,,ib ,union ,calendar ,no4 #ddd #aaeth ,,congress #b;d ,session ,h4 ,r4 #dbdb ,report ,no4 #aae-ehe ,,in ,,the ,,house ,,of ,,representatives ,november #c1 #bjag ,mr4 ,roe of ,tennessee 7for himself1 ,mr4 ,coffman1 ,mr4 ,wenstrup1 ,mrs4 ,radewagen1 ,mr4 ,bost1 ,mr4 ,poliquin1 ,mr4 ,arrington1 ,mr4 ,rutherford1 ,mr4 ,higgins of ,louisiana1 ,mr4 ,bergman1 ,mr4 ,banks of ,indiana1 ,miss ,gonzlez-,coln of ,puerto ,rico1 ,mr4 ,bilirakis1 ,mr4 ,dunn1 ,mr4 ,walz1 ,ms4 ,kuster of ,new ,hampshire1 ,miss ,rice of ,new ,york1 ,mr4 ,correa1 ,mr4 ,sablan1 ,ms4 ,esty of ,connecticut1 ,mr4 ,peters1 ,mr4 ,o',rourke1 ,mr4 ,takano1 and ,ms4 ,brownley of ,california7 introduced the following bill2 which was referred to the ,committee on ,veterans' ,affairs ,march #e1 #bjah;,additional sponsors3 ,mr4 ,emmer1 ,mr4 ,stewart1 ,mr4 ,messer1 ,mr4 ,hudson1 ,mr4 ,johnson of ,ohio1 and ,mr4 ,webster of ,florida ,march #e1 #bjah ,reported with an amendment1 committed to the ,committee of the ,whole ,house on the ,state of the ,union1 and ordered to be printed ,strike out all after the enacting clause and insert the part printed in italic ,for text of introduced bill1 see copy of bill as introduced on ,november #c1 #bjag ,a ,,bill ,to amend title #ch1 ,united ,states ,code1 to establish a permanent ,,va ,care in the ,community ,program1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,,va ,care in the ,community ,act4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,title ,i--,improved access for veterans to non-,department of ,veterans ,affairs medical care ,sec4 #aja4 ,assignment of veterans to primary care providers4 ,sec4 #ajb4 ,establishment of ,,va ,care in the ,community ,program4 ,sec4 #ajc4 ,veterans ,care ,agreements4 ,sec4 #ajd4 ,modification of authority to enter into agreements with ,state homes to provide nursing home care4 ,sec4 #aje4 ,department of ,veterans ,affairs electronic interface for processing of medical claims4 ,sec4 #ajf4 ,funding for ,,va ,care in the ,community ,program4 ,sec4 #ajg4 ,termination of certain provisions authorizing medical care to veterans through non-,department of ,veterans ,affairs providers4 ,sec4 #ajh4 ,implementation and transition4 ,sec4 #aji4 ,transplant procedures with live donors and related services4 ,title ,,ii--,other administrative matters ,sec4 #bja4 ,reimbursement for emergency ambulance services4 ,sec4 #bjb4 ,improvement of care coordination for veterans through exchange of certain medical records4 ,sec4 #bjc4 ,elimination of copayment offset4 ,sec4 #bjd4 ,use of ,department of ,veterans ,affairs ,medical ,care ,collections ,fund for certain improvements in collections4 ,sec4 #bje4 ,department of ,veterans ,affairs health care productivity improvement4 ,sec4 #bjf4 ,licensure of health care professionals of the ,department of ,veterans ,affairs providing treatment via telemedicine4 ,sec4 #bjg4 ,establishment of processes to ensure safe opioid prescribing practices by non-,department of ,veterans ,affairs health care providers4 ,sec4 #bjh4 ,assessment of health care furnished by the ,department to veterans who live in the territories4 ,sec4 #bji4 ,oversight and accountability of financial processes of ,department of ,veterans ,affairs4 ,sec4 #baj4 ,authority for ,department of ,veterans ,affairs ,center for ,innovation for ,care and ,payment4 ,title ,,iii--,improvements to ,recruitment of ,physicians ,sec4 #cja4 ,designated scholarships for physicians and dentists under ,department of ,veterans ,affairs ,health ,professional ,scholarship ,program4 ,sec4 #cjb4 ,establishment of ,department of ,veterans ,affairs ,specialty ,education ,loan ,repayment ,program4 ,sec4 #cjc4 ,veterans healing veterans medical access and scholarship program4 ,i ,improved access for veterans to non-,department of ,veterans ,affairs medical care #aja4 ,assignment of veterans to primary care providers ,section #agjf of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new subsection3 7d7 7#a7 ,except as provided in section #agjc;,a of this title1 in furnishing primary care under this chapter1 the ,secretary shall assign each eligible veteran to-- 7,a7 a patient-aligned care team of the ,department2 or 7,b7 a dedicated primary care provider of the ,department as a part of any other model of providing consistent primary care determined appropriate by the ,secretary4 7#b7 ,each patient-aligned care team of the ,department shall consist of a team of health care professionals of the ,department who-- 7,a7 provide to each eligible veteran comprehensive primary care in partnership with the veteran2 and 7,b7 manage and coordinate comprehensive hospital care and medical services consistent with the goals of care agreed upon by the veteran and team4 7#c7 ,the ,secretary shall ensure that an eligible veteran is not simultaneously assigned to more than one patient-aligned care team or dedicated primary care provider under this subsection at a single location1 including by establishing procedures in the event a primary care provider retires or is otherwise no longer able to treat the veteran4 ,in the case of an eligible veteran who resides in more than one location1 the ,secretary may assign such veteran to a patient-aligned care team or dedicated primary care provider at each such location4 7#d7 ,the term eligible veteran means a veteran who-- 7,a7 is enrolled in the patient enrollment system of the ,department established and operated under section #agje7;a7 of this title2 and 7,b7 has-- 7i7 been furnished hospital care or medical services at or through a ,department facility on at least one occasion during the two-year period preceding the date of the determination of eligibility2 or 7ii7 requested a first-time appointment for hospital care or medical services at a ,department facility4 4 #ajb4 ,establishment of ,,va ,care in the ,community ,program 7a7 ,establishment of program 7#a7 ,in general ,chapter #ag of title #ch1 ,united ,states ,code1 is amended by inserting after section #agjc the following new section3 #agjc;,a4 ,,va ,care in the ,community ,program 7a7 ,program 7#a7 ,subject to the availability of appropriations for such purpose1 hospital care1 medical services1 and extended care services under this chapter shall be furnished to an eligible veteran through contracts or agreements authorized under subsection 7d71 or contracts or agreements1 including national contracts or agreements1 authorized under section #haec of this title or any other provision of law administered by the ,secretary1 with network providers for the furnishing of such care and services to veterans4 7#b7 ,subject to subsection 7b71 an eligible veteran may select a provider of such care or services from among network providers4 7#c7 ,the ,secretary shall coordinate the furnishing of care and services under this section to eligible veterans4 7#d7 7,a7 ,in carrying out this section1 the ,secretary shall establish regional networks of network providers4 ,the ,secretary shall determine1 and may modify1 such regions based on the capacity and market assessments of ,veterans ,integrated ,service ,networks conducted under subsection 7k7 or upon recognized need4 7,b7 ,the ,secretary may enter into one or more contracts for the purposes of managing the operations of the regional networks and for the delivery of care pursuant to this section4 7,c7 ,the ,secretary shall-- 7i7 verify upon enrollment1 and annually thereafter1 that network providers have not been excluded from participation in other federally funded health care programs2 and 7ii7 submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate an annual report on the results of such verifications4 7b7 ,primary and specialty care 7#a7 7,a7 ,if the ,secretary is unable to assign an eligible veteran to a patient-aligned care team or dedicated primary care provider under section #agjf7;d7 of this title because the ,secretary determines such a care team or provider at a ,department facility is not available-- 7i7 the ,secretary shall consult with the veteran regarding available primary care providers from among network providers that are located in the regional network in which the veteran resides or a regional network that is adjacent to the regional network in which the veteran resides2 and 7ii7 the veteran may select one of the available primary care providers to serve as the dedicated primary care provider of the veteran4 7,b7 ,in determining whether a patient-aligned care team or dedicated provider under section #agjf7;d7 of this title is available for assignment to a veteran1 the ,secretary shall take into consideration each of the following3 7i7 ,whether the veteran faces an unusual or excessive burden in accessing such patient-aligned care team or dedicated provider at a medical facility of the ,department including with respect to-- 7,i7 geographical challenges2 7,,ii7 environmental factors1 including roads that are not accessible to the general public1 traffic1 or hazardous weather2 7,,iii7 a medical condition of the veteran2 or 7,,iv7 such other factors as determined by the ,secretary4 7ii7 ,whether the veteran reasonably believes that the assignment of a particular care team or provider to the veteran would detrimentally affect the patient-provider relationship and result in sub-optimal care to the veteran4 7iii7 ,whether the panel size of the care team or provider is at such a number that it would result in difficulty for the veteran in accessing timely care or in sub-optimal care to the veteran4 7iv7 ,whether the veteran resides in a ,state where the ,department does not operated a full-service medical facility4 7,c7 ,if the ,secretary determines that a patient-aligned care team or dedicated primary care provider at a ,department facility has become available for assignment to an eligible veteran who had been assigned to a network provider under subparagraph 7,a71 the ,secretary shall provide the veteran with the option of reassignment to the team or provider at the ,department facility4 7,d7 ,in the case of an eligible veteran who is assigned to a network provider under subparagraph 7,a71 the ,secretary shall reevaluate such assignment not earlier than one year after a veteran makes a selection under subparagraph 7,a77ii71 and on an annual basis thereafter1 to-- 7i7 determine whether the ,secretary is able to assign to the veteran a patient-aligned care team or dedicated primary care provider under section #agjf7;d7 of this title2 and 7ii7 in consultation with and upon approval of the veteran1 make such assignment if able4 7#b7 7,a7 7i7 ,except as provided in clause 7ii71 the ,secretary may only furnish specialty hospital care1 medical services1 or extended care services to an eligible veteran under this section pursuant to a referral for such specialty care or services made by the primary care provider of the veteran4 7ii7 ,the ,secretary may designate specialties which shall be exempt from the requirement under clause 7i74 7,b7 ,the ,secretary shall determine whether to furnish specialty hospital care1 medical services1 or extended care services to an eligible veteran pursuant to subparagraph 7,a7-- 7i7 at a medical facility of the ,department that is within a reasonable distance of the residence of the veteran1 as determined by the ,secretary2 7ii7 by a network provider that1 to the greatest extent practicable1 is located in the regional network in which the veteran resides or a regional network that is adjacent to the regional network in which the veteran resides2 or 7iii7 pursuant to an agreement described in subparagraph 7,c74 7,c7 ,an agreement described in this subparagraph is an agreement entered into by the ,secretary with a network provider under which-- 7i7 specialty hospital care1 medical services1 or extended care services are furnished to an eligible veteran pursuant to subparagraph 7,a7-- 7,i7 at a medical facility of the ,department by a network provider possessing the appropriate credentials1 as determined by the ,secretary2 or 7,,ii7 at a facility of a network provider by a health care provider of the ,department2 and 7ii7 such specialty care or services are so furnished either-- 7,i7 in accordance with this section with respect to fees and payments for care and services furnished under subsection 7a72 or 7,,ii7 at no cost to the ,united ,states4 7,d7 ,in making the determination under subparagraph 7,b71 the ,secretary shall give priority to medical facilities and health care providers of the ,department but shall take into account-- 7i7 whether the veteran faces an unusual or excessive burden in accessing such specialty hospital care1 medical services1 or extended care services at a medical facility of the ,department1 including with respect to-- 7,i7 geographical challenges2 7,,ii7 environmental factors1 such as roads that are not accessible to the general public1 traffic1 or hazardous weather2 7,,iii7 a medical condition of the veteran2 or 7,,iv7 such other factors as determined by the ,secretary2 7ii7 whether the primary care provider of the veteran recommends that such specialty hospital care1 medical services1 or extended care services should be furnished by a network provider2 7iii7 whether the veteran resides in a ,state where the ,department does not operate a full-service medical facility2 and 7iv7 in the case of a veteran who requires an organ or bone marrow transplant1 whether the veteran has1 in the opinion of the primary care provider of the veteran1 a medically compelling reason to travel outside the region of the ,organ ,procurement and ,transplantation ,network1 established under section #cgb of the ,national ,organ ,transplantation ,act 7,public ,law #ih-ejg2 #db ,u4,s4,c4 #bgd71 in which the veteran resides1 to receive such transplant4 7,e7 ,the ,secretary shall ensure that each medical facility of the ,department processes referrals for specialty hospital care1 medical services1 or extended care services in a standardized manner1 including with respect to the organization of the program office responsible for such referrals4 7,f7 ,in carrying out this section1 the ,secretary shall establish a process to review any disagreement between an eligible veteran and the ,department1 or between an eligible veteran and a health care provider of the ,department1 regarding the eligibility of the veteran to receive care or services from a network provider under this section or the assignment of a primary care provider of the ,department to the veteran4 ,in reviewing a disagreement under such process with respect to the availability of and assignment to a patient aligned care team or dedicated primary care provider1 the ,secretary may give deference to the veteran with respect to any determination under subsection 7b77#a77;,b77ii74 7,g7 7i7 ,the ,secretary shall develop procedures to ensure that assigning a veteran to a patient-aligned care team or dedicated primary care provider under subparagraph 7,a71 7,c71 or 7,d7 does not adversely affect the continuity or quality of care for the veteran during the transition4 7ii7 ,procedures under clause 7i7 shall provide for-- 7,i7 the appointment of a contact in the ,department for the veteran who shall provide information to the veteran and resolve issues regarding the transition2 7,,ii7 the transfer of relevant medical records2 7,,iii7 coordination of care between providers2 7,,iv7 the continued treatment of chronic or current episodes of care 7by means including medication1 subspecialty care1 and ancillary services72 and 7,v7 any other action the ,secretary determines is necessary4 7c7 ,episodes of care 7#a7 ,the ,secretary shall ensure that1 at the election of an eligible veteran who receives hospital care1 medical services1 or extended care services from a network provider in an episode of care under this section1 the veteran receives such care or services from that network provider1 another network provider selected by the veteran1 or a health care provider of the ,department1 through the completion of the episode of care1 including all specialty and ancillary services determined necessary by the provider as part of the treatment recommended in the course of such care or services4 ,in making such determination with respect to necessary specialty and ancillary services provided by a network provider1 the network provider shall consult with the ,secretary1 acting through the program office of the appropriate medical facility4 7#b7 ,in cases of episodes of care that the ,secretary determines case management to be appropriate1 the ,secretary shall provide case management to an eligible veteran who receives hospital care1 medical services1 or extended care services from a network provider for such episodes of care4 ,the ,secretary may provide such case management through the ,veterans ,health ,administration or through an entity that manages the operations of the regional networks pursuant to subsection 7a77#d77;,b74 7d7 ,care and services through contracts and agreements 7#a7 ,the ,secretary shall enter into contracts or agreements1 including national contracts or agreements for1 but not limited to1 dialysis1 for furnishing care and services to eligible veterans under this section with network providers4 7#b7 7,a7 ,in entering into a contract or agreement under paragraph 7#a7 with a network provider1 the ,secretary shall-- 7i7 negotiate rates for the furnishing of care and services under this section2 and 7ii7 reimburse the provider for such care and services at the rates negotiated pursuant to clause 7i7 as provided in such contract or agreement4 7,b7 7i7 ,except as provided in paragraph 7#c71 rates negotiated under subparagraph 7,a77i7 shall not be more than the rates paid by the ,united ,states to a provider of services 7as defined in section #ahfa7u7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7u777 or a supplier 7as defined in section #ahfa7;d7 of such ,act 7#db ,u4,s4,c4 #aciex7d777 under the ,medicare ,program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 for the same care or services4 7ii7 ,in determining the rates under the ,medicare ,program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 for purposes of clause 7i71 in the case of care or services furnished by a provider of services with respect to which such rates are determined under a fee schedule to which the area wage index under section #ahhf7;d77#c77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#c77;,e77 applies1 such area wage index so applied to such provider of services may not be less than #a4jj4 7,c7 ,in carrying out paragraph 7#b71 the ,secretary may incorporate the use of value-based reimbursement models to promote the provision of high-quality care4 7#c7 7,a7 ,with respect to the furnishing of care or services under this section to an eligible veteran who resides in a highly rural area 7as defined under the rural-urban commuting area codes developed by the ,secretary of ,agriculture and the ,secretary of ,health and ,human ,services71 the ,secretary of ,veterans ,affairs may negotiate a rate that is more than the rate paid by the ,united ,states as described in paragraph 7#b77;,b74 7,b7 ,with respect to furnishing care or services under this section in ,alaska1 the ,alaska ,fee ,schedule of the ,department of ,veterans ,affairs will be followed1 except for when another payment agreement1 including a contract or provider agreement1 is in place4 7,c7 ,with respect to furnishing care or services under this section in a ,state with an ,all-,payer ,model ,agreement under the ,social ,security ,act that became effective on or after ,january #a1 #bjad1 the ,medicare payment rates under paragraph 7#b77;,b7 shall be calculated based on the payment rates under such agreement1 or any such successor agreement4 7,d7 ,with respect to furnishing care or services under this section in a location in which the ,secretary determines that adjusting the rate paid by the ,united ,states as described in paragraph 7#b77;,b7 is appropriate1 the ,secretary may negotiate such an adjusted rate4 7,e7 ,with respect to furnishing care or services under this section in a location or in a situation in which an exception to the rates paid by the ,united ,states under the ,medicare ,program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 for the same care or services applies1 the ,secretary may follow such exception4 7,f7 ,with respect to furnishing care or services under this section for care or services not covered under the ,medicare ,program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 the ,secretary shall establish a schedule of fees for such care or services4 7,g7 ,with respect to furnishing care or services under this section pursuant to an agreement with a tribal or ,federal entity1 the ,secretary may negotiate a rate that is more than the rate paid by the ,united ,states as described in paragraph 7#b77;,b74 7#d7 ,for the furnishing of care or services pursuant to a contract or agreement under paragraph 7#a71 a network provider may not collect any amount that is greater than the rate negotiated pursuant to paragraph 7#b77;,a74 7#e7 7,a7 ,if1 in the course of an episode of care under this section1 any part of care or services is furnished by a medical provider who is not a network provider1 the ,secretary may compensate such provider for furnishing such care or services4 7,b7 ,the ,secretary shall make reasonable efforts to enter into a contract or agreement under this section with any provider who is compensated pursuant to subparagraph 7,a74 7e7 ,prompt payment standard 7#a7 ,the ,secretary shall ensure that claims for payments for hospital care1 medical services1 or extended care services furnished under this section are processed in accordance with this subsection1 regardless of whether such claims are-- 7,a7 made by a network provider to the ,secretary2 7,b7 made by a network provider to a regional network operated by a contractor pursuant to subsection 7a77#d77;,b72 or 7,c7 made by such a regional network to the ,secretary4 7#b7 ,a covered claimant that seeks payment for hospital care1 medical services1 or extended care services furnished under this section shall submit to the covered payer a claim for payment not later than-- 7,a7 with respect to a claim by a network provider1 #ahj days after the date on which the network provider furnishes such care or services2 or 7,b7 with respect to a claim by a regional network operated by a contractor1 #ahj days after the date on which the contractor pays the network provider for furnishing such care or services4 7#c7 ,notwithstanding chapter #ci of title #ca or any other provision of law1 the covered payer shall pay a covered claimant for hospital care1 medical services1 or extended care services furnished under this section-- 7,a7 in the case of a clean claim submitted to the covered payer on paper1 not later than #de calendar days after receiving the claim2 or 7,b7 in the case of a clean claim submitted to the covered payer electronically1 not later than #cj calendar days after receiving the claim4 7#d7 7,a7 ,if the covered payer denies a claim submitted by a covered claimant under paragraph 7#a71 the covered payer shall notify the covered claimant of the reason for denying the claim and the additional information1 if any1 that may be required to process the claim-- 7i7 in the case of a clean claim submitted to the covered payer on paper1 not later than #de calendar days after receiving the claim2 or 7ii7 in the case of a clean claim submitted to the covered payer electronically1 not later than #cj calendar days after receiving the claim4 7,b7 ,upon receipt by the covered payer of additional information specified under subparagraph 7,a7 relating to a claim1 the covered payer shall pay1 deny1 or otherwise adjudicate the claim1 as appropriate1 not later than #cj calendar days after receiving such information4 7#e7 7,a7 ,if the covered payer has not paid a covered claimant or denied a clean claim for payment by the covered claimant under this subsection during the appropriate period specified in this subsection1 such clean claim shall be considered overdue4 7,b7 ,if a clean claim for payment by a covered claimant is considered overdue under subparagraph 7,a71 in addition to the amount the covered payer owes the covered claimant under the claim1 the covered payer shall owe the covered claimant an interest penalty amount that shall-- 7i7 be prorated daily2 7ii7 accrue from the date the payment was overdue2 7iii7 be payable at the time the claim is paid2 and 7iv7 be computed at the rate of interest established by the ,secretary of the ,treasury1 and published in the ,federal ,register1 for interest payments under subsections 7a77#a7 and 7b7 of section #gaji of title #da that is in effect at the time the covered payer accrues the obligation to pay the interest penalty amount4 7#f7 7,a7 ,if the covered payer overpays a covered claimant for hospital care1 medical services1 or extended care services furnished under this section-- 7i7 the covered payer shall deduct the amount of any overpayment from payments due to the covered claimant after the date of such overpayment2 or 7ii7 if the covered payer determines that there are no such payments due after the date of the overpayment1 the covered claimant shall refund the amount of such overpayment not later than #cj days after such determination4 7,b7 7i7 ,before deducting any amount from a payment to a covered claimant under subparagraph 7,a71 the covered payer shall ensure that the covered claimant is provided an opportunity-- 7,i7 to dispute the existence or amount of any overpayment owed to the covered payer2 and 7,,ii7 to request a compromise with respect to any such overpayment4 7ii7 ,the covered payer may not make any deduction from a payment to a covered claimant under subparagraph 7,a7 unless the covered payer has made reasonable efforts to notify the covered claimant of the rights of the covered claimant under subclauses 7,i7 and 7,,ii7 of clause 7i74 7iii7 ,upon receiving a dispute under subclause 7,i7 of clause 7i7 or a request under subclause 7,,ii7 of such clause1 the covered payer shall make a determination with respect to such dispute or request before making any deduction under subparagraph 7,a7 unless the time required to make such a determination would jeopardize the ability of the covered payer to recover the full amount owed to the covered payer4 7#g7 ,notwithstanding any other provision of law1 the ,secretary may1 except in the case of a fraudulent claim1 false claim1 or misrepresented claim1 compromise any claim of an amount owed to the ,united ,states under this section4 7#h7 ,this subsection shall apply only to payments made on a claims basis and not to capitation or other forms of periodic payments to network providers4 7#i7 ,a network provider that provides hospital care1 medical services1 or extended care services to an eligible veteran under this section may not seek any payment for such care or services from the eligible veteran4 7#aj7 ,with respect to making a payment for hospital care or medical services furnished to an eligible veteran by a network provider under this section-- 7,a7 the ,secretary may not require receipt by the veteran or the ,department of a medical record under subsection 7g7 detailing such care or services before a covered payer makes a payment for such care or services2 and 7,b7 the ,secretary may require that the network provider attests to such care or services so provided before a covered payer makes a payment for such care or services4 7f7 ,cost-,sharing 7#a7 ,the ,secretary shall require an eligible veteran to pay a copayment for the receipt of care or services under this section only if such eligible veteran would be required to pay a copayment for the receipt of such care or services at a medical facility of the ,department or from a health care provider of the ,department under this chapter4 7#b7 ,the amount of a copayment charged under paragraph 7#a7 may not exceed the amount of the copayment that would be payable by such eligible veteran for the receipt of such care or services at a medical facility of the ,department or from a health care provider of the ,department under this chapter4 7#c7 ,in any case in which an eligible veteran is furnished hospital care or medical services under this section for a non-service-connected disability described in subsection 7a77#b7 of section #agbi of this title1 the ,secretary shall recover or collect reasonable charges for such care or services from a health-plan contract described in section #agje;,a in accordance with such section #agbi4 7g7 ,medical records 7#a7 ,the ,secretary shall ensure that any network provider that furnishes care or services under this section to an eligible veteran-- 7,a7 upon the request of the veteran1 provides to the veteran the medical records related to such care or services2 and 7,b7 upon the completion of the provision of such care or services to such veteran1 provides to the ,department the medical records for the veteran furnished care or services under this section in a timeframe and format specified by the ,secretary for purposes of this section1 except the ,secretary may not require that any payment by the ,secretary to the eligible provider be contingent on such provision of medical records4 7#b7 ,to the extent practicable1 the ,secretary shall submit to a network provider that furnishes care or services under this section to an eligible veteran the medical records of such eligible veteran that are maintained by the ,department and are relevant to such care or services4 7#c7 ,to the extent practicable1 the ,secretary shall-- 7,a7 ensure that the medical records shared under paragraphs 7#a7 and 7#b7 are shared in an electronic format accessible by network providers and the ,department through an ,internet website2 and 7,b7 provide to network providers access to the electronic patient health record system of the ,department1 or successor system1 for the purpose of furnishing care or services under this section4 7h7 ,use of card ,the ,secretary shall ensure that the veteran health identification card1 or such successor identification card1 includes sufficient information to act as an identification card for an eligible entity or other non-,department facility4 ,the ,secretary may not use any amounts made available to the ,secretary to issue separate identification cards solely for the purpose of carrying out this section4 7i7 ,prescription medications 7#a7 ,with respect to requirements relating to the licensing or credentialing of a network provider1 the ,secretary shall ensure that the network provider is able to submit prescriptions for pharmaceutical agents on the formulary of the ,department to pharmacies of the ,department in a manner that is substantially similar to the manner in which the network provider submits prescriptions to retail pharmacies4 7#b7 ,nothing in this section shall be construed to affect the process of the ,department for filling and paying for prescription medications4 7j7 ,quality of care ,in carrying out this section1 the ,secretary shall use the quality of care standards set forth or used by the ,centers for ,medicare ,medicaid ,services or other quality of care standards1 as determined by the ,secretary4 7k7 ,capacity and commercial market assessments 7#a7 ,on a periodic basis1 but not less often than once every three years1 the ,secretary shall conduct an assessment of the capacity of each ,veterans ,integrated ,service ,network and medical facility of the ,department to furnish care or services under this chapter4 ,each such assessment shall-- 7,a7 identify gaps in furnishing such care or services at such ,veterans ,integrated ,service ,network or medical facility2 7,b7 identify how such gaps can be filled by-- 7i7 entering into contracts or agreements with network providers under this section or with entities under other provisions of law2 7ii7 making changes in the way such care and services are furnished at such ,veterans ,integrated ,service ,network or medical facility1 including but not limited to-- 7,i7 extending hours of operation2 7,,ii7 adding personnel2 or 7,,iii7 expanding space through construction1 leasing1 or sharing of health care facilities2 and 7iii7 the building or realignment of ,department resources or personnel2 7,c7 forecast1 based on future projections and historical trends1 both the short- and long-term demand in furnishing care or services at such ,veterans ,integrated ,service ,network or medical facility and assess how such demand affects the needs to use such network providers2 7,d7 include a commercial health care market assessment of designated catchment areas in the ,united ,states conducted by a nongovernmental entity2 and 7,e7 consider the unique ability of the ,federal ,government to retain a presence in an area otherwise devoid of commercial health care providers or from which such providers are at a risk of leaving4 7#b7 ,the ,secretary shall submit each assessment under paragraph 7#a7 to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate and shall make each such assessment publicly available4 7l7 ,allocation of funds ,the ,secretary shall develop a plan for the allocation of funds in the ,medical ,community ,care account4 7m7 ,reports on rates ,not later than ,december #ca1 #bjai1 and annually thereafter during each of the subsequent three years1 the ,secretary shall submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a report detailing1 for the fiscal year preceding the fiscal year during which the report is submitted1 the rates paid by the ,secretary for hospital care1 medical services1 or extended care services under this section that1 pursuant to subsection 7d77#c71 are more than the rates described in subsection 7d77#b77;,b7 for the same care or services4 7n7 ,definitions ,in this section3 7#a7 ,the term clean claim means a claim submitted-- 7,a7 to the covered payer by a covered claimant for purposes of payment by the covered payer of expenses for hospital care or medical services furnished under this section2 7,b7 that contains substantially all of the required elements necessary for accurate adjudication1 without requiring additional information from the network provider2 and 7,c7 in such a nationally recognized format as may be prescribed by the ,secretary for purposes of paying claims for hospital care or medical services furnished under this section4 7#b7 ,the term covered claimant means-- 7,a7 a network provider that submits a claim to the ,secretary for purposes of payment by the ,secretary of expenses for hospital care or medical services furnished under this section2 or 7,b7 a regional network operated by a contractor pursuant to subsection 7a77#d77;,b7 that submits a claim to the ,secretary for purposes of reimbursement for a payment made by the contractor to a network provider for hospital care or medical services furnished under this section4 7#c7 ,the term covered payer means-- 7,a7 a regional network operated by a contractor pursuant to subsection 7a77#d77;,b7 with respect to a claim made by a network provider to the contractor for purposes of payment by the contractor of expenses for hospital care or medical services furnished under this section2 or 7,b7 the ,secretary with respect to-- 7i7 a claim made by a network provider to the ,secretary for purposes of payment by the ,secretary of expenses for hospital care or medical services furnished under this section2 and 7ii7 a claim made by a regional network operated by a contractor pursuant to subsection 7a77#d77;,b7 for purposes of reimbursement for a payment described by subparagraph 7,a74 7#d7 ,the term eligible veteran means a veteran who-- 7,a7 is enrolled in the patient enrollment system of the ,department established and operated under section #agje7;a7 of this title2 and 7,b7 has-- 7i7 been furnished hospital care or medical services at or through a ,department facility on at least one occasion during the two-year period preceding the date of the determination of eligibility2 or 7ii7 requested a first-time appointment for hospital care or medical services at a ,department facility4 7#e7 ,the term fraudulent claim means a claim by a network provider for reimbursement under this section that includes an intentional and deliberate misrepresentation of a material fact or facts that is intended to induce the ,secretary to pay an amount that was not legally owed to the provider4 4 7#b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag of such title is amended by inserting after the item relating to section #agjc the following new item3 #agjc;,a4 ,,va ,care in the ,community ,program4 4 7b7 ,conforming amendments ,the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf7 is amended-- 7#a7 in section #aja7p77#a7 7#ch ,u4,s4,c4 #agja note71 by inserting before the period at the end the following3 or the date on which the ,secretary certifies to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate that the ,secretary is fully implementing section #agjc;,a of title #ch1 ,united ,states ,code1 whichever occurs first2 and 7#b7 in section #bjh7a71 by striking section #aja and inserting section #agjc;,a of title #ch1 ,united ,states ,code4 7c7 ,definitions ,section #agja of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new paragraphs3 7#aa7 ,the term network provider means any of the following health care providers that have entered into a contract or agreement under which the provider agrees to furnish care and services to eligible veterans under section #agjc;,a of this title3 7,a7 ,any health care provider or supplier that is participating in the ,medicare ,program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 including any physician furnishing services under such program4 7,b7 ,any 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,c7 ,any ,federally-qualified health center 7as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7774 7,d7 ,the ,department of ,defense4 7,e7 ,the ,indian ,health ,service4 7,f7 ,any health care provider that is an academic affiliate of the ,department4 7,g7 ,any health care provider not otherwise covered under any of subparagraphs 7,a7 through 7,f7 that meets criteria established by the ,secretary for purposes of such section4 7#ab7 ,the term ,,va ,care in the ,community ,program means the program under which the ,secretary furnishes hospital care or medical services to veterans through network providers pursuant to section #agjc;,a of this title4 4 7d7 ,transition of provision of care ,this ,act1 and the amendments made by this ,act1 may not be construed to affect the obligations of the ,secretary of ,veterans ,affairs under contracts and agreements for the provision of hospital care1 medical services1 and extended care services entered into before the date of the enactment of this ,act at the terms and rates contained in such contracts and agreements4 #ajc4 ,veterans ,care ,agreements 7a7 ,in general ,subchapter ,i of chapter #ag of title #ch1 ,united ,states ,code1 is further amended by inserting after section #agjc;,a1 as added by section #ajb1 the following new section3 #agjc;,b4 ,veterans ,care ,agreements with non-network providers 7a7 ,veterans ,care ,agreements 7#a7 ,in addition to furnishing hospital care1 medical services1 or extended care services under this chapter at facilities of the ,department or under contracts or agreements entered into pursuant to section #agjc;,a of this title or any other provision of law other than this section1 the ,secretary may furnish such care and services to eligible veterans through the use of agreements1 to be known as ,veterans ,care ,agreements1 entered into under this section by the ,secretary with eligible non-network providers4 7#b7 ,the ,secretary may enter into a ,veterans ,care ,agreement under this section with an eligible non-network provider if the ,secretary determines that-- 7,a7 the provision of the hospital care1 medical services1 or extended care services at a ,department facility is impracticable or inadvisable because of the medical condition of the veteran1 the travel involved1 or the nature of the care or services required1 or a combination of such factors2 and 7,b7 such care or services are not available to be furnished by a non-,department health care provider under a contract or agreement entered into pursuant to a provision of law other than this section4 7#c7 7,a7 ,in accordance with subparagraphs 7,c7 and 7,d71 the ,secretary shall review each ,veterans ,care ,agreement with a non-network provider to determine whether it is practical or advisable to1 instead of carrying out such agreement-- 7i7 provide at a ,department facility the hospital care1 medical services1 or extended care services covered by such agreement2 or 7ii7 enter into an agreement with the provider under section #agjc;,a of this title to provide such care or services4 7,b7 ,if the ,secretary determines pursuant to a review of a ,veterans ,care ,agreement under subparagraph 7,a7 that it is practical or advisable to provide hospital care1 medical services1 or extended care services at a ,department facility1 or enter into an agreement under section #agjc;,a of this title to provide such care or services1 as the case may be1 the ,secretary-- 7i7 may not renew the ,veterans ,care ,agreement2 and 7ii7 shall take such actions as are necessary to implement such determination4 7,c7 ,this paragraph shall apply with respect to ,veterans ,care ,agreements entered into with a non-network provider whose gross annual revenue1 as determined under subsection 7b77#a71 exceeds-- 7i7 #c1jjj1jjj1 in the case of a provider that furnishes homemaker or home health aide services2 or 7ii7 #a1jjj1jjj1 in the case of any other provider4 7,d7 ,the ,secretary shall conduct each review of a ,veterans ,care ,agreement under subparagraph 7,a7 as follows3 7i7 ,once during the #ah-month period beginning on the date that is six months after date on which the agreement is entered into4 7ii7 ,not less than once during each four-year period beginning on the date on which the review under subparagraph 7,a7 is conducted4 7b7 ,eligible non-,network providers ,a provider of hospital care1 medical services1 or extended care services is eligible to enter into a ,veterans ,care ,agreement under this section if the ,secretary determines that the provider meets the following criteria3 7#a7 ,the gross annual revenue of the provider under contracts or agreements entered into with the ,secretary in the year preceding the year in which the provider enters into the ,veterans ,care ,agreement does not exceed-- 7,a7 #e1jjj1jjj 7as adjusted in a manner similar to amounts adjusted pursuant to section #ecab of this title71 in the case of a provider that furnishes homemaker or home health aide services2 or 7,b7 #b1jjj1jjj 7as so adjusted71 in the case of any other provider4 7#b7 ,the provider is not a network provider and does not otherwise provide hospital care1 medical services1 or extended care services to patients pursuant to a contract entered into with the ,department4 7#c7 ,the provider is-- 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;cc7a772 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 #acieu7h772 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 plan2 7,d7 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,e7 a center for independent living 7as defined in section #gjb of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gif;a774 7#d7 ,the provider is certified pursuant to the process established under subsection 7c77#a74 7#e7 ,any additional criteria determined appropriate by the ,secretary4 7c7 ,provider certification 7#a7 ,the ,secretary shall establish a process for the certification of eligible providers to enter into ,veterans ,care ,agreements under this section that shall1 at a minimum1 set forth the following3 7,a7 ,procedures for the submission of applications for certification and deadlines for actions taken by the ,secretary with respect to such applications4 7,b7 ,standards and procedures for the approval and denial of certifications and the revocation of certifications4 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 #acie7;j77#b77;,b77 and the standards set forth under section #i4ajd of title #dh1 ,code of ,federal ,regulations1 or any successor regulation4 7,d7 ,requirement for denial or revocation of certification if the ,secretary determines that the otherwise 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 system4 7,e7 ,procedures by which a provider whose certification is denied or revoked under the procedures established under this subsection will be identified as an excluded source on the list maintained in the ,system for ,award ,management1 or successor system1 if the ,secretary determines that such exclusion is appropriate4 7#b7 ,to the extent practicable1 the ,secretary shall establish the procedures under paragraph 7#a7 in a manner that takes into account any certification process administered by another department or agency of the ,federal ,government that an eligible provider has completed by reason of being a provider described in any of subparagraphs 7,a7 through 7,e7 of subsection 7b77#d74 7#c7 ,the ,secretary shall-- 7,a7 verify upon enrollment1 and annually thereafter1 that eligible providers have not been excluded from participation in other federally funded health care programs2 and 7,b7 submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate an annual report on the results of such verifications4 7d7 ,terms of ,agreements ,subsections 7d71 7e71 7f71 and 7g7 of section #agjc;,a of this title shall apply with respect to a ,veterans ,care ,agreement in the same manner such subsections apply to contracts and agreements entered into under such section4 7e7 ,exclusion of certain ,federal contracting provisions 7#a7 ,notwithstanding any other provision of law1 the ,secretary may enter into a ,veterans ,care ,agreement using procedures other than competitive procedures4 7#b7 7,a7 ,except as provided in subparagraph 7,b7 and unless otherwise provided in this section1 an eligible non-network provider that enters into a ,veterans ,care ,agreement under this section is not subject to1 in the carrying out of the agreement1 any provision of law that providers of services and suppliers 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 seq47 are not subject to4 7,b7 ,in addition to the provisions of laws covered by subparagraph 7,a71 an eligible non-network provider shall be subject to the following provisions of law3 7i7 ,any applicable law regarding integrity1 ethics1 or fraud1 or that subject a person to civil or criminal penalties4 7ii7 ,section #aceb of title #ca1 except for the filing requirements under subsection 7b7 of such section4 7iii7 ,section #dgje or #dgab of title #da1 and any other applicable law regarding the protection of whistleblowers4 7iv7 ,section #dgjf7;d7 of title #da4 7v7 ,title ,,vii of the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj;e et seq47 to the same extent as such title applies with respect to the eligible non-network provider in providing care or services through an agreement or arrangement other than under a ,veterans ,care ,agreement4 7f7 ,termination of a ,veterans ,care agreement 7#a7 ,an eligible non-network provider may terminate a ,veterans ,care ,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 a ,veterans ,care ,agreement with an eligible non-network provider under this section at such time and upon such notice to the provider as the ,secretary may specify for the purposes of this section1 if the ,secretary determines necessary4 7g7 ,disputes 7#a7 ,the ,secretary shall establish administrative procedures for providers with which the ,secretary has entered into a ,veterans ,care ,agreement 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 a ,veterans ,care ,agreement under this section1 a provider must first exhaust the administrative procedures established by the ,secretary under paragraph 7#a74 7h7 ,authority ,to pay for other authorized services 7#a7 ,if1 in the course of an episode of care for which hospital care1 medical services1 or extended care services are furnished to an eligible veteran pursuant to a ,veterans ,care ,agreement1 any part of such care or services is furnished by a medical provider who is not an eligible non-network provider or a network provider1 the ,secretary may compensate such provider for furnishing such care or services4 7#b7 ,the ,secretary shall make reasonable efforts to enter into a ,veterans ,care ,agreement with any provider who is compensated pursuant to paragraph 7#a74 7i7 ,annual reports 7#a7 ,not later than ,december #ca of the year following the fiscal year in which the ,secretary first enters into a ,veterans ,care ,agreement under this section1 and each year thereafter1 the ,secretary shall submit to the appropriate congressional committees an annual report that includes a list of all ,veterans ,care ,agreements entered into as of the date of the report4 7#b7 ,the requirement to submit a report under paragraph 7#a7 shall terminate on the date that is five years after the date of the enactment of this section4 7j7 ,quality of care ,in carrying out this section1 the ,secretary shall use the quality of care standards set forth or used by the ,centers for ,medicare ,medicaid ,services or other quality of care standards1 as determined by the ,secretary4 7k7 ,delegation ,the ,secretary may delegate the authority to enter into or terminate a ,veterans ,care ,agreement to an official of the ,department at a level not below the ,director of a ,veterans ,integrated ,service ,network or the ,director of a ,network ,contracting ,office4 7l7 ,definitions ,in this section3 7#a7 ,the term appropriate congressional committees means-- 7,a7 the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate2 and 7,b7 the ,committees on ,appropriations of the ,house of ,representatives and the ,senate4 7#b7 ,the term eligible veteran has the meaning given such term in section #agjc;,a7m7 of this title4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item relating to section #agjc;,a1 as added by section #ajb1 the following new item3 #agjc;,b4 ,veterans ,care ,agreements with non-network providers4 4 #ajd4 ,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 ,treatment of certain laws ,such section is amended by adding at the end the following new paragraph3 7#d7 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 7i7 ,except as provided in clause 7ii7 and unless otherwise provided in this section or in regulations prescribed pursuant to this section1 a ,state home that enters into an agreement under this section is not subject to1 in the carrying out of the agreement1 any law to which providers of services and suppliers are not subject 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 ,the exclusion under clause 7i7 does not apply to laws regarding integrity1 ethics1 fraud1 or that subject a person to civil or criminal penalties4 7,c7 ,title ,,vii of the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj;e et seq47 shall apply with respect to a ,state home that enters into an agreement under this section to the same extent as such title applies with respect to the ,state home in providing care or services through an agreement or arrangement other than under this section4 4 7c7 ,effective date 7#a7 ,in general ,the amendments made by this section shall apply to agreements entered into under section #agde of such title on and after the date on which the regulations prescribed by the ,secretary of ,veterans ,affairs to implement such amendments take effect4 7#b7 ,publication ,the ,secretary shall publish the date described in paragraph 7#a7 in the ,federal ,register not later than #cj days before such date4 #aje4 ,department of ,veterans ,affairs electronic interface for processing of medical claims 7a7 ,electronic interface ,not later than the implementation date specified in section #ajh7;a71 the ,chief ,information ,officer of the ,department of ,veterans ,affairs shall ensure that the information technology system used by the ,department to receive1 process1 and pay claims under the ,,va ,care in the ,community ,program established in section #agjc;,a of title #ch1 ,united ,states ,code1 as added by section #ajb1 and under ,veterans ,care ,agreements established in section #agjc;,b of such title1 as added by section #ajc1 includes the following3 7#a7 ,a function through which a covered non-,department health care provider may submit all required data and supporting information required for claims reimbursement through electronic data interchanges4 7#b7 ,an ability to automatically adjudicate claims4 7#c7 ,a centralized claims database that is accessible nationwide4 7#d7 ,integration with the relevant eligibility and authorization information technology systems of the ,department4 7#e7 ,ability for a covered non-,department health care provider to ascertain the status of a pending claim submitted by the provider1 receive information regarding missing documentation or discrepancies that may impede claim processing timelines or result in rejection1 and receive notification when such claim is accepted for reimbursement or rejected4 7#f7 ,a claim review system similar to that used by the ,centers for ,medicare ,medicaid ,services1 as of the date of the enactment of this ,act1 including the use of contractors to perform audits through data analytics1 to determine the appropriateness and accuracy of claims of providers and to ensure program integrity and oversight4 7b7 ,security and privacy ,the ,chief ,information ,officer shall also ensure that the information technology system covered under subsection 7a7 meets the following criteria3 7#a7 ,such system shall be developed and implemented in compliance with all applicable laws1 regulations and ,federal ,government standards regarding information security1 privacy1 and accessibility4 7#b7 ,such system shall provide for the elicitation1 analysis1 and prioritization of functional and nonfunctional information security and privacy requirements for such system1 including security and privacy services and architectural requirements relating to security and privacy based on a thorough risk assessment of all reasonably anticipated cyber and noncyber threats to the security and privacy of electronic protected health information made available through such interface4 7#c7 ,such system shall provide for the elicitation1 analysis1 and prioritization of secure development requirements relating to such system4 7#d7 ,such system shall provide assurance that the prioritized information security and privacy requirements of such system-- 7,a7 are correctly implemented in the design and implementation of such system through the systems development lifecycle2 and 7,b7 satisfy the information objectives of such system relating to security and privacy throughout the systems development lifecycle4 7c7 ,contract authority ,the ,chief ,information ,officer may enter into a contract for purposes of carrying out this section4 7d7 ,definitions ,in this section3 7#a7 ,the term electronic protected health information has the meaning given that term in section #afj4ajc of title #de1 ,code of ,federal ,regulations1 as in effect on the date of the enactment of this ,act4 7#b7 ,the term covered non-,department health care provider means-- 7,a7 a network provider 7as defined by section #agja7aa7 of title #ch1 ,united ,states ,code1 as added by section #ajb72 7,b7 a non-network provider with which the ,secretary has entered into a ,veterans ,care ,agreement under section #agjc;,b of such title1 as added by section #ajc2 or 7,c7 any other non-,department eligible provider or non-,department health care provider that furnishes hospital care or medical services pursuant to chapter #ag of such title4 7#c7 ,the term secure development requirements means1 with respect to the information technology system established under subsection 7a71 activities that are required to be completed during the system development lifecycle of such interface1 such as secure coding principles and test methodologies4 7#d7 ,the term ,,va ,care in the ,community ,program has the meaning given that term in section #agja7ab7 of title #ch1 ,united ,states ,code1 as added by section #ajb4 #ajf4 ,funding for ,,va ,care in the ,community ,program 7a7 ,in general ,all amounts required to carry out the ,,va ,care in the ,community ,program and ,veterans ,care ,agreements under section #agjc;,b of title #ch1 ,united ,states ,code1 shall be derived from the ,veterans ,health ,administration1 ,medical ,community ,care account4 7b7 ,transfer of amounts 7#a7 ,in general ,any unobligated amounts in the ,veterans ,choice ,fund under section #hjb of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 shall be transferred to the ,veterans ,health ,administration1 ,medical ,community ,care account on the later of the following dates3 7,a7 ,the date that is one year after the date of the enactment of this ,act4 7,b7 ,the date on which the ,secretary of ,veterans ,affairs submits to the ,committees on ,veterans' ,affairs of the ,senate and the ,house of ,representatives the certification required by section #ajg7;c74 7#b7 ,conforming repeal 7,a7 ,in general ,effective immediately following the transfer of amounts under paragraph 7#a71 section #hjb of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 is repealed4 7,b7 ,conforming amendment ,section #djjc of the ,surface ,transportation and ,veterans ,health ,care ,choice ,improvement ,act of #bjae 7,public ,law #aad-da2 #ch ,u4,s4,c4 #agja note7 is amended by striking for non-,department provider programs 7as defined in section #b7;d77 and all that follows through #ahjb7 and inserting the following3 for the ,,va ,care in the ,community ,program 7as defined in section #agja7ab7 of title #ch1 ,united ,states ,code7 and ,veterans ,care ,agreements under section #agjc;,b of title #ch1 ,united ,states ,code4 7c7 ,,va ,care in the ,community ,program defined ,in this section1 the term ,,va ,care in the ,community ,program has the meaning given that term in section #agja7ab7 of title #ch1 ,united ,states ,code1 as added by section #ajb4 #ajg4 ,termination of certain provisions authorizing medical care to veterans through non-,department of ,veterans ,affairs providers 7a7 ,termination of authority ,to contract for care in non-,department facilities 7#a7 ,in general ,section #fjcof title #ch1 ,united ,states ,code1 is amended by adding at the end the following new subsection3 7e7 ,the authority of the ,secretary to carry out this section terminates on the date on which the ,secretary certifies to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate that the ,secretary is fully implementing section #agjc;,a of this title4 4 7#b7 ,conforming amendments 7,a7 ,dental care ,section #agab7;a7 of such title is amended-- 7i7 in paragraph 7#c71 by striking under clause 7#a71 7#b71 or 7#e7 of section #agjc7;a7 of this title and inserting under the ,,va ,care in the ,community ,program2 and 7ii7 in paragraph 7#d77;,a71 in the first sentence-- 7,i7 by striking and section #agjc of this title and inserting and the ,,va ,care in the ,community ,program 7with respect to such a year beginning on or after the date on which the ,secretary commences implementation of the ,,va ,care in the ,community ,program72 and 7,,ii7 by striking in section #agjc of this title and inserting under the ,,va ,care in the ,community ,program4 7,b7 ,readjustment counseling ,section #agab;,a7e77#a7 of such title is amended by striking 7under sections #agjc7;a77#b7 and #agaj7;a77#a77;,b7 of this title7 and inserting 7under the ,,va ,care in the ,community ,program74 7,c7 ,death in ,department facility ,section #bcjc7;a77#b77;,b77i7 of such title is amended by striking in accordance with section #agjc of this title and inserting under the ,,va ,care in the ,community ,program4 7,d7 ,medicare provider agreements ,section #ahff7;a77#a77,l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77,l77 is amended-- 7i7 by striking under section #agjc of title #ch and inserting under the ,,va ,care in the ,community ,program 7as defined in section #agja7ab7 of title #ch1 ,united ,states ,code72 and 7ii7 by striking such section and inserting such program4 7b7 ,repeal of authority ,to contract for scarce medical specialists 7#a7 ,in general ,section #gdji of title #ch1 ,united ,states ,code1 is repealed4 7#b7 ,clerical amendment ,the table of sections at the beginning of chapter #gd of such title is amended by striking the item relating to section #gdji4 7c7 ,effective date ,the amendments made by subsections 7a7 and 7b7 shall take effect on the date on which the ,secretary certifies to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate that the ,secretary is fully implementing section #agjc;,a of title #ch1 ,united ,states ,code1 as added by section #ajb4 #ajh4 ,implementation and transition 7a7 ,implementation ,the ,secretary of ,veterans ,affairs shall commence the implementation of section #agjc;,a of title #ch1 ,united ,states ,code1 as added by section #ajb1 and section #agjc;,b of such title1 as added by section #ajc1 and shall make the transfer under section #ajf7;b71 by not later than one year after the date of the enactment of this ,act4 ,the ,secretary shall prescribe interim final regulations to implement such sections and publish such regulations in the ,federal ,register4 7b7 ,training ,before commencing the implementation of sections #agjc;,a and #agjc;,b of title #ch1 ,united ,states ,code1 as added by sections #ajb and #ajc1 respectively1 the ,secretary of ,veterans ,affairs shall-- 7#a7 certify to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate that-- 7,a7 each network provider 7as defined by section #agja7aa7 of title #ch1 ,united ,states ,code7 and eligible non-network provider that furnishes care or services under such section #agjc;,a or section #agjc;,b is trained to furnish such care or services under such sections2 and 7,b7 each employee of the ,department that refers1 authorizes1 or coordinates such care or services is trained to carry out such sections2 and 7#b7 establish standard1 written guidance for network providers1 non-,department health care providers1 and any non-,department administrative entities acting on behalf of such providers1 with respect to the policies and procedures for furnishing care or services under such sections4 #aji4 ,transplant procedures with live donors and related services 7a7 ,in general ,subchapter ,i of chapter #ag of title #ch1 ,united ,states ,code1 is further amended by inserting after section #agjc;,b1 as added by section #ajc1 the following new section3 #agjc;,c4 ,transplant procedures with live donors and related services 7a7 ,in general ,subject to subsections 7b7 and 7c71 in a case in which a veteran is eligible for a transplant procedure from the ,department1 the ,secretary may provide for an operation on a live donor to carry out such procedure for such veteran1 notwithstanding that the live donor may not be eligible for health care from the ,department4 7b7 ,other services ,subject to the availability of appropriations for such purpose1 the ,secretary shall furnish to a live donor any care or services before and after conducting the transplant procedure under subsection 7a7 that may be required in connection with such procedure4 7c7 ,use of non-,department facilities 7#a7 ,in carrying out this subsection1 the ,secretary may provide for the operation described in subsection 7a7 on a live donor and furnish to the live donor the care and services described in subsection 7b7 at a non-,department facility pursuant to an agreement entered into by the ,secretary under this section4 ,the live donor shall be deemed to be an individual eligible for hospital care and medical services at a non-,department facility pursuant to such an agreement solely for the purposes of receiving such operation1 care1 and services at the non-,department facility4 7#b7 ,the ,secretary may only provide for an operation at a non-,department of ,veterans ,affairs transplant center pursuant to paragraph 7#a7 if the center is in compliance with regulations prescribed by the ,centers for ,medicare ,medicaid ,services applicable to transplant centers4 4 7b7 ,clerical amendment ,the table of section at the beginning of such chapter is further amended by inserting after the item relating to section #agjc;,b1 as added by section #ajc1 the following new item3 #agjc;,c4 ,transplant procedures with live donors and related services4 4 ,,ii ,other administrative matters #bja4 ,reimbursement for emergency ambulance services 7a7 ,in general ,section #agbe7;c7 of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new paragraph3 7#e7 ,in delineating the circumstances under which reimbursement may be made under this section for ambulance services for an individual1 the ,secretary shall treat such services as emergency services for which reimbursement may be made under this section if the ,secretary determines that-- 7,a7 the request for ambulance services was made as a result of the sudden onset of a medical condition of such a nature that a prudent layperson who possesses an average knowledge of health and medicine-- 7i7 would have reasonably expected that a delay in seeking immediate medical attention would have been hazardous to the life or health of the individual2 or 7ii7 could reasonably expect the absence of immediate medical attention to result in placing the health of the individual in serious jeopardy1 the serious impairment of bodily functions1 or the serious dysfunction of any bodily organ or part2 and 7,b7 the individual is transported to the most appropriate medical facility capable of treating such medical condition4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall take effect on the date of the enactment of this ,act and shall apply with respect to ambulance services provided on or after ,january #a1 #bjai4 #bjb4 ,improvement of care coordination for veterans through exchange of certain medical records ,section #gccb7;b7 of title #ch1 ,united ,states ,code1 is amended-- 7#a7 in paragraph 7#b71 by adding at the end the following new subparagraphs3 7,i7 ,to a public or private health care provider in order to provide treatment or health care to a shared patient4 7,j7 ,to a third party in order to recover or collect reasonable charges for care furnished to a veteran for a non-service-connected disability pursuant to section #agbi of this title or section #a of ,public ,law #hg-fic 7#db ,u4,s4,c4 #bfea74 2 and 7#b7 by adding at the end the following new paragraph3 7#d7 ,nothing in this section shall be construed to authorize any provision of records in violation of relevant health record privacy laws1 including the ,health ,insurance ,portability and ,accountability ,act of #aiif 7,public ,law #ajd-aia74 4 #bjc4 ,elimination of copayment offset 7a7 ,in general ,section #agbi7;a7 of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new paragraph3 7#d7 ,notwithstanding any other provision of law1 any amount that the ,united ,states may collect or recover under this section shall not affect any copayment amount a veteran is otherwise obligated to pay under this chapter4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall take effect on the date of the enactment of this ,act and apply with respect to a copayment obligation that arises on or after the date of the enactment of this ,act4 #bjd4 ,use of ,department of ,veterans ,affairs ,medical ,care ,collections ,fund for certain improvements in collections ,section #agbi;,a7c77#a77;,b7 of title #ch1 ,united ,states ,code1 is amended by inserting 7including with respect to automatic data processing or information technology improvements7 after collection4 #bje4 ,department of ,veterans ,affairs health care productivity improvement 7a7 ,in general ,subchapter ,i of chapter #ag of title #ch1 ,united ,states ,code1 is further amended by inserting after section #agje;,a the following new section3 #agje;,b4 ,management of health care3 productivity 7a7 ,relative value unit tracking ,the ,secretary shall track relative value units for all ,department providers4 7b7 ,clinical procedure coding training ,the ,secretary shall require all ,department providers to attend training on clinical procedure coding4 7c7 ,performance standards 7#a7 ,the ,secretary shall establish for each ,department facility-- 7,a7 in accordance with paragraph 7#b71 standardized performance standards based on nationally recognized relative value unit production standards applicable to each specific profession in order to evaluate clinical productivity at the provider and facility level2 7,b7 remediation plans to address low clinical productivity and clinical inefficiency2 and 7,c7 an ongoing process to systematically review the content1 implementation1 and outcome of the plans developed under subparagraph 7,b74 7#b7 ,in establishing the performance standards under paragraph 7#a77;,a71 the ,secretary may-- 7,a7 incorporate values-based productivity models2 and 7,b7 take into account non-clinical duties1 including with respect to training and research4 7d7 ,definitions ,in this section3 7#a7 ,the term ,department provider means an employee of the ,department whose primary responsibilities include furnishing hospital care or medical services1 including a physician1 a dentist1 an optometrist1 a podiatrist1 a chiropractor1 an advanced practice registered nurse1 and a physician's assistant acting as an independent provider4 7#b7 ,the term relative value unit means a unit for measuring workload by determining the time1 mental effort and judgment1 technical skill1 physical effort1 and stress involved in delivering a procedure4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such chapter is further amended by inserting after the item relating to section #agje;,a the following new item3 #agje;,b4 ,management of health care3 productivity4 4 7c7 ,report ,not later than one year after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report on the implementation of section #agje;,b of title #ch1 ,united ,states ,code1 as added by subsection 7a74 ,such report shall include1 for each professional category of ,department providers1 the relative value unit of such category of providers at the national1 ,veterans ,integrated ,service ,network1 and facility levels4 #bjf4 ,licensure of health care professionals of the ,department of ,veterans ,affairs providing treatment via telemedicine 7a7 ,in general ,chapter #ag of title #ch1 ,united ,states ,code1 is further amended by inserting after section #agcj;,a the following new section3 #agcj;,b4 ,licensure of health care professionals providing treatment via telemedicine 7a7 ,in general ,notwithstanding any provision of law regarding the licensure of health care professionals1 a covered health care professional may practice the health care profession of the health care professional at any location in any ,state1 regardless of where the covered health care professional or the patient is located1 if the covered health care professional is using telemedicine to provide treatment to an individual under this chapter4 7b7 ,property of federal government ,subsection 7a7 shall apply to a covered health care professional providing treatment to a patient regardless of whether the covered health care professional or patient is located in a facility owned by the ,federal ,government during such treatment4 7c7 ,construction ,nothing in this section may be construed to remove1 limit1 or otherwise affect any obligation of a covered health care professional under the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hja et seq474 7d7 ,covered health care professional defined ,in this section1 the term covered health care professional means a health care professional who-- 7#a7 is an employee of the ,department appointed under the authority under section #gcjf1 #gdja1 #gdje1 #gdjf1 or #gdjh of this title1 or title #e2 7#b7 is authorized by the ,secretary to provide health care under this chapter2 7#c7 is required to adhere to all quality standards relating to the provision of telemedicine in accordance with applicable policies of the ,department2 and 7#d7 has an active1 current1 full1 and unrestricted license1 registration1 or certification in a ,state to practice the health care profession of the health care professional4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag of such title is further amended by inserting after the item relating to section #agcj;,a the following new item3 #agcj;,b4 ,licensure of health care professionals providing treatment via telemedicine4 4 7c7 ,report on telemedicine 7#a7 ,in general ,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 on the effectiveness of the use of telemedicine by the ,department of ,veterans ,affairs4 7#b7 ,elements ,the report required by paragraph 7#a7 shall include an assessment of the following3 7,a7 ,the satisfaction of veterans with telemedicine furnished by the ,department4 7,b7 ,the satisfaction of health care providers in providing telemedicine furnished by the ,department4 7,c7 ,the effect of telemedicine furnished by the ,department on the following3 7i7 ,the ability of veterans to access health care1 whether from the ,department or from non-,department health care providers4 7ii7 ,the frequency of use by veterans of telemedicine4 7iii7 ,the productivity of health care providers4 7iv7 ,wait times for an appointment for the receipt of health care from the ,department4 7v7 ,the reduction1 if any1 in the use by veterans of in-person services at ,department facilities and non-,department facilities4 7,d7 ,the types of appointments for the receipt of telemedicine furnished by the ,department that were provided during the one-year period preceding the submittal of the report4 7,e7 ,the number of appointments for the receipt of telemedicine furnished by the ,department that were requested during such period1 disaggregated by ,veterans ,integrated ,service ,network4 7,f7 ,savings by the ,department1 if any1 including travel costs1 of furnishing health care through the use of telemedicine during such period4 #bjg4 ,establishment of processes to ensure safe opioid prescribing practices by non-,department of ,veterans ,affairs health care providers 7a7 ,receipt and review of guidelines ,the ,secretary of ,veterans ,affairs shall ensure that all covered health care providers are provided a copy of and certify that they have reviewed the evidence-based guidelines for prescribing opioids set forth by the ,opioid ,safety ,initiative of the ,department of ,veterans ,affairs under sections #iaa7;a77#b7 and #iab7;c7 of the ,jason ,simcakoski ,memorial and ,promise ,act 7,public ,law #aad-aih2 #ch ,u4,s4,c4 #agja note7 before first providing care under the laws administered by the ,secretary and at any time when those guidelines are modified thereafter4 7b7 ,inclusion of medical history and current medications ,the ,secretary shall implement a process to ensure that1 if care of a veteran by a covered health care provider is authorized under the laws administered by the ,secretary1 the document authorizing such care includes the relevant medical history of the veteran and a list of all medications prescribed to the veteran4 7c7 ,submittal of prescriptions 7#a7 ,in general ,except as provided in paragraph 7#c71 the ,secretary shall require1 to the maximum extent practicable1 each covered health care provider to submit prescriptions for opioids-- 7,a7 to the ,department for prior authorization for the prescribing of a limited amount of opioids under contracts the ,department has with retail pharmacies2 or 7,b7 directly to a pharmacy of the ,department for the dispensing of such prescription4 7#b7 ,department responsibility ,in carrying out paragraph 7#a71 upon receipt by the ,department of a prescription for opioids for a veteran under the laws administered by the ,secretary1 the ,secretary shall-- 7,a7 record such prescription in the electronic health record of the veteran2 and 7,b7 monitor such prescription as outlined in the ,opioid ,safety ,initiative of the ,department4 7#c7 ,exception 7,a7 ,in general ,a covered health care provider is not required under paragraph 7#a77;,b7 to submit an opioid prescription directly to a pharmacy of the ,department if-- 7i7 the health care provider determines that there is an immediate medical need for the prescription1 including an urgent or emergent prescription or a prescription dispensed as part of an opioid treatment program that provides office-based medications2 and 7ii7 7,i7 following an inquiry into the matter1 a pharmacy of the ,department notifies the health care provider that it cannot fill the prescription in a timely manner2 or 7,,ii7 the health care provider determines that the requirement under paragraph 7#a77;,b7 would impose an undue hardship on the veteran1 including with respect to travel distances1 as determined by the ,secretary4 7,b7 ,notification to ,department ,if a covered health care provider uses an exception under subparagraph 7,a7 with respect to an opioid prescription for a veteran1 the health care provider shall1 on the same day the prescription is written1 submit to the ,secretary for inclusion in the electronic health record of the veteran a notice1 in such form as the ,secretary may establish1 providing information about the prescription and describing the reason for the exception4 7,c7 ,report 7i7 ,in general ,not less frequently than quarterly1 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 evaluating the compliance of covered health care providers with the requirements under this paragraph and setting forth data on the use by health care providers of exceptions under subparagraph 7,a7 and notices under subparagraph 7,b74 7ii7 ,elements ,each report required by clause 7i7 shall include the following with respect to the quarter covered by the report3 7,i7 ,the number of exceptions used under subparagraph 7,a7 and notices received under subparagraph 7,b74 7,,ii7 ,the rate of compliance by the ,department with the requirement under subparagraph 7,b7 to include such notices in the health records of veterans4 7,,iii7 ,the identification of any covered health care providers that1 based on criteria prescribed the ,secretary1 are determined by the ,secretary to be statistical outliers regarding the use of exceptions under subparagraph 7,a74 7d7 ,use of ,opioid ,safety ,initiative guidelines 7#a7 ,in general ,if a director of a medical center of the ,department or a ,veterans ,integrated ,service ,network determines that the opioid prescribing practices of a covered health care provider conflicts with or is otherwise inconsistent with the standards of appropriate and safe care1 as that term is used in section #iac7;d7 of the ,jason ,simcakoski ,memorial and ,promise ,act 7,public ,law #aad-aih2 #ch ,u4,s4,c4 #agja note71 the director shall take such action as the director considers appropriate to ensure the safety of all veterans receiving care from that health care provider1 including removing or directing the removal of any such health care provider from provider networks or otherwise refusing to authorize care of veterans by such health care provider in any program authorized under the laws administered by the ,secretary4 7#b7 ,inclusion in contracts ,the ,secretary shall ensure that any contracts entered into by the ,secretary with third parties involved in administering programs that provide care in the community to veterans under the laws administered by the ,secretary specifically grant the authority set forth in paragraph 7#a7 to such third parties and to the directors described in that paragraph1 as the case may be4 7e7 ,denial or revocation of eligibility of non-,department providers ,the ,secretary shall deny or revoke the eligibility of a non-,department health care provider to provide health care to veterans under the laws administered by the ,secretary if the ,secretary determines that the opioid prescribing practices of the provider-- 7#a7 violate the requirements of a medical license of the health care provider2 or 7#b7 detract from the ability of the health care provider to deliver safe and appropriate health care4 7f7 ,covered health care provider defined ,in this section1 the term covered health care provider means a non-,department of ,veterans ,affairs health care provider who provides health care to veterans under the laws administered by the ,secretary of ,veterans ,affairs4 #bjh4 ,assessment of health care furnished by the ,department to veterans who live in the territories 7a7 ,in general ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall submit to the ,committees on ,veterans' ,affairs of the ,senate and the ,house of ,representatives a report regarding health care furnished by the ,department of ,veterans ,affairs to veterans who live in the territories4 7b7 ,elements ,the report under subsection 7a7 shall include assessments of the following3 7#a7 ,the ability of the ,department to furnish to veterans who live in the territories the following3 7,a7 ,hospital care4 7,b7 ,medical services4 7,c7 ,mental health services4 7,d7 ,geriatric services4 7#b7 ,the feasibility of establishing a medical facility of the ,department in any territory that does not contain such a facility4 7c7 ,definition ,in this section1 the term territories means the ,northern ,mariana ,islands1 ,puerto ,rico1 ,american ,samoa1 ,guam1 and the ,virgin ,islands4 #bji4 ,oversight and accountability of financial processes of ,department of ,veterans ,affairs 7a7 ,sense of ,congress ,it is the sense of ,congress that-- 7#a7 the normal budget process for the ,department of ,veterans ,affairs should be grounded in sound actuarial analysis based on accurate demand forecasting2 7#b7 the regular budget process for the ,department should be the norm2 7#c7 supplemental requests for appropriations should be used sparingly and for unforeseen demand or natural occurrences2 and 7#d7 upon receipt of the financial audit of the ,office of ,inspector ,general of the ,department1 the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives shall give due consideration to the report1 including by holding hearings as appropriate 7b7 ,plans for use of supplemental appropriations required ,whenever the ,secretary submits to address a budgetary issue affecting the ,department of ,veterans ,affairs to ,congress a request for supplemental appropriations or any other appropriation when the request is submitted outside the standard budget process1 the ,secretary shall1 not later than #de days before the date on which such budgetary issue would start affecting a program or service1 submit to ,congress a justification for the request1 including a plan that details how the ,secretary intends to use the requested appropriation and how long the requested appropriation is expected to meet the needs of the ,department and certification that the request was made using an updated and sound actuarial analysis4 7c7 ,annual attestation regarding financial projections ,concurrent with the ,president's annual budget request submitted to ,congress under section #aaje of title #ca1 ,united ,states ,code1 for fiscal year #bjai and each fiscal year thereafter1 the ,chief ,financial ,officer of the ,department 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 the following3 7#a7 ,a statement of assurance that financial projections included in such budget or the supporting materials submitted along with such budget for the ,department of ,veterans ,affairs are sufficient to provide benefits and services under laws administered by the ,secretary of ,veterans ,affairs4 7#b7 ,a certification of the ,chief ,financial ,officer's responsibility for internal financial controls of the ,department4 7#c7 ,an attestation that the ,chief ,financial ,officer has collaborated sufficiently with the financial officers of the facilities and components of the ,department to be confident in such financial projections4 #baj4 ,authority for ,department of ,veterans ,affairs ,center for ,innovation for ,care and ,payment 7a7 ,in general ,subchapter ,i of chapter #ag1 as amended by section #ajc1 is further amended by inserting after section #agjc;,c1 as added by section #aji1 the following new section3 #agjc;,d4 ,center for ,innovation for ,care and ,payment 7a7 ,in general 7#a7 ,there is established within the ,department a ,center for ,innovation for ,care and ,payment 7in this section referred to as the ,center74 7#b7 ,the ,secretary1 acting through the ,center1 may carry out such pilot programs the ,secretary determines to be appropriate to develop innovative approaches to testing payment and service delivery models in order to reduce expenditures while preserving or enhancing the quality of care furnished by the ,department4 7#c7 ,the ,secretary1 acting through the ,center1 shall test payment and service delivery models to determine whether such models-- 7,a7 improve access to1 and quality1 timeliness1 and patient satisfaction of care and services2 and 7,b7 create cost savings for the ,department4 7#d7 7,a7 ,the ,secretary shall test a model in a location where the ,secretary determines that the model will addresses deficits in care 7including poor clinical outcomes or potentially avoidable expenditures7 for a defined population4 7,b7 ,the ,secretary shall focus on models the ,secretary expects to reduce program costs while preserving or enhancing the quality of care received by individuals receiving benefits under this chapter4 7,c7 ,the models selected may include those described in section #aaae;,a7b77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77;,b774 7#e7 ,in selecting a model for testing1 the ,secretary may consider1 in addition to other factors identified in this subsection1 the following factors3 7,a7 ,whether the model includes a regular process for monitoring and updating patient care plans in a manner that is consistent with the needs and preferences of individuals receiving benefits under this chapter4 7,b7 ,whether the model places the individual receiving benefits under this chapter at the center of the care team 7including family members and other caregivers7 of such individual4 7,c7 ,whether the model uses technology or new systems to coordinate care over time and across settings4 7,d7 ,whether the model demonstrates effective linkage with other public sector payers1 private sector payers1 or statewide payment models4 7#f7 7,a7 ,models tested under this section may not be designed in such a way that would allow the ,united ,states to recover or collect reasonable charges from a ,federal health care program for care or services furnished by the ,secretary to a veteran under pilot programs carried out under this section4 7,b7 ,in this paragraph1 the term ,federal health care program means-- 7i7 an insurance program described in section #ahaa of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c7 or established by section #ahca of such ,act 7#db ,u4,s4,c4 #acie;j72 or 7ii7 a ,state plan for medical assistance approved under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq472 or 7iii7 a ,,tricare program operated under sections #ajge1 #ajge;a1 #ajgf1 #ajgf;a1 #ajgf;c1 #ajgf;d1 #ajgf;e1 or #ajgf;f of title #aj4 7b7 ,duration ,each pilot program carried out by the ,secretary under this section shall terminate no later than five years after the date of the commencement of the pilot program4 7c7 ,location ,the ,secretary shall ensure that each pilot program carried out under this section occurs in an area or areas appropriate for the intended purposes of the pilot program4 7d7 ,budget ,funding for each pilot program carried out by the ,secretary under this section shall come from appropriations-- 7#a7 provided in advance in appropriations acts for the ,veterans ,health ,administration2 and 7#b7 provided for information technology systems4 7e7 ,notice ,the ,secretary shall-- 7#a7 publish information about each pilot program under this section in the ,federal ,register2 and 7#b7 take reasonable actions to provide direct notice to veterans eligible to participate in such pilot programs4 7f7 ,waiver of authorities 7#a7 ,subject to reporting under paragraph 7#b7 and approval under paragraph 7#c71 in implementing a pilot program under this section1 the ,secretary may waive such requirements in subchapters ,i1 ,,ii1 and ,,iii of this chapter as the ,secretary determines necessary solely for the purposes of carrying out this section with respect to testing models described in subsection 7a74 7#b7 ,before waiving any authority under paragraph 7#a71 the ,secretary shall submit a report to the ,speaker of the ,house of ,representatives1 the minority leader of the ,house of ,representatives1 the majority leader of the ,senate1 the minority leader of the ,senate1 and each standing committee with jurisdiction under the rules of the ,senate and of the ,house of ,representatives to report a bill to amend the provision or provisions of law that would be waived by the ,department describing in detail the following3 7,a7 ,the specific authorities to be waived under the pilot program4 7,b7 ,the standard or standards to be used in the pilot program in lieu of the waived authorities4 7,c7 ,the reasons for such waiver or waivers4 7,d7 ,a description of the metric or metrics the ,secretary will use to determine the effect of the waiver or waivers upon the access to and quality1 timeliness1 or patient satisfaction of care and services furnished through the pilot program4 7,e7 ,the anticipated cost savings1 if any1 of the pilot program4 7,f7 ,the schedule for interim reports on the pilot program describing the results of the pilot program so far and the feasibility and advisability of continuing the pilot program4 7,g7 ,the schedule for the termination of the pilot program and the submission of a final report on the pilot program describing the result of the pilot program and the feasibility and advisability of making the pilot program permanent4 7,h7 ,the estimated budget of the pilot program4 7#c7 7,a7 ,upon receipt of a report submitted under paragraph 7#b71 each ,house of ,congress shall provide copies of the report to the chairman and ranking member of each standing committee with jurisdiction under the rules of the ,house of ,representatives or the ,senate to report a bill to amend the provision or provisions of law that would be waived by the ,department under this subsection4 7,b7 7i7 ,the waiver requested by the ,secretary under paragraph 7#b7 shall be considered approved under this paragraph if there is enacted into law a bill or joint resolution approving such request in its entirety4 ,such bill or joint resolution shall be passed by recorded vote to reflect the vote of each member of ,congress thereon4 7ii7 ,the provisions of this paragraph are enacted by ,congress-- 7,i7 as an exercise of the rulemaking power of the ,senate and the ,house of ,representatives and as such shall be considered as part of the rules of each ,house of ,congress1 and shall supersede other rules only to the extent that they are inconsistent therewith2 and 7,,ii7 with full recognition of the constitutional right of either ,house of ,congress to change the rules 7so far as they relate to the procedures of that ,house7 at any time1 in the same manner1 and to the same extent as in the case of any other rule of that ,house4 7,c7 ,during the #fj-;calendar-day period beginning on the date on which the ,secretary submits the report described in paragraph 7#b7 to ,congress1 it shall be in order as a matter of highest privilege in each ,house of ,congress to consider a bill or joint resolution1 if offered by the majority leader of such ,house 7or a designee71 approving such request in its entirety4 7g7 ,limitations 7#a7 ,the waiver provisions in subsection 7f7 shall not apply unless the ,secretary1 in accordance with the requirements in subsection 7f71 submits the first proposal for a pilot program not later than #ah months after the date of the enactment of the ,,va ,care in the ,community ,act4 7#b7 ,notwithstanding section #ejb of this title1 decisions by the ,secretary under this section shall1 consistent with section #eaa of this title1 be final and conclusive and may not be reviewed by any other official or by any court1 whether by an action in the nature of mandamus or otherwise4 7#c7 7,a7 ,if the ,secretary determines that the pilot program is not improving the quality of care or producing cost savings1 the ,secretary shall-- 7i7 propose a modification to the pilot program in the interim report that shall also be considered a report under subsection 7f77#b77;,a7 and shall be subject to the terms and conditions of subsection 7f77#b72 or 7ii7 terminate such pilot program not later than #cj days after submitting the interim report to ,congress4 7,b7 ,if the ,secretary terminates the pilot program under subparagraph 7,a77ii71 for purposes of clauses 7vi7 and 7vii7 of subsection 7f77#b77;,a71 such interim report will also serve as the final report for that pilot program4 7h7 ,evaluation and reporting requirements 7#a7 ,the ,secretary shall conduct an evaluation of each model tested1 which shall include1 at a minimum1 an analysis of-- 7,a7 the quality of care furnished under the model1 including the measurement of patient-level outcomes and patient-centeredness criteria determined appropriate by the ,secretary2 and 7,b7 the changes in spending by reason of that model4 7#b7 ,the ,secretary shall make the results of each evaluation under this subsection available to the public in a timely fashion and may establish requirements for other entities participating in the testing of models under this section to collect and report information that the ,secretary determines is necessary to monitor and evaluate such models4 7i7 ,coordination and consultation 7#a7 ,the ,secretary shall consult with the ,under ,secretary for ,health and the ,special ,medical ,advisory ,group established pursuant to section #gcab of this title in the development and implementation of any pilot program operated under this section4 7#b7 ,in carrying out the duties under this section1 the ,secretary shall consult representatives of relevant ,federal agencies1 and clinical and analytical experts with expertise in medicine and health care management4 ,the ,secretary shall use appropriate mechanisms to seek input from interested parties4 7j7 ,expansion of successful pilot programs ,taking into account the evaluation under subsection 7f71 the ,secretary may1 through rulemaking1 expand 7including implementation on a nationwide basis7 the duration and the scope of a model that is being tested under subsection 7a7 to the extent determined appropriate by the ,secretary1 if-- 7#a7 the ,secretary determines that such expansion is expected to-- 7,a7 reduce spending without reducing the quality of care2 or 7,b7 improve the quality of patient care without increasing spending2 and 7#b7 the ,secretary determines that such expansion would not deny or limit the coverage or provision of benefits for individuals receiving benefits under this chapter4 4 7b7 ,conforming amendment ,the table of sections at the beginning of such chapter1 as amended by section #aji1 is further amended by inserting after the item relating to section #agjc;,c the following new item3 #agjc;,d4 ,center for ,innovation for ,care and ,payment4 4 ,,iii ,improvements to ,recruitment of ,physicians #cja4 ,designated scholarships for physicians and dentists under ,department of ,veterans ,affairs ,health ,professional ,scholarship ,program 7a7 ,scholarships for physicians and dentists ,section #gfab7;b7 of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new paragraph3 7#f7 7,a7 ,of the scholarships awarded under this subchapter1 the ,secretary shall ensure that not less than #ej scholarships are awarded each year to individuals who are accepted for enrollment or enrolled 7as described in section #gfjb of this title7 in a program of education or training leading to employment as a physician or dentist until such date as the ,secretary determines that the staffing shortage of physicians and dentists in the ,department is less than #ejj4 7,b7 ,after such date1 the ,secretary shall ensure that of the scholarships awarded under this subchapter1 a number of scholarships is awarded each year to individuals referred to in subparagraph 7,a7 in an amount equal to not less than ten percent of the staffing shortage of physicians and dentists in the ,department1 as determined by the ,secretary4 7,c7 ,notwithstanding subsection 7c77#a71 the agreement between the ,secretary and a participant in the ,scholarship ,program who receives a scholarship pursuant to this paragraph shall provide the following3 7i7 ,the ,secretary's agreement to provide the participant with a scholarship under this subchapter for a specified number 7from two to four7 of school years during which the participant is pursuing a course of education or training leading to employment as a physician or dentist4 7ii7 ,the participant's agreement to serve as a full-time employee in the ,veterans ,health ,administration for a period of time 7hereinafter in this subchapter referred to as the period of obligated service7 of #ah months for each school year or part thereof for which the participant was provided a scholarship under the ,scholarship ,program4 7,d7 ,in providing scholarships pursuant to this paragraph1 the ,secretary may provide a preference for applicants who are veterans4 7,e7 ,on an annual basis1 the ,secretary shall provide to appropriate educational institutions informational material about the availability of scholarships under this paragraph4 4 7b7 ,breach of agreement ,section #gfag7;b7 of such title is amended-- 7#a7 by redesignating paragraphs 7#d7 and 7#e7 as paragraphs 7#e7 and 7#f71 respectively2 and 7#b7 by inserting after paragraph 7#c7 the following new paragraph 7#d73 7#d7 ,in the case of a participant who is enrolled in a program or education or training leading to employment as a physician1 the participant fails to successfully complete post-graduate training leading to eligibility for board certification in a specialty4 4 7c7 ,extension of program ,section #gfai of such title is amended by striking ,december #ca1 #bjai and inserting ,december #ca1 #bjcc4 #cjb4 ,establishment of ,department of ,veterans ,affairs ,specialty ,education ,loan ,repayment ,program 7a7 ,in general ,chapter #gf of title #ch1 ,united ,states ,code1 is amended by inserting after subchapter ,,vii the following new subchapter3 ,,viii ,specialty ,education ,loan ,repayment ,program #gfia4 ,establishment ,as part of the ,educational ,assistance ,program1 the ,secretary may carry out a student loan repayment program under section #ecgi of title #e4 ,the program shall be known as the ,department of ,veterans ,affairs ,specialty ,education ,loan ,repayment ,program 7in this chapter referred to as the ,specialty ,education ,loan ,repayment ,program74 #gfib4 ,purpose ,the purpose of the ,specialty ,education ,loan ,repayment ,program is to assist1 through the establishment of an incentive program for certain individuals employed in the ,veterans ,health ,administration1 in meeting the staffing needs of the ,veterans ,health ,administration for physicians in medical specialties for which the ,secretary determines recruitment or retention of qualified personnel is difficult4 #gfic4 ,eligibility2 preference2 covered costs 7a7 ,eligibility ,an individual is eligible to participate in the ,specialty ,education ,loan ,repayment ,program if the individual-- 7#a7 is hired under section #gdja of this title to work in an occupation described in section #gfib of this title2 7#b7 owes any amount of principal or interest under a loan1 the proceeds of which were used by or on behalf of that individual to pay costs relating to a course of education or training which led to a degree that qualified the individual for the position referred to in paragraph 7#a72 and 7#c7 is-- 7,a7 recently graduated from an accredited medical or osteopathic school and matched to an accredited residency program in a medical specialty described in section #gfib of this title2 or 7,b7 a physician in training in a medical specialty described in section #gfib of this title with more than two years remaining in such training4 7b7 ,preference for veterans ,in selecting individuals for participation in the ,specialty ,education ,loan ,repayment ,program under this subchapter1 the ,secretary may give preference to veterans4 7c7 ,covered costs ,for purposes of subsection 7a77#b71 costs relating to a course of education or training include-- 7#a7 tuition expenses2 7#b7 all other reasonable educational expenses1 including expenses for fees1 books1 equipment1 and laboratory expenses2 and 7#c7 reasonable living expenses4 #gfid4 ,specialty education loan repayment 7a7 ,in general ,payments under the ,specialty ,education ,loan ,repayment ,program shall consist of payments for the principal and interest on loans described in section #gfhb7;a77#b7 of this title for individuals selected to participate in the ,program to the holders of such loans4 7b7 ,frequency of payment ,the ,secretary shall make payments for any given participant in the ,specialty ,education ,loan ,repayment ,program on a schedule determined appropriate by the ,secretary4 7c7 ,maximum amount2 waiver 7#a7 ,the amount of payments made for a participant under the ,specialty ,education ,loan ,repayment ,program may not exceed #afj1jjj over a total of four years of participation in the ,program1 of which not more than #dj1jjj of such payments may be made in each year of participation in the ,program4 7#b7 7,a7 ,the ,secretary may waive the limitations under paragraph 7#a7 in the case of a participant described in subparagraph 7,b74 ,in the case of such a waiver1 the total amount of payments payable to or for that participant is the total amount of the principal and the interest on the participant's loans referred to in subsection 7a74 7,b7 ,a participant described in this subparagraph is a participant in the ,program who the ,secretary determines serves in a position for which there is a shortage of qualified employees by reason of either the location or the requirements of the position4 #gfie4 ,choice of location ,each participant in the ,specialty ,education ,loan ,repayment ,program who completes residency may select1 from a list of medical facilities of the ,veterans ,health ,administration provided by the ,secretary1 at which such facility the participant will work in a medical specialty described in section #gfib of this title4 #gfif4 ,term of obligated service 7a7 ,in general ,in addition to any requirements under section #ecgi7;c7 of title #e1 a participant in the ,specialty ,education ,loan ,repayment ,program must agree1 in writing and before the ,secretary may make any payment to or for the participant1 to-- 7#a7 obtain a license to practice medicine in a ,state2 7#b7 successfully complete post-graduate training leading to eligibility for board certification in a specialty2 7#c7 serve as a full-time clinical practice employee of the ,veterans ,health ,administration for #ab months for every #dj1jjj in such benefits that the employee receives1 but in no case for fewer than #bd months2 and 7#d7 except as provided in subsection 7b71 to begin such service as a full-time practice employee by not later than #fj days after completing a residency4 7b7 ,fellowship ,in the case of a participant who receives an accredited fellowship in a medical specialty other than a medical specialty described in section #gfib of this title1 the ,secretary1 on written request of the participant1 may delay the term of obligated service under subsection 7a7 for the participant until after the participant completes the fellowship1 but in no case later than #fj days after completion of such fellowship4 7c7 ,penalty 7#a7 ,an employee who does not complete a period of obligated service under this section shall owe the ,federal ,government an amount determined in accordance with the following formula3 ,a,b77,t,s7,t774 7#b7 ,in the formula in paragraph 7#a73 7,a7 ,a is the amount the employee owes the ,federal ,government4 7,b7 ,b is the sum of all payments to or for the participant under the ,specialty ,education ,loan ,repayment ,program4 7,c7 ,t is the number of months in the period of obligated service of the employee4 7,d7 ,s is the number of whole months of such period of obligated service served by the employee4 #gfig4 ,relationship to ,educational ,assistance ,program ,assistance under the ,specialty ,education ,loan ,repayment ,program may be in addition to other assistance available to individuals under the ,educational ,assistance ,program4 4 7b7 ,conforming and technical amendments 7#a7 ,conforming amendments 7,a7 ,section #gfja7;a7 of title #ch1 ,united ,states ,code1 is amended-- 7i7 in paragraph 7#d71 by striking and2 7ii7 in paragraph 7#e71 by striking the period and inserting 2 and2 and 7iii7 by adding at the end the following new paragraph3 7#f7 the specialty education loan repayment program provided for in subchapter ,,viii of this chapter4 4 7,b7 ,section #gfjc7;a77#a7 of title #ch1 ,united ,states ,code1 is amended by striking or ,,vi and inserting ,,vi1 or ,,viii4 7,c7 ,section #gfjd of title #ch1 ,united ,states ,code1 is amended by striking or ,,vi each place it appears and inserting ,,vi1 or ,,viii4 7,d7 ,section #gfca of title #ch1 ,united ,states ,code1 is amended-- 7i7 in subsection 7a77#a7-- 7,i7 by striking and after scholarship amount12 and 7,,ii7 by inserting 1 and the maximum specialty education loan repayment amount after reduction payments amount2 and 7ii7 in subsection 7b7 by adding at the end the following new paragraph3 7#g7 ,the term specialty education loan repayment amount means the maximum amount of specialty education loan repayment payments payable to or for a participant in the ,department of ,veterans ,affairs ,specialty ,education ,loan ,repayment ,program under subchapter ,,viii of this chapter1 as specified in section #gfid7;c77#a7 of this title and as previously adjusted 7if at all7 in accordance with this section4 4 7,e7 ,section #gfcb of title #ch1 ,united ,states ,code1 is amended-- 7i7 in paragraph 7#a71 by striking and the ,education ,debt ,reduction ,program and inserting the ,education ,debt ,reduction ,program1 and the ,specialty ,education ,loan ,repayment ,program2 and 7ii7 in paragraph 7#d71 by striking and per participant in the ,education ,debt ,reduction ,program and inserting per participant in the ,education ,debt ,reduction ,program1 and per participant in the ,specialty ,education ,loan ,repayment ,program4 7#b7 ,table of sections ,the table of sections at the beginning of chapter #gf of such title is amended by inserting after the items relating to subchapter ,,vii the following3 ,subchapter ,,viii--,specialty ,education ,loan ,repayment ,program #gfia4 ,establishment4 #gfib4 ,purpose4 #gfic4 ,eligibility2 preference2 covered costs4 #gfid4 ,specialty education loan repayment4 #gfie4 ,choice of location4 #gfif4 ,term of obligated service4 #gfig4 ,relationship to ,educational ,assistance ,program4 4 7c7 ,needs of the ,,vha ,in making determinations each year under section #gfib of title #ch1 ,united ,states ,code1 as enacted by subsection 7a71 the ,secretary of ,veterans ,affairs shall consider the anticipated needs of the ,veterans ,health ,administration during the period two to six years in the future4 7d7 ,offer deadline ,in the case of an applicant who applies before receiving a residency match and whom the ,secretary of ,veterans ,affairs selects for participation in the ,specialty ,education ,loan ,repayment ,program established by subsection 7a71 the ,secretary shall offer participation to the applicant not later than #bh days after-- 7#a7 the applicant matches with a residency in a medical specialty described in section #gfib of title #ch1 ,united ,states ,code1 as enacted by subsection 7a72 and 7#b7 such match is published4 7e7 ,publicity ,the ,secretary of ,veterans ,affairs shall take such steps as the ,secretary determines are appropriate to publicize the ,specialty ,education ,loan ,repayment ,program established under subchapter ,,viii of chapter #gf of title #ch1 ,united ,states ,code1 as enacted by subsection 7a74 #cjc4 ,veterans healing veterans medical access and scholarship program 7a7 ,establishment ,the ,secretary of ,veterans ,affairs1 acting through the ,office of ,academic ,affiliations of the ,department of ,veterans ,affairs1 shall carry out a pilot program under which the ,secretary shall provide funding for the medical education of a total of #ah eligible veterans4 ,such funding shall be provided for two veterans enrolled in each covered medical schools in accordance with this section4 7b7 ,eligible veterans ,to be eligible to receive funding for medical education under this section1 a veteran shall-- 7#a7 have been discharged from the ,armed ,forces not more than ten years before the date of application for admission to a covered medical school2 7#b7 not be entitled to educational assistance under chapter #cj1 #ca1 #cb1 #cc1 #cd1 or #ce of title #ch1 ,united ,states ,code1 or chapter #afjf or #afjg of title #aj1 ,united ,states ,code2 7#c7 apply for admission to a covered medical school for the entering class of #bjai2 7#d7 indicate on such application for admission that the veteran would like to be considered for an award of funding under this section2 7#e7 meet the minimum admissions criteria for the covered medical school to which the veteran applies2 and 7#f7 enter into an agreement described in subsection 7e74 7c7 ,award of funding 7#a7 ,in general ,each covered medical school that opts to participate in the program under this section shall reserve two seats in the entering class of #bjai for eligible veterans who receive funding under such program4 ,such funding shall be awarded to the two eligible veterans with the highest admissions rankings for such class at such school4 7#b7 ,amount of funding ,each eligible veteran who receives funding under this section shall receive an amount equal to the actual cost of-- 7,a7 tuition at the covered medical school at which the veteran enrolls for four years2 7,b7 books1 fees1 and technical equipment2 7,c7 fees associated with the ,national ,residency ,match ,program2 7,d7 two away rotations performed during the fourth year at a ,department of ,veterans ,affairs medical facility2 and 7,e7 a monthly stipend for the four-year period during which the veteran is enrolled in medical school in an amount to be determined by the ,secretary4 7#c7 ,distribution of funding ,in the event that two or more eligible veterans do not apply for admission at one of the covered medical schools for the entering class of #bjai1 the ,secretary shall distribute the available funding to eligible veterans who applied for admission at other covered medical schools4 7d7 ,agreement 7#a7 ,terms of agreement ,each eligible veteran who accepts funding for medical education under this section shall enter into an agreement with the ,secretary that provides that the veteran agrees-- 7,a7 to maintain enrollment and attendance in the medical school2 7,b7 while enrolled in such medical school1 to maintain an acceptable level of academic standing 7as determined by the medical school under regulations prescribed by the ,secretary72 7,c7 to complete post-graduate training leading to eligibility for board certification in a speciality applicable to the ,department of ,veterans ,affairs1 as determined by the ,secretary2 7,d7 after completion of medical school1 to obtain a license to practice medicine in a ,state2 and 7,e7 after completion of medical school and post-graduate training1 to serve as a full-time clinical practice employee in the ,veterans ,health ,administration for a period of four years4 7#b7 ,breach of agreement ,if an eligible veteran who accepts funding under this section breaches the terms of the agreement described in paragraph 7#a71 the ,united ,states shall be entitled to recover damages in an amount equal to the total amount of such funding received by the veteran4 7e7 ,rule of construction ,nothing in this section shall be construed to prevent any covered medical school from accepting more than two eligible veterans for the entering class of #bjai4 7f7 ,report to ,congress ,not later than ,december #ca1 #bjbj1 and annually thereafter for the subsequent three years1 the ,secretary shall submit to ,congress a report on the pilot program under this section4 ,such report shall include the evaluation of the ,secretary of the success of the pilot program1 including the number of veterans who received funding under the program who matriculated and an evaluation of the academic progress of such veterans4 7g7 ,covered medical schools ,in this section1 the term covered medical school means any of the following4 7#a7 ,the ,teague-,cranston medical schools1 consisting of-- 7,a7 ,texas ,a,m ,college of ,medicine2 7,b7 ,quillen ,college of ,medicine at ,east ,tennessee ,state ,university2 7,c7 ,boonshoft ,school of ,medicine at ,wright ,state ,university2 7,d7 ,joan ,c4 ,edwards ,school of ,medicine at ,marshall ,university2 and 7,e7 ,university of ,south ,carolina ,school of ,medicine4 7#b7 ,charles ,r ,drew ,university of ,medicine and ,science4 7#c7 ,howard ,university ,college of ,medicine4 7#d7 ,meharry ,medical ,college4 7#e7 ,morehouse ,school of ,medicine4 ,march #e1 #bjah,reported with an amendment1 committed to the ,committee of the ,whole ,house on the ,state of the ,union1 and ordered to be printed