,directors2 and 7#b7 by striking 1 who shall be either a qualified doctor of medicine or a qualified doctor of dental surgery or dental medicine4 #dae4 ,pay for ,medical ,directors and ,directors of ,veterans ,integrated ,service ,networks 7a7 ,in general ,chapter #gd of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new subchapter3 ,,vii ,pay for ,medical ,directors and ,directors of ,veterans ,integrated ,service ,networks #gdha4 ,pay for ,medical ,directors and ,directors of ,veterans ,integrated ,service ,networks 7a7 ,elements of pay ,pay for a ,medical ,director or ,director of a ,veterans ,integrated ,service ,network appointed under section #gcjf7;a77#d7 of this title 7in this section referred to as a ,director7 shall consist of basic pay set forth under section #gdjd7;a7 of this title and market pay determined under subsection 7b74 7b7 ,market pay 7#a7 ,each ,director is eligible for market pay determined under this subsection4 7#b7 ,the amount of market pay payable to a ,director under this section shall be determined by the ,secretary on a case-by-case basis and shall consist of pay intended to reflect needs of the ,department with respect to the recruitment and retention 7as determined by the ,secretary7 of such ,director4 7#c7 ,in determining the amount of market pay payable to a ,director under this section1 the ,secretary shall-- 7,a7 consult not less than two national surveys on pay for hospital directors1 medical facility directors1 or other similar positions1 whether prepared by private1 public1 or quasi-public entities1 to make a general assessment of the range of potential pay for the ,director2 and 7,b7 take into account-- 7i7 the experience of the ,director in managing facilities or program offices of the ,department1 including the complexity of such facilities or offices2 7ii7 the complexity of the facility or facilities to be managed by the ,director2 7iii7 the labor market1 in such geographic area as the ,secretary considers relevant1 for hospital directors1 medical facility directors1 and other similar positions2 7iv7 the experience of the ,director in managing medical facilities for other ,federal agencies1 private entities1 or non-profit entities2 and 7v7 such other considerations as the ,secretary considers appropriate4 7#d7 7,a7 ,the ,secretary shall evaluate the amount of market pay payable to a ,director under this section not less frequently than once every two years and may adjust the market pay payable to such ,director as a result of such evaluation4 7,b7 ,a ,director whose market pay is evaluated under subparagraph 7,a7 shall receive written notice of the results of such evaluation4 7c7 ,requirements and limitations on total pay 7#a7 ,not less frequently than once every two years1 the ,secretary shall set forth a ,department-wide minimum and maximum amount for total annual pay under subsection 7a7 that may be paid to a ,director and shall publish each such amount in the ,federal ,register4 7#b7 ,the minimum and maximum amounts set forth under paragraph 7#a7 shall take effect not earlier than the date that is #fj days after the publication of such amounts under such paragraph4 7#c7 ,the sum of the basic pay set forth under section #gdjd7;a7 of this title and market pay determined under subsection 7b7 for a ,director for a calendar year-- 7,a7 may not be less than the most recent minimum amount set forth under paragraph 7#a7 before the beginning of such calendar year2 and 7,b7 may not be more than the most recent maximum amount set forth under such paragraph before the beginning of such calendar year4 7#d7 ,the total amount of compensation paid to a ,director under this title in any calendar year may not exceed the amount of annual compensation 7excluding expenses7 of the ,president under section #ajb of title #c4 7#e7 ,the ,secretary may not delegate to an officer or employee of the ,department the requirement of the ,secretary to set forth a ,department-wide minimum and maximum amount under paragraph 7#a74 7d7 ,treatment of pay ,pay under this section shall be considered pay for all purposes1 including retirement benefits under chapters #hc and #hd of title #e and other benefits4 7e7 ,ancillary effects of decreases in pay 7#a7 ,a decrease in pay of a ,director resulting from an adjustment in the amount of market pay of the ,director under subsection 7b7 shall not be treated as an adverse action4 7#b7 ,a decrease in the amount of pay of a ,director resulting from an involuntary reassignment in connection with a disciplinary action taken against the ,director is not subject to appeal or judicial review4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #gd of such title is amended by adding at the end the following3 ,subchapter ,,vii4 ,pay for ,medical ,directors and ,directors of ,veterans ,integrated ,service ,networks #gdha4 ,pay for ,medical ,directors and ,directors of ,veterans ,integrated ,service ,networks4 4 7c7 ,effective date ,the amendments made by this section shall take effect on the date that is one year after the date of the enactment of this ,act4 #daf4 ,additional requirements for hiring of health care providers by ,department of ,veterans ,affairs 7a7 ,in general ,the ,secretary of ,veterans ,affairs shall1 as part of the hiring process for each health care provider considered for a position at the ,department of ,veterans ,affairs after the date of the enactment of this ,act1 require from the medical board of each ,state in which the health care provider holds or has held a medical license-- 7#a7 information on any violation of the requirements of the medical license of the health care provider2 and 7#b7 information on whether the health care provider has entered into any settlement agreement for a disciplinary charge relating to the practice of medicine by the health care provider4 7b7 ,regulations ,the ,secretary shall prescribe regulations to carry out this section4 #dag4 ,provision of information on health care providers of ,department of ,veterans ,affairs to ,state medical boards 7a7 ,in general ,notwithstanding section #eeb;a of title #e1 ,united ,states ,code1 the ,secretary of ,veterans ,affairs shall1 with respect to each health care provider of the ,department of ,veterans ,affairs that has violated a requirement of their medical license1 provide to the medical board of each ,state in which the health care provider is licensed or practices all relevant information contained in the ,state ,licensing ,board ,reporting ,file or any successor file of the ,department with respect to such violation4 7b7 ,no request required ,the ,secretary shall provide the information required in subsection 7a7 to a medical board described in such subsection notwithstanding that such board may not have formally requested such information from the ,department4 #dah4 ,report on compliance by ,department of ,veterans ,affairs with reviews of health care providers leaving the ,department or transferring to other facilities ,not later than two years after the date of the enactment of this ,act1 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 compliance by the ,department of ,veterans ,affairs with the policy of the ,department-- 7#a7 to conduct a review of each health care provider of the ,department who transfers to another medical facility of the ,department or leaves the ,department to determine whether there are any concerns1 complaints1 or allegations of violations relating to the medical practice of the health care provider2 and 7#b7 to take appropriate action with respect to any such concern1 complaint1 or allegation4 ,b ,opioid therapy and pain management #dba4 ,guidelines on management of opioid therapy by ,department of ,veterans ,affairs and ,department of ,defense and implementation of such guidelines by ,department of ,veterans ,affairs 7a7 ,guidelines 7#a7 ,in general ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs and the ,secretary of ,defense shall jointly update the ,,va_/,,dod ,clinical ,practice ,guideline for ,management of ,opioid ,therapy for ,chronic ,pain to include the following3 7,a7 ,except as provided in paragraph 7#b71 guidelines developed by the ,centers for ,disease ,control and ,prevention for safely prescribing opioids for the treatment of chronic1 non-cancer pain in outpatient settings upon the release of such guidelines by the ,centers for ,disease ,control and ,prevention4 7,b7 ,enhanced guidance with respect to absolute contraindications for opioid therapy1 including guidance with respect to the following3 7i7 ,the coadministration of drugs that are capable of inducing a life-limiting drug-drug interaction1 including benzodiazepines4 7ii7 ,the treatment of patients with current acute psychiatric instability or substance use disorder or patients at risk of suicide4 7iii7 ,the use of opioid therapy to treat patients without any pain1 including to treat mental health disorders other than opioid use disorder4 7,c7 ,enhanced guidance with respect to the treatment of patients with behaviors or comorbidities1 such as post-traumatic stress disorder1 psychiatric disorders1 or a history of substance abuse or addiction1 that require consultation or comanagement of opioid therapy with one or more specialists in pain management1 mental health1 or addictions4 7,d7 ,enhanced guidance with respect to the conduct by health care providers of an effectiveness assessment for patients receiving opioid therapy1 including patients on long-term opioid therapy1 to determine-- 7i7 whether opioid therapy is meeting the expected goals of the patient and health care provider of relieving pain and improving function2 and 7ii7 whether opioid therapy should be continued4 7,e7 ,requirements that each health care provider of the ,department of ,veterans ,affairs1 before initiating opioid therapy to treat a patient1 use the ,opioid ,therapy ,risk ,report tool of the ,department1 including by accessing the most recent patient information from the prescription drug monitoring program of each ,state1 as required to be included in such tool under section #dbb7;d77#a71 to assess the risk for adverse outcomes of opioid therapy for the patient1 including the concurrent use of controlled substances such as benzodiazepines1 as part of the comprehensive assessment conducted by the health care provider4 7,f7 ,guidelines to govern the methodologies used by health care providers of the ,department of ,veterans ,affairs and the ,department of ,defense to safely titrate and taper opioid therapy when adjusting or discontinuing the use of opioid therapy1 including-- 7i7 prescription of the lowest effective dose based on patient need2 7ii7 use of opioids only for a limited period of time2 and 7iii7 augmentation of opioid therapy with other pain management therapies and modalities4 7,g7 ,guidelines with respect to appropriate case management for patients receiving opioid therapy who transition between inpatient and outpatient health care settings1 which may include the use of care transition plans4 7,h7 ,enhanced recommendations with respect to the use of routine and random urine drug tests for all patients before and during opioid therapy to help prevent substance abuse1 dependence1 and diversion1 including requirements-- 7i7 that such tests occur not less frequently than once each year2 and 7ii7 that health care providers appropriately interpret and respond to the results from such tests to tailor pain therapy1 safeguards1 and risk management strategies to each patient4 7,i7 ,guidance that health care providers discuss with patients1 before initiating opioid therapy1 options for pain management therapies without the use of opioids and options to augment opioid therapy with other clinical and complementary and integrative health services to minimize opioid dependence4 7#b7 ,treatment of certain guidelines developed after deadline ,if the ,centers for ,disease ,control and ,prevention release the guidelines described in paragraph 7#a77;,a7 after the date on which the ,secretary of ,veterans ,affairs and the ,secretary of ,defense jointly update the ,,va_/,,dod ,clinical ,practice ,guideline for ,management of ,opioid ,therapy for ,chronic ,pain1 as required under paragraph 7#a71 the ,secretary of ,veterans ,affairs and the ,secretary of ,defense shall jointly modify such updated clinical practice guideline to include the guidelines described in paragraph 7#a77;,a74 7b7 ,consultation before update ,before updating the clinical practice guideline under subsection 7a71 the ,secretary of ,veterans ,affairs and the ,secretary of ,defense shall jointly consult with the ,pain ,management ,working ,group of the ,health ,executive ,committee of the ,department of ,veterans ,affairs-,department of ,defense ,joint ,executive ,committee established under section #cbj of title #ch1 ,united ,states ,code4 7c7 ,controlled substance defined ,in this section1 the term controlled substance has the meaning given that term in section #ajb of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hjb74 #dbb4 ,improvement of opioid safety measures by ,department of ,veterans ,affairs 7a7 ,expansion of ,opioid ,safety ,initiative ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall expand the ,opioid ,safety ,initiative of the ,department of ,veterans ,affairs to include all medical facilities of the ,department4 7b7 ,pain management education and training 7#a7 ,in general ,in carrying out the ,opioid ,safety ,initiative of the ,department1 the ,secretary shall require all employees of the ,department responsible for prescribing opioids to receive education and training described in paragraph 7#b74 7#b7 ,education and training ,education and training described in this paragraph is education and training on pain management and safe opioid prescribing practices for purposes of safely and effectively managing patients with chronic pain and includes education and training on the following3 7,a7 ,the implementation of and full compliance with the ,,va_/,,dod ,clinical ,practice ,guideline for ,management of ,opioid ,therapy for ,chronic ,pain1 including any update to such guideline4 7,b7 ,the use of evidence-based pain management therapies1 including cognitive-behavioral therapy1 non-opioid alternatives1 and non-drug approaches to managing pain and related health conditions including complementary and integrative health services4 7,c7 ,screening and identification of patients with substance use disorder1 including drug-seeking behavior1 before prescribing opioids1 assessment of the risk potential for patients developing an addiction1 and referral of patients to appropriate addiction treatment professionals if addiction is identified or strongly suspected4 7,d7 ,communication with patients on the potential harm associated with the use of opioids and other controlled substances1 including the need to safely store and dispose of supplies relating to the use of opioids and other controlled substances4 7,e7 ,such other education and training as the ,secretary considers appropriate to ensure that veterans receive safe1 high-quality pain management care from the ,department4 7#c7 ,use of existing program ,in providing education and training described in paragraph 7#b71 the ,secretary shall use the ,interdisciplinary ,chronic ,pain ,management ,training ,team ,program of the ,department4 7c7 ,pain management teams 7#a7 ,in general ,in carrying out the ,opioid ,safety ,initiative of the ,department1 each medical facility of the ,department shall identify and designate a pain management team of health care professionals1 which may include board certified pain medicine specialists1 responsible for coordinating and overseeing therapy at such facility for patients experiencing acute and chronic pain that is non-cancer related4 7#b7 ,establishment of protocols 7,a7 ,in general ,the director of each ,veterans ,integrated ,service ,network shall establish protocols for the designation of pain management teams at each medical facility within that ,veterans ,integrated ,service ,network4 7,b7 ,consultation on prescription of opioids ,each protocol established for a medical facility under subparagraph 7,a7 shall ensure that any health care provider without expertise in prescribing analgesics or who has not completed the education and training under subsection 7b71 such as a mental health care provider1 does not prescribe opioids to a patient unless that health care provider-- 7i7 consults with a health care provider with pain management expertise or who is on the pain management team of the medical facility2 and 7ii7 refers the patient to that pain management team for any subsequent prescriptions and related therapy4 7#c7 ,report 7,a7 ,in general ,not later than one year after the date of the enactment of this ,act1 the head of each medical facility of the ,department shall submit to the director of the ,veterans ,integrated ,service ,network in which the medical facility is located a report identifying the health care professionals that have been designated as members of the pain management team at the medical facility4 7,b7 ,elements ,each report submitted under subparagraph 7,a7 with respect to a medical facility of the ,department shall include-- 7i7 a certification as to whether all members of the pain management team at the medical facility have completed the education and training required under subsection 7b72 and 7ii7 a plan for the management and referral of patients to such pain management team if health care providers without expertise in prescribing analgesics prescribe opioid medications to treat acute and chronic pain that is non-cancer related4 7d7 ,tracking and monitoring of opioid use 7#a7 ,prescription drug monitoring programs of ,states ,in carrying out the ,opioid ,safety ,initiative and the ,opioid ,therapy ,risk ,report tool of the ,department1 the ,secretary shall-- 7,a7 ensure access by health care providers of the ,department to information on controlled substances1 including opioids and benzodiazepines1 prescribed to veterans who receive care outside the ,department through the prescription drug monitoring program of each ,state1 including by seeking to enter into memoranda of understanding with ,states to allow such access2 7,b7 include such information in the ,opioid ,therapy ,risk ,report2 and 7,c7 require health care providers of the ,department to submit to the prescription drug monitoring program of each ,state information on prescriptions of controlled substances received by veterans in that ,state under the laws administered by the ,secretary4 7#b7 ,report on tracking of data on opioid use ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report on the feasibility and advisability of improving the ,opioid ,therapy ,risk ,report tool of the ,department to allow for more advanced real-time tracking of and access to data on-- 7,a7 the key clinical indicators with respect to the totality of opioid use by veterans2 7,b7 concurrent prescribing by health care providers of the ,department of opioids in different health care settings1 include data on concurrent prescribing of opioids to treat mental health disorders other than opioid use disorder2 and 7,c7 mail-order prescriptions of opioids prescribed to veterans under the laws administered by the ,secretary4 7e7 ,availability of opioid receptor antagonists 7#a7 ,increased availability and use 7,a7 ,in general ,the ,secretary shall increase the availability of opioid receptor antagonists approved by the ,food and ,drug ,administration1 such as naloxone1 to veterans4 7,b7 ,availability1 training1 and distribution ,in carrying out subparagraph 7,a71 the ,secretary shall1 not later than #ij days after the date of the enactment of this ,act-- 7i7 equip each pharmacy of the ,department with opioid receptor antagonists approved by the ,food and ,drug ,administration to be dispensed to outpatients as needed2 and 7ii7 expand the ,overdose ,education and ,naloxone ,distribution program of the ,department to ensure that all veterans in receipt of health care under the laws administered by the ,secretary who are at risk of opioid overdose may access such opioid receptor antagonists and training on the proper administration of such opioid receptor antagonists4 7,c7 ,veterans who are at risk ,for purposes of subparagraph 7,b71 veterans who are at risk of opioid overdose include-- 7i7 veterans receiving long-term opioid therapy2 7ii7 veterans receiving opioid therapy who have a history of substance use disorder or prior instances of overdose2 and 7iii7 veterans who are at risk as determined by a health care provider who is treating the veteran4 7#b7 ,report ,not later than #abj 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 compliance with paragraph 7#a7 that includes an assessment of any remaining steps to be carried out by the ,department to comply with such paragraph4 7f7 ,inclusion of certain information and capabilities in ,opioid ,therapy ,risk ,report tool 7#a7 ,information ,the ,secretary shall include in the ,opioid ,therapy ,risk ,report tool of the ,department-- 7,a7 information on the most recent time the tool was accessed by a health care provider of the ,department with respect to each veteran2 and 7,b7 information on the results of the most recent urine drug test for each veteran4 7#b7 ,capabilities ,the ,secretary shall include in the ,opioid ,therapy ,risk ,report tool the ability of health care providers of the ,department to determine whether a health care provider of the ,department prescribed opioids to a veteran without checking the information in the tool with respect to the veteran4 7g7 ,notification of risk in computerized health record ,the ,secretary shall modify the ,computerized ,patient ,record ,system of the ,department to ensure that any health care provider that accesses the record of a veteran1 regardless of the reason the veteran seeks care from the health care provider1 will be immediately notified whether the veteran-- 7#a7 is receiving opioid therapy and has a history of substance use disorder or prior instances of overdose2 7#b7 has a history of opioid abuse2 or 7#c7 is at risk of becoming an opioid abuser as determined by a health care provider who is treating the veteran4 7h7 ,controlled substance defined ,in this section1 the term controlled substance has the meaning given that term in section #ajb of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hjb74 #dbc4 ,enhancement of joint working group on pain management of the ,department of ,veterans ,affairs and the ,department of ,defense 7a7 ,in general ,not later than #ij days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs and the ,secretary of ,defense shall ensure that the ,pain ,management ,working ,group of the ,health ,executive ,committee of the ,department of ,veterans ,affairs-,department of ,defense ,joint ,executive ,committee established under section #cbj of title #ch1 ,united ,states ,code1 includes a focus on the following3 7#a7 ,the opioid prescribing practices of health care providers of each ,department4 7#b7 ,the ability of each ,department to manage acute and chronic pain among individuals receiving health care from that ,department1 including training health care providers with respect to pain management4 7#c7 ,the use by each ,department of complementary and integrative health in treating such individuals4 7#d7 ,the concurrent use by health care providers of each ,department of opioids and prescription drugs to treat mental health disorders1 including benzodiazepines4 7#e7 ,the practice by health care providers of each ,department of prescribing opioids to treat mental health disorders4 7#f7 ,the coordination in coverage of and consistent access to medications prescribed for patients transitioning from receiving health care from the ,department of ,defense to receiving health care from the ,department of ,veterans ,affairs4 7#g7 ,the ability of each ,department to identify and treat substance use disorders among individuals receiving health care from that ,department4 7b7 ,coordination and consultation ,the ,secretary of ,veterans ,affairs and the ,secretary of ,defense shall ensure that the working group described in subsection 7a7-- 7#a7 coordinates the activities of the working group with other relevant working groups established under section #cbj of title #ch1 ,united ,states ,code1 including the working groups on evidence based practice1 patient safety1 pharmacy1 and psychological health2 7#b7 consults with other relevant ,federal agencies1 including the ,centers for ,disease ,control and ,prevention1 with respect to the activities of the working group2 and 7#c7 consults with the ,department of ,veterans ,affairs and the ,department of ,defense with respect to1 reviews1 and comments on the ,,va_/,,dod ,clinical ,practice ,guideline for ,management of ,opioid ,therapy for ,chronic ,pain1 or any successor guideline1 before any update to the guideline is released4 7c7 ,consultation ,the ,secretary of ,veterans ,affairs and the ,secretary of ,defense shall ensure that the working group described in subsection 7a7 is able to meaningfully consult with respect to the updated guideline required under subsection 7a7 of section #dba1 as required by subsection 7b7 of such section1 not later than one year after the date of the enactment of this ,act4 #dbd4 ,establishment of pain management boards of ,department of ,veterans ,affairs 7a7 ,in general ,subchapter ,i of chapter #gc of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new section3 #gcji;,a4 ,pain management boards 7a7 ,establishment ,the ,secretary shall establish in each ,veterans ,integrated ,service ,network a ,pain ,management ,board 7in this section referred to as a ,board74 7b7 ,activities 7#a7 ,each ,board may-- 7,a7 consult with health care professionals and other employees of the ,department located in the ,veterans ,integrated ,service ,network covered by the ,board1 patients who are being treated at medical facilities of the ,department located in such ,veterans ,integrated ,service ,network1 and family members of such patients with respect to the pain management resources and best practices of the ,department2 7,b7 oversee compliance by the health care professionals and other employees of the ,department with the best practices of the ,department1 including by issuing recommendations to improve compliance with those best practices2 7,c7 provide oversight of the pain management practices of the pain management teams of each medical facility of the ,department and the health care professionals and other employees of the ,department that are located in the ,veterans ,integrated ,service ,network covered by the ,board2 7,d7 host educational events1 as the ,board considers appropriate1 for individuals specified in subparagraph 7,a7 on pain management and treatment that may include the sharing of updated research and best practices from medical experts1 other health care systems1 and such other ,federal agencies as the ,board considers necessary to carry out this subparagraph2 and 7,e7 host public events1 as the ,board considers appropriate1 during which health care professionals discuss and share best practices on pain management and complementary and integrative health4 7#b7 7,a7 ,each ,board may provide treatment recommendations for patients with complex clinical pain who are being treated at a medical facility of the ,department located in the ,veterans ,integrated ,service ,network covered by the ,board1 and assist in facilitating communication between such patients and their health care providers1 regardless of whether such treatment is on an in-patient or out-patient basis1 and for whom a request for such recommendations1 subject to subparagraph 7,c71 has been made by an individual described in subparagraph 7,b74 7,b7 ,an individual described in this subparagraph is one of the following individuals3 7i7 ,the patient4 7ii7 ,the spouse of the patient4 7iii7 ,a family member of the patient or another individual if such family member or individual has been designated by the patient to make health care decisions for the patient or to receive health care information with respect to the patient4 7iv7 ,a physician of the patient4 7v7 ,an employee of the medical facility of the ,department described in subparagraph 7,a74 7,c7 ,an individual described in subparagraph 7,b7 may not request treatment recommendations under subparagraph 7,a7 unless the individual-- 7i7 has requested treatment recommendations from the pain management team of the medical facility of the ,department at which the patient is receiving treatment2 and 7ii7 has received treatment recommendations from such team and is not satisfied with those treatment recommendations4 7,d7 ,treatment recommendations provided under subparagraph 7,a7 shall assist the patient and health care provider in determining the best treatment plan for the patient and shall not dictate the treatment plan used by the health care provider4 7#c7 ,based on treatment recommendations developed under paragraph 7#b77;,a71 consultations conducted under paragraph 7#a77;,a71 and educational and public events hosted under subparagraphs 7,d7 and 7,e7 of paragraph 7#a71 each ,board may provide to health care professionals of the ,department located in the ,veterans ,integrated ,service ,network covered by the ,board recommendations on the best practices regarding pain management in cases of complex clinical pain4 7#d7 7,a7 ,not later than ,january #ca of each 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 contains comprehensive information from each ,board 7with all personally identifiable information of patients redacted7 on pain management practices carried out in the ,veterans ,integrated ,service ,network covered by the ,board4 7,b7 ,each report submitted by the ,secretary under subparagraph 7,a7 shall include1 for the year preceding the submittal of the report-- 7i7 a summary and explanation of the treatment recommendations provided under paragraph #b7;,a7 during such year2 and 7ii7 the recommendations for best practices provided to health care professionals under paragraph 7#c7 during such year4 7#e7 ,the ,federal ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 shall not apply to any ,board4 7c7 ,membership 7#a7 ,each ,board shall include the following individuals appointed by the ,secretary3 7,a7 ,a board certified pain medicine specialist4 7,b7 ,a trained and qualified member of the primary care team of a medical facility of the ,department with experience in pain care1 such as a nurse practitioner4 7,c7 ,a pain psychologist4 7,d7 ,a pain social worker4 7,e7 ,a clinical pharmacist4 7,f7 ,a pain point of contact for a ,veterans ,integrated ,service ,network4 7,g7 ,a physician with addiction and psychopharmacology expertise and experience4 7,h7 ,an allied health care professional4 7,i7 ,a clinician with expertise in complementary and integrative health4 7,j7 ,a clinical behavioral therapist4 7,k7 ,a patient advocate4 7,l7 ,a representative of the labor interests of employees of the ,department who are responsible for prescribing drugs4 7,m7 ,two current or former clinical patients who are representative of the demographic of patients served by the ,veterans ,integrated ,service ,network covered by the ,board4 7,n7 ,a family member of a current or former clinical patient who is representative of the demographic of patients served by the ,veterans ,integrated ,service ,network covered by the ,board4 7#b7 ,the ,secretary shall determine the terms of service of the members of each ,board1 taking into consideration the clinical duties of members who are employees of the ,department4 7#c7 7,a7 ,members of each ,board shall serve without pay and1 except as provided in subparagraph 7,b71 members who are full-time officers or employees of the ,united ,states may not receive additional pay1 allowances1 or benefits by reason of their service on the ,board4 7,b7 ,members may receive travel expenses1 including per diem in lieu of subsistence1 for travel in connection with their duties as members of the ,board4 7,c7 7i7 ,except as provided in clause 7ii71 any member who has clinical duties as an officer or employee of the ,united ,states shall be relieved of such duties during periods in which such relief is necessary for the member to carry out the duties of the ,board4 7ii7 ,the ,secretary shall ensure that carrying out the duties of the ,board does not prevent any member who has clinical duties as an employee of the ,department from furnishing direct clinical care as appropriate to maintain quality patient care4 7d7 ,participation of certain members 7#a7 ,in carrying out the activities of a ,board under subsection 7b71 any member appointed under subsection 7c77#a7 solely based on qualifications under subparagraph 7,k71 7,l71 7,m71 or 7,n7 of subsection 7c77#a7-- 7,a7 may not have access to specific information identifying a patient and other confidential information relating to a patient2 and 7,b7 except as provided in paragraph 7#b71 may not participate in providing treatment recommendations under subsection 7b77#b77;,a74 7#b7 ,in carrying out the activities of the ,board under subsection 7b71 a member appointed under subsection 7c77#a7 solely based on qualifications under subparagraph 7,k7 of subsection 7c77#a7 may be present during the provision of treatment recommendations under subsection 7b77#b77;,a7 with the consent and upon the request of the patient for which such treatment recommendations are provided for purposes of representing the interests of the patient4 7e7 ,employment protections ,no adverse personnel action may be made against an employee of the ,department in connection with a communication by the employee with a member of a ,board relating to the activities of the ,board under subsection 7b7 and any such communication shall be covered by the employment and whistleblower protections otherwise applicable to communications by employees of the ,department4 7f7 ,resources of ,department ,the ,secretary shall make available to each ,board the resources and personnel of the ,department necessary for the ,board to carry out the activities of the ,board under subsection 7b71 including resources and personnel of the ,general ,counsel of the ,department4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #gc of such title is amended by inserting after the item relating to section #gcji the following new item3 #gcji;,a4 ,pain management boards4 4 7c7 ,effective date ,the amendments made by this section shall take effect on the date that is one year after the date of the enactment of this ,act4 #dbe4 ,review1 investigation1 and report on use of opioids in treatment by ,department of ,veterans ,affairs 7a7 ,independent review 7#a7 ,in general ,not later than two years after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall enter into a contract with an independent entity with expertise in assessing clinical prescribing practices to conduct an independent review of the ,opioid ,safety ,initiative of the ,department of ,veterans ,affairs and the opioid prescribing practices of health care providers of the ,department4 7#b7 ,report 7,a7 ,in general ,not later than #cj days after completing the independent review under paragraph 7#a71 the independent entity that carried out such review shall submit to the ,secretary1 the ,committee on ,veterans' ,affairs of the ,senate1 and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on the findings and recommendations of the independent entity with respect to such review4 7,b7 ,elements ,the report submitted under subparagraph 7,a7 by the independent entity described in such subparagraph-- 7i7 shall include-- 7,i7 recommendations on such improvements to the ,opioid ,safety ,initiative of the ,department as the independent entity considers appropriate2 7,,ii7 information with respect to-- 7aa7 deaths resulting from sentinel events involving veterans prescribed opioids by a health care provider of the ,department2 7bb7 overall prescription rates and prescription indications of opioids at all medical facilities of the ,department to treat non-cancer1 non-palliative1 and non-hospice care patients1 including whether such prescription rates for each medical facility or health care provider of the ,department conflicts with or is otherwise inconsistent with the standards of appropriate and safe care with respect to such prescription rates2 7cc7 the prescription rates and prescription indications of benzodiazepines and opioids concomitantly by health care providers of the ,department1 including whether such prescription rates for each medical facility or health care provider of the ,department conflicts with or is otherwise inconsistent with the standards of appropriate and safe care with respect to such prescription rates2 7dd7 the practice by health care providers of the ,department of prescribing opioids to treat patients without any pain1 including to treat patients with mental health disorders other than opioid use disorder2 and 7ee7 the effectiveness of opioid therapy for patients receiving such therapy1 including the effectiveness of long-term opioid therapy2 and 7,,iii7 an assessment of the compliance of the ,department with the ,,va_/,,dod ,clinical ,practice ,guideline for ,management of ,opioid ,therapy for ,chronic ,pain1 as updated under section #dba7;a72 and 7ii7 may include recommendations with respect to whether the ,department should implement policies relating to performance management1 such as written warnings or performance improvement plans1 for health care providers of the ,department that are-- 7,i7 not practicing at a level meeting or exceeding the minimum level standard of care established by the ,department2 and 7,,ii7 not following the enhanced guidance with respect to absolute contraindications for opioid therapy set forth in the ,,va_/,,dod ,clinical ,practice ,guideline for ,management of ,opioid ,therapy for ,chronic ,pain1 as updated under section #dba7;a74 7b7 ,annual review1 investigation1 and report on opioid therapy 7#a7 ,annual review of prescription rates ,not later than one year after the date of the enactment of this ,act1 and not less frequently than annually thereafter1 the ,secretary of ,veterans ,affairs shall1 with respect to each medical facility of the ,department of ,veterans ,affairs1 collect and review information on opioids prescribed by health care providers at the facility to treat non-cancer1 non-palliative1 and non-hospice care patients1 including information on-- 7,a7 the prescription rate at which each health care provider at the facility prescribed benzodiazepines and opioids concurrently to such patients and the aggregate such prescription rate for all health care providers at the facility2 7,b7 the prescription rate at which each health care provider at the facility prescribed benzodiazepines or opioids to such patients to treat conditions for which opioids or benzodiazepines are not an approved treatment and the aggregate such prescription rate for all health care providers at the facility2 7,c7 the prescription rate at which each health care provider at the facility prescribed or dispensed mail-order prescriptions of opioids to such patients while such patients were being treated with opioids on an inpatient-basis and the aggregate such prescription rate for all health care providers at the facility2 and 7,d7 the prescription rate at which each health care provider at the facility prescribed opioids to such patients who were also concurrently prescribed opioids by a health care provider that is not a health care provider of the ,department and the aggregate such prescription rate for all health care providers at the facility4 7#b7 ,investigation of prescription rates ,if the ,secretary determines that a prescription rate described in paragraph 7#a7 with respect to a health care provider or medical facility of the ,department conflicts with or is otherwise inconsistent with the standards of appropriate and safe care1 the ,secretary shall-- 7,a7 include information relating to such determination1 prescription rate1 and health care provider or medical facility1 as the case may be1 in the report submitted under paragraph 7#c77;,f72 7,b7 through the ,office of the ,medical ,inspector of the ,veterans ,health ,administration1 conduct a full investigation of the health care provider or medical facility1 as the case may be2 and 7,c7 immediately notify the ,committee on ,veterans' ,affairs of the ,senate1 the ,committee on ,veterans' ,affairs of the ,house of ,representatives1 and each ,member of the ,senate and the ,house of ,representatives who represents the area in which the health care provider or medical facility1 as the case may be1 is located4 7#c7 ,report on opioid therapy ,not later than one year after the date of the enactment of this ,act1 and not less frequently than annually thereafter1 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 contains1 for the one year period preceding the submittal of the report1 the following3 7,a7 ,the number of patients and the percentage of the patient population of the ,department of ,veterans ,affairs who were prescribed benzodiazepines and opioids concurrently by a health care provider of the ,department4 7,b7 ,the number of patients and the percentage of the patient population of the ,department without any pain who were prescribed opioids by a health care provider of the ,department1 including those who were prescribed benzodiazepines and opioids concurrently4 7,c7 ,the number of non-cancer1 non-palliative1 and non-hospice care patients and the percentage of such patients who were treated with opioids by a health care provider of the ,department on an inpatient-basis and who also received prescription opioids by mail from the ,department while being treated on an inpatient-basis4 7,d7 ,the number of non-cancer1 non-palliative1 and non-hospice care patients and the percentage of such patients who were prescribed opioids concurrently by a health care provider of the ,department and a health care provider that is not a health care provider of the ,department4 7,e7 ,with respect to each medical facility of the ,department1 the number of times a pharmacist at the facility overrode a critical drug interaction warning with respect to an interaction between opioids and another medication before dispensing a medication to a veteran4 7,f7 ,the results of the review conducted under paragraph 7#a7 7including a summary of such review at the ,veterans ,integrated ,service ,network level7 and the investigation conducted under paragraph 7#b7 7including information described in paragraph 7#b77;,a771 compiled in such a manner as the ,secretary determines appropriate to ensure that the information is easily accessible4 7,g7 ,an assessment of the compliance of the ,department with the ,,va_/,,dod ,clinical ,practice ,guideline for ,management of ,opioid ,therapy for ,chronic ,pain1 including any update to such guideline4 7c7 ,prescription rate defined ,in this section1 the term prescription rate means1 with respect to a health care provider or medical facility of the ,department1 each of the following3 7#a7 ,the number of patients treated with opioids by the health care provider or at the medical facility1 as the case may be1 divided by the total number of pharmacy users of that health care provider or at that medical facility4 7#b7 ,the average number of morphine equivalents per day prescribed by the health care provider or at the medical facility1 as the case may be1 to patients being treated with opioids4 7#c7 ,of the patients being treated with opioids by the health care provider or at the medical facility1 as the case may be1 the average number of prescriptions of opioids per patient4 ,c ,patient advocacy #dca4 ,establishment of ,office of ,patient ,advocacy of the ,department of ,veterans ,affairs 7a7 ,in general ,subchapter ,i of chapter #gc of title #ch1 ,united ,states ,code1 as amended by section #dbd7;a71 is further amended by adding at the end the following new section3 #gcji;,b4 ,office of ,patient ,advocacy 7a7 ,establishment ,there is established in the ,department within the ,office of the ,under ,secretary for ,health an office to be known as the ,office of ,patient ,advocacy 7in this section referred to as the ,office74 7b7 ,head 7#a7 ,the ,director of the ,office of ,patient ,advocacy shall be the head of the ,office4 7#b7 ,the ,director of the ,office of ,patient ,advocacy shall be appointed by the ,under ,secretary for ,health from among individuals qualified to perform the duties of the position and shall report directly to the ,under ,secretary for ,health4 7c7 ,function 7#a7 ,the function of the ,office is to carry out the ,patient ,advocacy ,program of the ,department4 7#b7 ,in carrying out the ,patient ,advocacy ,program of the ,department1 the ,director shall ensure that patient advocates of the ,department-- 7,a7 advocate on behalf of veterans with respect to health care received and sought by veterans under the laws administered by the ,secretary2 7,b7 carry out the responsibilities specified in subsection 7d72 and 7,c7 receive training in patient advocacy4 7d7 ,patient advocacy responsibilities ,the responsibilities of each patient advocate at a medical facility of the ,department are the following3 7#a7 ,to resolve complaints by veterans with respect to health care furnished under the laws administered by the ,secretary that cannot be resolved at the point of service or at a higher level easily accessible to the veteran4 7#b7 ,to present at various meetings and to various committees the issues experienced by veterans in receiving such health care at such medical facility4 7#c7 ,to express to veterans their rights and responsibilities as patients in receiving such health care4 7#d7 ,to manage the ,patient ,advocate ,tracking ,system of the ,department at such medical facility4 7#e7 ,to compile data at such medical facility of complaints made by veterans with respect to the receipt of such health care at such medical facility and the satisfaction of veterans with such health care at such medical facility to determine whether there are trends in such data4 7#f7 ,to ensure that a process is in place for the distribution of the data compiled under paragraph 7#e7 to appropriate leaders1 committees1 services1 and staff of the ,department4 7#g7 ,to identify1 not less frequently than quarterly1 opportunities for improvements in the furnishing of such health care to veterans at such medical facility based on complaints by veterans4 7#h7 ,to ensure that any significant complaint by a veteran with respect to such health care is brought to the attention of appropriate staff of the ,department to trigger an assessment of whether there needs to be a further analysis of the problem at the facility-wide level4 7#i7 ,to support any patient advocacy programs carried out by the ,department4 7#aj7 ,to ensure that all appeals and final decisions with respect to the receipt of such health care are entered into the ,patient ,advocate ,tracking ,system of the ,department4 7#aa7 ,to understand all laws1 directives1 and other rules with respect to the rights and responsibilities of veterans in receiving such health care1 including the appeals processes available to veterans4 7#ab7 ,to ensure that veterans receiving mental health care1 or the surrogate decision makers for such veterans1 are aware of the rights of veterans to seek representation from systems established under section #ajc of the ,protection and ,advocacy for ,mentally ,ill ,individuals ,act of #aihf 7#db ,u4,s4,c4 #ajhjc7 to protect and advocate the rights of individuals with mental illness and to investigate incidents of abuse and neglect of such individuals4 7#ac7 ,to fulfill requirements established by the ,secretary with respect to the inspection of controlled substances4 7#ad7 ,to document potentially threatening behavior and report such behavior to appropriate authorities4 7e7 ,training ,in providing training to patient advocates under subsection 7c77#b77;,c71 the ,director shall ensure that such training is consistent throughout the ,department4 7f7 ,controlled substance defined ,in this section1 the term controlled substance has the meaning given that term in section #ajb of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hjb74 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #gc of such title1 as amended by section #dbd7;b71 is further amended by adding after the item relating to section #gcji;,a the following new item3 #gcji;,b4 ,office of ,patient ,advocacy4 4 7c7 ,date fully operational ,the ,secretary of ,veterans ,affairs shall ensure that the ,office of ,patient ,advocacy established in section #gcji;,b of title #ch1 ,united ,states ,code1 as added by subsection 7a71 is fully operational not later than the date that is one year after the date of the enactment of this ,act4 #dcb4 ,community meetings on improving care from ,department of ,veterans ,affairs 7a7 ,community meetings 7#a7 ,medical centers ,not later than #ij days after the date of the enactment of this ,act1 and not less frequently than once every #ij days thereafter1 each medical center of the ,department of ,veterans ,affairs shall host a community meeting open to the public on improving health care from the ,department4 7#b7 ,community based outpatient clinics ,not later than one year after the date of the enactment of this ,act1 and not less frequently than annually thereafter1 each community based outpatient clinic of the ,department shall host a community meeting open to the public on improving health care from the ,department4 7b7 ,attendance by ,director of ,veterans ,integrated ,service ,network or designee 7#a7 ,in general ,subject to paragraph 7#b71 each community meeting hosted by a medical center or community based outpatient clinic under subsection 7a7 shall be attended by the ,director of the ,veterans ,integrated ,service ,network in which the medical center or community based outpatient clinic1 as the case may be1 is located1 or an employee designated by the ,director who works in the office of the ,director 4 7#b7 ,attendance by ,director ,each ,director of a ,veterans ,integrated ,service ,network shall attend not less than one community meeting under subsection 7a7 hosted by each medical center located in the ,veterans ,integrated ,service ,network each year4 7c7 ,notice ,each medical center or community based outpatient clinic hosting a community meeting shall send timely notice of the community meeting to the ,committee on ,veterans' ,affairs of the ,senate1 the ,committee on ,veterans' ,affairs of the ,house of ,representatives1 and each ,member of the ,senate and the ,house of ,representatives who represents the area in which the medical facility is located4 #dcc4 ,improvement of awareness of patient advocacy program and patient bill of rights of ,department of ,veterans ,affairs ,not later than #ij days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall1 in as many prominent locations as appropriate to be seen by the largest percentage of patients and family members of patients at each medical facility of the ,department of ,veterans ,affairs-- 7#a7 display the purposes of the ,patient ,advocacy ,program of the ,department and the contact information for the patient advocate at such medical facility2 and 7#b7 display the rights and responsibilities of-- 7,a7 patients and family members of patients at such medical facility2 and 7,b7 with respect to community living centers and other residential facilities of the ,department1 residents and family members of residents at such medical facility4 #dcd4 ,comptroller ,general ,report on ,patient ,advocacy ,program of ,department of ,veterans ,affairs 7a7 ,in general ,not later than three years after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states 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 ,patient ,advocacy ,program of the ,department of ,veterans ,affairs 7in this section referred to as the ,program7 as carried out under the ,office of ,patient ,advocacy of the ,department established in section #gcji;,b of title #ch1 ,united ,states ,code1 as added by section #dca7;a74 7b7 ,elements ,the report required by subsection 7a7-- 7#a7 shall include-- 7,a7 such recommendations and proposals for improving or modifying the ,program as the ,comptroller ,general considers appropriate2 and 7,b7 such other information with respect to the ,program as the ,comptroller ,general considers appropriate2 and 7#b7 may include-- 7,a7 a description of the ,program1 including-- 7i7 the purposes of the ,program2 7ii7 the activities carried out under the ,program2 and 7iii7 the sufficiency of the ,program in achieving the purposes of the ,program2 7,b7 an assessment of the sufficiency of staffing of employees of the ,department responsible for carrying out the ,program2 7,c7 an assessment of the sufficiency of the training of such employees2 and 7,d7 an assessment of-- 7i7 awareness of the ,program among veterans and their family members2 and 7ii7 the use of the ,program by veterans and their family members4 ,d ,complementary and integrative health #dda4 ,expansion of research and education on and delivery of complementary and integrative health to veterans 7a7 ,development of plan ,to expand research1 education1 and delivery ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall develop a plan to expand materially and substantially the scope of the effectiveness of research and education on1 and delivery and integration of1 complementary and integrative health services into the health care services provided to veterans4 7b7 ,elements ,the plan required by subsection 7a7 shall provide for the following3 7#a7 ,research on the following3 7,a7 ,the effectiveness of various complementary and integrative health services1 including the effectiveness of such services integrated with clinical therapies4 7,b7 ,approaches to integrating complementary and integrative health services into other health care services provided by the ,department4 7#b7 ,education and training for health care professionals of the ,department on the following3 7,a7 complementary and integrative health services selected by the ,secretary for purposes of the plan4 7,b7 ,appropriate uses of such services4 7,c7 ,integration of such services into the delivery of health care to veterans4 7#c7 ,research1 education1 and clinical activities on complementary and integrative health at centers of innovation at medical centers of the ,department4 7#d7 ,identification or development of metrics and outcome measures to evaluate the effectiveness of the provision and integration of complementary and integrative health services into the delivery of health care to veterans4 7#e7 ,integration and delivery of complementary and integrative health services with other health care services provided by the ,department4 7c7 ,consultation 7#a7 ,in general ,in carrying out subsection 7a71 the ,secretary shall consult with the following3 7,a7 ,the ,director of the ,national ,center for ,complementary and ,integrative ,health of the ,national ,institutes of ,health4 7,b7 ,the ,commissioner of ,food and ,drugs4 7,c7 ,institutions of higher education1 private research institutes1 and individual researchers with extensive experience in complementary and integrative health and the integration of complementary and integrative health practices into the delivery of health care4 7,d7 ,nationally recognized providers of complementary and integrative health4 7,e7 ,such other officials1 entities1 and individuals with expertise on complementary and integrative health as the ,secretary considers appropriate4 7#b7 ,scope of consultation ,the ,secretary shall undertake consultation under paragraph 7#a7 in carrying out subsection 7a7 with respect to the following3 7,a7 ,to develop the plan4 7,b7 ,to identify specific complementary and integrative health practices that1 on the basis of research findings or promising clinical interventions1 are appropriate to include as services to veterans4 7,c7 ,to identify barriers to the effective provision and integration of complementary and integrative health services into the delivery of health care to veterans1 and to identify mechanisms for overcoming such barriers4 7d7 ,complementary and integrative health defined ,in this section1 the term complementary and integrative health has the meaning given that term by the ,national ,institutes of ,health4 #ddb4 ,pilot program on integration of complementary and integrative health within ,department of ,veterans ,affairs medical centers 7a7 ,pilot program required ,not later than #ahj days after the completion of the development of the plan under section #dda1 the ,secretary of ,veterans ,affairs shall-- 7#a7 carry out1 through the ,office of ,patient ,centered ,care and ,cultural ,transformation of the ,department of ,veterans ,affairs1 a pilot program to assess the feasibility and advisability of integrating the delivery of complementary and integrative health services selected by the ,secretary with other health care services provided by the ,department for veterans with mental health conditions1 chronic pain conditions1 other chronic conditions1 and such other conditions as the ,secretary determines appropriate2 and 7#b7 in developing the pilot program-- 7,a7 use the plan developed under section #dda2 and 7,b7 identify and1 to the extent practicable1 resolve barriers to the provision of complementary and integrative health services selected by the ,secretary and the integration of those services with other health care services provided by the ,department4 7b7 ,duration of pilot program ,the ,secretary shall carry out the pilot program during the three-year period beginning on the date that is #ahj days after the completion of the development of the plan under section #dda4 7c7 ,locations 7#a7 ,in general ,the ,secretary shall carry out the pilot program at not fewer than #ae medical centers of the ,department4 7#b7 ,polytrauma centers ,not less than two of the medical centers designated under paragraph 7#a7 shall be located at polytrauma rehabilitation centers of the ,department4 7#c7 ,medical centers with prescription rate of opioids that conflicts with care standards 7,a7 ,in general ,in selecting medical centers under paragraph 7#a71 the ,secretary shall give priority to medical centers of the ,department at which there is a prescription rate of opioids that conflicts with or is otherwise inconsistent with the standards of appropriate and safe care4 7,b7 ,prescription rate defined ,in this paragraph1 the term prescription rate means1 with respect to a medical center of the ,department1 each of the following3 7i7 ,the number of patients treated with opioids at the medical center divided by the total number of pharmacy users at the medical center4 7ii7 ,the average number of morphine equivalents per day prescribed at the medical center to patients being treated with opioids4 7iii7 ,of the patients being treated with opioids at the medical center1 the average number of prescriptions of opioids per patient4 7#d7 ,selection of locations ,in carrying out the pilot program1 the ,secretary shall select locations that include the following areas3 7,a7 ,rural areas4 7,b7 ,areas that are not in close proximity to an active duty military installation4 7,c7 ,areas representing different geographic locations1 such as census tracts established by the ,bureau of the ,census4 7d7 ,provision of services ,under the pilot program1 the ,secretary shall provide covered services to covered veterans by integrating complementary and integrative health services with other services provided by the ,department at the medical centers designated under subsection 7c77#a74 7e7 ,covered veterans ,for purposes of the pilot program1 a covered veteran is any veteran who-- 7#a7 has a mental health condition diagnosed by a clinician of the ,department2 7#b7 experiences chronic pain2 7#c7 has a chronic condition being treated by a clinician of the ,department2 or 7#d7 is not described in paragraph 7#a71 7#b71 or 7#c7 and requests to participate in the pilot program or is referred by a clinician of the ,department who is treating the veteran4 7f7 ,covered services 7#a7 ,in general ,for purposes of the pilot program1 covered services are services consisting of complementary and integrative health services as selected by the ,secretary4 7#b7 ,administration of services ,covered services shall be administered under the pilot program as follows3 7,a7 ,covered services shall be administered by professionals or other instructors with appropriate training and expertise in complementary and integrative health services who are employees of the ,department or with whom the ,department enters into an agreement to provide such services4 7,b7 ,covered services shall be included as part of the ,patient ,aligned ,care ,teams initiative of the ,office of ,patient ,care ,services1 ,primary ,care ,program ,office1 in coordination with the ,office of ,patient ,centered ,care and ,cultural ,transformation4 7,c7 ,covered services shall be made available to-- 7i7 covered veterans who have received conventional treatments from the ,department for the conditions for which the covered veteran seeks complementary and integrative health services under the pilot program2 and 7ii7 covered veterans who have not received conventional treatments from the ,department for such conditions4 7g7 ,voluntary participation ,the participation of a veteran in the pilot program shall be at the election of the veteran and in consultation with a clinician of the ,department4 7h7 ,report 7#a7 ,in general ,not later than three years after the date of the commencement of the pilot program1 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 pilot program4 7#b7 ,elements ,the report submitted under paragraph 7#a7 shall include the following3 7,a7 ,the findings and conclusions of the ,secretary with respect to the pilot program1 including with respect to-- 7i7 the use and efficacy of the complementary and integrative health services established under the pilot program2 7ii7 the outreach conducted by the ,secretary to inform veterans and community organizations about the pilot program2 and 7iii7 an assessment of the benefit of the pilot program to covered veterans in mental health diagnoses1 pain management1 and treatment of chronic illness4 7,b7 ,barriers identified under subsection 7a77#b77;,b7 that were not resolved4 7,c7 ,such recommendations for the continuation or expansion of the pilot program as the ,secretary considers appropriate4 7i7 ,complementary and integrative health defined ,in this section1 the term complementary and integrative health shall have the meaning given that term in section #dda7;d74 ,e ,family caregivers #dea4 ,expansion of family caregiver program of ,department of ,veterans ,affairs 7a7 ,family caregiver program 7#a7 ,expansion of eligibility 7,a7 ,in general ,subsection 7a77#b77;,b7 of section #agbj;,g of title #ch1 ,united ,states ,code1 is amended to read as follows3 7,b7 for assistance provided under this subsection-- 7i7 before the date on which the ,secretary submits to ,congress a certification that the ,department has fully implemented the information technology system required by section #deb7;a7 of the ,jason ,simcakoski ,memorial ,act1 has a serious injury 7including traumatic brain injury1 psychological trauma1 or other mental disorder7 incurred or aggravated in the line of duty in the active military1 naval1 or air service on or after ,september #aa1 #bjja2 7ii7 during the two-year period beginning on the date specified in clause 7i71 has a serious injury 7including traumatic brain injury1 psychological trauma1 or other mental disorder7 incurred or aggravated in the line of duty in the active military1 naval1 or air service-- 7,i7 on or before ,may #g1 #aige2 or 7,,ii7 on or after ,september #aa1 #bjja2 or 7iii7 after the date that is two years after the date specified in clause 7i71 has a serious injury 7including traumatic brain injury1 psychological trauma1 or other mental disorder7 incurred or aggravated in the line of duty in the active military1 naval1 or air service2 and 4 7,b7 ,publication in ,federal ,register ,not later than #cj days after the date on which the ,secretary of ,veterans ,affairs submits to ,congress the certification described in subsection 7a77#b77;,b77i7 of section #agbj;,g of such title1 as amended by subparagraph 7,a7 of this paragraph1 the ,secretary shall publish the date specified in such subsection in the ,federal ,register4 7#b7 ,expansion of needed services in eligibility criteria ,subsection 7a77#b77;,c7 of such section is amended-- 7,a7 in clause 7ii71 by striking 2 or and inserting a semicolon2 7,b7 by redesignating clause 7iii7 as clause 7iv72 and 7,c7 by inserting after clause 7ii7 the following new clause 7iii73 7iii7 a need for regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired2 or 4 7#c7 ,expansion of services provided ,subsection 7a77#c77;,a77ii7 of such section is amended-- 7,a7 in subclause 7,,iv71 by striking 2 and and inserting a semicolon2 7,b7 in subclause 7,v71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following new subclause3 7,,vi7 through the use of contracts with1 or the provision of grants to1 public or private entities-- 7aa7 financial planning services relating to the needs of injured veterans and their caregivers2 and 7bb7 legal services1 including legal advice and consultation1 relating to the needs of injured veterans and their caregivers4 4 7#d7 ,modification of stipend calculation ,subsection 7a77#c77;,c7 of such section is amended-- 7,a7 by redesignating clause 7iii7 as clause 7iv72 and 7,b7 by inserting after clause 7ii7 the following new clause 7iii73 7iii7 ,in determining the amount and degree of personal care services provided under clause 7i7 with respect to an eligible veteran whose need for personal care services is based in whole or in part on a need for supervision or protection under paragraph 7#b77;,c77ii7 or regular instruction or supervision under paragraph 7#b77;,c77iii71 the ,secretary shall take into account the following3 7,i7 ,the assessment by the family caregiver of the needs and limitations of the veteran4 7,,ii7 ,the extent to which the veteran can function safely and independently in the absence of such supervision1 protection1 or instruction4 7,,iii7 ,the amount of time required for the family caregiver to provide such supervision1 protection1 or instruction to the veteran4 4 7#e7 ,periodic evaluation of need for certain services ,subsection 7a77#c7 of such section is amended by adding at the end the following new subparagraph3 7,d7 ,in providing instruction1 preparation1 and training under subparagraph 7,a77i77,i7 and technical support under subparagraph 7,a77i77,,ii7 to each family caregiver who is approved as a provider of personal care services for an eligible veteran under paragraph 7#f71 the ,secretary shall periodically evaluate the needs of the eligible veteran and the skills of the family caregiver of such veteran to determine if additional instruction1 preparation1 training1 or technical support under those subparagraphs is necessary4 4 7#f7 ,use of primary care teams ,subsection 7a77#e7 of such section is amended1 in the matter preceding subparagraph 7,a71 by inserting 7in collaboration with the primary care team for the eligible veteran to the maximum extent practicable7 after evaluate4 7#g7 ,assistance for family caregivers ,subsection 7a7 of such section is amended by adding at the end the following new paragraph3 7#aa7 7,a7 ,in providing assistance under this subsection to family caregivers of eligible veterans1 the ,secretary may enter into contracts1 provider agreements1 and memoranda of understanding with ,federal agencies1 ,states1 and private1 nonprofit1 and other entities to provide such assistance to such family caregivers4 7,b7 ,the ,secretary may provide assistance under this paragraph only if such assistance is reasonably accessible to the family caregiver and is substantially equivalent or better in quality to similar services provided by the ,department4 7,c7 ,the ,secretary may provide fair compensation to ,federal agencies1 ,states1 and other entities that provide assistance under this paragraph4 4 7b7 ,modification of definition of personal care services ,subsection 7d77#d7 of such section is amended-- 7#a7 in subparagraph 7,a71 by striking independent2 7#b7 by redesignating subparagraph 7,b7 as subparagraph 7,d72 and 7#c7 by inserting after subparagraph 7,a7 the following new subparagraphs3 7,b7 ,supervision or protection based on symptoms or residuals of neurological or other impairment or injury4 7,c7 ,regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired4 4 #deb4 ,implementation of information technology system of ,department of ,veterans ,affairs to assess and improve the family caregiver program 7a7 ,implementation of new system 7#a7 ,in general ,not later than ,december #ca1 #bjaf1 the ,secretary of ,veterans ,affairs shall implement an information technology system that fully supports the ,program and allows for data assessment and comprehensive monitoring of the ,program4 7#b7 ,elements of system ,the information technology system required to be implemented under paragraph 7#a7 shall include the following3 7,a7 ,the ability to easily retrieve data that will allow all aspects of the ,program 7at the medical center and aggregate levels7 and the workload trends for the ,program to be assessed and comprehensively monitored4 7,b7 ,the ability to manage data with respect to a number of caregivers that is more than the number of caregivers that the ,secretary expects to apply for the ,program4 7,c7 ,the ability to integrate the system with other relevant information technology systems of the ,veterans ,health ,administration4 7b7 ,assessment of ,program ,not later than #ahj days after implementing the system described in subsection 7a71 the ,secretary shall1 through the ,under ,secretary for ,health1 use data from the system and other relevant data to conduct an assessment of how key aspects of the ,program are structured and carried out4 7c7 ,ongoing monitoring of and modifications to ,program 7#a7 ,monitoring ,the ,secretary shall use the system implemented under subsection 7a7 to monitor and assess the workload of the ,program1 including monitoring and assessment of data on-- 7,a7 the status of applications1 appeals1 and home visits in connection with the ,program2 and 7,b7 the use by caregivers participating in the ,program of other support services under the ,program such as respite care4 7#b7 ,modifications ,based on the monitoring and assessment conducted under paragraph 7#a71 the ,secretary shall identify and implement such modifications to the ,program as the ,secretary considers necessary to ensure the ,program is functioning as intended and providing veterans and caregivers participating in the ,program with services in a timely manner4 7d7 ,reports 7#a7 ,initial report 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 ,senate1 the ,committee on ,veterans' ,affairs of the ,house of ,representatives1 and the ,comptroller ,general of the ,united ,states a report that includes-- 7i7 the status of the planning1 development1 and deployment of the system required to be implemented under subsection 7a71 including any changes in the timeline for the implementation of the system2 and 7ii7 an assessment of the needs of family caregivers of veterans described in subparagraph 7,b71 the resources needed for the inclusion of such family caregivers in the ,program1 and such changes to the ,program as the ,secretary considers necessary to ensure the successful expansion of the ,program to include such family caregivers4 7,b7 ,veterans described ,veterans described in this subparagraph are veterans who are eligible for the ,program under clause 7ii7 or 7iii7 of section #agbj;,g7a77#b77;,b7 of title #ch1 ,united ,states ,code1 as amended by section #dea7;a77#a7 of this ,act1 solely due to a serious injury 7including traumatic brain injury1 psychological trauma1 or other mental disorder7 incurred or aggravated in the line of duty in the active military1 naval1 or air service before ,september #aa1 #bjja4 7#b7 ,notification by ,comptroller ,general ,the ,comptroller ,general shall review the report submitted under paragraph 7#a7 and notify the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives with respect to the progress of the ,secretary in-- 7,a7 fully implementing the system required under subsection 7a72 and 7,b7 implementing a process for using such system to monitor and assess the ,program under subsection 7c77#a7 and modify the ,program as considered necessary under subsection 7c77#b74 7#c7 ,final report 7,a7 ,in general ,not later than ,december #ca1 #bjag1 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate1 the ,committee on ,veterans' ,affairs of the ,house of ,representatives1 and the ,comptroller ,general a report on the implementation of subsections 7a7 through 7c74 7,b7 ,elements ,the report required by subparagraph 7,a7 shall include the following3 7i7 ,a certification by the ,secretary with respect to whether the information technology system described in subsection 7a7 has been implemented4 7ii7 ,a description of how the ,secretary has implemented such system4 7iii7 ,a description of the modifications to the ,program1 if any1 that were identified and implemented under subsection 7c77#b74 7iv7 ,a description of how the ,secretary is using such system to monitor the workload of the ,program4 7e7 ,definitions ,in this section3 7#a7 ,active military1 naval1 or air service ,the term active military1 naval1 or air service has the meaning given that term in section #aja of title #ch1 ,united ,states ,code4 7#b7 ,program ,the term ,program means the program of comprehensive assistance for family caregivers under section #agbj;,g7a7 of title #ch1 ,united ,states ,code1 as amended by section #dea of this ,act4 #dec4 ,modifications to annual evaluation report on caregiver program of ,department of ,veterans ,affairs 7a7 ,barriers to care and services ,subparagraph 7,a77iv7 of section #aja7;c77#b7 of the ,caregivers and ,veterans ,omnibus ,health ,services ,act of #bjaj 7,public ,law #aaa-afc2 #ch ,u4,s4,c4 #agbj;,g note7 is amended by inserting 1 including a description of any barriers to accessing and receiving care and services under such programs before the semicolon4 7b7 ,sufficiency of training for family caregiver program ,subparagraph 7,b7 of such section is amended-- 7#a7 in clause 7i71 by striking 2 and and inserting a semicolon2 7#b7 in clause 7ii71 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following new clause3 7iii7 an evaluation of the sufficiency and consistency of the training provided to family caregivers under such program in preparing family caregivers to provide care to veterans under such program4 4 #ded4 ,advisory committee on caregiver policy 7a7 ,establishment ,there is established in the ,department of ,veterans ,affairs an advisory committee on policies relating to caregivers of veterans 7in this section referred to as the ,committee74 7b7 ,composition ,the ,committee shall be composed of the following3 7#a7 ,a chair selected by the ,secretary of ,veterans ,affairs4 7#b7 ,a representative from each of the following agencies or organizations selected by the head of such agency or organization3 7,a7 ,the ,department of ,veterans ,affairs4 7,b7 ,the ,department of ,defense4 7,c7 ,the ,department of ,health and ,human ,services4 7,d7 ,the ,department of ,labor4 7,e7 ,the ,centers for ,medicare and ,medicaid ,services4 7#c7 ,not less than seven individuals who are not employees of the ,federal ,government selected by the ,secretary from among the following individuals3 7,a7 ,academic experts in fields relating to caregivers4 7,b7 ,clinicians4 7,c7 ,caregivers4 7,d7 ,individuals in receipt of caregiver services4 7,e7 ,such other individuals with expertise that is relevant to the duties of the ,committee as the ,secretary considers appropriate4 7c7 ,duties ,the duties of the ,committee are as follows3 7#a7 ,to regularly review and recommend policies of the ,department of ,veterans ,affairs relating to caregivers of veterans4 7#b7 ,to examine and advise the implementation of such policies4 7#c7 ,to evaluate the effectiveness of such policies4 7#d7 ,to recommend standards of care for caregiver services and respite care services provided to a caregiver or veteran by a non-profit or private sector entity4 7#e7 ,to develop recommendations for legislative or administrative action to enhance the provision of services to caregivers and veterans1 including eliminating gaps in such services and eliminating disparities in eligibility for such services4 7#f7 ,to make recommendations on coordination with ,state and local agencies and relevant non-profit organizations on maximizing the use and effectiveness of resources for caregivers of veterans4 7d7 ,reports 7#a7 ,annual report to ,secretary 7,a7 ,in general ,not later than ,december #ca1 #bjaf1 and not less frequently than annually thereafter until the termination date specified in subsection 7e71 the chair of the ,committee shall submit to the ,secretary a report on policies and services of the ,department of ,veterans ,affairs relating to caregivers of veterans4 7,b7 ,elements ,each report required by subparagraph 7,a7 shall include the following3 7i7 ,an assessment of the policies of the ,department relating to caregivers of veterans and services provided pursuant to such policies as of the date of submittal of the report4 7ii7 ,a description of any recommendations made by the ,committee to improve the coordination of services for caregivers of veterans between the ,department and the entities specified in subparagraphs 7,b7 through 7,e7 of subsection 7b77#b7 and to eliminate barriers to the effective use of such services1 including with respect to eligibility criteria4 7iii7 ,an evaluation of the effectiveness of the ,department in providing services for caregivers of veterans4 7iv7 ,an evaluation of the quality and sufficiency of services for caregivers of veterans available from non-governmental organizations4 7v7 ,a description of any gaps identified by the ,committee in care or services provided by caregivers to veterans and recommendations for legislative or administrative action to address such gaps4 7vi7 ,such other matters or recommendations as the chair considers appropriate4 7#b7 ,transmittal to ,congress ,not later than #ij days after the receipt of a report under paragraph 7#a71 the ,secretary shall transmit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a copy of such report1 together with such comments and recommendations concerning such report as the ,secretary considers appropriate4 7e7 ,termination ,the ,committee shall terminate on ,december #ca1 #bjba4 #dee4 ,comprehensive study on seriously injured veterans and their caregivers 7a7 ,study required ,during the period specified in subsection 7d71 the ,secretary of ,veterans ,affairs shall provide for the conduct by an independent entity of a comprehensive study on the following3 7#a7 ,veterans who have incurred a serious injury or illness1 including a mental health injury or illness4 7#b7 ,individuals who are acting as caregivers for veterans4 7b7 ,elements ,the comprehensive study required by subsection 7a7 shall include the following with respect to each veteran included in such study3 7#a7 ,the health of the veteran and1 if applicable1 the impact of the caregiver of such veteran on the health of such veteran4 7#b7 ,the employment status of the veteran and1 if applicable1 the impact of the caregiver of such veteran on the employment status of such veteran4 7#c7 ,the financial status and needs of the veteran4 7#d7 ,the use by the veteran of benefits available to such veteran from the ,department of ,veterans ,affairs4 7#e7 ,such other information as the ,secretary considers appropriate4 7c7 ,contract ,the ,secretary shall enter into a contract with an appropriate independent entity to conduct the study required by subsection 7a74 7d7 ,period specified ,the period specified in this subsection is the one-year period beginning on the date that is four years after the date specified in section #agbj;,g7a77#b77;,b77i7 of title #ch1 ,united ,states ,code1 as amended by section #dea7;a77#a7 of this ,act4 7e7 ,report ,not later than #cj days after the end of the period specified in subsection 7d71 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 the study required by subsection 7a74 ,f ,health care agreements #dfa4 ,authorization of agreements between the ,department of ,veterans ,affairs and non-,department extended care providers 7a7 ,in general ,subchapter ,i of chapter #ag of title #ch1 ,united ,states ,code1 is amended by adding after section #agjc the following new section3 #agjc;,a4 ,veterans ,extended ,care ,agreements with certain health care providers 7a7 ,agreements to furnish extended care 7#a7 ,in addition to the authority of the ,secretary under this chapter to furnish extended care at facilities of the ,department and under contracts or sharing agreements entered into under authorities other than this section1 the ,secretary may furnish extended care through the use of agreements entered into under this section4 ,an agreement entered into under this section may be referred to as a ,veterans ,extended ,care ,agreement4 7#b7 ,the ,secretary may enter into agreements to furnish extended care under this section with eligible providers that are certified under subsection 7d7 if the ,secretary is not feasibly able to furnish extended care at facilities of the ,department4 7#c7 ,an eligible provider1 at its discretion1 may opt to enter into an agreement under this section instead of a contract or sharing agreement under authorities other than this section4 7b7 ,receipt of extended care 7#a7 ,eligibility of a veteran for extended care under this section shall be determined as if such care were furnished in a facility of the ,department and provisions of this title applicable to veterans receiving extended care in a facility of the ,department shall apply to veterans receiving such care under this section4 7#b7 ,in carrying out this section1 the ,secretary-- 7,a7 may not direct veterans seeking extended care to health care providers that have entered into contracts or sharing agreements under authorities other than this section2 and 7,b7 shall ensure that veterans have the option to determine whether to receive extended care from a health care provider described in subparagraph 7,a7 or an eligible provider that has entered into an agreement under this section4 7c7 ,eligible providers ,for purposes of this section1 an eligible provider is one of the following3 7#a7 ,a provider of services that has enrolled and entered into a provider agreement under section #ahff7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a774 7#b7 ,a physician or supplier that has enrolled and entered into a participation agreement under section #ahdb7;h7 of such ,act 7#db ,u4,s4,c4 #acieu7h774 7#c7 ,a provider of items and services receiving payment under a ,state plan under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq47 or a waiver of such a plan4 7#d7 ,a provider that is-- 7,a7 an ,aging and ,disability ,resource ,center1 an area agency on aging1 or a ,state agency 7as defined in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb772 or 7,b7 a center for independent living 7as defined in section #gjb of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gif;a774 7#e7 ,such other health care providers as the ,secretary considers appropriate for purposes of this section4 7d7 ,certification of eligible providers 7#a7 ,the ,secretary shall establish a process for the certification of eligible providers under this section that shall1 at a minimum1 set forth the following4 7,a7 ,procedures for the submittal of applications for certification and deadlines for actions taken by the ,secretary with respect to such applications4 7,b7 ,standards and procedures for approval and denial of certification1 duration of certification1 revocation of certification1 and recertification4 7,c7 ,procedures for assessing eligible providers based on the risk of fraud1 waste1 and abuse of such providers similar to the level of screening under section #ahff7;j77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7j77#b77;,b77 and the standards set forth under section #i4ajd of title #dh1 ,code of ,federal ,regulations1 or any successor regulation4 7#b7 ,the ,secretary shall deny or revoke certification to an eligible provider under this subsection if the ,secretary determines that the eligible provider is currently-- 7,a7 excluded from participation in a ,federal health care program 7as defined in section #aabh;,b7f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7f777 under section #aabh or #aabh;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g and #acbj;a-#g;a72 or 7,b7 identified as an excluded source on the list maintained in the ,system for ,award ,management1 or any successor system4 7e7 ,terms of agreements ,each agreement entered into with an eligible provider under this section shall include provisions requiring the eligible provider to do the following3 7#a7 ,to accept payment for extended care furnished under this section at rates established by the ,secretary for purposes of this section1 which shall be1 to the extent practicable1 the rates paid by the ,united ,states for such care to providers of services and suppliers under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 7#b7 ,to accept payment under paragraph 7#a7 as payment in full for extended care furnished under this section and to not seek any payment for such care from the recipient of such care4 7#c7 ,to furnish under this section only the extended care authorized by the ,department under this section unless the eligible provider receives prior written consent from the ,department to furnish extended care outside the scope of such authorization4 7#d7 ,to bill the ,department for extended care furnished under this section in accordance with a methodology established by the ,secretary for purposes of this section4 7#e7 ,not to seek to recover or collect from a health-plan contract or third party1 as those terms are defined in section #agbi of this title1 for any extended care for which payment is made by the ,department under this section4 7#f7 ,to provide medical records for veterans furnished extended care under this section to the ,department in a time frame and format specified by the ,secretary for purposes of this section4 7#g7 ,to meet such other terms and conditions1 including quality of care assurance standards1 as the ,secretary may specify for purposes of this section4 7f7 ,termination of agreements 7#a7 ,an eligible provider may terminate an agreement with the ,secretary under this section at such time and upon such notice to the ,secretary as the ,secretary may specify for purposes of this section4 7#b7 ,the ,secretary may terminate an agreement with an eligible provider under this section at such time and upon such notice to the eligible provider as the ,secretary may specify for purposes of this section1 if the ,secretary-- 7,a7 determines that the eligible provider failed to comply substantially with the provisions of the agreement or with the provisions of this section and the regulations prescribed thereunder2 7,b7 determines that the eligible provider is-- 7i7 excluded from participation in a ,federal health care program 7as defined in section #aabh;,b7f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7f777 under section #aabh or #aabh;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g and #acbj;a-#g;a72 or 7ii7 identified as an excluded source on the list maintained in the ,system for ,award ,management1 or any successor system2 7,c7 ascertains that the eligible provider has been convicted of a felony or other serious offense under ,federal or ,state law and determines that the continued participation of the eligible provider would be detrimental to the best interests of veterans or the ,department2 or 7,d7 determines that it is reasonable to terminate the agreement based on the health care needs of a veteran or veterans4 7g7 ,periodic review of certain agreements 7#a7 ,not less frequently than once every two years1 the ,secretary shall review each ,veterans ,extended ,care ,agreement of material size entered into during the two-year period preceding the review to determine whether it is feasible and advisable to furnish the extended care furnished under such agreement at facilities of the ,department or through contracts or sharing agreements entered into under authorities other than this section4 7#b7 7,a7 ,subject to subparagraph 7,b71 a ,veterans ,extended ,care ,agreement is of material size as determined by the ,secretary for purposes of this section4 7,b7 ,a ,veterans ,extended ,care ,agreement entered into after ,september #cj1 #bjaf1 is of material size if the purchase of extended care under the agreement exceeds #a1jjj1jjj annually4 ,the ,secretary may adjust such amount to account for changes in the cost of health care based upon recognized health care market surveys and other available data and shall publish any such adjustments in the ,federal ,register4 7h7 ,exclusion of certain ,federal contracting provisions 7#a7 ,an agreement under this section may be entered into without regard to any law that would require the ,secretary to use competitive procedures in selecting the party with which to enter into the agreement4 7#b7 7,a7 ,except as provided in subparagraph 7,b7 and unless otherwise provided in this section or regulations prescribed pursuant to this section1 an eligible provider that enters into an agreement under this section is not subject to1 in the carrying out of the agreement1 any law that providers of services and suppliers under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 are not subject to4 7,b7 ,notwithstanding subparagraph 7,a71 an eligible provider that enters into an agreement under this section shall be subject to all laws regarding integrity1 ethics1 fraud1 or that subject a person to civil or criminal penalties as if such laws were incorporated into its provider agreements4 7i7 ,quality of care ,the ,secretary shall establish through regulation a system or systems for-- 7#a7 monitoring the quality of extended care furnished to veterans under this section2 and 7#b7 assessing the quality of extended care furnished by an eligible provider under this section prior to the renewal of a ,veterans ,extended ,care ,agreement with the eligible provider4 7j7 ,dispute resolution 7#a7 ,the ,secretary shall establish administrative procedures for eligible providers with which the ,secretary has entered an agreement under this section to present any dispute arising under or related to the agreement4 7#b7 ,before using any dispute resolution mechanism under chapter #ga of title #da with respect to a dispute arising under an agreement under this section1 an eligible provider must first exhaust the administrative procedures established by the ,secretary under paragraph 7#a74 7k7 ,sunset ,the ,secretary may not furnish extended care through the use of an agreement entered into under this section after the date that is two years after the date of the enactment of the ,jason ,simcakoski ,memorial ,act4 4 7b7 ,regulations ,the ,secretary of ,veterans ,affairs shall prescribe an interim final rule to carry out section #agjc;,a of such title1 as added by subsection 7a71 not later than one year after the date of the enactment of this ,act4 7c7 ,clerical amendment ,the table of sections at the beginning of chapter #ag of such title is amended by inserting after the item related to section #agjc the following new item3 #agjc;,a4 ,veterans ,extended ,care ,agreements with certain health care providers4 4 #dfb4 ,modification of authority to enter into agreements with ,state homes to provide nursing home care 7a7 ,use of agreements 7#a7 ,in general ,paragraph 7#a7 of section #agde7;a7 of title #ch1 ,united ,states ,code1 is amended1 in the matter preceding subparagraph 7,a71 by striking a contract 7or agreement under section #agbj7;c77#a7 of this title7 and inserting an agreement4 7#b7 ,payment ,paragraph 7#b7 of such section is amended by striking contract 7or agreement7 each place it appears and inserting agreement4 7b7 ,exclusion of certain ,federal contracting provisions ,such section is amended by adding at the end the following new paragraphs3 7#d7 7,a7 ,an agreement under paragraph 7#a7 may be entered into without regard to any law that would require the ,secretary to use competitive procedures in selecting the party with which to enter into the agreement4 7,b7 7i7 ,except as provided in clause 7ii7 and unless otherwise provided in this section or regulations prescribed pursuant to this section1 a ,state home that enters into an agreement under paragraph 7#a7 is not subject to1 in the carrying out of the agreement1 any law that a provider described in subparagraph 7,c7 is not subject to under the original ,medicare fee-for-service program under parts ,a and ,b of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 or the ,medicaid program under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq474 7ii7 ,notwithstanding clause 7i71 a ,state home that enters into an agreement under paragraph 7#a7 shall be subject to all laws regarding integrity1 ethics1 fraud1 or that subject a person to civil or criminal penalties as if such laws were incorporated into its provider agreements4 7,c7 ,a provider described in this subparagraph is one of the following3 7i7 ,a provider of services that has enrolled and entered into a provider agreement under section #ahff7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a774 7ii7 ,a physician or supplier that has enrolled and entered into a participation agreement under section #ahdb7;h7 of such ,act 7#db ,u4,s4,c4 #acieu7h774 7iii7 ,a provider of items and services receiving payment under a ,state plan under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq47 or a waiver of such a plan4 7#e7 ,the ,secretary may not furnish nursing home care under an agreement entered into under paragraph 7#a7 after the date that is two years after the date of the enactment of the ,jason ,simcakoski ,memorial ,act4 4 7c7 ,effective date ,the amendments made by this section shall apply to agreements entered into under section #agde7;a7 of such title on and after the date that is #cj days after the date of the enactment of this ,act4 ,v ,other matters #eja4 ,extension of temporary increase in number of judges on ,united ,states ,court of ,appeals for ,veterans ,claims 7a7 ,in general ,subsection 7i77#b7 of section #gbec of title #ch1 ,united ,states ,code1 is amended by striking ,january #a1 #bjac and inserting ,january #a1 #bjba4 7b7 ,report 7#a7 ,in general ,not later than ,june #cj1 #bjbj1 the chief judge of the ,united ,states ,court of ,appeals for ,veterans ,claims 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 temporary expansions of the ,court under section #gbec of title #ch1 ,united ,states ,code4 7#b7 ,contents ,the report required by paragraph 7#a7 shall include the following3 7,a7 ,an assessment of the effect of the expansions on ensuring appeals are handled in a timely manner4 7,b7 ,a description of the ways in which the complexity levels of the appeals acted on by the ,court may have changed based on service during recent conflicts compared to those based on service from previous eras4 7,c7 ,a recommendation on whether the number of judges should be adjusted at the end of the temporary expansion period1 including statistics1 projections1 trend analyses1 and other information to support the recommendation4 #ejb4 ,repeal inapplicability of modification of basic allowance for housing to benefits under laws administered by ,secretary of ,veterans ,affairs 7a7 ,repeal ,subsection 7b7 of section #fjd of the ,carl ,levin and ,howard ,p4 ,buck ,mc,keon ,national ,defense ,authorization ,act for ,fiscal ,year #bjae 7,public ,law #aac-bia2 #cg ,u4,s4,c4 #djc note7 is repealed4 7b7 ,effective date ,the amendment made by subsection 7a7 shall take effect on ,january #a1 #bjaf4 #ejc4 ,department of ,veterans ,affairs program of internal audits 7a7 ,in general ,subchapter ,,ii of chapter #e of title #ch1 ,united ,states ,code1 is amended by inserting after section #ebg the following new section3 #ebg;,a4 ,program of internal audits 7a7 ,program required 7#a7 ,the ,secretary shall carry out a program of internal audits and self-analysis to improve the furnishing of benefits and health care to veterans and their families4 7#b7 ,the ,secretary shall carry out the program required by paragraph 7#a7 through an office the ,secretary shall establish for purposes of the program within the office of the ,secretary that is interdisciplinary and independent of-- 7,a7 the other offices within the office of the ,secretary2 and 7,b7 the covered administrations 7or functions of such administrations71 staff organizations1 and staff offices identified under subsection 7b77#a77;,a74 7b7 ,program requirements 7#a7 ,in carrying out the program required by subsection 7a71 the ,secretary shall-- 7,a7 conduct periodic risk assessments of the ,department to identify those covered administrations 7or functions of such administrations71 staff organizations1 and staff offices of the ,department the audit of which would lead towards the greatest improvement in the furnishing of benefits and health care to veterans and their families2 7,b7 develop plans that are informed by the risk assessments conducted under paragraph 7#a7 to conduct internal audits of the covered administrations 7or functions of such administrations71 staff organizations1 and staff offices identified under subparagraph 7,a72 and 7,c7 conduct internal audits in accordance with the plans developed pursuant to subparagraph 7,b74 7#b7 ,the ,secretary shall carry out under the program required by subsection 7a7 an audit of not fewer than five covered administrations 7or functions of such administrations71 staff organizations1 or staff offices of the ,department each year4 7#c7 ,in identifying covered administrations 7or functions of such administrations71 staff organizations1 and staff offices of the ,department under paragraph 7#a77;,a71 the ,secretary shall accord priority to the covered administrations and functions of such administrations4 7#d7 7,a7 ,for purposes of this subsection1 the covered administrations of the ,department are the following3 7i7 ,the ,national ,cemetery ,administration4 7ii7 ,the ,veterans ,benefits ,administration4 7iii7 ,the ,veterans ,health ,administration4 7,b7 ,for purposes this subsection1 the covered staff organizations of the ,department are the following3 7i7 ,the ,office of ,acquisition1 ,logistics1 and ,construction4 7ii7 ,the ,advisory ,committee ,management ,office4 7iii7 ,the ,board of ,veterans' ,appeals4 7iv7 ,the ,center for ,faith-,based and ,neighborhood ,partnerships4 7v7 ,the ,center for ,minority ,veterans4 7vi7 ,the ,center for ,women ,veterans4 7vii7 ,the ,office of ,general ,counsel4 7viii7 ,the ,office of ,regulation ,policy and ,management4 7ix7 ,the ,office of ,employment ,discrimination ,complaint ,adjudication4 7x7 ,the ,office of ,interagency ,care and ,benefits ,coordination4 7xi7 ,the ,office of ,small and ,disadvantaged ,business ,utilization4 7xii7 ,the ,office of ,survivors ,assistance4 7xiii7 ,the ,veterans' ,service ,organizations ,liaison4 7,c7 ,for purposes of this subsection1 the covered staff offices of the ,department are the following3 7i7 ,the office of the ,assistant ,secretary for ,congressional and ,legislative ,affairs4 7ii7 ,the office of the ,assistant ,secretary for ,human ,resources and ,administration4 7iii7 ,the office of the ,assistant ,secretary for ,information and ,technology4 7iv7 ,the ,office of ,management4 7v7 ,the office of the ,assistant ,secretary for ,operations1 ,security1 and ,preparedness4 7vi7 ,the office of the ,assistant ,secretary for ,policy and ,planning4 7vii7 ,the office of the ,assistant ,secretary for ,public and ,intergovernmental ,affairs4 7c7 ,reports 7#a7 7,a7 ,not later than #ij days after completing an audit under the program required by subsection 7a71 the ,secretary shall submit to the appropriate committees of ,congress a report on the audit4 7,b7 ,each report submitted under subparagraph 7,a7 with respect to an audit shall include the following3 7i7 ,a summary of the audit4 7ii7 ,the findings of the ,secretary with respect to the audit4 7iii7 ,such recommendations as the ,secretary may have for legislative or administrative action to improve the furnishing of benefits and health care to veterans and their families4 7iv7 ,plans to carry out the recommendations submitted under clause 7iii71 including timelines for completion of such plans4 7#b7 7,a7 ,not later than ,september #a of each year1 the ,secretary shall submit to the appropriate committees of ,congress a report on the administration of this section4 7,b7 ,each report submitted under subparagraph 7,a7 shall include the following3 7i7 ,a detailed description of each matter for which a recommendation was submitted under clause 7iii7 of paragraph 7#a77;,b7 and with respect to which plans that were submitted under clause 7iv7 of such paragraph have not been completed4 7ii7 ,a plan for the conduct of audits under this section during the first fiscal year beginning after the fiscal year in which the report is submitted1 which shall include the following3 7,i7 ,a description of any risk assessments the ,secretary plans to conduct in such fiscal year4 7,,ii7 ,a summary of each audit the ,secretary plans to conduct in such fiscal year1 including a description of the subject matter of the audit and identification of the administration1 office1 or function to be audited4 7#c7 ,in this subsection1 the term appropriate committees of ,congress includes-- 7,a7 the ,committee on ,veterans' ,affairs1 the ,committee on ,appropriations1 and the ,committee on ,homeland ,security and ,governmental ,affairs of the ,senate2 and 7,b7 the ,committee on ,veterans' ,affairs1 the ,committee on ,appropriations1 and the ,committee on ,oversight and ,government ,reform of the ,house of ,representatives4 4 7b7 ,first risk assessment ,the ,secretary of ,veterans ,affairs shall complete the first risk assessment required by section #ebg;,a7b77#a77;,a7 of such title1 as added by subsection 7a71 by not later than #ahj days after the date of the enactment of this ,act4 7c7 ,clerical amendment ,the table of sections at the beginning of chapter #e of such title is amended by inserting after the item relating to section #ebg the following new item3 #ebg;,a4 ,program of internal audits4 4 #ejd4 ,improvement of training for managers ,the ,secretary of ,veterans ,affairs shall provide to each employee of the ,department of ,veterans ,affairs who is employed by the ,department in a managerial position periodic training on the following3 7#a7 ,the rights of whistleblowers and how to address a report by an employee of a hostile work environment1 reprisal1 or harassment4 7#b7 ,how to effectively motivate1 manage1 and reward the employees who report to the manager4 7#c7 ,how to effectively manage employees who are performing at an unacceptable level and access assistance from the human resources office of the ,department and the ,office of the ,general ,counsel of the ,department with respect to those employees4 ,amend the title so as to read3 ,a bill to amend title #ch1 ,united ,states ,code1 to improve the benefits and health care provided by the ,department of ,veterans ,affairs1 and for other purposes44 ,december #g1 #bjaf,reported with an amendment and an amendment to the title