,,ii #aae? ,,congress #a/ ,session ,s4 #bahd ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,decemb] #a1 #bjag ,mr4 ,mc,cain 7= himself & ,mr4 ,moran7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,vet]ans' ,affairs ,a ,,bill ,to am5d title #ch1 ,unit$ ,/ates ,code1 to improve vet]ans' heal? c>e b5efits1 & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,vet]ans ,community ,c>e & ,access ,act ( #bjag4 7b7 ,table ( cont5ts ,! table ( cont5ts = ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4 ,sec4 #b4 ,ref]5ces to title #ch1 ,unit$ ,/ates ,code4 ,,title ,i--,develop+ an integrat$ high-p]=m+ network ,subtitle ,a--,e/abli%+ ! ,vet]ans ,community ,c>e ,program ,sec4 #aja4 ,e/abli%m5t ( ,vet]ans ,community ,c>e ,program4 ,sec4 #ajb4 ,/rategy reg>d+ ! ,high ,p]=m+ ,integrat$ ,heal?c>e ,network ( ! ,dep>tm5t4 ,sec4 #ajc4 ,access /&>ds & /&>ds = quality4 ,subtitle ,b--,=m+ p>tn]%ips & agreem5ts ,sec4 #aaa4 ,cont9uity ( c>e & exi/+ agreem5ts4 ,sec4 #aab4 ,au?orization ( agreem5ts betwe5 ,dep>tm5t ( ,vet]ans ,affairs & non-,dep>tm5t provid]s4 ,sec4 #aac4 ,prev5tion ( c]ta9 heal? c>e provid]s f provid+ non-,dep>tm5t heal? c>e s]vices to vet]ans4 ,sec4 #aad4 ,con=m+ am5dm5ts = ,/ate vet]ans homes4 ,subtitle ,c--,pay+ provid]s ,sec4 #aba4 ,prompt paym5t to provid]s4 ,sec4 #abb4 ,paym5t rates = community c>e4 ,sec4 #abc4 ,au?ority to pay = au?oriz$ c>e n subject to an agreem5t4 ,,title ,,ii--,/reaml9+ community c>e programs ,subtitle ,a--,/reaml9+ community c>e programs ,sec4 #bja4 ,access to walk-9 c>e4 ,sec4 #bjb4 ,vet]ans ,*oice ,fund flexibility4 ,sec4 #bjc4 ,con=m+ am5dm5ts4 ,subtitle ,b--,improv+ in=mation %>+ ) provid]s ,sec4 #baa4 ,improv+ in=mation %>+ ) community provid]s4 ,sec4 #bab4 ,e/abli%m5t ( processes to ensure safe opioid prescrib+ practices by non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e provid]s4 ,subtitle ,c--,improv+ collections ,sec4 #bba4 ,align+ ) be/ practices on collection ( heal? insurance in=mation4 ,sec4 #bbb4 ,improv+ au?ority to collect4 ,,title ,,iii--,improv+ ,dep>tm5t ( ,vet]ans ,affairs c>e deliv]y ,subtitle ,a--,improv+ p]sonnel practices ,sec4 #cja4 ,lic5sure ( heal? c>e pr(essionals ( ! ,dep>tm5t ( ,vet]ans ,affairs provid+ treatm5t via telem$ic9e4 ,sec4 #cjb4 ,graduate m$ical education & resid5cy4 ,sec4 #cjc4 ,annual report on aw>ds or bonuses aw>d$ to c]ta9 high-level employees ( ! dep>tm5t ( vet]ans affairs4 ,subtitle ,b--,facilities1 con/ruction1 & leases ,sec4 #caa4 ,facilitat+ %>+ ( m$ical facilities ) o!r ,f$]al ag5cies4 ,sec4 #cab4 ,review ( enhanc$ use leases4 ,,title ,,iv--,innovative pilot programs ,sec4 #dja4 ,pilot program to e/abli% or affiliate ) graduate m$ical resid5cy programs at facilities op]at$ by ,indian tribes1 tribal organizations1 & ! ,indian ,heal? ,s]vice 9 rural areas4 ,sec4 #djb4 ,au?ority = ,dep>tm5t ( ,vet]ans ,affairs ,c5t] = ,innovation = ,c>e & ,paym5t4 ,,title ,v--,o!r heal? c>e matt]s ,sec4 #eja4 ,au?orization ( appropriations = heal? c>e f ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #ejb4 ,appropriation ( am\nts = ,vet]ans ,*oice ,program4 ,sec4 #ejc4 ,applicability ( ,directive ( ,(fice ( ,f$]al ,contract ,compliance ,programs4 ,sec4 #ejd4 ,am5d+ /atutory requirem5ts = ! position ( ! ,*ief ,(fic] ( ! ,readju/m5t ,c\nsel+ ,s]vice4 ,sec4 #eje4 ,au?orization ( c]ta9 major m$ical facility projects ( ! ,dep>tm5t ( ,vet]ans ,affairs4 #b4 ,ref]5ces to title #ch1 ,unit$ ,/ates ,code ,except z o!rwise expressly provid$1 :5ev] 9 ?is ,act an am5dm5t or repeal is express$ 9 t]ms ( an am5dm5t to1 or repeal (1 a section or o!r provision1 ! ref]5ce %all be consid]$ to be made to a section or o!r provision ( title #ch1 ,unit$ ,/ates ,code4 ,i ,develop+ an integrat$ high-p]=m+ network ,a ,e/abli%+ ! ,vet]ans ,community ,c>e ,program #aja4 ,e/abli%m5t ( ,vet]ans ,community ,c>e ,program 7a7 ,e/abli%m5t 7#a7 ,9 g5]al ,section #agjc is am5d$ to read z foll[s3 #agjc4 ,vet]ans ,community ,c>e ,program 7a7 ,9 g5]al 7#a7 ,subject to ! availability ( appropriations = su* purpose & subject to p>agraph 7#d71 hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices "u ?is *apt] %all be furni%$ to a cov]$ vet]an describ$ 9 subsection 7b7 by heal? c>e provid]s specifi$ 9 subsection 7c7 9 accordance ) ?is section4 7#b7 ,! furni%+ ( c>e & s]vices "u ?is section may be ref]r$ to z ! ,vet]ans ,community ,c>e ,program4 7#c7 7,a7 ,9 c>ry+ out ?is section1 ! ,secret>y may develop categories ( c]ta9 heal? c>e provid]s specifi$ 9 subsection 7c7 = ! purpose ( provid+ a cov]$ vet]an hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices :5 ! cov]$ vet]an does n /ate a pref]5ce = a heal? c>e provid]4 7,b7 ,9 develop+ categories ( heal? c>e provid]s "u subp>agraph 7,a71 ! ,secret>y %all n-- 7i7 prioritize or rank su* categories 9 a mann] t limits ! options a cov]$ vet]an may h 9 select+ a heal? c>e provid] specifi$ 9 subsection 7c72 or 7ii7 direct a cov]$ vet]an to receive c>e or s]vices f c]ta9 heal? c>e provid]s in/ead ( o!r heal? c>e provid]s4 7#d7 ,9 c>ry+ out ?is section1 ! ,secret>y %all n limit any hospital c>e1 m$ical s]vice1 ext5d$ c>e s]vice1 or class ( hospital c>e1 m$ical s]vice1 or ext5d$ c>e s]vice t are set =? 9 ! ,m$ical ,b5efits ,package ( ! ,dep>tm5t1 z modifi$ z det]m9$ by ! ,secret>y4 7b7 ,cov]$ vet]ans ,= purposes ( ?is section1 a cov]$ vet]an is any vet]an :o-- 7#a7 7,a7 is enroll$ 9 ! pati5t enrollm5t sy/em ( ! ,dep>tm5t e/abli%$ & op]at$ "u section #agje ( ?is title2 or 7,b7 is n enroll$ 9 su* sy/em b is o!rwise entitl$ to hospital c>e1 a m$ical s]vice1 or an ext5d$ c>e s]vice "u subsection 7c77#b7 ( su* section2 & 7#b7 7,a7 has be5 furni%$ hospital c>e or m$ical s]vices "u ?is *apt] on at lea/ "o occasion dur+ ! prec$+ two-ye> p]iod2 or 7,b7 reque/$ a fir/-"t appo9tm5t = hospital c>e or m$ical s]vices at a ,dep>tm5t facility4 7c7 ,heal? c>e provid]s specifi$ ,heal? c>e provid]s specifi$ 9 ?is subsection are ! foll[+3 7#a7 ,any heal? c>e provid] t is p>ticipat+ 9 ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 includ+ any physician furni%+ s]vices "u su* a program4 7#b7 ,! ,dep>tm5t ( ,def5se4 7#c7 ,! ,indian ,heal? ,s]vice4 7#d7 ,any ,f$]ally-qualifi$ heal? c5t] 7z def9$ 9 section #aije7l77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7774 7#e7 ,any heal? c>e provid] n o!rwise cov]$ "u any ( p>agraphs 7#a7 ?r\gh 7#d7 t meets crit]ia e/abli%$ by ! ,secret>y = purposes ( ?is section4 7d7 ,contracts ,to e/abli% networks ( heal? c>e provid]s 7#a7 ,! ,secret>y %all ent] into consolidat$1 competitively bid contracts1 :i* may be regional contracts1 to e/abli% networks ( non-,dep>tm5t heal? c>e provid]s specifi$ 9 p>agraphs 7#a7 & 7#e7 ( subsection 7c7 = contract purposes (-- 7,a7 provid+ suffici5t access to hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices "u ?is section2 7,b7 manag+ ! op]ations ( su* heal? c>e provid]s2 & 7,c7 manag+ ! deliv]y ( hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices "u ?is section4 7#b7 ,! ,secret>y may t]m9ate a contract ) an entity ent]$ into "u p>agraph 7#a7 at su* "t & ^u su* notice to ! entity z ! ,secret>y may specify = purposes ( ?is section4 7#c7 7,a7 ,:5ev] ! ,secret>y provides notice to an entity "u p>agraph 7#b7 t ! entity is fail+ to meet contractual obligations ent]$ into "u p>agraph 7#a71 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report on su* failure & ! decision ( ! ,secret>y to t]m9ate ! contract "u p>agraph 7#b74 7,b7 ,ea* report submitt$ "u subp>agraph 7,a7 %all include ! foll[+3 7i7 ,an explanation ( ! reasons = t]m9at+ ! contract4 7ii7 ,a description ( ! effect ( ! failure ( ! entity to meet contractual obligations & ! t]m9ation ( ! contract1 includ+ ) respect to co/1 s*$ule1 & requirem5ts4 7iii7 ,a description ( ! actions tak5 by ! ,secret>y to mitigate su* failure & t]m9ation4 7e7 ,coord9ation ( c>e & s]vices 7#a7 ,! ,secret>y %all ensure t = ea* cov]$ vet]an seek+ c>e or s]vices "u ?is section1 a c>e coord9ation team is provid$ by a m$ical facility ( ! ,dep>tm5t4 7#b7 ,! ,secret>y %all ensure t ea* c>e coord9ation team provid$ "u ?is section1 ) respect to a cov]$ vet]an1 is responsible = ! foll[+3 7,a7 ,coord9ation & managem5t ( hospital c>e1 m$ical s]vices 7includ+ telem$ic9e71 & ext5d$ c>e s]vices furni%$ "u ?is title1 includ+ ! foll[+3 7i7 ,collaboration ) ! pati5t align$ c>e teams 7,,pact7 )9 ! m$ical facility ( ! ,dep>tm5t2 & 7ii7 ,coord9ation )9 & across ,vet]ans ,integrat$ ,s]vice ,networks ) non-,dep>tm5t heal? c>e provid]s act+ "u a contract or agreem5t to furni% hospital c>e1 a m$ical s]vice1 or an ext5d$ c>e s]vice on behalf ( ! ,dep>tm5t & :o meets su* t]ms & conditions z ! ,secret>y may require4 7,b7 ,ensure cont9uity ( c>e = ! cov]$ vet]an to avoid any delay or lapse 9 c>e or s]vices f an action or error ( ! ,dep>tm5t or any individual ( ! c>e coord9ation team ( ! cov]$ vet]an4 7,c7 ,submitt+ in=mation to ! ,secret>y 9 fur!rance ( analysis conduct$ "u section #agcj;,b7a7 ( ?is title4 7#c7 ,! ,secret>y %all develop an organizational con/ruct = c>e coord9ation teams at m$ical facilities ( ! ,dep>tm5t t may include ! foll[+ individuals3 7,a7 ,an employee ( ! ,dep>tm5t :o furni%es hospital c>e1 a m$ical s]vice1 or an ext5d$ c>e s]vice at ! facility4 7,b7 ,a non-,dep>tm5t heal? c>e provid] act+ "u a contract or agreem5t to furni% hospital c>e1 a m$ical s]vice1 or an ext5d$ c>e s]vice on behalf ( ! ,dep>tm5t & :o meets su* t]ms & conditions z ! ,secret>y may require4 7,c7 ,an employee ( ! ,dep>tm5t or a heal? c>e provid] describ$ 9 subp>agraph 7,b7 :o s]ves to seamlessly coord9ate ! deliv]y ( hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices to cov]$ vet]ans4 7f7 ,eligibility re=m & conditions t require access to community c>e 7#a7 ,subject to ! availability ( appropriations1 ! ,secret>y %all furni% hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices to a cov]$ vet]an1 at ! election ( a cov]$ vet]an1 ?r\gh heal? c>e provid]s specifi$ 9 subsection 7c7 z foll[s3 7,a7 ,:5 a m$ical facility ( ! ,dep>tm5t does n (f] ! hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices ! cov]$ vet]an requires4 7,b7 ,:5 a m$ical facility ( ! ,dep>tm5t _c furni% or s*$ule an appo9tm5t = hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices 9 accordance ) access /&>ds e/abli%$ "u section #agjc;,b ( ?is title4 7,c7 ,:5 ! cov]$ vet]an & a ref]r+ cl9ician ( ! cov]$ vet]an agree t furni%+ hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices ?r\gh a non-,dep>tm5t entity or provid] w\ld be 9 ! be/ m$ical int]e/ ( ! cov]$ vet]an1 aft] consid]ation ( ! /&>ds e/abli%$ "u sections #agjc;,b & #agjc;,c ( ?is title or due to a non-cl9ical reason1 compell+ circum/ance1 or o!r consid]ations t are 9 ! be/ m$ical int]e/ ( ! cov]$ vet]an4 7#b7 ,n lat] ?an #abj days aft] ! date ( ! enactm5t ( ! ,vet]ans ,community ,c>e & ,access ,act ( #bjag1 ! ,secret>y %all submit to ! appropriate committees ( ,congress a report describ+ ! guidel9es & /&>ds ! ,secret>y int5ds to use to c>ry out p>agraph 7#a7 9 accordance ) sections #agjc;,b & #agjc;,c ( ?is title4 7g7 ,s*$ul+ s]vices 7#a7 ,! ,secret>y %all ensure t s]vices are e/abli%$ 9 ord] to s*$ule appo9tm5ts = hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices "u ?is *apt]4 7#b7 7,a7 ,9 c>ry+ out p>agraph 7#a71 ! ,secret>y %all det]m9e :e!r s]vices e/abli%$ "u su* p>agraph %\ld reside )9 ! respective m$ical facility ( ! ,dep>tm5t or reside ) an entity ) :om ! ,secret>y ent]s into a contract = su* s]vices4 7,b7 ,9 c>ry+ out subp>agraph 7,a71 ! ,secret>y %all assess ! foll[+3 7i7 ,:e!r a m$ical facility ( ! ,dep>tm5t is curr5tly manag+ s*$ul+ s]vices & ! ,secret>y det]m9es su* m$ical facility has ! capability to cont9ue to manage s*$ul+4 7ii7 ,:e!r a m$ical facility ( ! ,dep>tm5t has ! capacity to manage s*$ul+ s]vices bas$ on ! foll[+3 7,i7 ,an initial review ( ! m$ical facility to acquire s*$ul+ s]vice responsibilities & ! pref]5ce ( ! m$ical facility to acquire su* responsibilities4 7,,ii7 ,! m>ket area assessm5t curr5tly und]way pursuant to section #agcj;,b7c7 ( ?is title4 7,,iii7 ,! capacity ( ! m$ical facility to p]=m s*$ul+ s]vices t meet /&>ds e/abli%$ "u sections #agjc;,b & #agjc;,c ( ?is title4 7iii7 ,:e!r "o or m contracts 7 9 effect on ! day be=e ! date ( ! enactm5t ( ! ,vet]ans ,community ,c>e & ,access ,act ( #bjag t include s*$ul+ s]vices1 z det]m9$ by ! ,secret>y1 & may be modifi$ by ! ,secret>y = s]vices "u ?is subsection4 7h7 ,def9itions ,9 ?is section3 7#a7 ,! t]m appropriate committees ( ,congress means-- 7,a7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,s5ate2 & 7,b7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives4 7#b7 ,! t]m cl9ician has ! mean+ giv5 t t]m by ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices & includes ,doctors ( ,m$ic9e 7,,md71 ,doctors ( ,o/eopa?y 7,,d71 ,doctors ( ,d5tal ,surg]y or ,d5tal ,m$ic9e 7,,dmd_/,,dds71 ,doctors ( ,podiatry1 ,doctors ( ,optometry1 ,*iropractors1 ,physician ,assi/ants 7,,pa71 ,nurse ,practition]s 7,,np71 ,cl9ical ,nurse ,speciali/s1 ,c]tifi$ ,regi/]$ ,nurse ,ane/heti/s1 & su* o!r heal? pr(essionals z ! ,secret>y may specify = purposes ( ?is section4 7#c7 ,! t]m m$ical facility ( ! ,dep>tm5t includes a m$ical c5t]1 a community-bas$ outpati5t cl9ic1 an outpati5t cl9ic1 or any o!r facility ( ! ,dep>tm5t at :i* hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices are furni%$4 4 7#b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #ag ( su* title is am5d$ by /rik+ ! item relat+ to section #agjc & ins]t+ ! foll[+ new item3 #agjc4 ,vet]ans ,community ,c>e ,program4 4 7b7 ,regulations ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all promulgate regulations to c>ry out section #agjc ( title #ch1 ,unit$ ,/ates ,code1 z am5d$ by subsection 7a74 7c7 ,effective date ,! am5dm5ts made by subsection 7a7 %all take effect on ! date t ! ,secret>y promulgates regulations "u subsection 7b74 #ajb4 ,/rategy reg>d+ ! ,high ,p]=m+ ,integrat$ ,heal?c>e ,network ( ! ,dep>tm5t 7a7 ,9 g5]al ,sub*apt] ,,iii ( *apt] #ag is am5d$ by ins]t+ aft] section #agcj;,a ! foll[+ new section3 #agcj;,b4 ,quadr5nial ,vet]ans ,heal? ,adm9i/ration review1 managem5t ( high-p]=m+ integrat$ heal?c>e network1 & m>ket area assessm5ts 7a7 ,quadr5nial ,vet]ans ,heal? ,adm9i/ration review 7#a7 ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ! ,vet]ans ,community ,c>e & ,access ,act ( #bjag & n less frequ5tly ?an once e f\r ye>s !reaft]1 ! ,secret>y %all conduct a compreh5sive exam9ation 7to be kn[n z a quadr5nial ,vet]ans ,heal? ,adm9i/ration review7 ( programs & policies ( ! ,dep>tm5t reg>d+ ! deliv]y ( heal? c>e s]vices & ! ne$ = heal? c>e s]vices = vet]ans 9 future ye>s4 7#b7 ,! ,secret>y %all designate an individual 9 a ,s5ior ,executive ,s]vice position 7z def9$ 9 section #cacb7;a7 ( title #e7 or equival5t z ! ,director ( ! ,high-,p]=m+ ,integrat$ ,heal?c>e ,network ( ! ,dep>tm5t 79 ?is section ref]r$ to z ! ,director7 :o %all be responsible = c>ry+ out ?is section & advis+ ! ,secret>y & ! ,"u ,secret>y = ,heal? on matt]s p]ta9+ to ?is section4 7#c7 ,ea* quadr5nial ,vet]ans ,heal? ,adm9i/ration review conduct$ "u p>agraph 7#a7 %all include a /rategic plan to meet future requirem5ts & dem& = hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices "u ! laws adm9i/]$ by ! ,secret>y t includes a five-ye> budget =eca/ = meet+ su* requirem5ts & dem& bas$ on ! in=mation conta9$ 9 ! m>ket area assessm5ts conduct$ "u subsection 7c7 & su* o!r in=mation z ! ,secret>y consid]s appropriate4 7#d7 ,9 prep>+ ! quadr5nial ,vet]ans ,heal? ,adm9i/ration review "u p>agraph 7#a71 includ+ ! /rategic plan "u p>agraph 7#c71 ! ,secret>y %all-- 7,a7 consid] ! access & quality /&>ds e/abli%$ "u sections #agjc;,b & #agjc;,c ( ?is title1 respectively2 7,b7 consid] ! ne$s ( ! ,dep>tm5t to furni% heal? c>e s]vices to vet]ans bas$ on-- 7i7 id5tifi$ heal? c>e s]vices t provide managem5t ( heal? conditions or disord]s relat$ to milit>y s]vice = :i* !re is limit$ exp]i5ce or access to su* heal? c>e s]vices f non-,dep>tm5t heal? c>e provid]s 9 ! comm]cial m>ket2 7ii7 ! ov]all heal? ( vet]ans ?r\gh\t _! lifespan2 or 7iii7 su* o!r s]vices z ! ,secret>y det]m9es appropriate2 7,c7 consult ) key /akehold]s )9 ! ,dep>tm5t1 ! heads ( o!r ,f$]al ag5cies1 & o!r relevant gov]nm5tal & nongov]nm5tal entities1 includ+ ,/ate1 local1 & tribal gov]nm5t (ficials1 memb]s ( ,congress1 vet]ans s]vice organizations1 private sector repres5tatives1 academics1 & o!r policy exp]ts2 7,d7 id5tify em]g+ issues1 tr5ds1 problems1 & opportunities t c\ld affect heal? c>e s]vices furni%$ "u ! laws adm9i/]$ by ! ,secret>y2 7,e7 develop recomm5dations reg>d+ bo? %ort- & long-t]m priorities = heal? c>e s]vices furni%$ "u ! laws adm9i/]$ by ! ,secret>y2 7,f7 comp>e ! ,vet]ans ,equitable ,res\rce ,allocation 7,,v]a7 sy/em to o!r res\rce allocation sy/ems or models = ! purpose ( analyz+ ! effectiv5ess ( su* sy/ems 9 allocat+ res\rces to furni% hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices to vet]ans2 & 7,g7 consid] ! "w ( ! ,c5t] = ,innovation = ,c>e & ,paym5t "u section #agjc;,f ( ?is title ) respect to rese>*1 developm5t1 & te/+ paym5t & s]vice deliv]y models4 7b7 ,managem5t ( high-,p]=m+ integrat$ heal?c>e network 7#a7 ,! ,director %all be responsible = ! managem5t1 design1 implem5tation1 & assessm5t ( ! high-p]=m+ integrat$ heal?c>e network ( ! ,dep>tm5t4 7#b7 ,9 manag+1 design+1 implem5t+1 & assess+ ! high-p]=m+ integrat$ heal?c>e network ( ! ,dep>tm5t "u ?is subsection1 ! ,director %all be responsible = ! foll[+3 7,a7 ,ov]see+ ! trans=mation & organizational *ange across ! ,dep>tm5t to a*ieve su* high-p]=m+ integrat$ heal?c>e network4 7,b7 ,develop+ & implem5t+ ! quadr5nial ,vet]ans ,heal? ,adm9i/ration review & /rategic plan "u subsection 7a74 7,c7 ,ov]see+ ! m>ket area assessm5ts p]=m$ "u subsection 7c74 7,d7 ,develop+ ! capital infra/ructure plann+ & procurem5t processes1 :e!r m9or or major con/ruction projects or leases1 9 coord9ation ) o!r (fices ( ! ,dep>tm5t4 7,e7 ,develop+ a multi-ye> budget process t is capable ( =eca/+ future ye> budget requirem5ts & project+ ! co/ ( deliv]+ heal? c>e s]vices "u a high-p]=m+ integrat$ heal?c>e network4 7#c7 ,to ensure t ! ,director is able to c>ry out ! responsibilities "u p>agraph 7#b71 ! ,secret>y %all ensure t coord9ation & in=mation %>+ occurs ) o!r relevant (fices ( ! ,dep>tm5t1 includ+ ! foll[+ (fices3 7,a7 ,! ,(fice ( ,managem5t4 7,b7 ,! ,(fice ( ,acquisition1 ,logi/ics & ,con/ruction4 7,c7 ,! ,(fice ( ,in=mation & ,te*nology4 7#d7 ,9 c>ry+ out ?is subsection1 ! ,director %all conf] ) ! ,director ( ! ,def5se ,heal? ,ag5cy & consid] be/ practices & recomm5dations f non-,dep>tm5t entities1 includ+ entities c>ry+ out m>ket area assessm5ts "u subsection 7c71 t h develop$ plans1 implem5t$ sy/ems1 or advis$ o!r heal?c>e sy/ems4 7#e7 7,a7 ,n less frequ5tly ?an once e ?ree mon?s1 ! ,secret>y or ! ,director %all brief ! appropriate committees ( ,congress on ! activities conduct$ "u ?is subsection4 7,b7 ,ea* brief+ conduct$ "u subp>agraph 7,a7 %all include ! foll[+3 7i7 ,an assessm5t ( any rem$iation or improvem5t conduct$ by ! ,dep>tm5t ) respect to a m$ical s]vice l9e ( ! ,dep>tm5t t ! ,secret>y has det]m9$ does n meet an access /&>d or /&>d = quality e/abli%$ "u section #agjc;,b or #agjc;,c ( ?is title1 respectively1 9 provid+ hospital c>e1 a m$ical s]vice1 or an ext5d$ c>e s]vice1 includ+ ! foll[+3 7,i7 ,an assessm5t ( ! factors t l$ ! ,secret>y to make su* det]m9ation4 7,,ii7 ,an assessm5t ( ! m$ical s]vice l9e 9 relation to ! m>ket area assessm5t mo/ rec5tly p]=m$ "u subsection 7c71 p>ticul>ly ) respect to h[ x relates to ! dem& = ! m$ical s]vice l9e 9 ! area & by vet]ans us+ a m$ical facility ( ! ,dep>tm5t = su* m$ical s]vice l9e4 7,,iii7 ,a plan ) specific actions1 & ! "t to complete !m1 to meet ! access /&>ds & /&>ds = quality e/abli%$ "u sections #agjc;,b & #agjc;,c ( ?is title1 respectively1 :i* %all include consid]ation (-- 7aa7 increas+ p]sonnel or tempor>y p]sonnel assi/ance1 includ+ mobile deploym5t teams2 7bb7 special hir+ inc5tives1 includ+ ! ,education ,debt ,r$uction ,program "u sub*apt] ,,vii ( *apt] #gf ( ?is title & recruitm5t1 relocation1 & ret5tion inc5tives2 7cc7 us+ direct hir+ au?ority2 7dd7 provid+ improv$ tra9+ opportunities = /aff2 7ee7 acquir+ improv$ equipm5t2 7ff7 mak+ /ructural modifications to ! facility us$ by ! m$ical s]vice l9e2 7gg7 p>tn]+ ) heal? c>e provid]s t h ! capacity to meet ! dem& 9 ! m>ket area & meet access & quality /&>ds e/abli%$ "u sections #agjc;,b & #agjc;,c ( ?is title2 & 7hh7 su* o!r actions z ! ,secret>y consid]s appropriate4 7ii7 ,an assessm5t ( ! progress made by ! ,dep>tm5t ) respect to ! responsibilities ( ! ,director "u p>agraph 7#b74 7c7 ,m>ket area assessm5ts 7#a7 ,n less frequ5tly ?an once e f\r ye>s1 ! ,secret>y %all p]=m m>ket area assessm5ts reg>d+ ! heal? c>e s]vices furni%$ "u ! laws adm9i/]$ by ! ,secret>y4 7#b7 ,ea* m>ket area assessm5t p]=m$ "u p>agraph 7#a7 %all include ! foll[+3 7,a7 ,an assessm5t ( ! dem& = hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices f ! ,dep>tm5t1 disaggregat$ by geographic m>ket areas t are consi/5t ) indu/ry m>ket areas or b\nd>ies1 includ+ ! numb] ( reque/s = su* c>e & s]vices "u ! laws adm9i/]$ by ! ,secret>y4 7,b7 ,an inv5tory ( ! heal? c>e capacity ( ! ,dep>tm5t across ! facilities ( ! ,dep>tm5t4 7,c7 ,an assessm5t ( ! heal? c>e capacity to be provid$ ?r\gh contract$ community c>e provid]s & provid]s :o ent]$ into a provid] agreem5t ) ! ,dep>tm5t "u section #agjc;,a ( ?is title1 includ+ ! numb] ( provid]s1 ! geographic location ( ! provid]s1 & categories or types ( heal? c>e s]vices provid$ by ! provid]s4 7,d7 ,an assessm5t obta9$ f o!r ,f$]al direct deliv]y sy/ems ( _! capacity to provide heal? c>e to vet]ans4 7,e7 ,an assessm5t ( ! heal? c>e capacity ( non-contract$ provid]s :]e !re is insuffici5t network supply4 7,f7 ,an assessm5t ( ! heal? c>e capacity ( academic affiliates & o!r collaborations ( ! ,dep>tm5t z x relates to provid+ heal? c>e to vet]ans4 7,g7 ,an assessm5t ( ! effects on heal? c>e capacity by ! access & quality /&>ds e/abli%$ "u sections #agjc;,b & #agjc;,c ( ?is title1 respectively4 7,h7 ,! numb] ( appo9tm5ts = heal? c>e s]vices "u ! laws adm9i/]$ by ! ,secret>y1 disaggregat$ by-- 7i7 appo9tm5ts at facilities ( ! ,dep>tm5t2 & 7ii7 appo9tm5ts ) non-,dep>tm5t heal? c>e provid]s4 7,i7 ,analysis ( in=mation submitt$ f c>e coord9ation teams "u section #agjc7;e77#b77;,d7 ( ?is title f ea* ,dep>tm5t m$ical facility t includes ! foll[+3 7i7 ,an analysis ( coord9ation & managem5t be/ practices4 7ii7 ,satisfaction survey data f ! cov]$ vet]ans f ea* c>e coord9ation team "u section #agjc7;e7 ( ?is title4 7iii7 ,f9d+s & det]m9ations relat$ to ! coord9ation ( c>e "u section #agjc7;e7 ( ?is title to assi/ ! ,director 9 ! design1 implem5tation1 & assessm5t ( ! high-p]=m+ integrat$ heal?c>e network ( ! ,dep>tm5t4 7iv7 ,a /&>diz$ climate survey develop$ jo9tly ) ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ,alliance to ,mod]nize ,heal?c>e 7,,camh7 = ! employees ( ea* m$ical facility ( ! ,dep>tm5t t compiles data on culture1 communication1 teamwork1 quality ( worklife1 rew>ds or recognition1 lead]%ip1 & productivity4 7#c7 ,! ,secret>y %all submit to ! appropriate committees ( ,congress ea* m>ket area assessm5t p]=m$ "u p>agraph 7#a7 & ! complete m>ket area assessm5t be+ p]=m$ on ! day be=e ! date ( ! enactm5t ( ! ,vet]ans ,community ,c>e & ,access ,act ( #bjag 9 ! same =m z su* assessm5ts are deliv]$ to ! ,secret>y4 7#d7 ,! ,secret>y %all use ! m>ket area assessm5ts p]=m$ "u p>agraph 7#a7 to in=m ! quadr5nial ,vet]ans ,heal? ,adm9i/ration review & /rategic plan "u subsection 7a7 & to det]m9e ! capacity ( ! ,dep>tm5t & ! capacity ( ! heal? c>e provid] networks e/abli%$ "u section #agjc7;d7 ( ?is title4 7#e7 ,! ,secret>y %all publi% ! capacity f9d+s & results f ! m>ket area assessm5ts p]=m$ "u p>agraph 7#a7 ) respect to ! ,dep>tm5t & heal? c>e provid] networks e/abli%$ "u section #agjc7;d7 ( ?is title on a publicly accessible ,int]net website ( ! ,dep>tm5t4 7d7 ,dep>tm5t budget ,! ,secret>y %all ensure t ! budget reque/ ( ! ,dep>tm5t = any fiscal ye> 7z submitt$ ) ! budget ( ! ,presid5t "u section #aaje7;a7 ( title #ca7 reflects ! f9d+s ( ! ,secret>y ) respect to ! mo/ rec5t in=mation describ$ 9 subsection 7b77#e7 & is consi/5t ) ! quadr5nial ,vet]ans ,heal? ,adm9i/ration review & /rategic plan "u subsection 7a74 7e7 ,appropriate committees ( ,congress def9$ ,9 ?is section1 ! t]m appropriate committees ( ,congress means-- 7#a7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,s5ate2 & 7#b7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #ag is am5d$ by ins]t+ aft] ! item relat+ to section #agcj;,a ! foll[+ new item3 #agcj;,b4 ,quadr5nial ,vet]ans ,heal? ,adm9i/ration review1 managem5t ( high-p]=m+ integrat$ heal?c>e network1 & m>ket area assessm5ts4 4 7c7 ,waiv] ( c]ta9 requirem5ts = m>ket assessm5t 9 progress ,p>agraph 7#b7 ( section #agcj;,b7c7 ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a71 %all n apply to a m>ket area assessm5t t 0 be+ p]=m$ by ! ,secret>y ( ,vet]ans ,affairs on ! day be=e ! date ( ! enactm5t ( ?is ,act4 #ajc4 ,access /&>ds & /&>ds = quality 7a7 ,9 g5]al ,sub*apt] ,i ( *apt] #ag is am5d$ by ins]t+ aft] section #agjc ! foll[+ new sections3 #agjc;,b4 ,access /&>ds 7a7 ,9 g5]al 7#a7 ,! ,secret>y %all e/abli% access /&>ds = hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices furni%$ by ! ,dep>tm5t1 includ+ ?r\gh heal? c>e provid]s "u section #agjc ( ?is title4 7#b7 ,! ,secret>y %all ensure t ! hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices furni%$ to a vet]an by ! ,dep>tm5t1 includ+ ?r\gh heal? c>e provid]s "u section #agjc ( ?is title1 is furni%$ )9 ! access /&>ds e/abli%$ "u p>agraph 7#a74 7#c7 ,! access /&>ds e/abli%$ "u p>agraph 7#a7 %all align ) ! categories ( hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices set =? "u subsection 7b7 & %all be in=m$ by ! m>ket area assessm5ts p]=m$ "u section #agcj;,b7c7 ( ?is title4 7b7 ,categories ( hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices furni%$ ,! categories ( hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices subject to access /&>ds e/abli%$ "u subsection 7a7 are z foll[s3 7#a7 ,prim>y c>e s]vices4 7#b7 ,specialty c>e s]vices1 includ+ s]vices t may require a ref]ral & s]vices t may be consid]$ wellness or prev5tative c>e4 7#c7 ,behavioral heal? s]vices1 includ+ m5tal heal? & sub/ance abuse disord] treatm5t4 7#d7 ,urg5t c>e4 7#e7 ,home heal? s]vices1 includ+ s]vices t may be virtual4 7#f7 ,d5tal s]vices4 7#g7 ,z det]m9$ by ! ,secret>y1 any additional types ( s]vices = :i* ! ,dep>tm5t or ! networks e/abli%$ "u section #agjc7;d7 ( ?is title h exp]i5c$ increas$ dem& accord+ to ! m>ket area assessm5ts p]=m$ "u section #agcj;,b7c7 ( ?is title or an increase 9 access compla9ts to network heal? c>e provid]s or ! ,dep>tm5t4 7c7 ,application 7#a7 ,! ,secret>y may e/abli% & apply access /&>ds "u subsection 7a7 accord+ to ! m>ket area assessm5ts "u section #agcj;,b7c7 ( ?is title4 7#b7 ,9 c>ry+ out section #agjc ( ?is title1 ! ,secret>y %all apply access /&>ds e/abli%$ "u subsection 7a7 to a cov]$ vet]an "u su* section ) respect to ! resid5ce1 z def9$ 9 section #ag4aeje ( title #ch1 ,code ( ,f$]al ,regulations 7or any successor regulation71 ( ! cov]$ vet]an4 7d7 ,comp>ative in=mation ,! ,secret>y %all ensure t ! access /&>ds requir$ by subsection 7a7 provide vet]ans1 employees ( ! ,dep>tm5t1 & heal? provid]s 9 ! ,vet]ans ,community ,c>e ,program e/abli%$ "u section #agjc ( ?is title ) relevant comp>ative in=mation t is cle>1 useful1 & timely1 s t vet]ans c make in=m$ & responsible decisions reg>d+ _! hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices4 7e7 ,coord9ation ,! ,secret>y %all coord9ate ) ! ,secret>y ( ,def5se1 & may consult ) ! ,secret>y ( ,heal? & ,human ,s]vices1 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 entities 9 ! private sector1 & o!r nongov]nm5tal entities 9 e/abli%+ access /&>ds "u subsection 7a74 7f7 ,p]iodic review ,n lat] ?an two ye>s aft] ! date on :i* ! ,secret>y e/abli%es access /&>ds "u ?is section & n less frequ5tly ?an once e ?ree ye>s !reaft]1 ! ,secret>y %all-- 7#a7 conduct a review ( su* /&>ds2 & 7#b7 submit to ! appropriate committees ( ,congress a report t includes ! foll[+3 7,a7 ,a report on ! f9d+s ( ! ,secret>y ) respect to ! review conduct$ "u p>agraph 7#a7 & any modification to su* /&>ds z ! ,secret>y consid]s appropriate4 7,b7 ,= ea* m$ical s]vice l9e t ! ,secret>y det]m9$1 dur+ ! p]iod cov]$ by ! report1 did n meet a /&>d e/abli%$ "u ?is section1 id5tification ( ! lead]%ip team 9 ! facility & ! ,vet]ans ,integrat$ ,s]vice ,network t are responsible = ov]see+ ! progress ( ! m$ical s]vice l9e 9 meet+ su* /&>d4 7g7 ,publication ,! ,secret>y %all publi% ! heal? c>e access /&>ds e/abli%$ "u subsection 7a7 & any modifications to su* /&>ds 9 ! ,f$]al ,regi/] & on a publicly accessible ,int]net website ( ! ,dep>tm5t4 7h7 ,appropriate committees ( congress def9$ ,9 ?is section1 ! t]m appropriate committees ( ,congress means-- 7#a7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,s5ate2 & 7#b7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives4 #agjc;,c4 ,/&>ds = quality 7a7 ,9 g5]al 7#a7 ,! ,secret>y %all e/abli% /&>ds = quality reg>d+ hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices furni%$ by ! ,dep>tm5t1 includ+ ?r\gh heal? c>e provid]s "u section #agjc ( ?is title4 7#b7 ,! ,secret>y %all ensure t ! hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices furni%$ to a vet]an by ! ,dep>tm5t1 includ+ ?r\gh heal? c>e provid]s "u section #agjc ( ?is title1 is furni%$ )9 ! /&>ds = quality e/abli%$ "u p>agraph 7#a74 7#c7 ,! /&>ds = quality e/abli%$ "u p>agraph 7#a7 %all align ) ! ,dep>tm5t ( ,def5se accord+ to categories ( hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices set =? "u section #agjc;,b7b7 ( ?is title & %all be in=m$ by ! m>ket area assessm5ts p]=m$ "u section #agcj;,b7c7 ( ?is title4 7#d7 ,9 e/abli%+ /&>ds = quality "u p>agraph 7#a71 ! ,secret>y %all-- 7,a7 conduct a survey ( cov]$ vet]ans describ$ 9 section #agjc7;b7 ( ?is title ?r\gh a ?ird p>ty entity to assess ! satisfaction ( su* vet]ans ) s]vice & quality ( c>e2 & 7,b7 collect data sets t include1 at a m9imum-- 7i7 g5]al in=mation2 7ii7 surveys ( pati5ts' exp]i5ces2 7iii7 timely & effective c>e2 7iv7 complications2 7v7 readmissions & dea?s2 7vi7 use ( m$ical imag+2 7vii7 paym5t & value ( c>e2 & 7viii7 use ( telem$ic9e4 7#e7 ,! ,secret>y %all develop su* /&>ds = quality & collect data accord+ to heal? c>e sett+s consi/5t ) ! ,dep>tm5t ( ,def5se & ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 includ+1 at a m9imum1 ! foll[+3 7,a7 ,inpati5t hospitals4 7,b7 ,nurs+ homes4 7,c7 ,individual heal? c>e provid]s4 7,d7 ,dialysis facilities4 7,e7 ,hospice4 7,f7 ,inpati5t rehabilitation facilities4 7,g7 ,long-t]m c>e hospitals4 7,h7 ,outpati5t facilities4 7#f7 ,! /&>ds = quality e/abli%$ "u p>agraph 7#a7 %all be in=m$ by exi/+ heal? quality measures1 su* z ^? def9$ by ! ,health,care ,effectiv5ess ,data & ,in=mation ,set1 t are appli$ to public & privately sponsor$ heal? c>e sy/ems ) ! purpose ( provid+ vet]ans relevant comp>ative in=mation to make in=m$ decisions reg>d+ _! heal? c>e4 7b7 ,improv+ & /r5g!n+ quality /&>ds ,n lat] ?an "o ye> aft] ! date on :i* ! ,secret>y e/abli%es /&>ds "u subsection 7a71 ! ,secret>y %all-- 7#a7 publi% ! quality rat+ ( m$ical facilities ( ! ,dep>tm5t on a publicly available ,int]net website1 su* z a website ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 = ! purpose ( provid+ vet]ans ) in=mation t all[s !m to comp>e p]=mance measure in=mation among ,dep>tm5t & community heal? c>e provid]s :o provide hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices "u section #agjc ( ?is title2 & 7#b7 consid] & solicit public comm5t on pot5tial *anges to ! e/abli%$ quality measures to ensure t !y include ! mo/ up-to-date & applicable indu/ry measures = vet]ans4 7c7 ,coord9ation ,! ,secret>y %all coord9ate ) ! ,secret>y ( ,def5se1 & may consult ) ! ,secret>y ( ,heal? & ,human ,s]vices1 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 entities 9 ! private sector1 & o!r nongov]nm5tal entities 9 e/abli%+ /&>ds = quality "u ?is section4 7d7 ,p]iodic review ,n lat] ?an two ye>s aft] ! date on :i* ! ,secret>y e/abli%es /&>ds = quality "u ?is section & n less frequ5tly ?an once e ?ree ye>s !reaft]1 ! ,secret>y %all-- 7#a7 conduct a review ( su* /&>ds across ! ,dep>tm5t2 & 7#b7 submit to ! appropriate committees ( ,congress a report t includes ! foll[+3 7,a7 ,a report on ! f9d+s ( ! ,secret>y ) respect to ! review conduct$ "u p>agraph 7#a7 & any modification to su* /&>ds z ! ,secret>y consid]s appropriate4 7,b7 ,= ea* m$ical s]vice l9e t ! ,secret>y det]m9$1 dur+ ! p]iod cov]$ by ! report1 did n meet a /&>d e/abli%$ "u ?is section1 id5tification ( ! lead]%ip team 9 ! facility & ! ,vet]ans ,integrat$ ,s]vice ,network t are responsible = ov]see+ ! progress ( ! m$ical s]vice l9e 9 meet+ su* /&>d4 7e7 ,publication ,! ,secret>y %all publi% ! heal? c>e quality /&>ds e/abli%$ "u subsection 7a7 & any modifications to su* /&>ds 9 ! ,f$]al ,regi/] & on a publicly accessible ,int]net website ( ! ,dep>tm5t4 7f7 ,appropriate committees ( congress def9$ ,9 ?is section1 ! t]m appropriate committees ( ,congress means-- 7#a7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,s5ate2 & 7#b7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #ag1 z am5d$ by section #ajb1 is fur!r am5d$ by ins]t+ aft] ! item relat+ to section #agjc ! foll[+ new items3 #agjc;,b4 ,access /&>ds4#agjc;,c4 ,/&>ds = quality4 4 7c7 ,submittal ( access /&>ds & /&>ds = quality 7#a7 ,9 g5]al ,n lat] ?an ,july #a1 #bjah1 ! ,secret>y ( ,vet]ans ,affairs %all submit to ! appropriate committees ( ,congress a report detail+ ! access /&>ds & /&>ds = quality e/abli%$ "u sections #agjc;,b & #agjc;,c ( title #ch1 ,unit$ ,/ates ,code1 respectively1 z add$ by subsection 7a74 7#b7 ,appropriate committees ( ,congress def9$ ,9 ?is subsection1 ! t]m appropriate committees ( ,congress means-- 7,a7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,s5ate2 & 7,b7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives4 ,b ,=m+ p>tn]%ips & agreem5ts #aaa4 ,cont9uity ( c>e & exi/+ agreem5ts 7a7 ,9 g5]al ,not)/&+ section #agjc ( title #ch1 ,unit$ ,/ates ,code1 z am5d$ by section #aja ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all ensure vet]ans d n exp]i5ce a delay or lapse 9 c>e or s]vices by cont9u+ ! foll[+3 7#a7 ,all contracts1 memor&ums ( und]/&+1 & memor&ums ( agreem5ts t 7 9 effect on ! day be=e ! date ( ! enactm5t ( ?is ,act betwe5 ! ,dep>tm5t ( ,vet]ans ,affairs & ! ,am]ican ,indian & ,alaska ,native heal? c>e sy/ems z e/abli%$ "u ! auspices ( ! ,dep>tm5t ( ,vet]ans ,affairs & ,indian ,heal? ,s]vice ,memor&um ( ,und]/&+1 sign$ ,octob] #a1 #bjaj4 7#b7 ,! ,national ,reimbursem5t ,agreem5t1 sign$ ,decemb] #e1 #bjab4 7#c7 ,agreem5ts t 7 9 effect on ! day be=e ! date ( ! enactm5t ( ?is ,act & ent]$ into "u section #aja1 #ajb1 or #ajc ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf74 7#d7 ,agreem5ts t 7 9 effect on ! day be=e ! date ( ! enactm5t ( ?is ,act = ! purpose ( dialysis treatm5t1 only if ! contracts or agreem5ts e/abli%$ "u section #agjc ( title #ch1 ,unit$ ,/ates ,code1 z am5d$ by section #aja ( ?is ,act1 d n /ipulate t su* treatm5ts be furni%$ by provid]s "u su* contracts or agreem5ts4 7b7 ,modifications ,subsection 7a7 %all n be con/ru$ to prohibit ! ,secret>y & ! p>ties to ! contracts1 agreem5ts1 memor&ums ( und]/&+1 & memor&ums ( agreem5ts describ$ 9 su* subsection f mak+ su* *anges to su* contracts1 agreem5ts1 memor&ums ( und]/&+1 & memor&ums ( agreem5ts z may be o!rwise au?oriz$ pursuant to o!r provisions ( law or ! t]ms ( ! contracts1 agreem5ts1 memor&ums ( und]/&+1 & memor&ums ( agreem5ts4 7c7 ,treatm5t ( exi/+ contractors ,to ! ext5t practicable1 ! ,secret>y %all give heal? c>e provid]s :o are provid+ hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices pursuant to a contract ) ! ,secret>y "u section #agjc ( title #ch1 ,unit$ ,/ates ,code1 z 9 effect on ! day be=e ! date ( ! enactm5t ( ?is ,act1 ! opportunity to furni% hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices "u su* section z am5d$ by section #aja ( ?is ,act4 #aab4 ,au?orization ( agreem5ts betwe5 ,dep>tm5t ( ,vet]ans ,affairs & non-,dep>tm5t provid]s 7a7 ,9 g5]al ,sub*apt] ,i ( *apt] #ag1 z am5d$ by sections #aja & #ajc1 is fur!r am5d$ by ins]t+ aft] section #agjc ! foll[+ new section3 #agjc;,a4 ,agreem5ts ) eligible entities or provid]s2 c]tification processes 7a7 ,agreem5ts au?oriz$ 7#a7 7,a7 ,:5 hospital c>e1 a m$ical s]vice1 or an ext5d$ c>e s]vice is n available to a vet]an describ$ 9 section #agjc7;b7 ( ?is title f a m$ical facility ( ! ,dep>tm5t or ?r\gh a contract or %>+ agreem5t ent]$ into "u ?is title "u an au?ority o!r ?an ?is section1 ! ,secret>y may furni% su* c>e or s]vice to su* vet]an to avoid a delay or lapse 9 su* c>e or s]vice by ent]+ into an agreem5t "u ?is section ) a heal? c>e provid] specifi$ 9 section #agjc7;c7 ( ?is title to provide su* c>e or s]vice4 7,b7 ,an agreem5t ent]$ into "u ?is section to provide hospital c>e1 a m$ical s]vice1 or an ext5d$ c>e s]vice %all be kn[n z a ,vet]ans ,c>e ,agreem5t4 7,c7 ,= purposes ( subp>agraph 7,a71 hospital c>e1 a m$ical s]vice1 or an ext5d$ c>e s]vice may be consid]$ n available to a vet]an f a m$ical facility ( ! ,dep>tm5t or ?r\gh a contract or %>+ agreem5t describ$ 9 su* subp>agraph :5 ! ,secret>y det]m9es ! vet]an's m$ical condition1 ! travel involv$1 ! nature ( ! c>e or s]vices requir$1 or a comb9ation ( ^! factors make ! use ( a facility ( ! ,dep>tm5t or a contract or %>+ agreem5t describ$ 9 su* subp>agraph impracticable or inadvisable4 7,d7 ,a ,vet]ans ,c>e ,agreem5t may be ent]$ into by ! ,secret>y or any ,dep>tm5t (ficial au?oriz$ by ! ,secret>y4 7#b7 7,a7 ,subject to subp>agraph 7,b71 ! ,secret>y %all review ea* ,vet]ans ,c>e ,agreem5t ( mat]ial size1 z det]m9$ by ! ,secret>y or set =? 9 p>agraph 7#c71 = hospital c>e1 a m$ical s]vice1 or an ext5d$ c>e s]vice to det]m9e :e!r x is feasible & advisable to provide su* c>e or s]vice )9 a facility ( ! ,dep>tm5t or by contract or %>+ agreem5t ent]$ into pursuant to ano!r provision ( law &1 if s1 take action to d s4 7,b7 7i7 ,! ,secret>y %all review ea* ,vet]ans ,c>e ,agreem5t ( mat]ial size t has be5 9 effect = at lea/ six mon?s )9 ! fir/ two ye>s ( its tak+ effect1 & no less frequ5tly ?an once e f\r ye>s !reaft]4 7ii7 ,if a ,vet]ans ,c>e ,agreem5t has n be5 9 effect = at lea/ six mon?s by ! date ( ! review requir$ by subp>agraph 7,a71 ! agreem5t w be review$ dur+ ! next cycle requir$ by subp>agraph 7,a71 & su* review w s]ve z its review )9 ! fir/ two ye>s ( its tak+ effect = purposes ( clause 7i74 7#c7 ,9 addition to su* o!r ,vet]ans ,c>e ,agreem5ts z ! ,secret>y may det]m9e are ( mat]ial size1 ea* ,vet]ans ,c>e ,agreem5t t takes effect aft] ! date ( ! enactm5t ( ! ,vet]ans ,community ,c>e & ,access ,act ( #bjag %all be consid]$ ( mat]ial size4 7#d7 7,a7 ,! ,secret>y1 & any o!r ,dep>tm5t (ficial au?oriz$ by ! ,secret>y1 may ent] into an agreem5t "u ?is section = ext5d$ c>e s]vices only if ! ,secret>y does n expect su* agreem5t w\ld result 9 an obligation ( ! ,dep>tm5t t exce$s a rate ( #e1jjj1jjj annually4 7,b7 ,if ! ,secret>y ent]s into an agreem5t ) a provid] "u ?is section & pursuant to ! agreem5t ! ,dep>tm5t incurs an obligation t exce$s an annual rate (1 ) respect to ext5d$ c>e s]vices1 ! rate set =? 9 subp>agraph 7,a71 & ) respect to s]vices t are n ext5d$ c>e s]vices1 #b1jjj1jjj1 ! ,secret>y %all submit to ! appropriate committees ( ,congress notice t su* obligation has exce$$ su* rate & an acc\nt+ ( ! co/ & ne$ = su* agreem5t if su* provid] is unable or unwill+ to ent] into a contract or o!r agreem5t "u section #agjc ( ?is title4 7,c7 ,9 ?is p>agraph1 ! t]m appropriate committees ( ,congress means-- 7i7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,s5ate2 & 7ii7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives4 7b7 ,eligible entities & provid]s ,= purposes ( ?is section1 an eligible entity or provid] is-- 7#a7 any provid] ( s]vices t has enroll$ & ent]$ into a provid] agreem5t "u section #ahff7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77 & any physician or o!r suppli] :o has enroll$ & ent]$ into a p>ticipation agreem5t "u section #ahdb7;h7 ( su* ,act 7#db ,u4,s4,c4 #acieu7h772 7#b7 any provid] p>ticipat+ "u a ,/ate plan "u title ,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et seq472 or 7#c7 any entity or provid] n describ$ 9 p>agraph 7#a7 or 7#b7 ( ?is subsection t ! ,secret>y det]m9es to be eligible pursuant to ! c]tification process describ$ 9 subsection 7c74 7c7 ,eligible entity or provid] c]tification process ,! ,secret>y %all e/abli% by regulation a process = ! c]tification ( eligible entities or provid]s or rec]tification ( eligible entities or provid]s "u ?is section4 ,su* a process %all1 at a m9imum-- 7#a7 e/abli% deadl9es = actions on applications = c]tification2 7#b7 set =? /&>ds = an approval or d5ial ( c]tification1 duration ( c]tification1 revocation ( an eligible entity or provid]'s c]tification1 & rec]tification ( eligible entities or provid]s2 7#c7 require ! d5ial ( c]tification if ! ,secret>y det]m9es ! eligible entity or provid] is exclud$ f p>ticipation 9 a ,f$]al heal? c>e program "u section #aabh or section #aabh;,a ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g or #acbj;a-#g;a7 or is curr5tly id5tifi$ z an exclud$ s\rce on ! ,sy/em = ,aw>d ,managem5t ,exclusions li/ describ$ 9 "p #i ( title #dh1 ,code ( ,f$]al ,regulations1 & "p #ahj ( title #b ( su* ,code1 or successor regulations2 7#d7 e/abli% proc$ures = scre5+ eligible entities or provid]s accord+ to ! risk ( fraud1 wa/e1 & abuse t are simil> to ! /&>ds "u section #ahff7;j77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7j77#b77;,b77 & section #i4ajd & subp>t #i4d ( title #dh1 ,code ( ,f$]al ,regulations1 or successor regulations2 & 7#e7 incorporate & apply ! re/rictions & p5alties set =? 9 *apt] #ba ( title #da & treat ?is section z a procurem5t program only = purposes ( apply+ su* provisions4 7d7 ,rates ,to ! ext5t practicable1 ! rates paid by ! ,secret>y = hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices provid$ "u a ,vet]ans ,c>e ,agreem5t %all be 9 accordance ) ! rates paid by ! ,unit$ ,/ates "u ! ,m$ic>e program4 7e7 ,t]ms ( ,vet]ans ,c>e ,agreem5ts 7#a7 ,pursuant to regulations promulgat$ "u subsection 7k71 ! ,secret>y may def9e ! requirem5ts = provid]s & entities ent]+ into agreem5ts "u ?is section bas$ ^u su* factors z ! numb] ( pati5ts receiv+ c>e or s]vices1 ! numb] ( employees employ$ by ! entity or provid] furni%+ su* c>e or s]vices1 ! am\nt paid by ! ,secret>y to ! provid] or entity1 or o!r factors z det]m9$ by ! ,secret>y4 7#b7 ,to furni% hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices "u ?is section1 an eligible entity or provid] %all agree-- 7,a7 to accept paym5t at ! rates e/abli%$ 9 regulations prescrib$ "u ?is section2 7,b7 t paym5t by ! ,secret>y "u ?is section on behalf ( a vet]an to a provid] ( s]vices or c>e %all1 unless reject$ & refund$ by ! provid] )9 #cj days ( receipt1 con/itute paym5t 9 full & ext+ui% any liability on ! "p ( ! vet]an = ! treatm5t or c>e provid$1 & no provision ( a contract1 agreem5t1 or assignm5t to ! contr>y %all op]ate to modify1 limit1 or negate ?is requirem5t2 7,c7 to provide only ! c>e & s]vices au?oriz$ by ! ,dep>tm5t "u ?is section & to obta9 ! prior writt5 cons5t ( ! ,dep>tm5t to furni% c>e or s]vices outside ! scope ( su* au?orization2 7,d7 to bill ! ,dep>tm5t 9 accordance ) ! me?odology outl9$ 9 regulations prescrib$ "u ?is section2 7,e7 to n seek to recov] or collect f a heal? plan contract or ?ird p>ty1 z ^? t]ms are def9$ 9 section #agbi ( ?is title1 = any s]vice = :i* paym5t is made by ! ,dep>tm5t2 7,f7 to provide m$ical records to ! ,dep>tm5t 9 ! "t frame & =mat specifi$ by ! ,dep>tm5t2 & 7,g7 to meet su* o!r t]ms & conditions1 includ+ quality ( c>e assurance /&>ds1 z ! ,secret>y may specify 9 regulation4 7f7 ,discont9uation or nonr5ewal ( a ,vet]ans ,c>e ,agreem5ts 7#a7 ,an eligible entity or provid] may discont9ue a ,vet]ans ,c>e ,agreem5t at su* "t & ^u su* notice to ! ,secret>y z may be provid$ 9 regulations prescrib$ "u ?is section4 7#b7 ,! ,secret>y may discont9ue a ,vet]ans ,c>e ,agreem5t ) an eligible entity or provid] at su* "t & ^u su* reasonable notice to ! eligible entity or provid] z may be specifi$ 9 regulations prescrib$ "u ?is section1 if an (ficial designat$ by ! ,secret>y-- 7,a7 has det]m9$ t ! eligible entity or provid] fail$ to comply sub/antially ) ! provisions ( ! ,vet]ans ,c>e ,agreem5t1 or ) ! provisions ( ?is section or regulations prescrib$ "u ?is section2 7,b7 has det]m9$ ! eligible entity or provid] is exclud$ f p>ticipation 9 a ,f$]al heal? c>e program "u section #aabh or section #aabh;,a ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g or #acbj;a-#g;a7 or is id5tifi$ on ! ,sy/em = ,aw>d ,managem5t ,exclusions li/ z provid$ 9 "p #i ( title #dh1 ,code ( ,f$]al ,regulations1 & "p #ahj ( title #b ( su* ,code1 or successor regulations2 7,c7 has asc]ta9$ t ! eligible entity or provid] has be5 convict$ ( a felony or o!r s]i\s (f5se "u ,f$]al or ,/ate law & det]m9es ! eligible entity or provid]'s cont9u$ p>ticipation w\ld be detrim5tal to ! be/ int]e/s ( vet]ans or ! ,dep>tm5t2 or 7,d7 has det]m9$ t x is reasonable to t]m9ate ! agreem5t bas$ on ! heal? c>e ne$s ( a vet]an4 7g7 ,quality ( c>e ,! /&>ds = quality e/abli%$ "u section #agjc;,c ( ?is title %all be appli$ 9 monitor+ ! quality ( c>e provid$ to vet]ans ?r\gh ,vet]ans ,c>e ,agreem5ts & = assess+ ! quality ( hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices furni%$ by eligible entities & provid]s be=e ! r5ewal ( ,vet]ans ,c>e ,agreem5ts4 7h7 ,disputes 7#a7 ,! ,secret>y %all promulgate adm9i/rative proc$ures = eligible entities & provid]s to pres5t all disputes aris+ "u or relat$ to ,vet]ans ,c>e ,agreem5ts4 7#b7 ,su* proc$ures con/itute ! eligible entities' & provid]s' exhau/ive & exclusive adm9i/rative rem$ies4 7#c7 ,eligible entities or provid]s mu/ fir/ exhau/ su* adm9i/rative proc$ures be=e seek+ any judicial review "u section #acdf ( title #bh 7kn[n z ! ,tuck] ,act74 7#d7 ,disputes "u ?is section mu/ p]ta9 to ei!r ! scope ( au?orization "u ! ,vet]ans ,c>e ,agreem5t or claims = paym5t subject to ! ,vet]ans ,c>e ,agreem5t & are n claims = ! purposes ( su* laws t w\ld o!rwise require application ( sections #gaja ?r\gh #gaji ( title #da1 ,unit$ ,/ates ,code4 7i7 ,applicability ( o!r provisions ( law 7#a7 ,a ,vet]ans ,c>e ,agreem5t may be au?oriz$ by ! ,secret>y or any ,dep>tm5t (ficial au?oriz$ by ! ,secret>y1 & su* action is n an aw>d = ! purposes ( su* laws t w\ld o!rwise require ! use ( competitive proc$ures = furni%+ ( c>e & s]vices4 7#b7 7,a7 ,except z provid$ 9 subp>agraph 7,b71 & unless o!rwise provid$ 9 ?is section or regulations prescrib$ pursuant to ?is section1 an eligible entity or provid] t ent]s into an agreem5t "u ?is section is n subject to1 9 ! c>ry+ out ( ! agreem5t1 any law to :i* provid]s ( s]vices & suppli]s "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 are n subject4 7,b7 ,an eligible entity or provid] t ent]s into an agreem5t "u ?is section is subject to-- 7i7 all laws reg>d+ integrity1 e?ics1 or fraud1 or t subject a p]son to civil or crim9al p5alties2 & 7ii7 all laws t protect aga9/ employm5t discrim9ation or t o!rwise ensure equal employm5t opportunities4 7j7 ,p>ity ( treatm5t ,eligibility = hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices furni%$ to any vet]an pursuant to a ,vet]ans ,c>e ,agreem5t %all be subject to ! same t]ms z ?\gh provid$ 9 a facility ( ! ,dep>tm5t1 & provisions ( ?is *apt] applicable to vet]ans receiv+ su* c>e & s]vices 9 a facility ( ! ,dep>tm5t %all apply to vet]ans treat$ "u ?is section4 7k7 ,rulemak+ ,! ,secret>y %all promulgate regulations to c>ry out ?is section4 4 7b7 ,cl]ical ,am5dm5t ,! table ( sections at ! beg9n+ ( su* *apt] is am5d$ by ins]t+ aft] ! item relat$ to section #agjc ! foll[+ new item3 #agjc;,a4 ,agreem5ts ) eligible entities or provid]s2 c]tification processes4 4 #aac4 ,prev5tion ( c]ta9 heal? c>e provid]s f provid+ non-,dep>tm5t heal? c>e s]vices to vet]ans 7a7 ,9 g5]al ,on & aft] ! date t is "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all d5y or revoke ! eligibility ( a heal? c>e provid] to provide non-,dep>tm5t heal? c>e s]vices to vet]ans if ! ,secret>y det]m9es t ! heal? c>e provid]-- 7#a7 0 remov$ f employm5t ) ! ,dep>tm5t ( ,vet]ans ,affairs due to conduct t violat$ a policy ( ! ,dep>tm5t relat+ to ! deliv]y ( safe & appropriate heal? c>e2 or 7#b7 violat$ ! requirem5ts ( a m$ical lic5se ( ! heal? c>e provid] t result$ 9 ! loss ( su* m$ical lic5se4 7b7 ,p]missive action ,on & aft] ! date t is "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y may d5y1 revoke1 or susp5d ! eligibility ( a heal? c>e provid] to provide non-,dep>tm5t heal? c>e s]vices if ! ,secret>y det]m9es su* action is necess>y to imm$iately protect ! heal?1 safety1 or welf>e ( vet]ans & ! heal? c>e provid] is "u inve/igation by ! m$ical lic5s+ bo>d ( a ,/ate 9 :i* ! heal? c>e provid] is lic5s$ or practices4 7c7 ,susp5sion ,! ,secret>y %all susp5d ! eligibility ( a heal? c>e provid] to provide non-,dep>tm5t heal? c>e s]vices to vet]ans if ! heal? c>e provid] is susp5d$ f s]v+ z a heal? c>e provid] ( ! ,dep>tm5t4 7d7 ,comptroll] ,g5]al report ,n lat] ?an two ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress a report on ! implem5tation by ! ,secret>y ( ?is section1 includ+ ! foll[+3 7#a7 ,! aggregate numb] ( heal? c>e provid]s d5i$ or susp5d$ "u ?is section f p>ticipation 9 provid+ non-,dep>tm5t heal? c>e s]vices4 7#b7 ,an evaluation ( any impact on access to heal? c>e = pati5ts or /aff+ %ortages 9 programs ( ! ,dep>tm5t provid+ non-,dep>tm5t heal? c>e s]vices4 7#c7 ,an explanation ( ! coord9ation ( ! ,dep>tm5t ) ! m$ical lic5s+ bo>ds ( ,/ates 9 implem5t+ ?is section1 ! am\nt ( involvem5t ( su* bo>ds 9 su* implem5tation1 & ef=ts by ! ,dep>tm5t to address any conc]ns rais$ by su* bo>ds ) respect to su* implem5tation4 7#d7 ,su* recomm5dations z ! ,comptroll] ,g5]al consid]s appropriate reg>d+ h>moniz+ eligibility crit]ia betwe5 heal? c>e provid]s ( ! ,dep>tm5t & heal? c>e provid]s eligible to provide non-,dep>tm5t heal? c>e s]vices4 7e7 ,non-,dep>tm5t heal? c>e s]vices def9$ ,9 ?is section1 ! t]m non-,dep>tm5t heal? c>e s]vices means hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices furni%$ at non-,dep>tm5t facilities "u *apt] #ag ( title #ch1 ,unit$ ,/ates ,code4 #aad4 ,con=m+ am5dm5ts = ,/ate vet]ans homes 7a7 ,9 g5]al ,section #agde7;a7 is am5d$-- 7#a7 9 p>agraph 7#a71 by /rik+ 7or agreem5t "u section #agbj7;c77#a7 ( ?is title7 & ins]t+ 7or an agreem5t72 & 7#b7 by add+ at ! end ! foll[+ new p>agraph3 7#d7 7,a7 ,an agreem5t "u ?is section may be au?oriz$ by ! ,secret>y or any ,dep>tm5t (ficial au?oriz$ by ! ,secret>y1 & any su* action is n an aw>d = purposes ( su* laws t w\ld o!rwise require ! use ( competitive proc$ures = ! furni%+ ( hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices4 7,b7 7i7 ,except z provid$ 9 clause 7ii71 & unless o!rwise provid$ 9 ?is section or regulations prescrib$ pursuant to ?is section1 a ,/ate home t ent]s into an agreem5t "u ?is section is n subject to1 9 ! c>ry+ out ( ! agreem5t1 any provision ( law to :i* provid]s ( s]vices & suppli]s "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 are n subject4 7ii7 ,a ,/ate home t ent]s into an agreem5t "u ?is section is subject to-- 7,i7 all provisions ( law reg>d+ integrity1 e?ics1 or fraud1 or t subject a p]son to civil or crim9al p5alties2 & 7,,ii7 all provisions ( law t protect aga9/ employm5t discrim9ation or t o!rwise ensure equal employm5t opportunities4 7iii7 ,not)/&+ subp>agraph 7,b77ii77,i71 a ,/ate home t ent]s into an agreem5t "u ?is section may n be treat$ z a ,f$]al contractor or subcontractor = purposes ( *apt] #fg ( title #da 7kn[n z ! ,mc,namara-,o',h>a ,s]vice ,contract ,act ( #aife74 4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all apply to c>e provid$ on or aft] ! effective date ( regulations issu$ by ! ,secret>y ( ,vet]ans ,affairs to c>ry out ?is section4 ,c ,pay+ provid]s #aba4 ,prompt paym5t to provid]s 7a7 ,9 g5]al ,sub*apt] ,i ( *apt] #ag is am5d$ by ins]t+ aft] section #agjc;,c1 z add$ by section #ajc ( ?is ,act1 ! foll[+ new section3 #agjc;,d4 ,prompt paym5t /&>d 7a7 ,9 g5]al 7#a7 ,not)/&+ any o!r provision ( ?is title or ( any o!r provision ( law1 ! ,secret>y %all pay = hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices furni%$ by heal? c>e entities or provid]s "u ?is *apt] )9 #de cal5d> days ^u receipt ( a clean pap] claim or #cj cal5d> days ^u receipt ( a clean electronic claim4 7#b7 ,if a claim is d5i$1 ! ,secret>y %all1 )9 #de cal5d> days ( d5ial = a pap] claim & #cj cal5d> days ( d5ial = an electronic claim1 notify ! heal? c>e entity or provid] ( ! reason = d5y+ ! claim & :at1 if any1 additional in=mation is requir$ to process ! claim4 7#c7 ,^u ! receipt ( ! additional in=mation1 ! ,secret>y %all ensure t ! claim is paid1 d5i$1 or o!rwise adjudicat$ )9 #cj cal5d> days f ! receipt ( ! reque/$ in=mation4 7#d7 ,?is section %all only apply to paym5ts made on an invoice basis & %all n apply to capitation or o!r =ms ( p]iodic paym5t to entities or provid]s4 7b7 ,submittal ( claims by heal? c>e entities & provid]s ,a heal? c>e entity or provid] t furni%es hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices "u ?is *apt] %all submit to ! ,secret>y a claim = paym5t = furni%+ ! c>e or s]vices n lat] ?an #ahj days aft] ! date on :i* ! entity or provid] furni%$ ! c>e or s]vices4 7c7 ,fraudul5t claims 7#a7 ,sections #cgbi ?r\gh #cgcc ( title #ca %all apply to fraudul5t claims = paym5t submitt$ to ! ,secret>y by a heal? c>e entity or provid] "u ?is *apt]4 7#b7 ,pursuant to regulations prescrib$ by ! ,secret>y1 ! ,secret>y %all b> a heal? c>e entity or provid] f furni%+ hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices "u ?is *apt] :5 ! ,secret>y det]m9es ! entity or provid] has submitt$ to ! ,secret>y fraudul5t heal? c>e claims = paym5t by ! ,secret>y4 7d7 ,ov]due claims 7#a7 ,any claim t has n be5 d5i$ ) notice1 made p5d+ ) notice1 or paid to ! heal? c>e entity or provid] by ! ,secret>y %all be ov]due if ! notice or paym5t is n receiv$ by ! entity or provid] )9 ! "t p]iods specifi$ 9 subsection 7a74 7#b7 7,a7 ,if a claim is ov]due "u ?is subsection1 ! ,secret>y may1 "u ! requirem5ts e/abli%$ by subsection 7a7 & consi/5t ) ! provisions ( *apt] #ci ( title #ca 7commonly ref]r$ to z ! ,prompt ,paym5t ,act71 require t int]e/ be paid on clean claims4 7,b7 ,int]e/ paid "u subp>agraph 7,a7 %all be comput$ at ! rate ( int]e/ e/abli%$ by ! ,secret>y ( ! ,treasury "u section #cijb ( title #ca & publi%$ 9 ! ,f$]al ,regi/]4 7e7 ,ov]paym5t 7#a7 ,! ,secret>y %all d$uct ! am\nt ( any ov]paym5t f paym5ts due a heal? c>e entity or provid] "u ?is *apt]4 7#b7 ,d$uctions may n be made "u ?is subsection unless ! ,secret>y has made reasonable ef=ts to notify a heal? c>e entity or provid] ( ! "r to dispute ! exi/5ce or am\nt ( su* indebt$ness & ! "r to reque/ a compromise ( su* indebt$ness4 7#c7 ,! ,secret>y %all make a det]m9ation ) respect to any su* dispute or reque/ prior to d$uct+ any ov]paym5t unless ! "t requir$ to make su* a det]m9ation be=e mak+ any d$uctions w\ld jeop>dize ! ,secret>y's ability to recov] ! full am\nt ( su* indebt$ness4 7f7 ,in=mation & docum5tation requir$ 7#a7 ,! ,secret>y %all provide to all heal? c>e entities & provid]s p>ticipat+ 9 a program to furni% hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices "u ?is *apt] a li/ ( in=mation & docum5tation t is requir$ to e/abli% a clean claim "u ?is section4 7#b7 ,! ,secret>y %all consult ) entities 9 ! heal? c>e indu/ry1 9 ! public & private sector1 to det]m9e ! in=mation & docum5tation to include 9 ! li/ "u p>agraph 7#a74 7#c7 ,if ! ,secret>y modifies ! in=mation & docum5tation includ$ 9 ! li/ "u p>agraph 7#a71 ! ,secret>y %all notify all heal? c>e entities & provid]s describ$ 9 p>agraph 7#a7 n lat] ?an #cj days be=e su* modifications take effect4 7g7 ,process+ ( claims ,9 process+ a claim = comp5sation = hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices furni%$ by a heal? c>e entity or provid] "u ?is *apt]1 ! ,secret>y %all act ?r\gh-- 7#a7 a non-,dep>tm5t entity t is "u contract or agreem5t = ! program e/abli%$ "u section #agjc7;a7 ( ?is title2 or 7#b7 a non-,dep>tm5t entity t specializes 9 su* process+ = o!r ,f$]al ag5cy heal? c>e sy/ems4 7h7 ,report on enc\nt] data sy/em 7#a7 ,n lat] ?an #ij days aft] ! date ( ! enactm5t ( ! ,vet]ans ,community ,c>e & ,access ,act ( #bjag1 ! ,secret>y %all submit to ! appropriate committees ( ,congress a report on ! feasibility & advisability ( adopt+ a fund+ me*anism simil> to :at is utiliz$ by o!r ,f$]al ag5cies to all[ a contract$ entity to act z a fiscal int]m$i>y = ! ,f$]al ,gov]nm5t to di/ribute1 or pass ?r\gh1 ,f$]al ,gov]nm5t funds = c]ta9 non-und]writt5 hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices4 7#b7 ,! ,secret>y may coord9ate ) ! ,dep>tm5t ( ,def5se1 ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 & ! ,dep>tm5t ( ! ,treasury 9 develop+ ! report requir$ by p>agraph 7#a74 7i7 ,def9itions ,9 ?is section3 7#a7 ,! t]m appropriate committees ( ,congress means-- 7,a7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,s5ate2 & 7,b7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives4 7#b7 ,! t]m clean electronic claim means ! transmission ( data = purposes ( paym5t ( cov]$ heal? c>e exp5ses t is submitt$ to ! ,secret>y :i* conta9s sub/antially all ( ! requir$ data elem5ts necess>y = accurate adjudication1 )\t obta9+ additional in=mation f ! entity or provid] t furni%$ ! c>e or s]vice1 submitt$ 9 su* =mat z prescrib$ by ! ,secret>y 9 regulations = ! purpose ( pay+ claims = c>e or s]vices4 7#c7 ,! t]m clean pap] claim means a pap] claim = paym5t ( cov]$ heal? c>e exp5ses t is submitt$ to ! ,secret>y :i* conta9s sub/antially all ( ! requir$ data elem5ts necess>y = accurate adjudication1 )\t obta9+ additional in=mation f ! entity or provid] t furni%$ ! c>e or s]vice1 submitt$ 9 su* =mat z prescrib$ by ! ,secret>y 9 regulations = ! purpose ( pay+ claims = c>e or s]vices4 7#d7 ,! t]m fraudul5t claims means ! int5tional & delib]ate misrepres5tation ( a mat]ial fact or facts by a heal? c>e entity or provid] made to induce ! ,secret>y to pay a claim t 0 n legally payable to t provid]4 ,?is t]m1 z us$ 9 ?is section1 %all n include a good fai? int]pretation by a heal? c>e entity or provid] ( utilization1 m$ical necessity1 cod+1 & bill+ requirem5ts ( ! ,secret>y4 7#e7 ,! t]m heal? c>e entity or provid] includes any non-,dep>tm5t heal? c>e entity or provid]1 b does n include any ,f$]al heal? c>e entity or provid]4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( su* *apt] is am5d$ by ins]t+ aft] ! item relat$ to section #agjc;,c1 z add$ by section #ajc ( ?is ,act1 ! foll[+ new item3 #agjc;,d4 ,prompt paym5t /&>d4 4 #abb4 ,paym5t rates = community c>e 7a7 ,9 g5]al ,sub*apt] ,i ( *apt] #ag1 z am5d$ by section #aba ( ?is ,act1 is fur!r am5d$ by ins]t+ aft] section #agjc;,d ! foll[+ new section3 #agjc;,e4 ,paym5t rates = community c>e 7a7 ,9 g5]al ,except z provid$ 9 subsection 7b71 & to ! ext5t practicable1 ! rate paid = hospital c>e or m$ical s]vices "u any provision 9 ?is title may n exce$ ! rate paid by ! ,unit$ ,/ates to a provid] ( s]vices 7z def9$ 9 section #ahfa7u7 ( ! ,social ,security ,act 7#aciex7u777 or a suppli] 7z def9$ 9 section #ahfa 7d7 ( su* ,act 7#db ,u4,s4,c4 #aciex7d777 "u ! ,m$ic>e program "u title ,,xi or title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq4 & #acie et seq47 = ! same c>e or s]vices1 includ+ rates adju/$ = critical access hospitals "u section #ahcd7;g7 ( su* ,act 7#db ,u4,s4,c4 #aciem7g774 7b7 ,exception 7#a7 7,a7 ,a high] rate ?an ! rate paid by ! ,unit$ ,/ates z describ$ 9 subsection 7a7 may be negotiat$ ) respect to ! furni%+ ( c>e or s]vices to a vet]an describ$ 9 section #agjc7;b7 ( ?is title :o resides 9 a highly rural area or 9 a m>ket area :]e ! availability ( c>e or s]vices is limit$ & a high] rate ( pay may be requir$4 7,b7 ,9 ?is p>agraph1 ! t]m highly rural area means an area locat$ 9 a c\nty t has few] ?an sev5 individuals resid+ 9 t c\nty p] squ>e mile4 7#b7 ,) respect to furni%+ c>e or s]vices "u ?is section 9 ,alaska1 ! ,alaska ,fee ,s*$ule ( ! ,dep>tm5t ( ,vet]ans ,affairs %all be foll[$1 except = :5 ano!r paym5t agreem5t1 includ+ a contract1 provid] agreem5t or ,vet]ans ,c>e ,agreem5t1 is 9 place4 7#c7 ,) respect to furni%+ c>e or s]vices "u ?is section 9 a ,/ate ) an ,all-,pay] ,model ,agreem5t "u section #ahad7;b77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7b77#c77 t became effective on or aft] ,janu>y #a1 #bjad1 ! ,m$ic>e paym5t rates "u subp>agraph 7,a7 %all be calculat$ bas$ on ! paym5t rates "u su* agreem5t4 7c7 ,value-,bas$ reimbursem5t ,not)/&+ subsection 7a71 ! ,secret>y %all incorporate1 to ! greate/ ext5t practicable1 ! use ( value-bas$ reimbursem5t models to promote ! provision ( high quality c>e4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( su* *apt] is am5d$ by ins]t+ aft] ! item relat+ to section #agjc;,d1 z add$ by section #aba ( ?is ,act1 ! foll[+ new item3 #agjc;,e4 ,paym5t ,rates = ,community ,c>e4 4 #abc4 ,au?ority to pay = au?oriz$ c>e n subject to an agreem5t 7a7 ,9 g5]al ,sub*apt] ,,iv ( *apt] #ha is am5d$ by add+ at ! end ! foll[+ new section3 #haei4 ,au?ority to pay = s]vices au?oriz$ b n subject to an agreem5t 7a7 ,9 g5]al ,if1 9 ! c\rse ( furni%+ hospital c>e1 a m$ical s]vice1 or an ext5d$ c>e s]vice au?oriz$ by ! ,secret>y & pursuant to a contract1 agreem5t1 or o!r arrangem5t ) ! ,secret>y1 a provid] t is n a p>ty to ! contract1 agreem5t1 or o!r arrangem5t furni%es hospital c>e1 a m$ical s]vice1 or an ext5d$ c>e s]vice t ! ,secret>y consid]s necess>y1 ! ,secret>y may comp5sate ! provid] = ! co/ ( su* c>e or s]vice4 7b7 ,reports on use ( au?ority ,:5ev] ! ,secret>y comp5sates a provid] "u subsection 7a7 = ! furni%+ ( hospital c>e1 a m$ical s]vice1 or an ext5d$ c>e s]vice1 ! c>e coord9ation team t coord9at$ ! furni%+ ( su* c>e or s]vice "u section #agjc7;e77#a7 ( ?is title %all-- 7#a7 submit to ! appropriate committees ( ,congress a report on ! furni%+ ( su* c>e2 & 7#b7 analyze ! future dem& = su* c>e or s]vice f su* provid]4 7c7 ,new contracts & agreem5ts ,! ,secret>y %all take reasonable ef=ts to ent] into a contract1 agreem5t1 or o!r arrangem5t ) a provid] describ$ 9 subsection 7a7 to ensure t future c>e & s]vices au?oriz$ by ! ,secret>y & furni%$ by ! provid] are subject to su* a contract1 agreem5t1 or o!r arrangem5t4 7d7 ,def9itions ,9 ?is section3 7#a7 ,! t]m appropriate committees ( ,congress means-- 7,a7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,s5ate2 & 7,b7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives4 7#b7 ,! t]ms hospital c>e & m$ical s]vice h ! mean+s giv5 su* t]ms 9 section #agja ( ?is title4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( su* *apt] is am5d$ by ins]t+ aft] ! item relat+ to section #haeh ! foll[+ new item3 #haei4 ,au?ority to pay = s]vices au?oriz$ b n subject to an agreem5t4 4 ,,ii ,/reaml9+ community c>e programs ,a ,/reaml9+ community c>e programs #bja4 ,access to walk-9 c>e 7a7 ,9 g5]al ,*apt] #ag is am5d$ by ins]t+ aft] section #agbe ! foll[+ new section3 #agbe;,a4 ,access to walk-9 c>e 7a7 ,proc$ures ,to ensure access to walk-,9 c>e ,! ,secret>y %all develop proc$ures to ensure t cov]$ vet]ans are able to access walk-9 c>e f qualify+ non-,dep>tm5t entities or provid]s4 7b7 ,cov]$ vet]ans ,= purposes ( ?is section1 a cov]$ vet]an is any vet]an describ$ 9 section #agjc7;b7 ( ?is title4 7c7 ,qualify+ non-,dep>tm5t entities or provid]s ,= purposes ( ?is section1 a qualify+ non-,dep>tm5t entity or provid] is a non-,dep>tm5t entity or provid] t-- 7#a7 has ent]$ into a contract or o!r agreem5t ) ! ,secret>y to furni% s]vices "u ?is section2 or 7#b7 ent]$ into an agreem5t ) ! ,secret>y t 0 9 effect on ! day be=e ! date ( ! enactm5t ( ! ,vet]ans ,community ,c>e & ,access ,act ( #bjag to furni% walk-9 c>e4 7d7 ,f$]ally-,qualifi$ heal? c5t]s ,:5ev] practicable1 ! ,secret>y may use a ,f$]ally-qualifi$ heal? c5t] 7z def9$ 9 section #aije7l77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b777 to c>ry out ?is section4 7e7 ,cont9uity ( c>e 7#a7 ,! ,secret>y %all ensure cont9uity ( c>e = ea* cov]$ vet]an :o receives a walk-9 c>e s]vice "u ?is section ?r\gh ! c>e coord9ation team provid$ su* cov]$ vet]an "u section #agjc7;e77#a7 ( ?is title4 7#b7 ,! ,secret>y %all in=m & educate cov]$ vet]ans on proc$ures to utilize & access walk-9 c>e "u ?is section4 7#c7 ,! ,secret>y %all develop a me*anism to coord9ate ) qualify+ non-,dep>tm5t entities or provid]s ?r\gh ! c>e coord9ation teams provid$ "u section #agjc7;e77#a7 ( ?is title t includes ! use ( m$ical records f walk-9 c>e provid]s to accurately repres5t access to c>e1 heal? ne$s ( ! cov]$ vet]ans1 & to monitor conditions ( cov]$ vet]ans4 7f7 ,copaym5ts 7#a7 ,! ,secret>y %all require ea* cov]$ vet]an to pay ! ,unit$ ,/ates a copaym5t = ea* episode ( walk-9 c>e provid$ "u ?is section1 except if ! episode ( walk-9 c>e = ! cov]$ vet]an is relat$ to a s]vice-connect$ disability ( ! cov]$ vet]an4 7#b7 ,! ,secret>y may adju/ ! copaym5t requir$ ( a cov]$ vet]an "u ?is subsection bas$ ^u ! priority gr\p ( enrollm5t ( ! vet]an1 ! numb] ( episodes ( c>e furni%$ to a cov]$ vet]an dur+ a ye>1 & o!r factors ! ,secret>y consid]s appropriate "u ?is section4 7#c7 ,! am\nt or am\nts ( ! copaym5ts requir$ "u ?is subsection %all be prescrib$ by ! ,secret>y by rule4 7#d7 ,copaym5ts requir$ by ?is subsection %all apply not)/&+ any o!r provision ( law t w\ld all[ ! ,secret>y to (fset a cov]$ vet]an's copaym5t obligation ) am\nts recov]$ f a ?ird p>ty "u section #agbi ( ?is title4 7g7 ,regulations ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ! ,vet]ans ,community ,c>e & ,access ,act ( #bjag1 ! ,secret>y %all promulgate regulations to c>ry out ?is section4 7h7 ,walk-,9 c>e def9$ ,9 ?is section1 ! t]m walk-9 c>e means non-urg5t1 non-em]g5t1 conv5i5ce c>e provid$ by a qualify+ non-,dep>tm5t entity or provid] t furni%es episodic c>e & n longitud9al managem5t ( conditions & c]ta9 s]vices z def9$ ?r\gh contracts or agreem5ts describ$ 9 subsection 7c7 or regulations ! ,secret>y %all prescribe = purposes ( ?is section4 4 7b7 ,effective date ,section #agbe;,a ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a7 %all take effect on ! date ^u :i* f9al regulations implem5t+ su* section take effect4 7c7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( su* *apt] is am5d$ by ins]t+ aft] ! item relat$ to section #agbe ! foll[+ new item3 #agbe;,a4 ,access to walk-9 c>e4 4 #bjb4 ,vet]ans ,*oice ,fund flexibility ,section #hjb ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 is am5d$-- 7#a7 9 subsection 7c7-- 7,a7 9 p>agraph 7#a71 by /rik+ by p>agraph 7#c7 & ins]t+ 9 p>agraphs 7#c7 & 7#d72 & 7,b7 by add+ at ! end ! foll[+ new p>agraph3 7#d7 ,p]man5t au?ority = o!r uses ,beg9n+ 9 fiscal ye> #bjai1 am\nts rema9+ 9 ! ,vet]ans ,*oice ,fund may be us$ to furni% hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices to individuals pursuant to *apt] #ag ( title #ch1 ,unit$ ,/ates ,code1 at non-,dep>tm5t facilities or ?r\gh non-,dep>tm5t provid]s at ,dep>tm5t facilities1 includ+ pursuant to non-,dep>tm5t provid] programs o!r ?an ! program e/abli%$ by section #aja4 ,su* am\nts %all be available 9 addition to am\nts available 9 o!r appropriations acc\nts = su* purposes4 2 & 7#b7 9 subsection 7d77#a71 by /rik+ to subsection 7c77#c7 & ins]t+ to p>agraphs 7#c7 & 7#d7 ( subsection 7c74 #bjc4 ,con=m+ am5dm5ts 7a7 ,9 g5]al 7#a7 ,title #ch ,title #ch1 ,unit$ ,/ates ,code1 is am5d$-- 7,a7 9 section #agab7;a7-- 7i7 9 p>agraph 7#c71 by /rik+ "u clause 7#a71 7#b71 or 7#e7 ( section #agjc7;a7 ( ?is title & ins]t+ or ent]$ an agreem5t2 & 7ii7 9 p>agraph 7#d77;,a71 by /rik+ "u ! provisions ( ?is subsection & section #agjc ( ?is title2 7,b7 9 section #agab;,a7e77#a7-- 7i7 by ins]t+ or agreem5ts aft] contracts2 & 7ii7 by /rik+ 7"u sections #agjc7;a77#b7 & #agaj7;a77#a77;,b7 ( ?is title72 & 7,c7 9 section #bcjc7;a77#b77;,b77i71 by /rik+ ) section #agjc & ins]t+ ) sections #agjc;,a1 #haaa1 & #haec4 7#b7 ,social ,security ,act ,section #ahff7;a77#a77,l7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77,l77 is am5d$ by /rik+ "u section #agjc & ins]t+ "u *apt] #ag4 7#c7 ,vet]ans' ,b5efits ,improvem5ts ,act ( #aiid ,section #ajd7;a77#d77;,a7 ( ! ,vet]ans' ,b5efits ,improvem5ts ,act ( #aiid 7,public ,law #ajc-ddf2 #ch ,u4,s4,c4 #aaag note7 is am5d$ by /rik+ 9 section #agjc & ins]t+ 9 sections #agjc;,a1 #haaa1 & #haec4 7b7 ,effective date ,! am5dm5ts made by subsection 7a7 %all take effect on ! date describ$ 9 section #aja7;b77#b74 ,b ,improv+ in=mation %>+ ) provid]s #baa4 ,improv+ in=mation %>+ ) community provid]s ,section #gccb7;b77#b7 is am5d$ by /rik+ subp>agraph 7,h7 & ins]t+ ! foll[+ new subp>agraphs3 7,h7 7i7 ,to a non-,dep>tm5t entity 7includ+ private entities & o!r ,f$]al ag5cies7 = purposes ( provid+ heal? c>e1 includ+ hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices1 to pati5ts4 7ii7 ,an entity to :i* a record is disclos$ "u ?is subp>agraph may n disclose or use su* record = a purpose o!r ?an t = :i* ! disclosure 0 made4 7,i7 ,to a ?ird p>ty 9 ord] to recov] or collect reasonable *>ges = c>e furni%$ to1 or paid on behalf (1 a pati5t 9 connection ) a non-s]vice connect$ disability z p]mitt$ by section #agbi ( ?is title or = a condition = :i* recov]y is au?oriz$ or ) respect to :i* ! ,unit$ ,/ates is deem$ to be a ?ird p>ty b5efici>y "u ! ,act entitl$ ,an ,act to provide = ! recov]y f torti\sly liable ?ird p]sons ( ! co/ ( hospital & m$ical c>e & treatm5t furni%$ by ! ,unit$ ,/ates 7,public ,law #hg-fic2 #db ,u4,s4,c4 #bfea et seq42 commonly kn[n z ! ,f$]al ,m$ical ,c>e ,recov]y ,act74 4 #bab4 ,e/abli%m5t ( processes to ensure safe opioid prescrib+ practices by non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e provid]s 7a7 ,receipt & review ( guidel9es ,! ,secret>y ( ,vet]ans ,affairs %all ensure t all cov]$ heal? c>e provid]s are provid$ a copy ( & c]tify t !y h review$ ! evid5ce-bas$ guidel9es = prescrib+ opioids set =? by ! ,opioid ,safety ,initiative ( ! ,dep>tm5t ( ,vet]ans ,affairs "u sections #iaa7;a77#b7 & #iab7;c7 ( ! ,jason ,simcakoski ,memorial & ,promise ,act 7,public ,law #aad-aih2 #ch ,u4,s4,c4 #agja note7 be=e fir/ provid+ c>e "u ! laws adm9i/]$ by ! ,secret>y & at any "t :5 ^? guidel9es are modifi$ !reaft]4 7b7 ,inclusion ( m$ical hi/ory & curr5t m$ications ,! ,secret>y %all implem5t a process to ensure t1 if c>e ( a vet]an by a cov]$ heal? c>e provid] is au?oriz$ "u ! laws adm9i/]$ by ! ,secret>y1 ! docum5t au?oriz+ su* c>e includes ! relevant m$ical hi/ory ( ! vet]an & a li/ ( all m$ications prescrib$ to ! vet]an4 7c7 ,submittal ( prescriptions 7#a7 ,9 g5]al ,except z provid$ 9 p>agraph 7#c71 ! ,secret>y %all require1 to ! maximum ext5t practicable1 ea* cov]$ heal? c>e provid] to submit prescriptions = opioids-- 7,a7 to ! ,dep>tm5t = prior au?orization = ! prescrib+ ( a limit$ am\nt ( opioids "u contracts ! ,dep>tm5t has ) retail ph>macies2 or 7,b7 directly to a ph>macy ( ! ,dep>tm5t = ! disp5s+ ( su* prescription4 7#b7 ,dep>tm5t responsibility ,9 c>ry+ out p>agraph 7#a71 ^u receipt by ! ,dep>tm5t ( a prescription = opioids = a vet]an "u ! laws adm9i/]$ by ! ,secret>y1 ! ,secret>y %all-- 7,a7 record su* prescription 9 ! electronic heal? record ( ! vet]an2 & 7,b7 monitor su* prescription z outl9$ 9 ! ,opioid ,safety ,initiative ( ! ,dep>tm5t4 7#c7 ,exception 7,a7 ,9 g5]al ,a cov]$ heal? c>e provid] is n requir$ "u p>agraph 7#a77;,b7 to submit an opioid prescription directly to a ph>macy ( ! ,dep>tm5t if-- 7i7 ! heal? c>e provid] det]m9es t !re is an imm$iate m$ical ne$ = ! prescription1 includ+ an urg5t or em]g5t prescription or a prescription disp5s$ z "p ( an opioid treatm5t program t provides (fice-bas$ m$ications2 & 7ii7 7,i7 foll[+ an inquiry into ! matt]1 a ph>macy ( ! ,dep>tm5t notifies ! heal? c>e provid] t x _c fill ! prescription 9 a timely mann]2 or 7,,ii7 ! heal? c>e provid] det]m9es t ! requirem5t "u p>agraph 7#a77;,b7 w\ld impose an undue h>d%ip on ! vet]an1 includ+ ) respect to travel di/ances1 z det]m9$ by ! ,secret>y4 7,b7 ,notification to ,dep>tm5t ,if a cov]$ heal? c>e provid] uses an exception "u subp>agraph 7,a7 ) respect to an opioid prescription = a vet]an1 ! heal? c>e provid] %all1 on ! same day ! prescription is writt51 submit to ! ,secret>y = inclusion 9 ! electronic heal? record ( ! vet]an a notice1 9 su* =m z ! ,secret>y may e/abli%1 provid+ in=mation ab\t ! prescription & describ+ ! reason = ! exception4 7,c7 ,report 7i7 ,9 g5]al ,n less frequ5tly ?an qu>t]ly1 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report evaluat+ ! compliance ( cov]$ heal? c>e provid]s ) ! requirem5ts "u ?is p>agraph & sett+ =? data on ! use by heal? c>e provid]s ( exceptions "u subp>agraph 7,a7 & notices "u subp>agraph 7,b74 7ii7 ,elem5ts ,ea* report requir$ by clause 7i7 %all include ! foll[+ ) respect to ! qu>t] cov]$ by ! report3 7,i7 ,! numb] ( exceptions us$ "u subp>agraph 7,a7 & notices receiv$ "u subp>agraph 7,b74 7,,ii7 ,! rate ( compliance by ! ,dep>tm5t ) ! requirem5t "u subp>agraph 7,b7 to include su* notices 9 ! heal? records ( vet]ans4 7,,iii7 ,! id5tification ( any cov]$ heal? c>e provid]s t1 bas$ on crit]ia prescrib$ ! ,secret>y1 are det]m9$ by ! ,secret>y to be /ati/ical outli]s reg>d+ ! use ( exceptions "u subp>agraph 7,a74 7d7 ,use ( ,opioid ,safety ,initiative guidel9es 7#a7 ,9 g5]al ,if a director ( a m$ical c5t] ( ! ,dep>tm5t or a ,vet]ans ,integrat$ ,s]vice ,network det]m9es t ! opioid prescrib+ practices ( a cov]$ heal? c>e provid] conflicts ) or is o!rwise inconsi/5t ) ! /&>ds ( appropriate & safe c>e1 z t t]m is us$ 9 section #iac7;d7 ( ! ,jason ,simcakoski ,memorial & ,promise ,act 7,public ,law #aad-aih2 #ch ,u4,s4,c4 #agja note71 ! director %all take su* action z ! director consid]s appropriate to ensure ! safety ( all vet]ans receiv+ c>e f t heal? c>e provid]1 includ+ remov+ or direct+ ! removal ( any su* heal? c>e provid] f provid] networks or o!rwise refus+ to au?orize c>e ( vet]ans by su* heal? c>e provid] 9 any program au?oriz$ "u ! laws adm9i/]$ by ! ,secret>y4 7#b7 ,inclusion 9 contracts ,! ,secret>y %all ensure t any contracts ent]$ into by ! ,secret>y ) ?ird p>ties involv$ 9 adm9i/]+ programs t provide c>e 9 ! community to vet]ans "u ! laws adm9i/]$ by ! ,secret>y specifically grant ! au?ority set =? 9 p>agraph 7#a7 to su* ?ird p>ties & to ! directors describ$ 9 t p>agraph1 z ! case may be4 7e7 ,d5ial or revocation ( eligibility ( non-,dep>tm5t provid]s ,! ,secret>y %all d5y or revoke ! eligibility ( a non-,dep>tm5t heal? c>e provid] to provide heal? c>e to vet]ans "u ! laws adm9i/]$ by ! ,secret>y if ! ,secret>y det]m9es t ! opioid prescrib+ practices ( ! provid]-- 7#a7 violate ! requirem5ts ( a m$ical lic5se ( ! heal? c>e provid]2 or 7#b7 detract f ! ability ( ! heal? c>e provid] to deliv] safe & appropriate heal? c>e4 7f7 ,cov]$ heal? c>e provid] def9$ ,9 ?is section1 ! t]m cov]$ heal? c>e provid] means a non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e provid] :o provides heal? c>e to vet]ans "u ! laws adm9i/]$ by ! ,secret>y ( ,vet]ans ,affairs4 ,c ,improv+ collections #bba4 ,align+ ) be/ practices on collection ( heal? insurance in=mation ,section #agje;,a is am5d$-- 7#a7 9 subsection 7a77#a71 by /rik+ ,any individual & all t foll[s ?r\gh cov]$4 & ins]t+ ! foll[+3 ,any individual :o applies = or seeks hospital c>e or m$ical s]vices "u ?is *apt] %all1 at ! "t ( su* application1 or o!rwise :5 reque/$ by ! ,secret>y1 furni% ! ,secret>y ) su* curr5t in=mation z ! ,secret>y may require to id5tify any heal?-plan contract1 z def9$ 9 subsection 7i77l7 ( section #agbi1 "u :i* su* individual is cov]$1 to include1 z applicable1 ! "n1 address1 & telephone numb] ( su* heal?-plan contract2 ! "n ( ! policy hold]1 if cov]age "u a heal?-plan contract is 9 ! "n ( a p]son o!r ?an su* individual2 ! plan id5tification numb]2 & ! gr\p code ( ! plans42 & 7#b7 9 subsection 7c7-- 7,a7 by /rik+ ,! ,secret>y & ins]t+ 7#a7 ,except z provid$ 9 p>agraph 7#b71 ! ,secret>y2 & 7,b7 by add+ at ! end ! foll[+ new p>agraph3 7#b7 ,! ,secret>y may *>ge an individual :o does n provide ! in=mation requir$ by subsection 7a7 reasonable *>ges = ! provision ( su* c>e & s]vices4 4 #bbb4 ,improv+ au?ority to collect 7a7 ,broad5+ scope ( applicability ,section #agbi is am5d$-- 7#a7 9 subsection 7a7-- 7,a7 9 p>agraph 7#b77;,a7-- 7i7 by /rik+ ! vet]an's & ins]t+ ! individual's2 & 7ii7 by /rik+ ! vet]an & ins]t+ ! individual2 & 7,b7 9 p>agraph 7#c7-- 7i7 9 ! matt] prec$+ subp>agraph 7,a71 by /rik+ ! vet]an & ins]t+ ! individual2 & 7ii7 9 subp>agraph 7,a71 by /rik+ ! vet]an's & ins]t+ ! individual's2 7#b7 9 subsection 7b7-- 7,a7 9 p>agraph 7#a7-- 7i7 by /rik+ ! vet]an & ins]t+ ! individual2 & 7ii7 by /rik+ ! vet]an's & ins]t+ ! individual's2 & 7,b7 9 p>agraph 7#b7-- 7i7 9 subp>agraph 7,a7-- 7,i7 by /rik+ ! vet]an & ins]t+ ! individual2 & 7,,ii7 by /rik+ ! vet]an's & ins]t+ ! individual's2 & 7ii7 9 subp>agraph 7,b7-- 7,i7 9 clause 7i71 by /rik+ ! vet]an & ins]t+ ! individual2 & 7,,ii7 9 clause 7ii7-- 7aa7 by /rik+ ! vet]an & ins]t+ ! individual2 & 7bb7 by /rik+ ! vet]an's ea* place x appe>s & ins]t+ ! individual's2 7#c7 9 subsection 7e71 by /rik+ ,a vet]an & ins]t+ ,an individual2 & 7#d7 9 subsection 7h7-- 7,a7 9 p>agraph 7#a7-- 7i7 9 ! matt] prec$+ subp>agraph 7,a71 by /rik+ a vet]an & ins]t+ an individual2 7ii7 9 subp>agraph 7,a71 by /rik+ ! vet]an & ins]t+ ! individual2 & 7iii7 9 subp>agraph 7,b71 by /rik+ ! vet]an & ins]t+ ! individual2 & 7,b7 9 p>agraph 7#b7-- 7i7 by /rik+ ,a vet]an & ins]t+ ,an individual2 7ii7 by /rik+ a vet]an & ins]t+ an individual2 & 7iii7 by /rik+ ! vet]an & ins]t+ ! individual4 7b7 ,additional am5dm5ts ,su* section is fur!r am5d$-- 7#a7 9 subsection 7a7-- 7,a7 9 p>agraph 7#a71 by /rik+ 7#a7 ,subject & all t foll[s ?r\gh ! p]iod & ins]t+ ! foll[+3 7#a7 ,subject to ! provisions ( ?is section1 9 any case 9 :i* ! ,unit$ ,/ates is requir$ by law to furni% or pay = c>e or s]vices "u ?is *apt] = a non-s]vice-connect$ disability describ$ 9 p>agraph 7#b7 ( ?is subsection1 ! ,unit$ ,/ates has ! "r to recov] or collect f a ?ird p>ty ! reasonable *>ges ( c>e or s]vices s furni%$ or paid = to ! ext5t t ! recipi5t or provid] ( ! c>e or s]vices w\ld be eligible to receive paym5t = su* c>e or s]vices f su* ?ird p>ty if ! c>e or s]vices _h n be5 furni%$ or paid = by a dep>tm5t or ag5cy ( ! ,unit$ ,/ates42 7,b7 9 p>agraph 7#b7-- 7i7 9 subp>agraph 7,c71 by /rik+ ! semicolon & ins]t+ 2 or2 7ii7 by am5d+ subp>agraph 7,d7 to read z foll[s3 7,d7 t is incurr$ by an individual :o is entitl$ to c>e 7or paym5t ( ! exp5ses ( c>e7 "u a heal?-plan contract4 2 & 7iii7 by /rik+ subp>agraph 7,e72 & 7,c7 by add+ at ! end ! foll[+ new p>agraph3 7#d7 ,9 ! case ( a heal?-plan contract :]e ! ,unit$ ,/ates has a "r to recov] or collect reasonable *>ges1 ! ,secret>y %all collect f a vet]an or responsible individual any copaym5t or co/-%>e requir$ "u ?is *apt]4 2 7#b7 9 subsection 7b71 by add+ at ! end ! foll[+ new p>agraph3 7#c7 7,a7 ,! obligation ( ! ?ird p>ty to pay is n dep5d5t ^u an individual execut+ an assignm5t ( b5efits to ! ,unit$ ,/ates1 nor is ! obligation to pay dep5d5t ^u any o!r submission by ! b5efici>y to ! ?ird p>ty1 includ+ any claim or appeal4 7,b7 ,9 any case 9 :i* ! ,secret>y makes a claim1 appeal1 repres5tation1 or o!r fil+ "u ! au?ority ( ?is *apt]1 any proc$ural requirem5t 9 any ?ird-p>ty plan = ! b5efici>y ( su* plan to make ! claim1 appeal1 repres5tation1 or o!r fil+ is deem$ to be satisfi$4 2 & 7#c7 9 subsection 7f7-- 7,a7 by ins]t+ 7#a7 be=e ,no law2 & 7,b7 by add+ at ! end ! foll[+ new p>agraph3 7#b7 ,! abs5ce ( a p>ticipat+ provid] agreem5t1 ,vet]ans ,c>e ,agreem5t1 or o!r contractual arrangem5t ) a ?ird p>ty describ$ 9 subsection 7i77#c77;,d7 %all n op]ate to prev5t1 or r$uce ! am\nt (1 any su* recov]y or collection by ! ,unit$ ,/ates4 ,= purposes ( ?is section1 ! ,dep>tm5t %all recov] or collect z if x 7 a p>ticipat+ provid]4 2 & 7c7 ,def9itions ,subsection 7i7 ( su* section is am5d$ to read z foll[s3 7i7 ,9 ?is section3 7#a7 ,! t]m heal?-plan contract includes any ( ! foll[+3 7,a7 ,an insurance policy or contract includ+ any heal? ma9t5ance organization1 pref]r$ provid] organization1 po9t ( s]vice organization1 acc\ntable c>e organization1 or any o!r type ( heal? insurance policy or contract1 m$ical or hospital s]vice agreem5t1 memb]%ip or subscription contract1 or simil> arrangem5t "u :i* hospital c>e or m$ical s]vices = individuals are provid$ or ! exp5ses ( su* s]vices are paid4 7,b7 ,a work]s' comp5sation law or plan4 7#b7 ,! t]m paym5t includes reimbursem5t & indemnification4 7#c7 ,! t]m ?ird p>ty means any ( ! foll[+3 7,a7 ,a ,/ate or political subdivision ( a ,/ate4 7,b7 ,an employ] or an employ]'s insurance c>ri]4 7,c7 ,an automobile accid5t rep>ations or liability insurance c>ri]4 7,d7 ,a p]son or entity obligat$ to provide1 or to pay ! exp5ses (1 heal? s]vices "u a heal?-plan contract4 7#d7 ,! t]m reasonable *>ges %all include ! foll[+3 7,a7 ,= hospital c>e or m$ical s]vices furni%$ by ! ,dep>tm5t1 *>ges e/abli%$ 9 accordance ) ?is section4 7,b7 ,= hospital c>e or m$ical s]vices paid = "u subp>agraphs 7,a7 & 7,b7 ( subsection 7a77#b71 ! am\nt paid to a non-,dep>tm5t entity or provid]4 4 ,,iii ,improv+ ,dep>tm5t ( ,vet]ans ,affairs c>e deliv]y ,a ,improv+ p]sonnel practices #cja4 ,lic5sure ( heal? c>e pr(essionals ( ! ,dep>tm5t ( ,vet]ans ,affairs provid+ treatm5t via telem$ic9e 7a7 ,9 g5]al ,*apt] #ag1 z am5d$ by section #ajb1 is fur!r am5d$ by add+ at ! end ! foll[+ new section3 #agcj;,c4 ,lic5sure ( heal? c>e pr(essionals provid+ treatm5t via telem$ic9e 7a7 ,9 g5]al ,not)/&+ any provision ( law reg>d+ ! lic5sure ( heal? c>e pr(essionals1 a cov]$ heal? c>e pr(essional may practice ! heal? c>e pr(ession ( ! heal? c>e pr(essional at any location 9 any ,/ate1 reg>dless ( :]e 9 a ,/ate ! cov]$ heal? c>e pr(essional or ! pati5t is locat$1 if ! cov]$ heal? c>e pr(essional is us+ telem$ic9e to provide treatm5t to an individual "u ?is *apt]4 7b7 ,cov]$ heal? c>e pr(essionals ,= purposes ( ?is section1 a cov]$ heal? c>e pr(essional is any heal? c>e pr(essional :o-- 7#a7 is an employee ( ! ,dep>tm5t appo9t$ "u ?is title or title #e2 7#b7 is au?oriz$ by ! ,secret>y to provide heal? c>e "u ?is *apt]2 7#c7 is requir$ to adh]e to all /&>ds = quality relat+ to ! provision ( m$ic9e 9 accordance ) applicable policies ( ! ,dep>tm5t2 & 7#d7 has an active1 curr5t1 full1 & unre/rict$ lic5se1 regi/ration1 or c]tification 9 a ,/ate to practice ! heal? c>e pr(ession ( ! heal? c>e pr(essional4 7c7 ,prop]ty ( ,f$]al gov]nm5t ,subsection 7a7 %all apply to a cov]$ heal? c>e pr(essional provid+ treatm5t to a pati5t reg>dless ( :e!r ! cov]$ heal? c>e pr(essional or pati5t is locat$ 9 a facility own$ by ! ,f$]al ,gov]nm5t dur+ su* treatm5t4 7d7 ,relation to ,/ate law 7#a7 ,! provisions ( ?is section %all sup]s$e any provisions ( ! law ( any ,/ate to ! ext5t t su* provision ( ,/ate law are inconsi/5t ) ?is section4 7#b7 ,no ,/ate %all d5y or revoke ! lic5se1 regi/ration1 or c]tification ( a cov]$ heal? c>e pr(essional :o o!rwise meets ! qualifications ( ! ,/ate = hold+ ! lic5se1 regi/ration1 or c]tification on ! basis t ! cov]$ heal? c>e pr(essional has engag$ or int5ds to engage 9 activity cov]$ by subsection 7a74 7e7 ,rule ( con/ruction ,no?+ 9 ?is section may be con/ru$ to remove1 limit1 or o!rwise affect any obligation ( a cov]$ heal? c>e pr(essional "u ! ,controll$ ,sub/ances ,act 7#ba ,u4,s4,c4 #hja et seq474 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #ag ( su* title is am5d$ by ins]t+ aft] ! item relat+ to section #agcj;,b1 z add$ by section #ajb1 ! foll[+ new item3 #agcj;,c4 ,lic5sure ( heal? c>e pr(essionals provid+ treatm5t via telem$ic9e4 4 7c7 ,report on telem$ic9e 7#a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! e>li] ( ! date on :i* s]vices provid$ "u section #agcj;,c ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a71 fir/ occur or regulations are promulgat$ to c>ry out su* section1 ! ,secret>y ( ,vet]ans ,affairs %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report on ! effectiv5ess ( ! use ( telem$ic9e by ! ,dep>tm5t ( ,vet]ans ,affairs4 7#b7 ,elem5ts ,! report requir$ by p>agraph 7#a7 %all include an assessm5t ( ! foll[+3 7,a7 ,! satisfaction ( vet]ans ) telem$ic9e furni%$ by ! ,dep>tm5t4 7,b7 ,! satisfaction ( heal? c>e provid]s 9 provid+ telem$ic9e furni%$ by ! ,dep>tm5t4 7,c7 ,! effect ( telem$ic9e furni%$ by ! ,dep>tm5t on ! foll[+3 7i7 ,! ability ( vet]ans to access heal? c>e1 :e!r f ! ,dep>tm5t or f non-,dep>tm5t heal? c>e provid]s4 7ii7 ,! frequ5cy ( use by vet]ans ( telem$ic9e4 7iii7 ,! productivity ( heal? c>e provid]s4 7iv7 ,wait times = an appo9tm5t = ! receipt ( heal? c>e f ! ,dep>tm5t4 7v7 ,! use by vet]ans ( 9-p]son s]vices at ,dep>tm5t facilities & non-,dep>tm5t facilities4 7,d7 ,! types ( appo9tm5ts = ! receipt ( telem$ic9e furni%$ by ! ,dep>tm5t t 7 provid$ dur+ ! "o-ye> p]iod prec$+ ! submittal ( ! report4 7,e7 ,! numb] ( appo9tm5ts = ! receipt ( telem$ic9e furni%$ by ! ,dep>tm5t t 7 reque/$ dur+ su* p]iod1 disaggregat$ by m$ical facility4 7,f7 ,sav+s by ! ,dep>tm5t1 if any1 includ+ travel co/s1 f furni%+ heal? c>e ?r\gh ! use ( telem$ic9e dur+ su* p]iod4 #cjb4 ,graduate m$ical education & resid5cy 7a7 ,increase 9 numb] ( graduate m$ical education resid5cy positions 7#a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all increase ! numb] ( graduate m$ical education resid5cy positions at cov]$ facilities by n few] ?an #a1ejj positions 9 ! #aj-ye> p]iod beg9n+ on ! date ( ! enactm5t ( ?is ,act4 7#b7 ,cov]$ facilities ,= purposes ( ?is section1 a cov]$ facility is any ( ! foll[+3 7,a7 ,a facility ( ! ,dep>tm5t ( ,vet]ans ,affairs4 7,b7 ,a facility op]at$ by an ,indian tribe or a tribal organization1 z ^? t]ms are def9$ 9 section #d ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #ecjd74 7,c7 ,a facility op]at$ by ! ,indian ,heal? ,s]vice4 7,d7 ,a ,f$]ally-qualifi$ heal? c5t]1 z def9$ 9 section #aije7l77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b774 7,e7 ,a community heal? c5t]4 7,f7 ,a facility op]at$ by ! ,dep>tm5t ( ,def5se4 7,g7 ,su* o!r heal? c>e facility z ! ,secret>y consid]s appropriate = purposes ( ?is section4 7#c7 ,/ip5ds & b5efits ,! ,secret>y may pay /ip5ds & provide b5efits = resid5ts 9 positions "u p>agraph 7#a71 reg>dless ( :e!r !y h be5 assign$ 9 a ,dep>tm5t facility4 7#d7 ,p>amet]s = location1 affiliate sponsor1 & duration ,:5 det]m9+ *>act]i/ics ( resid5cy positions "u p>agraph 7#a71 ! ,secret>y %all consid] ! ext5t to :i* !re is a cl9ical ne$ = provid]s1 z det]m9$ by ! m>ket area assessm5t mo/ rec5tly p]=m$ "u section #agcj;,b7c7 ( title #ch1 ,unit$ ,/ates ,code1 z add$ by section #ajb4 7#e7 ,p>amet]s = types ( specialties ,:5 det]m9+ ! types ( specialties to be includ$ 9 resid5cy positions "u p>agraph 7#a71 ! ,secret>y %all consid] ! foll[+3 7,a7 ,! types ( specialties t improve ! quality & cov]age ( m$ical s]vices provid$ to vet]ans4 7,b7 ,! range ( cl9ical specialties cov]$ by provid]s 9 /&>diz$ geographic areas surr\nd+ facilities4 7,c7 ,:e!r ! specialty is includ$ 9 ! mo/ rec5t /aff+ %ortage det]m9ation ( ! ,dep>tm5t "u section #gdab ( title #ch1 ,unit$ ,/ates ,code4 7,d7 ,! mo/ rec5t m>ket area assessm5t p]=m$ "u section #agcj;,b7c7 ( title #ch1 ,unit$ ,/ates ,code1 z add$ by section #ajb4 7b7 ,application ,to p>ticipate ,to p>ticipate z a resid5t 9 "o ( ! positions increas$ "u subsection 7a77#a71 an individual %all submit to ! ,secret>y an application !re= toge!r ) an agreem5t describ$ 9 subsection 7d7 "u :i* ! p>ticipant agrees to s]ve a p]iod ( obligat$ s]vice 9 ! ,vet]ans ,heal? ,adm9i/ration z provid$ 9 ! agreem5t 9 return = paym5t ( /ip5d & b5efit support z provid$ 9 ! agreem5t4 7c7 ,selection 7#a7 ,9 g5]al ,an individual becomes a p>ticipant 9 a resid5cy program "u ?is section ^u ! ,secret>y's approval ( ! individual's application "u subsection 7b7 & ! ,secret>y's acceptance ( ! agreem5t "u subsection 7d7 7if requir$74 7#b7 ,notice ,^u ! ,secret>y's approval ( an individual's p>ticipation 9 ! program "u p>agraph 7#a71 ! ,secret>y %all promptly notify ! individual ( t approval4 ,su* notice %all be 9 writ+4 7d7 ,agreem5t 7#a7 ,9 g5]al ,an agreem5t betwe5 ! ,secret>y & a resid5t 9 a position "u subsection 7a77#a7 %all be 9 writ+ & %all be sign$ by ! resid5t conta9+ su* t]ms z ! ,secret>y may specify4 7#b7 ,requirem5ts ,! agreem5t mu/ specify ! t]ms ( ! s]vice obligation result+ f p>ticipat+ z a resid5t "u ?is section1 includ+ by requir+ a s]vice obligation equal to ! numb] ( ye>s ( /ip5d & b5efit support4 7e7 ,conditions ( employm5t ,! ,secret>y may prescribe ! conditions ( employm5t ( p]sons appo9t$ to positions "u subsection 7a77#a71 includ+ necess>y tra9+1 & ! cu/om>y am\nt & t]ms ( pay = su* positions dur+ ! p]iod ( su* employm5t & tra9+4 7f7 ,obligat$ s]vice 7#a7 ,9 g5]al ,ea* p]son appo9t$ to a position "u subsection 7a77#a7 %all provide s]vice z a full-"t employee ( ! ,dep>tm5t = ! p]iod ( obligat$ s]vice provid$ 9 ! agreem5t ( ! p>ticipant ent]$ into "u subsection 7d74 ,su* s]vice %all be provid$ 9 ! full-"t cl9ical practice ( su* p>ticipant's pr(ession or 9 ano!r heal?-c>e position 9 an assignm5t or location det]m9$ by ! ,secret>y4 7#b7 ,comm5cem5t date ,n lat] ?an #fj days be=e ! date on :i* a p]son comm5ces s]v+ 9 a position "u subsection 7a77#a71 ! ,secret>y %all notify ! p]son ( su* date4 ,su* date %all be ! fir/ day ( ! p]son's p]iod ( obligat$ s]vice4 7g7 ,brea* ( agreem5t3 liability 7#a7 ,p5alty ,a p]son appo9t$ "u ?is section to a position "u subsection 7a77#a7 7o!r ?an a p]son :o is liable "u p>agraph 7#b77 :o fails to accept paym5t1 or in/ructs ! educational in/itution 9 :i* ! p]son is enroll$ n to accept paym5t1 9 :ole or 9 "p1 = a resid5cy "u ! agreem5t ent]$ into "u subsection 7d7 ( ?is title %all be liable to ! ,unit$ ,/ates = liquidat$ damages 9 ! am\nt ( #a1ejj4 ,su* liability is 9 addition to any p]iod ( obligat$ s]vice or o!r obligation or liability "u ! agreem5t4 7#b7 ,liability 7,a7 ,9 g5]al ,a p]son appo9t$ to a position "u subsection 7a77#a7 %all be liable to ! ,unit$ ,/ates = ! am\nt :i* has be5 paid to or on behalf ( ! p]son "u ! agreem5t if any ( ! foll[+ occurs3 7i7 ,! p]son is dismiss$ f ! position = discipl9>y reasons4 7ii7 ,! p]son volunt>ily t]m9ates ! resid5cy be=e ! completion ( su* c\rse ( tra9+4 7iii7 ,! p]son loses ! p]son's lic5se1 regi/ration1 or c]tification to practice ! p]son's heal? c>e pr(ession 9 a ,/ate4 7,b7 ,liability supplants s]vice obligation ,liability "u ?is p>agraph is 9 lieu ( any s]vice obligation aris+ "u ! p]son's agreem5t "u subsection 7d74 7h7 ,recov]y 7#a7 ,9 g5]al ,if a p]son brea*es ! p]son's agreem5t "u subsection 7d7 by fail+ 7= any reason7 to complete su* p]son's p]iod ( obligat$ s]vice1 ! ,unit$ ,/ates %all be entitl$ to recov] f ! p]son an am\nt equal to ! product (-- 7,a7 ?ree2 7,b7 ! sum (-- 7i7 ! am\nts paid "u ?is section to or on behalf ( ! p]son2 & 7ii7 ! int]e/ on su* am\nts t w\ld be payable if at ! "t ! am\nts 7 paid !y 7 loans be>+ int]e/ at ! maximum legal prevail+ rate1 z det]m9$ by ! ,treasur] ( ! ,unit$ ,/ates2 & 7,c7 ! quoti5t (-- 7i7 ! diff]5ce betwe5-- 7,i7 ! total numb] ( mon?s 9 ! p]son's p]iod ( obligat$ s]vice2 & 7,,ii7 ! numb] ( mon?s ( su* p]iod s]v$ by ! p]son2 & 7ii7 ! total numb] ( mon?s 9 ! p]son's p]iod ( obligat$ s]vice4 7#b7 ,p]iod ( recov]y ,any am\nt :i* ! ,unit$ ,/ates is entitl$ to recov] "u ?is subsection %all be paid to ! ,unit$ ,/ates n lat] ?an ! date t is "o ye> aft] ! date ( ! brea* ( ! agreem5t4 7i7 ,annual report 7#a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act & n less frequ5tly ?an once ea* ye> !reaft]1 ! ,secret>y %all submit to ! appropriate committees ( ,congress a report on ! implem5tation ( ?is section dur+ ! previ\s ye>4 7#b7 ,cont5ts ,ea* report submitt$ "u p>agraph 7#a7 %all include1 = ! p]iod cov]$ by ! report1 ! foll[+3 7,a7 ,! numb] ( positions describ$ 9 subsection 7a7 t 7 fill$4 7,b7 ,! location ( ea* su* position4 7,c7 ,! academic affiliate associat$ ) ea* su* position4 7,d7 ,a description ( ! *all5ges fac$ 9 fill+ ! positions describ$ 9 subsection 7a7 & ! actions ! ,secret>y has tak5 to address su* *all5ges4 7#c7 ,appropriate committees ( ,congress def9$ ,9 ?is subsection1 ! t]m appropriate committees ( ,congress means-- 7,a7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,s5ate2 & 7,b7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives4 #cjc4 ,annual report on aw>ds or bonuses aw>d$ to c]ta9 high-level employees ( ! dep>tm5t ( vet]ans affairs 7a7 ,9 g5]al ,*apt] #g is am5d$ by add+ at ! end ! foll[+ new section3 #gbf4 ,annual report on aw>ds to c]ta9 high-level employees 7a7 ,9 g5]al ,n lat] ?an #cj days aft] ! end ( ea* fiscal ye>1 ! ,secret>y %all submit to ! appropriate committees ( ,congress a report t conta9s1 = ! mo/ rec5t fiscal ye> end+ be=e ! submittal ( ! report1 a description ( ! p]=mance aw>ds & bonuses aw>d$ to ,regional ,(fice ,directors ( ! ,dep>tm5t1 ,directors ( ,m$ical ,c5t]s ( ! ,dep>tm5t1 & ,directors ( ,vet]ans ,integrat$ ,s]vice ,networks4 7b7 ,elem5ts ,ea* report submitt$ "u subsection 7a7 %all include ! foll[+ ) respect to ea* aw>d or bonus aw>d$ to an individual describ$ 9 su* subsection3 7#a7 ,! type ( aw>d or bonus1 specifically ^? aw>d$ = p]=mance or on ! basis ( recruitm5t1 relocation & ret5tion z ! case may be4 7#b7 ,! am\nt ( ea* aw>d or bonus4 7#c7 ,! job title ( ! individual aw>d$ ! aw>d or bonus4 7#d7 ,! location :]e ! individual aw>d$ ! aw>d or bonus works4 7c7 ,appropriate committees ( congress ,9 ?is section1 ! t]m appropriate committees ( ,congress means-- 7#a7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,s5ate2 & 7#b7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #g ( su* title is am5d$ by ins]t+ aft] ! item relat+ to section #gbe ! foll[+ new item3 #gbf4 ,annual report on aw>ds to c]ta9 high-level employees4 4 ,b ,facilities1 con/ruction1 & leases #caa4 ,facilitat+ %>+ ( m$ical facilities ) o!r ,f$]al ag5cies 7a7 ,con/ruction or lease ( %>$ facility 7#a7 ,9 g5]al ,sub*apt] ,i ( *apt] #ha is am5d$ by ins]t+ aft] section #haaa;,a ! foll[+ new section3 #haaa;,b4 ,au?ority to plan1 design1 con/ruct1 or lease a %>$ m$ical facility 7a7 ,9 g5]al 7#a7 ,! ,secret>y may ent] into agreem5ts ) o!r ,f$]al ag5cies = ! plann+1 design+1 con/ruct+1 or leas+ %>$ m$ical facilities ) ! goal ( improv+ access to1 & quality & co/ effectiv5ess (1 heal? c>e provid$ by ! ,dep>tm5t & o!r ,f$]al ag5cies4 7#b7 ,facilities plann$1 design$1 con/ruct$1 or leas$ "u p>agraph 7#a7 %all be manag$ by ! ,director ( ! ,high-,p]=m+ ,integrat$ ,heal?c>e ,network ( ! ,dep>tm5t designat$ "u section #agcj;,b7a7 ( ?is title4 7b7 ,transf] ( am\nts to o!r ,f$]al ag5cies 7#a7 ,! ,secret>y may transf] to ano!r ,f$]al ag5cy am\nts appropriat$ to ! ,dep>tm5t = ,con/ruction1 ,m9or ,projects = use = ! plann+1 design1 or con/ruction ( a %>$ m$ical facility if ! e/imat$ %>e ( ! project co/s to be borne by ! ,dep>tm5t does n exce$ ! ?re%old = a major m$ical facility con/ruction project "u section #hajd7;a77#c77;,a7 ( ?is title4 7#b7 ,! ,secret>y may transf] to ano!r ,f$]al ag5cy am\nts appropriat$ to ! ,dep>tm5t = ,con/ruction1 ,major ,projects = use = ! plann+1 design1 or con/ruction ( a %>$ m$ical facility if-- 7,a7 ! e/imat$ %>e ( ! project co/s to be borne by ! ,dep>tm5t is m ?an ! ?re%old = a major m$ical facility con/ruction project "u subsection 7a77#c77;,a7 ( section #hajd ( ?is title2 & 7,b7 ! requirem5ts = su* a project "u su* section h be5 met4 7#c7 ,! ,secret>y may transf] to ano!r ,f$]al ag5cy am\nts appropriat$ to ! applicable appropriations acc\nt ( ! ,dep>tm5t = ! purpose ( leas+ space = a %>$ m$ical facility if ! e/imat$ %>e ( ! lease co/s to be borne by ! ,dep>tm5t does n exce$ ! ?re%old = a major m$ical facility lease "u section #hajd7;a77#c77;,b7 ( ?is title4 7c7 ,transf] ( am\nts to ,dep>tm5t 7#a7 ,am\nts transf]r$ to ! ,dep>tm5t by ano!r ,f$]al ag5cy = ! necess>y exp5ses ( plann+1 design+1 or con/ruct+ a %>$ m$ical facility = :i* ! e/imat$ %>e ( ! project co/s to be borne by ! ,dep>tm5t does n exce$ ! ?re%old = a major m$ical facility project "u section #hajd7;a77#c77;,a7 ( ?is title may be deposit$ 9 ! ,con/ruction1 ,m9or ,projects acc\nt ( ! ,dep>tm5t & us$ = su* necess>y exp5ses4 7#b7 ,am\nts transf]r$ to ! ,dep>tm5t by ano!r ,f$]al ag5cy = ! necess>y exp5ses ( plann+1 design+1 or con/ruct+ a %>$ m$ical facility = :i* ! e/imat$ %>e ( ! project co/s to be borne by ! ,dep>tm5t is m ?an ! ?re%old = a major m$ical facility project "u section #hajd7;a77#c77;,a7 ( ?is title may be deposit$ 9 ! ,con/ruction1 ,major ,projects acc\nt ( ! ,dep>tm5t & us$ = su* necess>y exp5ses if ! requirem5ts = su* project "u section #hajd ( ?is title h be5 met4 7#c7 ,am\nts transf]r$ to ! ,dep>tm5t by ano!r ,f$]al ag5cy = ! purpose ( leas+ space = a %>$ m$ical facility may be cr$it$ to ! applicable appropriations acc\nt ( ! ,dep>tm5t & %all be available )\t fiscal ye> limitation4 7#d7 ,am\nts transf]r$ "u p>agraphs 7#a7 & 7#b7 %all be available = ! same "t p]iod z am\nts 9 ! acc\nt to :i* ^? am\nts are transf]r$4 4 7#b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( su* *apt] is am5d$ by ins]t+ aft] ! item relat+ to section #haaa;,a ! foll[+ new item3 #haaa;,b4 ,au?ority to plan1 design1 con/ruct1 or lease a %>$ m$ical facility4 7b7 ,modification ( def9ition ( m$ical facility ,p>agraph 7#c7 ( section #haja is am5d$ to read z foll[s3 7#c7 ,! t]m m$ical facility means any facility or "p !re( t is1 or w be1 "u ! jurisdiction ( ! ,secret>y1 or z o!rwise designat$ by law1 = ! provision ( heal?c>e s]vices 7includ+ hospital c>e1 outpati5t c>e1 nurs+ home c>e1 domicili>y c>e1 or m$ical s]vices71 includ+ any necess>y build+ & auxili>y /ructure1 g>age1 p>k+ facility1 me*anical equipm5t1 trackage facilities lead+ !reto1 abutt+ sidewalks1 accommodations = att5d+ p]sonnel1 & recreation facilities associat$ !re)4 4 #cab4 ,review ( enhanc$ use leases ,section #hafb is am5d$-- 7#a7 9 subsection 7a71 by am5d+ p>agraph 7#b7 to read z foll[s3 7#b7 ,) respect to enhanc$-use leases ent]$ into on or aft] ! date ( enactm5t ( ! ,vet]ans ,community ,c>e & ,access ,act ( #bjag1 ! ,secret>y may ent] into an enhanc$-use lease only if ! ,secret>y det]m9es t-- 7,a7 ! lease w n be inconsi/5t ) & w n adv]sely affect ! mission ( ! ,dep>tm5t2 & 7,b7 7i7 ! lease w enhance ! use ( ! prop]ty2 or 7ii7 ! leas$ prop]ty w provide supportive h\s+ z def9$ 9 section #hafa ( ?is title4 2 & 7#b7 9 subsection 7b71 by am5d+ p>agraph 7#f7 to read z foll[s3 7#f7 ,! ,director ( ! ,(fice ( ,managem5t & ,budget %all review ea* su* enhanc$-use lease prior to execution = compliance ) p>agraph 7#e7 ( ?is subsection4 4 ,,iv ,innovative pilot programs #dja4 ,pilot program to e/abli% or affiliate ) graduate m$ical resid5cy programs at facilities op]at$ by ,indian tribes1 tribal organizations1 & ! ,indian ,heal? ,s]vice 9 rural areas 7a7 ,pilot program requir$ ,! ,secret>y ( ,vet]ans ,affairs1 9 consultation ) ! ,director ( ! ,indian ,heal? ,s]vice1 %all c>ry out a pilot program-- 7#a7 to e/abli% graduate m$ical education resid5cy tra9+ programs at cov]$ facilities2 or 7#b7 to affiliate ) e/abli%$ programs describ$ 9 p>agraph 7#a74 7b7 ,cov]$ facilities ,= purposes ( ! pilot program1 a cov]$ facility is any facility-- 7#a7 describ$ 9 subp>agraph 7,b7 or 7,c7 ( section #cjb7;a77#b72 & 7#b7 locat$ 9 a rural or remote area1 z det]m9$ by ! ,secret>y & ! ,director ( ! ,indian ,heal? ,s]vice4 7c7 ,locations 7#a7 ,9 g5]al ,! ,secret>y %all c>ry out ! pilot program at n m ?an five cov]$ facilities t h be5 select$ by ! ,secret>y = purposes ( ! pilot program4 7#b7 ,crit]ia ,! ,secret>y %all e/abli% crit]ia = select+ cov]$ facilities "u p>agraph 7#a74 7d7 ,duration ,! ,secret>y %all c>ry out ! pilot program dur+ ! eight-ye> p]iod beg9n+ on ! date t is #ahj days aft] ! date ( ! enactm5t ( ?is ,act4 7e7 ,reimbursem5t ( co/s ,! ,secret>y %all reimburse ea* cov]$ facility p>ticipat+ 9 ! pilot program = ! foll[+ co/s associat$ ) ! pilot program3 7#a7 ,curriculum developm5t4 7#b7 ,recruitm5t1 tra9+1 sup]vision1 & ret5tion ( resid5ts & faculty4 7#c7 ,accr$itation ( programs ( education "u ! pilot program by ! ,accr$itation ,c\ncil = ,graduate ,m$ical ,education 7,,acgme7 or ! ,am]ican ,o/eopa?ic ,association 7,,aoa74 7#d7 ,! portion ( faculty sal>ies attributable to activities relat+ to c>ry+ out ! pilot program4 7#e7 ,paym5t = exp5ses relat+ to provid+ m$ical education "u ! pilot program4 7#f7 ,/ip5ds & b5efits4 7f7 ,p]iod ( obligat$ s]vice 7#a7 ,9 g5]al ,! ,secret>y %all ent] into an agreem5t ) ea* individual :o p>ticipates 9 ! pilot program "u :i* su* individual agrees to s]ve "u ! same t]ms z e/abli%$ "u section #cjb4 7#b7 ,loan repaym5t ,dur+ ! p]iod ( obligat$ s]vice ( an individual "u p>agraph 7#a71 ! individual-- 7,a7 %all be deem$ to be an eligible individual "u subsection 7b7 ( section #ajh ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afaf;a7 = purposes ( p>ticipation 9 ! ,indian ,heal? ,s]vice ,loan ,repaym5t ,program "u su* section dur+ ! portion ( su* p]iod t ! individual s]ves at a cov]$ facility2 & 7,b7 %all be deem$ to be an eligible individual "u section #gfhb7;a7 ( title #ch1 ,unit$ ,/ates ,code1 = purposes ( p>ticipation 9 ! ,dep>tm5t ( ,vet]ans ,affairs ,education ,debt ,r$uction ,program "u sub*apt] ,,vii ( *apt] #gf ( su* title dur+ ! portion ( su* p]iod t ! individual s]ves at a facility ( ! ,dep>tm5t4 7#c7 ,concurr5t s]vice ,any p]iod ( obligat$ s]vice requir$ ( an individual "u p>agraph 7#a7 %all be s]v$-- 7,a7 ) respect to s]vice at a cov]$ facility1 concurr5tly ) any p]iod ( obligat$ s]vice requir$ ( ! individual by ! ,indian ,heal? ,s]vice2 & 7,b7 ) respect to s]vice at a facility ( ! ,dep>tm5t ( ,vet]ans ,affairs1 concurr5tly ) any p]iod ( obligat$ s]vice requir$ ( ! individual by ! ,dep>tm5t4 7g7 ,treatm5t ( p>ticipants ,a resid5cy position into :i* a p>ticipant 9 ! pilot program is plac$ z "p ( ! pilot program %all be consid]$ a position ref]r$ to 9 section #cjb7;a77#a7 = purposes ( ! limitation on numb] ( new positions au?oriz$ "u su* section4 7h7 ,report ,n lat] ?an ?ree ye>s be=e ! date on :i* ! pilot program t]m9ates1 ! ,secret>y ( ,vet]ans ,affairs %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report on ! feasibility & advisability (-- 7#a7 exp&+ ! pilot program to additional locations2 & 7#b7 mak+ ! pilot program or any aspect ( ! pilot program p]man5t4 #djb4 ,au?ority = ,dep>tm5t ( ,vet]ans ,affairs ,c5t] = ,innovation = ,c>e & ,paym5t 7a7 ,9 g5]al ,sub*apt] ,i ( *apt] #ag1 z am5d$ by section #abb1 is fur!r am5d$ by ins]t+ aft] section #agjc;,e1 z add$ by section #abb1 ! foll[+ new section3 #agjc;,f4 ,c5t] = ,innovation = ,c>e & ,paym5t 7a7 ,9 g5]al 7#a7 ,!re is e/abli%$ )9 ! ,dep>tm5t a ,c5t] = ,innovation = ,c>e & ,paym5t 79 ?is section ref]r$ to z ! ,c5t]74 7#b7 ,! ,secret>y1 act+ ?r\gh ! ,c5t]1 may c>ry out su* pilot programs z appropriate to develop new1 innovative approa*es to te/+ paym5t & s]vice deliv]y models to r$uce exp5ditures :ile pres]v+ or enhanc+ ! quality ( c>e furni%$ by ! ,dep>tm5t4 7#c7 ,! ,secret>y1 act+ ?r\gh ! ,c5t]1 %all te/ paym5t & s]vice deliv]y models to det]m9e :e!r su* models improve ! access to & quality1 timel9ess1 & pati5t satisfaction ( su* c>e & s]vices1 z well z ! co/ sav+s associat$ ) su* models4 7#d7 7,a7 ,! ,secret>y %all te/ models :]e ! ,secret>y det]m9es t !re is evid5ce t ! model addresses a def9$ population = :i* !re are deficits c>e lead+ to poor cl9ical outcomes or pot5tially avoidable exp5ditures4 7,b7 ,! ,secret>y %all focus on models expect$ to r$uce program co/s :ile pres]v+ or enhanc+ ! quality ( c>e receiv$ by individuals receiv+ b5efits "u ?is *apt]4 7,c7 ,! models select$ may include ^? describ$ 9 section #aaae;,a7b77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77;,b774 7#e7 ,9 select+ models = te/+1 ! ,secret>y may consid] ! foll[+ additional factors3 7,a7 ,:e!r ! model includes a regul> process = monitor+ & updat+ pati5t c>e plans 9 a mann] t is consi/5t ) ! ne$s & pref]5ces ( applicable individuals4 7,b7 ,:e!r ! model places ! applicable individual1 includ+ family memb]s & o!r c>egiv]s ( ! applicable individual1 at ! c5t] ( ! c>e team ( ! applicable individual4 7,c7 ,:e!r ! model uses te*nology or new sy/ems to coord9ate c>e ov] "t & across sett+s4 7,d7 ,:e!r ! model demon/rates effective l9kage ) o!r public sector pay]s1 private sector pay]s1 or /atewide paym5t models4 7#f7 7,a7 ,models te/$ "u ?is section may n be design$ 9 su* a way t w\ld all[ ! ,unit$ ,/ates to recov] or collect reasonable *>ges f a ,f$]al heal? c>e program = c>e or s]vices furni%$ by ! ,secret>y to vet]ans "u pilot programs c>ri$ out "u ?is section4 7,b7 ,9 ?is p>agraph1 ! t]m ,f$]al heal? c>e program means-- 7i7 an insurance program describ$ 9 section #ahaa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;c7 or e/abli%$ by section #ahca ( su* ,act 7#db ,u4,s4,c4 #acie;j72 or 7ii7 a ,/ate plan = m$ical assi/ance approv$ "u title ,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et seq472 or 7iii7 a ,,tric>e program op]at$ "u sections #ajge1 #ajge;a1 #ajgf1 #ajgf;a1 #ajgf;c1 #ajgf;d1 #ajgf;e1 or #ajgf;f ( title #aj4 7b7 ,duration ,pilot programs c>ri$ out by ! ,secret>y "u ?is section %all t]m9ate no lat] ?an five ye>s aft] _! comm5cem5t4 7c7 ,location ,! ,secret>y %all ensure t pilot programs c>ri$ out "u ?is section occur 9 diff]5t areas t are appropriate = ! int5d$ purposes ( ! pilot program4 7d7 ,budget ,fund+ = pilot programs c>ri$ out by ! ,secret>y "u ?is section w be d]iv$ f appropriations provid$ 9 advance 9 appropriations ,acts = ! ,vet]ans ,heal? ,adm9i/ration & f appropriations provid$ = in=mation te*nology sy/ems4 7e7 ,notice ,! ,secret>y %all publi% in=mation ab\t su* pilot programs 9 ! ,f$]al ,regi/]1 & %all take reasonable actions to provide direct notice to vet]ans eligible to p>ticipate 9 a pilot program op]at$ "u ?is section4 7f7 ,waiv] ( au?orities 7#a7 ,subject to report+ "u p>agraph 7#b7 & approval "u p>agraph 7#c71 9 implem5t+ ! pilot programs "u ?is section1 ! ,secret>y may waive su* requirem5ts 9 sub*apt]s ,i1 ,,ii1 & ,,iii ( ?is *apt] z may be necess>y solely = ! purposes ( c>ry+ out ?is section ) respect to te/+ models describ$ 9 subsection 7a74 7#b7 ,be=e waiv+ any au?ority "u p>agraph 7#a71 ! ,secret>y %all submit a report to ! ,speak] ( ! ,h\se ( ,repres5tatives1 ! m9ority lead] ( ! ,h\se ( ,repres5tatives1 ! majority lead] ( ! ,s5ate1 ! m9ority lead] ( ! ,s5ate1 & ea* /&+ committee ) jurisdiction "u ! rules ( ! ,s5ate ( ! ,h\se ( ,repres5tatives to report a bill to am5d ! provision or provisions ( law t w\ld be waiv$ by ! ,dep>tm5t describ+ 9 detail ! foll[+3 7,a7 ,! specific au?orities to be waiv$ "u ! pilot program4 7,b7 ,! /&>d or /&>ds to be us$ 9 ! pilot program 9 lieu ( ! waiv$ au?orities4 7,c7 ,! reasons = su* waiv] or waiv]s4 7,d7 ,a description ( ! metric or metrics ! ,secret>y w use to det]m9e ! effect ( ! waiv] or waiv]s ^u ! access to & quality1 timel9ess1 or pati5t satisfaction ( c>e & s]vices furni%$ ?r\gh ! pilot program4 7,e7 ,! anticipat$ co/ sav+s1 if any1 ( ! pilot program4 7,f7 ,! s*$ule = int]im reports on ! pilot program describ+ ! results ( ! pilot program s f> & ! feasibility & advisability ( cont9u+ ! pilot program4 7,g7 ,! s*$ule = ! t]m9ation ( ! pilot program & ! submission ( a f9al report on ! pilot program describ+ ! result ( ! pilot program & ! feasibility & advisability ( mak+ ! pilot program p]man5t4 7,h7 ,! e/imat$ budget ( ! pilot program4 7#c7 7,a7 ,^u receipt ( a report submitt$ "u p>agraph 7#b71 ea* ,h\se %all provide copies ( ! report to ! *airman & rank+ memb] ( ea* /&+ committee ) jurisdiction "u ! rules ( ! ,h\se ( ,repres5tatives or ! ,s5ate to report a bill to am5d ! provision or provisions ( law t w\ld be waiv$ by ! ,dep>tm5t "u ?is subsection4 7,b7 7i7 ,! waiv] reque/$ by ! ,secret>y "u p>agraph 7#b7 %all be consid]$ approv$ "u ?is p>agraph if !re is enact$ into law a bill or jo9t resolution approv+ su* reque/ 9 its entirety4 ,su* bill or jo9t resolution %all be pass$ by record$ vote to reflect ! vote ( ea* memb] ( ,congress !reon4 7ii7 ,! provisions ( ?is p>agraph are enact$ by ! ,congress-- 7,i7 z an ex]cise ( ! rulemak+ p[] ( ! ,s5ate & ! ,h\se ( ,repres5tatives & z su* %all be consid]$ z "p ( ! rules ( ea* ,h\se1 & %all sup]s$e o!r rules only to ! ext5t t !y are inconsi/5t !re)2 & 7,,ii7 ) full recognition ( ! con/itutional "r ( ei!r ,h\se to *ange ! rules 7s f> z !y relate to ! proc$ures ( t ,h\se7 at any "t1 9 ! same mann]1 & to ! same ext5t z 9 ! case ( any o!r rule ( t ,h\se4 7,c7 ,dur+ ! #fj-;cal5d>-day p]iod beg9n+ on ! date on :i* ! ,secret>y submits ! report describ$ 9 p>agraph 7#b7 to ,congress1 x %all be 9 ord] z a matt] ( highe/ privilege 9 ea* ,h\se ( ,congress to consid] a bill or jo9t resolution1 if (f]$ by ! majority lead] ( su* ,h\se 7or a designee71 approv+ su* reque/ 9 its entirety4 7g7 ,limitations 7#a7 ,! waiv] provisions 9 subsection 7f7 %all n be available unless ! ,secret>y submits ! fir/ proposal1 9 accordance ) ! requirem5ts 9 subsection 7f71 = a pilot program )9 #ah mon?s ( ! date ( ! enactm5t ( ! ,vet]ans ,community ,c>e & ,access ,act ( #bjag4 7#b7 ,not)/&+ section #ejb ( ?is title1 decisions by ! ,secret>y "u ?is section %all1 consi/5t ) section #eaa ( ?is title1 be f9al & conclusive & may n be review$ by any o!r (ficial or by any c\rt1 :e!r by an action 9 ! nature ( m&amus or o!rwise4 7#c7 7,a7 ,if ! ,secret>y det]m9es t ! pilot program is n improv+ ! quality ( c>e or produc+ co/ sav+s1 ! ,secret>y %all-- 7i7 propose a modification to ! pilot program 9 ! int]im report t %all also be consid]$ a report "u subsection 7f77#b77;,a7 & %all be subject to ! t]ms & conditions ( subsection 7f77#b72 or 7ii7 t]m9ate su* pilot program )9 #cj days ( submitt+ ! int]im report to ,congress4 7,b7 ,if ! ,secret>y t]m9ates ! pilot program "u subp>agraph 7,a77ii71 = purposes ( clauses 7vi7 & 7vii7 ( subsection 7f77#b77;,a71 su* int]im report w also s]ve z ! f9al report = t pilot program4 7h7 ,evaluation & report+ requirem5ts 7#a7 ,! ,secret>y %all conduct an evaluation ( ea* model te/$1 :i* %all include1 at a m9imum1 an analysis (-- 7,a7 ! quality ( c>e furni%$ "u ! model1 includ+ ! measurem5t ( pati5t-level outcomes & pati5t-c5t]$ness crit]ia det]m9$ appropriate by ! ,secret>y2 & 7,b7 ! *anges 9 sp5d+ by reason ( t model4 7#b7 ,! ,secret>y %all make ! results ( ea* evaluation "u ?is subsection available to ! public 9 a timely fa%ion & may e/abli% requirem5ts = o!r entities p>ticipat+ 9 ! te/+ ( models "u ?is section to collect & report in=mation t ! ,secret>y det]m9es is necess>y to monitor & evaluate su* models4 7i7 ,coord9ation & consultation 7#a7 ,! ,secret>y %all obta9 advice f ! ,"u ,secret>y = ,heal? & ! ,special ,m$ical ,advisory ,gr\p e/abli%$ pursuant to section #gcab ( ?is title 9 ! developm5t & implem5tation ( any pilot program op]at$ "u ?is section4 7#b7 ,9 c>ry+ out ! duties "u ?is section1 ! ,secret>y %all consult repres5tatives ( relevant ,f$]al ag5cies1 & cl9ical & analytical exp]ts ) exp]tise 9 m$ic9e & heal? c>e managem5t4 ,! ,secret>y %all use appropriate me*anisms to seek input f int]e/$ p>ties4 7j7 ,expansion ( successful pilot programs ,tak+ into acc\nt ! evaluation "u subsection 7f71 ! ,secret>y may1 ?r\gh rulemak+1 exp& 7includ+ implem5tation on a nationwide basis7 ! duration & ! scope ( a model t is be+ te/$ "u subsection 7a7 to ! ext5t det]m9$ appropriate by ! ,secret>y1 if-- 7#a7 ! ,secret>y det]m9es t su* expansion is expect$ to-- 7,a7 r$uce sp5d+ )\t r$uc+ ! quality ( c>e2 or 7,b7 improve ! quality ( pati5t c>e )\t increas+ sp5d+2 & 7#b7 ! ,secret>y det]m9es t su* expansion w\ld n d5y or limit ! cov]age or provision ( b5efits = applicable individuals4 4 7b7 ,con=m+ am5dm5t ,! table ( sections at ! beg9n+ ( su* *apt]1 z am5d$ by section #abb1 is fur!r am5d$ by ins]t+ aft] ! item relat+ to section #agjc;,e ! foll[+ new item3 #agjc;,f4 ,c5t] = ,innovation = ,c>e & ,paym5t4 4 ,v ,o!r heal? c>e matt]s #eja4 ,au?orization ( appropriations = heal? c>e f ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,9 g5]al ,!re is au?oriz$ to be appropriat$ to ! ,secret>y ( ,vet]ans ,affairs su* am\nts z may be necess>y to c>ry out ! purposes set =? 9 subsection 7b74 7b7 ,use ( am\nts ,! purposes set =? 9 ?is subsection are z foll[s3 7#a7 ,to increase ! access ( vet]ans to c>e z foll[s3 7,a7 ,to hire prim>y c>e & specialty c>e physicians = employm5t 9 ! ,dep>tm5t ( ,vet]ans ,affairs4 7,b7 ,to hire o!r m$ical /aff1 includ+ ! foll[+3 7i7 ,physicians4 7ii7 ,nurses4 7iii7 ,social work]s4 7iv7 ,m5tal heal? pr(essionals4 7v7 ,physician assi/ants4 7vi7 ,o!r heal? c>e pr(essionals z ! ,secret>y consid]s appropriate4 7,c7 ,to c>ry out ! foll[+3 7i7 ,section #gdab ( title #ch1 ,unit$ ,/ates ,code4 7ii7 ,section #gcjb7;e7 ( su* title4 7iii7 ,sub*apt]s ,,ii & ,,vii ( *apt] #gf ( su* title4 7iv7 ,section #cja7;b77#b7 ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #gcjb note74 7,d7 ,to pay = exp5ses1 equipm5t1 & o!r co/s associat$ ) ! hir+ ( prim>y c>e1 specialty c>e physicians1 & o!r m$ical /aff "u subp>agraphs 7,a71 7,b71 & 7,c74 7#b7 ,to improve ! physical infra/ructure ( ! ,dep>tm5t z foll[s3 7,a7 ,to ma9ta9 & op]ate hospitals1 nurs+ homes1 domicili>y facilities1 & o!r facilities ( ! ,vet]ans ,heal? ,adm9i/ration4 7,b7 ,to ent] into contracts or hire tempor>y employees to repair1 alt]1 or improve facilities "u ! jurisdiction ( ! ,dep>tm5t t are n o!rwise provid$ = "u ?is p>agraph4 7,c7 ,to c>ry out leases = facilities ( ! ,dep>tm5t4 7,d7 ,to c>ry out m9or con/ruction projects ( ! ,dep>tm5t4 7#c7 ,to c>ry out sections #cjc & #dja4 7c7 ,fund+ plan & report 7#a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! date on :i* am\nts are appropriat$ to ! ,dep>tm5t pursuant to ! au?orization 9 subsection 7a71 ! ,secret>y ( ,vet]ans ,affairs %all submit to ! appropriate committees ( ,congress a fund+ plan & report on h[ ! ,secret>y int5ds to obligate ! am\nts s appropriat$ & h[ x relates to ! quadr5nial ,vet]ans ,heal? ,adm9i/ration review & /rategic plan "u section #agcj;,b7a7 ( title #ch1 ,unit$ ,/ates ,code1 z add$ by section #ajb4 7#b7 ,appropriate committees ( congress def9$ ,9 ?is subsection1 ! t]m appropriate committees ( ,congress means-- 7,a7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,s5ate2 & 7,b7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives4 #ejb4 ,appropriation ( am\nts = ,vet]ans ,*oice ,program 7a7 ,9 g5]al ,!re is au?oriz$ to be appropriat$1 & is appropriat$1 to ! ,secret>y ( ,vet]ans ,affairs1 out ( any funds 9 ! ,treasury n o!rwise appropriat$1 #d1jjj1jjj1jjj to be deposit$ 9 ! ,vet]ans ,*oice ,fund "u section #hjb ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note74 7b7 ,availability ,! am\nt appropriat$ "u subsection 7a7 %all rema9 available until exp5d$ pursuant to section #hjb7;c77#d7 ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 z add$ by section #bjb4 #ejc4 ,applicability ( ,directive ( ,(fice ( ,f$]al ,contract ,compliance ,programs 7a7 ,9 g5]al ,directive #bjad-ja ( ! ,(fice ( ,f$]al ,contract ,compliance ,programs ( ! ,dep>tm5t ( ,labor 7effective z ( ,may #g1 #bjad7 %all apply to any entity ent]+ into an agreem5t "u section #agjc;,a or section #agde ( title #ch1 ,unit$ ,/ates ,code1 z am5d$ by sections #aab & #aad1 respectively1 9 ! same mann] z su* directive applies to subcontractors "u ! ,,tric>e program = ! duration ( ! moratorium provid$ "u su* directive4 7b7 ,applicability p]iod ,! directive describ$ 9 subsection 7a71 & ! moratorium provid$ "u su* directive1 %all n be alt]$ or resc9d$ be=e ,may #g1 #bjai4 7c7 ,,tric>e program def9$ ,9 ?is section1 ! t]m ,,tric>e program has ! mean+ giv5 t t]m 9 section #ajgb ( title #aj1 ,unit$ ,/ates ,code4 #ejd4 ,am5d+ /atutory requirem5ts = ! position ( ! ,*ief ,(fic] ( ! ,readju/m5t ,c\nsel+ ,s]vice ,section #gcji7;b77#b7 is am5d$-- 7#a7 9 subp>agraph 7,b71 by /rik+ 9 ! ,readju/m5t ,c\nsel+ ,s]vice2 & 7#b7 9 subp>agraph 7,c71 by /rik+ 9 ! ,readju/m5t ,c\nsel+ ,s]vice4 #eje4 ,au?orization ( c]ta9 major m$ical facility projects ( ! ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,au?orization ,! ,secret>y ( ,vet]ans ,affairs may c>ry out ! foll[+ major m$ical facility project1 to be c>ri$ out 9 an am\nt n to exce$ ! am\nt specifi$ = t project3 ,realignm5t ( m$ical facilities 9 ,liv]more1 ,cali=nia1 9 an am\nt n to exce$ #aag1cjj1jjj4 7b7 ,au?orization ( appropriations = con/ruction ,!re is au?oriz$ to be appropriat$ to ! ,secret>y ( ,vet]ans ,affairs = fiscal ye> #bjah or ! ye> 9 :i* funds are appropriat$ = ! ,con/ruction1 ,major ,projects acc\nt1 #aag1cjj1jjj = ! project au?oriz$ 9 subsection 7a74 7c7 ,submittal ( in=mation ,n lat] ?an #ij days aft] ! date ( ! enactm5t ( ?is ,act1 = ! project au?oriz$ 9 section 7a71 ! ,secret>y ( ,vet]ans ,affairs %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives ! foll[+ in=mation3 7#a7 ,a l9e item acc\nt+ ( exp5ditures relat+ to con/ruction managem5t c>ri$ out by ! ,dep>tm5t ( ,vet]ans ,affairs = su* project4 7#b7 ,! future am\nts t are budget$ to be obligat$ = con/ruction managem5t c>ri$ out by ! ,dep>tm5t = su* project4 7#c7 ,a ju/ification = ! exp5ditures describ$ 9 p>agraph 7#a7 & ! future am\nts describ$ 9 p>agraph 7#b74 7#d7 ,any agreem5t ent]$ into by ! ,secret>y reg>d+ ! ,army ,corps ( ,eng9e]s provid+ s]vices relat+ to su* project1 includ+ reimbursem5t agreem5ts & ! co/s to ! ,dep>tm5t ( ,vet]ans ,affairs = su* s]vices4