,,ii ,calendar ,no4 #bgc #aaeth ,,congress #ast ,session ,s4 #baic ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,december #e1 #bjag,mr4 ,isakson1 from the ,committee on ,veterans' ,affairs1 reported the following original bill2 which was read twice and placed on the calendar ,a ,,bill ,to amend title #ch1 ,united ,states ,code1 to improve health care for veterans1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,caring for our ,veterans ,act of #bjag4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,references to title #ch1 ,united ,states ,code4 ,,title ,i--,developing an integrated high-performing network ,subtitle ,a--,establishing community care programs ,sec4 #aja4 ,establishment of ,veterans ,community ,care ,program4 ,sec4 #ajb4 ,authorization of agreements between ,department of ,veterans ,affairs and non-,department providers4 ,sec4 #ajc4 ,conforming amendments for ,state veterans homes4 ,sec4 #ajd4 ,access guidelines and standards for quality4 ,sec4 #aje4 ,access to walk-in care4 ,sec4 #ajf4 ,strategy regarding the ,department of ,veterans ,affairs ,high-,performing ,integrated ,health ,care ,network4 ,sec4 #ajg4 ,applicability of ,directive of ,office of ,federal ,contract ,compliance ,programs4 ,sec4 #ajh4 ,prevention of certain health care providers from providing non-,department health care services to veterans4 ,subtitle ,b--,paying providers and improving collections ,sec4 #aaa4 ,prompt payment to providers4 ,sec4 #aab4 ,authority to pay for authorized care not subject to an agreement4 ,sec4 #aac4 ,improvement of authority to recover the cost of services furnished for non-service-connected disabilities4 ,sec4 #aad4 ,processing of claims for reimbursement through electronic interface4 ,subtitle ,c--,education and training programs ,sec4 #aba4 ,education program on health care options4 ,sec4 #abb4 ,training program for administration of non-,department of ,veterans ,affairs health care4 ,sec4 #abc4 ,continuing medical education for non-,department medical professionals4 ,subtitle ,d--,other matters relating to non-,department of ,veterans ,affairs providers ,sec4 #aca4 ,establishment of processes to ensure safe opioid prescribing practices by non-,department of ,veterans ,affairs health care providers4 ,sec4 #acb4 ,improving information sharing with community providers4 ,sec4 #acc4 ,competency standards for non-,department of ,veterans ,affairs health care providers4 ,subtitle ,e--,other non-,department health care matters ,sec4 #ada4 ,plans for ,use of ,supplemental ,appropriations ,required4 ,sec4 #adb4 ,veterans ,choice ,fund flexibility4 ,sec4 #adc4 ,sunset of ,veterans ,choice ,program4 ,sec4 #add4 ,conforming amendments4 ,,title ,,ii--,improving ,department of ,veterans ,affairs health care delivery ,subtitle ,a--,personnel practices ,,part ,i--,administration ,sec4 #bja4 ,licensure of health care professionals of the ,department of ,veterans ,affairs providing treatment via telemedicine4 ,sec4 #bjb4 ,role of podiatrists in ,department of ,veterans ,affairs4 ,sec4 #bjc4 ,modification of treatment of certified clinical perfusionists of the ,department4 ,sec4 #bjd4 ,amending statutory requirements for the position of the ,chief ,officer of the ,readjustment ,counseling ,service4 ,sec4 #bje4 ,technical amendment to appointment and compensation system for directors of medical centers and directors of ,veterans ,integrated ,service ,networks4 ,sec4 #bjf4 ,identification and staffing of certain health care vacancies4 ,sec4 #bjg4 ,department of ,veterans ,affairs personnel transparency4 ,sec4 #bjh4 ,program on establishment of peer specialists in patient aligned care team settings within medical centers of ,department of ,veterans ,affairs4 ,sec4 #bji4 ,pilot program on increasing the use of medical scribes to maximize the efficiency of physicians at medical facilities of the ,department of ,veterans ,affairs4 ,sec4 #baj4 ,sense of ,congress regarding ,department of ,veterans ,affairs staffing levels4 ,,part ,,ii--,education and training ,sec4 #baa4 ,graduate medical education and residency4 ,sec4 #bab4 ,pilot program to establish or affiliate with graduate medical residency programs at facilities operated by ,indian tribes1 tribal organizations1 and the ,indian ,health ,service in rural areas4 ,sec4 #bac4 ,reimbursement of continuing professional education requirements for board certified advanced practice registered nurses4 ,sec4 #bad4 ,increase in maximum amount of debt that may be reduced under ,education ,debt ,reduction ,program of ,department of ,veterans ,affairs4 ,sec4 #bae4 ,demonstration program on training and employment of alternative dental health care providers for dental health care services for veterans in rural and other underserved communities4 ,,part ,,iii--,other personnel matters ,sec4 #bba4 ,exception on limitation on awards and bonuses for recruitment1 relocation1 and retention4 ,sec4 #bbb4 ,annual report on performance awards and bonuses awarded to certain high-level employees of the ,department4 ,sec4 #bbc4 ,authority to regulate additional pay for certain health care employees of the ,department4 ,sec4 #bbd4 ,modification of pay cap for nurses4 ,subtitle ,b--,improvement of underserved facilities of the ,department ,sec4 #bca4 ,development of criteria for designation of certain medical facilities of the ,department of ,veterans ,affairs as underserved facilities and plan to address problem of underserved facilities4 ,sec4 #bcb4 ,pilot program on tuition reimbursement and loan repayment for health care providers of the ,department of ,veterans ,affairs at underserved facilities4 ,sec4 #bcc4 ,program to furnish mobile deployment teams to underserved facilities4 ,sec4 #bcd4 ,inclusion of ,vet ,center employees in education debt reduction program of ,department of ,veterans ,affairs4 ,subtitle ,c--,construction and leases ,sec4 #bda4 ,definition of major medical facility project and major medical facility lease4 ,sec4 #bdb4 ,facilitating sharing of medical facilities with other ,federal agencies4 ,sec4 #bdc4 ,review of enhanced use leases4 ,sec4 #bdd4 ,authorization of certain major medical facility projects of the ,department of ,veterans ,affairs4 ,subtitle ,d--,other health care matters ,sec4 #bea4 ,program on use of wellness programs as complementary approach to mental health care for veterans and family members of veterans4 ,sec4 #beb4 ,authorization to provide for operations on live donors for purposes of conducting transplant procedures for veterans4 ,sec4 #bec4 ,sense of the ,senate4 ,,title ,,iii--,family caregivers ,sec4 #cja4 ,expansion of family caregiver program of ,department of ,veterans ,affairs4 ,sec4 #cjb4 ,implementation of information technology system of ,department of ,veterans ,affairs to assess and improve the family caregiver program4 ,sec4 #cjc4 ,modifications to annual evaluation report on caregiver program of ,department of ,veterans ,affairs4 ,,title ,,iv--,appropriation of amounts ,sec4 #dja4 ,appropriation of amounts for health care from ,department of ,veterans ,affairs4 ,sec4 #djb4 ,appropriation of amounts for ,veterans ,choice ,program4 #b4 ,references to title #ch1 ,united ,states ,code ,except as otherwise expressly provided1 whenever in this ,act an amendment or repeal is expressed in terms of an amendment to1 or repeal of1 a section or other provision1 the reference shall be considered to be made to a section or other provision of title #ch1 ,united ,states ,code4 ,i ,developing an integrated high-performing network ,a ,establishing community care programs #aja4 ,establishment of ,veterans ,community ,care ,program 7a7 ,establishment of program 7#a7 ,in general ,section #agjc is amended to read as follows3 #agjc4 ,veterans ,community ,care ,program 7a7 ,in general 7#a7 ,there is established a program to furnish hospital care1 medical services1 and extended care services to covered veterans through health care providers specified in subsection 7c74 7#b7 ,the ,secretary shall coordinate the furnishing of hospital care1 medical services1 and extended care services under this section to covered veterans1 including coordination of1 at a minimum1 the following3 7,a7 ,ensuring the scheduling of medical appointments in a timely manner and the establishment of a mechanism to receive medical records from non-,department providers4 7,b7 ,ensuring continuity of care and services4 7,c7 ,ensuring coordination among regional networks if the covered veteran accesses care and services in a different network than the regional network in which the covered veteran resides4 7,d7 ,ensuring that covered veterans do not experience a lapse resulting from errors or delays by the ,department or its contractors or an unusual or excessive burden in accessing hospital care1 medical services1 or extended care services4 7b7 ,covered veterans ,for purposes of this section1 a covered veteran is any veteran who-- 7#a7 is enrolled in the system of annual patient enrollment established and operated under section #agje of this title2 or 7#b7 is not enrolled in such system but is otherwise entitled to hospital care1 medical services1 or extended care services under subsection 7c77#b7 of such section4 7c7 ,health care providers specified ,health care providers specified in this subsection are the following3 7#a7 ,any health care provider that is participating in the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 including any physician furnishing services under such a program4 7#b7 ,the ,department of ,defense4 7#c7 ,the ,indian ,health ,service4 7#d7 ,any ,federally-qualified health center 7as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7774 7#e7 ,any health care provider not otherwise covered under any of paragraphs 7#a7 through 7#d7 that meets criteria established by the ,secretary for purposes of this section4 7d7 ,conditions under which care is required ,to be furnished through non-,department providers 7#a7 ,the ,secretary shall1 subject to the availability of appropriations1 furnish hospital care1 medical services1 and extended care services to a covered veteran through health care providers specified in subsection 7c7 if-- 7,a7 the ,department does not offer the care or services the veteran requires2 7,b7 the ,department does not operate a full-service medical facility in the ,state in which the covered veteran resides2 7,c7 the covered veteran was an eligible veteran under section #aja7;b77#b77;,b7 of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 as of the day before the date of the enactment of the ,caring for our ,veterans ,act of #bjag2 or 7,d7 the covered veteran and the covered veteran's primary care provider agree that furnishing care and services through a non-,department entity or provider would be in the best medical interest of the covered veteran based upon criteria developed by the ,secretary4 7#b7 ,the ,secretary shall ensure that the criteria developed under paragraph 7#a77;,d7 include consideration of the following3 7,a7 ,the distance between the covered veteran and the facility that provides the hospital care1 medical services1 or extended care services the veteran needs4 7,b7 ,the nature of the hospital care1 medical services1 or extended care services required4 7,c7 ,the frequency that the hospital care1 medical services1 or extended care services needs to be furnished4 7,d7 ,whether an appointment for the hospital care1 medical services1 or extended care services the covered veteran requires is available from a health care provider of the ,department within the lesser of-- 7i7 the access guidelines for such hospital care1 medical services1 or extended care services as established by the ,secretary2 and 7ii7 a period determined by a health care provider of the ,department to be clinically necessary for the receipt of such hospital care1 medical services1 or extended care services4 7,e7 ,whether the covered veteran faces an unusual or excessive burden to access hospital care1 medical services1 or extended care services from the ,department medical facility where a covered veteran seeks hospital care1 medical services1 or extended care services1 which shall include consideration of the following3 7i7 ,whether the covered veteran faces an excessive driving distance1 geographical challenge1 or environmental factor that impedes the access of the covered veteran4 7ii7 ,whether the hospital care1 medical services1 or extended care services sought by the veteran is provided by a medical facility of the ,department that is reasonably accessible to a covered veteran4 7iii7 ,whether a medical condition of the covered veteran affects the ability of the covered veteran to travel4 7iv7 ,whether there is compelling reason1 as determined by the ,secretary1 that the veteran needs to receive hospital care1 medical services1 or extended care services from a medical facility other than a medical facility of the ,department4 7v7 ,such other considerations as the ,secretary considers appropriate4 7#c7 ,if the ,secretary has determined that the ,department does not offer the care or services the covered veteran requires under subparagraph 7,a7 of paragraph 7#a71 that the ,department does not operate a full-service medical facility in the ,state in which the covered veteran resides under subparagraph 7,b7 of such paragraph1 or that the covered veteran is described under subparagraph 7,c7 of such paragraph1 the decision to receive hospital care1 medical services1 or extended care services under such subparagraphs from a health care provider specified in subsection 7c7 shall be at the election of the veteran4 7e7 ,conditions under which care is authorized to be furnished through non-,department providers 7#a7 7,a7 ,the ,secretary may furnish hospital care1 medical services1 or extended care services through a health care provider specified in subsection 7c7 to a covered veteran served by a medical service line of the ,department that the ,secretary has determined is not providing care that meets such quality and access standards as the ,secretary shall develop4 7,b7 ,in carrying out subparagraph 7,a71 the ,secretary shall-- 7i7 measure access of the medical service line at a facility of the ,department when compared with the same medical service line at different ,department facilities2 and 7ii7 measure quality at a medical service line of a facility of the ,department by comparing it with two or more distinct and appropriate quality measures at non-,department medical service lines4 7,c7 7i7 ,the ,secretary may not concurrently furnish hospital care1 medical services1 or extended care services under subparagraph 7,a7 with respect to more than three medical service lines described in such subparagraph at any one health care facility of the ,department4 7ii7 ,the ,secretary may not concurrently furnish hospital care1 medical services1 or extended care services under subparagraph 7,a7 with respect to more than #cf medical service lines nationally described in such subparagraph4 7#b7 ,the ,secretary may limit the types of hospital care1 medical services1 or extended care services covered veterans may receive under paragraph 7#a7 because of an access and quality deficiency of a medical service line in terms of the length of time such care and services will be available1 the location at which such care and services will be available1 and the clinical care and services that will be available4 7#c7 ,the hospital care1 medical services1 and extended care services authorized under paragraph 7#a7 with respect to a medical service line shall cease when the remediation described in subsection 7g7 with respect to such medical service line is complete4 7#d7 ,the ,secretary shall publish in the ,federal ,register1 and shall take all reasonable steps to provide direct notice to covered veterans affected under this subsection1 at least once each year stating the time period during which such care and services will be available1 the location or locations where such care and services will be available1 and the clinical services available at each location under this subsection in accordance with regulations the ,secretary shall prescribe4 7#e7 ,when the ,secretary exercises the authority under paragraph 7#a71 the decision to receive care or services under such paragraph from a health care provider specified in subsection 7c7 shall be at the election of the covered veteran4 7f7 ,review of decisions ,the review of any decision under subsection 7d7 or 7e7 shall be subject to the ,department's local clinical appeals process1 and such decisions may not be appealed to the ,board of ,veterans' ,appeals4 7g7 ,remediation of medical service lines 7#a7 ,not later than #cj days after determining under subsection 7e77#a7 that a medical service line of the ,department is providing hospital care1 medical services1 or extended care services that does not comply with the access guidelines and meet the standards of quality established by the ,secretary1 the ,secretary shall submit to ,congress an assessment of the factors that led the ,secretary to make such determination and a plan with specific actions1 and the time to complete them1 to be taken to comply with such access guidelines and meet such standards of quality1 including the following3 7,a7 ,increasing personnel or temporary personnel assistance1 including mobile deployment teams4 7,b7 ,special hiring incentives1 including the ,education ,debt ,reduction ,program under subchapter ,,vii of chapter #gf of this title and recruitment1 relocation1 and retention incentives4 7,c7 ,utilizing direct hiring authority4 7,d7 ,providing improved training opportunities for staff4 7,e7 ,acquiring improved equipment4 7,f7 ,making structural modifications to the facility used by the medical service line4 7,g7 ,such other actions as the ,secretary considers appropriate4 7#b7 ,in each assessment submitted under paragraph 7#a7 with respect to a medical service line1 the ,secretary shall identify the individuals at the ,central ,office of the ,veterans ,health ,administration1 the facility used by the medical service line1 and the central office of the relevant ,veterans ,integrated ,service ,network who are responsible for overseeing the progress of that medical service line in complying with the access guidelines and meeting the standards of quality established by the ,secretary4 7#c7 ,not later than #ahj days after submitting an assessment under paragraph 7#a7 with respect to a medical service line1 the ,secretary shall submit to ,congress a report on the progress of that medical service line in complying with the access guidelines and meeting the standards of quality established by the ,secretary and any other measures the ,secretary will take to assist the medical service line in complying with such access guidelines and meeting such standards of quality4 7#d7 ,not less frequently than once each year1 the ,secretary shall-- 7,a7 submit to ,congress an analysis of the remediation actions and costs of such actions taken with respect to each medical service line with respect to which the ,secretary submitted an assessment and plan under paragraph 7#a7 in the preceding year1 including an update on the progress of each such medical service line in meeting the quality and access standards established by the ,secretary and any other actions the ,secretary is undertaking to assist the medical service line in complying with access guidelines and meeting standards of quality as established by the ,secretary2 and 7,b7 publish such analysis on the ,internet website of the ,department4 7h7 ,access guidelines and standards for quality 7#a7 ,the ,secretary shall establish access guidelines under section #agjc;,b of this title and standards for quality under section #agjc;,c of this title for furnishing hospital care1 medical services1 or extended care services to a covered veteran for the purposes of subsections 7d7 and 7e74 7#b7 ,the ,secretary shall ensure that the access guidelines and standards for quality required by sections #agjc;,b and #agjc;,c of this title provide covered veterans1 employees of the ,department1 and health care providers in the network established under subsection 7j7 with relevant comparative information that is clear1 useful1 and timely1 so that covered veterans can make informed decisions regarding their health care4 7#c7 ,the ,secretary shall consult with all pertinent ,federal entities 7including the ,department of ,defense1 the ,department of ,health and ,human ,services1 and the ,centers for ,medicare ,medicaid ,services71 entities in the private sector1 and other nongovernmental entities in establishing access guidelines and standards for quality as required by sections #agjc;,b and #agjc;,c of this title4 7#d7 ,not later than #bgj days after the date of the enactment of the ,caring for our ,veterans ,act of #bjag1 the ,secretary shall submit to the appropriate committees of ,congress a report detailing the access guidelines and standards for quality established under sections #agjc;,b and #agjc;,c of this title4 7#e7 ,not later than three years after the date on which the ,secretary establishes access guidelines and standards for quality under paragraph 7#a7 and not less frequently than once every three years thereafter1 the ,secretary shall-- 7,a7 conduct a review of such guidelines and standards2 and 7,b7 submit to the appropriate committees of ,congress a report on the findings and any modification to the access guidelines and standards for quality with respect to the review conducted under subparagraph 7,a74 7#f7 ,the ,secretary shall ensure health care providers specified under subsection 7c7 are able to meet the applicable access guidelines and standards of quality established by the ,secretary4 7i7 ,tiered network 7#a7 ,to promote the provision of high-quality and high-value hospital care1 medical services1 and extended care services under this section1 the ,secretary may develop a tiered provider network of eligible providers based on criteria established by the ,secretary for purposes of this section4 7#b7 ,in developing a tiered provider network of eligible providers under paragraph 7#a71 the ,secretary shall not prioritize providers in a tier over providers in any other tier in a manner that limits the choice of a covered veteran in selecting a health care provider specified in subsection 7c7 for receipt of hospital care1 medical services1 or extended care services under this section4 7j7 ,contracts ,to establish networks of health care providers 7#a7 ,the ,secretary shall enter into consolidated1 competitively bid contracts to establish networks of health care providers specified in paragraphs 7#a7 and 7#e7 of subsection 7c7 for purposes of providing sufficient access to hospital care1 medical services1 or extended care services under this section4 7#b7 7,a7 ,the ,secretary shall1 to the extent practicable1 ensure that covered veterans are able to make their own appointments using advanced technology4 7,b7 ,to the extent practicable1 the ,secretary shall be responsible for the scheduling of appointments for hospital care1 medical services1 and extended care services under this section4 7#c7 7,a7 ,the ,secretary may terminate a contract with an entity entered into under paragraph 7#a7 at such time and upon such notice to the entity as the ,secretary may specify for purposes of this section1 if the ,secretary notifies the appropriate committees of ,congress that1 at a minimum-- 7i7 the entity-- 7,i7 failed to comply substantially with the provisions of the contract or with the provisions of this section and the regulations prescribed under this section2 7,,ii7 failed to comply with the access guidelines or meet the standards of quality established by the ,secretary2 7,,iii7 is excluded from participation in a ,federal health care program 7as defined in section #aabh;,b7f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7f777 under section #aabh or #aabh;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g and #acbj;a-#g;a72 7,,iv7 is identified as an excluded source on the list maintained in the ,system for ,award ,management1 or any successor system2 or 7,v7 has been convicted of a felony or other serious offense under ,federal or ,state law and the continued participation of the entity would be detrimental to the best interests of veterans or the ,department2 7ii7 it is reasonable to terminate the contract based on the health care needs of veterans2 or 7iii7 it is reasonable to terminate the contract based on coverage provided by contracts or sharing agreements entered into under authorities other than this section4 7,b7 ,nothing in subparagraph 7,a7 may be construed to restrict the authority of the ,secretary to terminate a contract entered into under paragraph 7#a7 under any other provision of law4 7#d7 ,whenever the ,secretary provides notice to an entity that the entity is failing to meet contractual obligations entered into under paragraph 7#a71 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on such failure4 ,such report shall include the following3 7,a7 ,an explanation of the reasons for providing such notice4 7,b7 ,a description of the effect of such failure1 including with respect to cost1 schedule1 and requirements4 7,c7 ,a description of the actions taken by the ,secretary to mitigate such failure4 7,d7 ,a description of the actions taken by the contractor to address such failure4 7,e7 ,a description of any effect on the community provider market for veterans in the affected area4 7#e7 7,a7 ,the ,secretary shall instruct each entity awarded a contract under paragraph 7#a7 to recognize and accept1 on an interim basis1 the credentials and qualifications of health care providers who are authorized to furnished hospital care and medical services to veterans under a community care program of the ,department in effect as of the day before the date of the enactment of the ,caring for our ,veterans ,act of #bjag1 including under the ,patient-,centered ,community ,care ,program and the ,veterans ,choice ,program under section #aja of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note71 as qualified providers under the program established under this section4 7,b7 ,the interim acceptance period under subparagraph 7,a7 shall be determined by the ,secretary based on the following criteria3 7i7 ,with respect to a health care provider1 when the current certification agreement for the health care provider expires4 7ii7 ,whether the ,department has enacted certification and eligibility criteria and regulatory procedures by which non-,department providers will be authorized under this section4 7#f7 ,the ,secretary shall establish through regulation a system or systems for monitoring the quality of care provided to covered veterans through a network under this subsection and for assessing the quality of hospital care1 medical services1 and extended care services furnished through such network before the renewal of the contract for such network4 7k7 ,payment rates for care and services 7#a7 ,except as provided in paragraph 7#b71 and to the extent practicable1 the rate paid for hospital care1 medical services1 or extended care services under any provision in this title may not exceed the rate paid by the ,united ,states to a provider of services 7as defined in section #ahfa7u7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7u777 or a supplier 7as defined in section #ahfa7;d7 of such ,act 7#db ,u4,s4,c4 #aciex7d777 under the ,medicare program under title ,,xi or title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq47 for the same care or services4 7#b7 7,a7 ,a higher rate than the rate paid by the ,united ,states as described in paragraph 7#a7 may be negotiated with respect to the furnishing of care or services to a covered veteran who resides in a highly rural area4 7,b7 ,in this paragraph1 the term highly rural area means an area located in a county that has fewer than seven individuals residing in that county per square mile4 7#c7 ,with respect to furnishing care or services under this section in ,alaska1 the ,alaska ,fee ,schedule of the ,department of ,veterans ,affairs shall be followed1 except for when another payment agreement1 including a contract or provider agreement1 is in effect4 7#d7 ,with respect to furnishing hospital care1 medical services1 or extended care services under this section in a ,state with an ,all-,payer ,model ,agreement under section #ahad7;b77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7b77#c77 that became effective on or after ,january #a1 #bjad1 the ,medicare payment rates under paragraph 7#b77;,a7 shall be calculated based on the payment rates under such agreement4 7#e7 ,notwithstanding paragraph 7#a71 the ,secretary may incorporate1 to the greatest extent practicable1 the use of value-based reimbursement models to promote the provision of high-quality care4 7#f7 ,with respect to hospital care1 medical services1 or extended care services for which there is not a rate paid under the ,medicare program as described in paragraph 7#a71 the rate paid for such care or services shall be determined by the ,secretary4 7l7 ,treatment of other health care plans 7#a7 ,in any case in which a covered veteran is furnished hospital care1 medical services1 or extended care services under this section for a non-service-connected disability described in subsection 7a77#b7 of section #agbi of this title1 the ,secretary shall recover or collect reasonable charges for such care or services from a health care plan described in paragraph 7#b7 in accordance with such section4 7#b7 ,a health care plan described in this paragraph-- 7,a7 is an insurance policy or contract1 medical or hospital service agreement1 membership or subscription contract1 or similar arrangement not administered by the ,secretary1 under which hospital care1 medical services1 or extended care services for individuals are provided or the expenses of such care or services are paid2 and 7,b7 does not include any such policy1 contract1 agreement1 or similar arrangement pursuant to title ,,xviii or ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 or chapter #ee of title #aj4 7m7 ,payment by veteran ,a covered veteran shall not pay a greater amount for receiving care or services under this section than the amount the veteran would pay for receiving the same or comparable care or services at a medical facility of the ,department or from a health care provider of the ,department4 7n7 ,monitoring of care provided 7#a7 7,a7 ,not later than #edj days after the date of the enactment of the ,caring for our ,veterans ,act of #bjag1 and not less frequently than annually thereafter1 the ,secretary shall submit to appropriate committees of ,congress a review of the types and frequency of care sought under subsection 7d74 7,b7 ,the review submitted under subparagraph 7,a7 shall include an assessment of the following3 7i7 ,the top #be percent of types of care and services most frequently provided under subsection 7d7 due to the ,department not offering such care and services4 7ii7 ,the frequency such care and services were sought by covered veterans under this section4 7iii7 ,an analysis of the reasons the ,department was unable to provide such care and services4 7iv7 ,any steps the ,department took to provide such care and services at a medical facility of the ,department4 7v7 ,the cost of such care and services4 7#b7 ,in monitoring the hospital care1 medical services1 and extended care services furnished under this section1 the ,secretary shall do the following3 7,a7 ,with respect to hospital care1 medical services1 and extended care services furnished through provider networks established under subsection 7j7-- 7i7 compile data on the types of hospital care1 medical services1 and extended care services furnished through such networks and how many patients used each type of care and service2 7ii7 identify gaps in hospital care1 medical services1 or extended care services furnished through such networks2 7iii7 identify how such gaps may be fixed through new contracts within such networks or changes in the manner in which hospital care1 medical services1 or extended care services are furnished through such networks2 7iv7 assess the total amounts spent by the ,department on hospital care1 medical services1 and extended care services furnished through such networks2 7v7 assess the timeliness of the ,department in referring hospital care1 medical services1 and extended care services to such networks2 and 7vi7 assess the timeliness of such networks in-- 7,i7 accepting referrals2 and 7,,ii7 scheduling and completing appointments4 7,b7 ,report the number of medical service lines the ,secretary has determined under subsection 7e77#a7 not to be providing hospital care1 medical services1 or extended care services that comply with the access guidelines or meet the standards of quality established by the ,secretary4 7,c7 ,assess the use of academic affiliates and centers of excellence of the ,department to furnish hospital care1 medical services1 and extended care services to covered veterans under this section4 7,d7 ,assess the hospital care1 medical services1 and extended care services furnished to covered veterans under this section by medical facilities operated by ,federal agencies other than the ,department4 7#c7 ,not later than #edj days after the date of the enactment of the ,caring for our ,veterans ,act of #bjag and not less frequently than once each year thereafter1 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on the information gathered under paragraph 7#b74 7o7 ,prohibition on certain limitations ,the ,secretary shall not limit the types of hospital care1 medical services1 or extended care services covered veterans may receive under this section if it is in the best interest of the veteran to receive such hospital care1 medical services1 or extended care services1 as determined by the veteran and the veteran's health care provider4 7p7 ,definitions ,in this section3 7#a7 ,the term appropriate committees of ,congress means-- 7,a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7,b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 7#b7 ,the term medical service line means a clinic within a ,department medical center4 4 7#b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag is amended by striking the item relating to section #agjc and inserting the following new item3 #agjc4 ,veterans ,community ,care ,program4 4 7b7 ,effective date ,section #agjc of title #ch1 ,united ,states ,code1 as amended by subsection 7a71 shall take effect on the later of-- 7#a7 the date that is #cj days after the date on which the ,secretary of ,veterans ,affairs submits the report required under section #aja7q77#b7 of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note72 or 7#b7 the date on which the ,secretary promulgates regulations pursuant to subsection 7c74 7c7 ,regulations ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall promulgate regulations to carry out section #agjc of title #ch1 ,united ,states ,code1 as amended by subsection 7a7 of this section4 7d7 ,continuity of existing agreements 7#a7 ,in general ,notwithstanding section #agjc of title #ch1 ,united ,states ,code1 as amended by subsection 7a71 the ,secretary of ,veterans ,affairs shall continue all contracts1 memorandums of understanding1 memorandums of agreements1 and other arrangements that were in effect on the day before the date of the enactment of this ,act between the ,department of ,veterans ,affairs and the ,american ,indian and ,alaska ,native health care systems as established under the terms of the ,department of ,veterans ,affairs and ,indian ,health ,service ,memorandum of ,understanding1 signed ,october #a1 #bjaj1 the ,national ,reimbursement ,agreement1 signed ,december #e1 #bjab1 and agreements entered into under sections #ajb and #ajc of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf74 7#b7 ,modifications ,paragraph 7#a7 shall not be construed to prohibit the ,secretary and the parties to the contracts1 memorandums of understanding1 memorandums of agreements1 and other arrangements described in such paragraph from making such changes to such contracts1 memorandums of understanding1 memorandums of agreements1 and other arrangements as may be otherwise authorized pursuant to other provisions of law or the terms of the contracts1 memorandums of understanding1 memorandums of agreements1 and other arrangements4 #ajb4 ,authorization of agreements between ,department of ,veterans ,affairs and non-,department providers 7a7 ,in general ,subchapter ,i of chapter #ag is amended by inserting after section #agjc the following new section3 #agjc;,a4 ,agreements with eligible entities or providers2 certification processes 7a7 ,agreements authorized 7#a7 7,a7 ,when hospital care1 a medical service1 or an extended care service required by a veteran who is entitled to such care or service under this chapter is not feasibly available to the veteran from a facility of the ,department or through a contract or sharing agreement entered into pursuant to another provision of law1 the ,secretary may furnish such care or service to such veteran by entering into an agreement under this section with an eligible entity or provider to provide such hospital care1 medical service1 or extended care service4 7,b7 ,an agreement entered into under this section to provide hospital care1 a medical service1 or an extended care service shall be known as a ,veterans ,care ,agreement4 7,c7 ,for purposes of subparagraph 7,a71 hospital care1 a medical service1 or an extended care service may be considered not feasibly available to a veteran from a facility of the ,department or through a contract or sharing agreement described in such subparagraph when the ,secretary determines the veteran's medical condition1 the travel involved1 the nature of the care or services required1 or a combination of these factors make the use of a facility of the ,department or a contract or sharing agreement described in such subparagraph impracticable or inadvisable4 7,d7 ,a ,veterans ,care ,agreement may be entered into by the ,secretary or any ,department official authorized by the ,secretary4 7#b7 7,a7 ,subject to subparagraph 7,b71 the ,secretary shall review each ,veterans ,care ,agreement of material size1 as determined by the ,secretary or set forth in paragraph 7#c71 for hospital care1 a medical service1 or an extended care service to determine whether it is feasible and advisable to provide such care or service within a facility of the ,department or by contract or sharing agreement entered into pursuant to another provision of law and1 if so1 take action to do so4 7,b7 7i7 ,the ,secretary shall review each ,veterans ,care ,agreement of material size that has been in effect for at least six months within the first two years of its taking effect1 and not less frequently than once every four years thereafter4 7ii7 ,if a ,veterans ,care ,agreement has not been in effect for at least six months by the date of the review required by subparagraph 7,a71 the agreement shall be reviewed during the next cycle required by subparagraph 7,a71 and such review shall serve as its review within the first two years of its taking effect for purposes of clause 7i74 7#c7 7,a7 ,in fiscal year #bjah and in each fiscal year thereafter1 in addition to such other ,veterans ,care ,agreements as the ,secretary may determine are of material size1 a ,veterans ,care ,agreement for the purchase of extended care services that exceeds #e1jjj1jjj annually shall be considered of material size4 7,b7 ,from time to time1 the ,secretary may publish a notice in the ,federal ,register to adjust the dollar amount specified in subparagraph 7,a7 to account for changes in the cost of health care based upon recognized health care market surveys and other available data4 7b7 ,eligible entities and providers ,for purposes of this section1 an eligible entity or provider is-- 7#a7 any provider of services that has enrolled and entered into a provider agreement under section #ahff7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77 and any physician or other supplier who has enrolled and entered into a participation agreement under section #ahdb7;h7 of such ,act 7#db ,u4,s4,c4 #acieu7h772 7#b7 any provider participating under a ,state plan under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq472 or 7#c7 any entity or provider not described in paragraph 7#a7 or 7#b7 of this subsection that the ,secretary determines to be eligible pursuant to the certification process described in subsection 7c74 7c7 ,eligible entity or provider certification process ,the ,secretary shall establish by regulation a process for the certification of eligible entities or providers or recertification of eligible entities or providers under this section4 ,such a process shall1 at a minimum-- 7#a7 establish deadlines for actions on applications for certification2 7#b7 set forth standards for an approval or denial of certification1 duration of certification1 revocation of an eligible entity or provider's certification1 and recertification of eligible entities or providers2 7#c7 require the denial of certification if the ,secretary determines the eligible entity or provider is excluded from participation in a ,federal health care program under section #aabh or section #aabh;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g or #acbj;a-#g;a7 or is currently identified as an excluded source on the ,system for ,award ,management ,exclusions list described in part #i of title #dh1 ,code of ,federal ,regulations1 and part #ahj of title #b of such ,code1 or successor regulations2 7#d7 establish procedures for screening eligible entities or providers according to the risk of fraud1 waste1 and abuse that are similar to the standards under section #ahff7;j77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7j77#b77;,b77 and section #i4ajd of title #dh1 ,code of ,federal ,regulations1 or successor regulations2 and 7#e7 incorporate and apply the restrictions and penalties set forth in chapter #ba of title #da and treat this section as a procurement program only for purposes of applying such provisions4 7d7 ,rates ,to the extent practicable1 the rates paid by the ,secretary for hospital care1 medical services1 and extended care services provided under a ,veterans ,care ,agreement shall be in accordance with the rates paid by the ,united ,states under the ,medicare program4 7e7 ,terms of ,veterans ,care ,agreements 7#a7 ,pursuant to regulations promulgated under subsection 7k71 the ,secretary may define the requirements for providers and entities entering into agreements under this section based upon such factors as the number of patients receiving care or services1 the number of employees employed by the entity or provider furnishing such care or services1 the amount paid by the ,secretary to the provider or entity1 or other factors as determined by the ,secretary4 7#b7 ,to furnish hospital care1 medical services1 or extended care services under this section1 an eligible entity or provider shall agree-- 7,a7 to accept payment at the rates established in regulations prescribed under this section2 7,b7 that payment by the ,secretary under this section on behalf of a veteran to a provider of services or care shall1 unless rejected and refunded by the provider within #cj days of receipt1 constitute payment in full and extinguish any liability on the part of the veteran for the treatment or care provided1 and no provision of a contract1 agreement1 or assignment to the contrary shall operate to modify1 limit1 or negate this requirement2 7,c7 to provide only the care and services authorized by the ,department under this section and to obtain the prior written consent of the ,department to furnish care or services outside the scope of such authorization2 7,d7 to bill the ,department in accordance with the methodology outlined in regulations prescribed under this section2 7,e7 to not seek to recover or collect from a health plan contract or third party1 as those terms are defined in section #agbi of this title1 for any care or service that is furnished or paid for by the ,department2 7,f7 to provide medical records to the ,department in the time frame and format specified by the ,department2 and 7,g7 to meet such other terms and conditions1 including quality of care assurance standards1 as the ,secretary may specify in regulation4 7f7 ,discontinuation or nonrenewal of a ,veterans ,care ,agreement 7#a7 ,an eligible entity or provider may discontinue a ,veterans ,care ,agreement at such time and upon such notice to the ,secretary as may be provided in regulations prescribed under this section4 7#b7 ,the ,secretary may discontinue a ,veterans ,care ,agreement with an eligible entity or provider at such time and upon such reasonable notice to the eligible entity or provider as may be specified in regulations prescribed under this section1 if an official designated by the ,secretary-- 7,a7 has determined that the eligible entity or provider failed to comply substantially with the provisions of the ,veterans ,care ,agreement1 or with the provisions of this section or regulations prescribed under this section2 7,b7 has determined the eligible entity or provider is excluded from participation in a ,federal health care program under section #aabh or section #aabh;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g or #acbj;a-#g;a7 or is identified on the ,system for ,award ,management ,exclusions list as provided in part #i of title #dh1 ,code of ,federal ,regulations1 and part #ahj of title #b of such ,code1 or successor regulations2 7,c7 has ascertained that the eligible entity or provider has been convicted of a felony or other serious offense under ,federal or ,state law and determines the eligible entity or provider's continued participation would be detrimental to the best interests of veterans or the ,department2 or 7,d7 has determined that it is reasonable to terminate the agreement based on the health care needs of a veteran4 7g7 ,quality of care ,the ,secretary shall establish through regulation a system or systems for monitoring the quality of care provided to veterans through ,veterans ,care ,agreements and for assessing the quality of hospital care1 medical services1 and extended care services furnished by eligible entities and providers before the renewal of ,veterans ,care ,agreements4 7h7 ,disputes 7#a7 ,the ,secretary shall promulgate administrative procedures for eligible entities and providers to present all disputes arising under or related to ,veterans ,care ,agreements4 7#b7 ,such procedures constitute the eligible entities' and providers' exhaustive and exclusive administrative remedies4 7#c7 ,eligible entities or providers must first exhaust such administrative procedures before seeking any judicial review under section #acdf of title #bh 7known as the ,tucker ,act74 7#d7 ,disputes under this section must pertain to either the scope of authorization under the ,veterans ,care ,agreement or claims for payment subject to the ,veterans ,care ,agreement and are not claims for the purposes of such laws that would otherwise require application of sections #gaja through #gaji of title #da1 ,united ,states ,code4 7i7 ,applicability of other provisions of law 7#a7 ,a ,veterans ,care ,agreement may be authorized by the ,secretary or any ,department official authorized by the ,secretary1 and such action shall not be treated as-- 7,a7 an award for the purposes of such laws that would otherwise require the use of competitive procedures for the furnishing of care and services2 or 7,b7 a ,federal contract for the acquisition of goods or services for purposes of any provision of ,federal law governing ,federal contracts for the acquisition of goods or services4 7#b7 7,a7 ,except as provided in subparagraph 7,b71 and unless otherwise provided in this section or regulations prescribed pursuant to this section1 an eligible entity or provider that enters into an agreement under this section is not subject to1 in the carrying out of the agreement1 any law to which providers of services and suppliers under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 are not subject4 7,b7 ,an eligible entity or provider that enters into an agreement under this section is subject to-- 7i7 all laws regarding integrity1 ethics1 or fraud1 or that subject a person to civil or criminal penalties2 and 7ii7 all laws that protect against employment discrimination or that otherwise ensure equal employment opportunities4 7#c7 ,notwithstanding paragraph 7#b77;,b77i71 an eligible entity or provider that enters into an agreement under this section shall not be treated as a ,federal contractor or subcontractor for purposes of chapter #fg of title #da 7commonly known as the ,mc,namara-,o',hara ,service ,contract ,act of #aife74 7j7 ,parity of treatment ,eligibility for hospital care1 medical services1 and extended care services furnished to any veteran pursuant to a ,veterans ,care ,agreement shall be subject to the same terms as though provided in a facility of the ,department1 and provisions of this chapter applicable to veterans receiving such care and services in a facility of the ,department shall apply to veterans treated under this section4 7k7 ,rulemaking ,the ,secretary shall promulgate regulations to carry out this section4 4 7b7 ,clerical ,amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item related to section #agjc the following new item3 #agjc;,a4 ,agreements with eligible entities or providers2 certification processes4 4 #ajc4 ,conforming amendments for ,state veterans homes 7a7 ,in general ,section #agde7;a7 is amended-- 7#a7 in paragraph 7#a71 by striking 7or agreement under section #agbj7;c77#a7 of this title7 and inserting 7or an agreement72 and 7#b7 by adding at the end the following new paragraph3 7#d7 7,a7 ,an agreement under this section may be authorized by the ,secretary or any ,department official authorized by the ,secretary1 and any such action is not an award for purposes of such laws that would otherwise require the use of competitive procedures for the furnishing of hospital care1 medical services1 and extended care services4 7,b7 7i7 ,except as provided in clause 7ii71 and unless otherwise provided in this section or regulations prescribed pursuant to this section1 a ,state home that enters into an agreement under this section is not subject to1 in the carrying out of the agreement1 any provision of law to which providers of services and suppliers under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 are not subject4 7ii7 ,a ,state home that enters into an agreement under this section is subject to-- 7,i7 all provisions of law regarding integrity1 ethics1 or fraud1 or that subject a person to civil or criminal penalties2 and 7,,ii7 all provisions of law that protect against employment discrimination or that otherwise ensure equal employment opportunities4 7iii7 ,notwithstanding subparagraph 7,b77ii77,i71 a ,state home that enters into an agreement under this section may not be treated as a ,federal contractor or subcontractor for purposes of chapter #fg of title #da 7known as the ,mc,namara-,o',hara ,service ,contract ,act of #aife74 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply to care provided on or after the effective date of regulations issued by the ,secretary of ,veterans ,affairs to carry out this section4 #ajd4 ,access guidelines and standards for quality 7a7 ,in general ,subchapter ,i of chapter #ag1 as amended by section #ajb1 is further amended by inserting after section #agjc;,a the following new sections3 #agjc;,b4 ,access guidelines ,the ,secretary shall consult with all pertinent ,federal entities to examine health care access measurements and establish localized benchmarking guidelines that can inform provider and veteran clinical decisionmaking4 ,the ,secretary shall establish such guidelines for all hospital care1 medical services1 and extended care services furnished or otherwise made available under laws administered by the ,secretary1 including through non-,department health care providers4 #agjc;,c4 ,standards for quality 7a7 ,in general 7#a7 ,the ,secretary shall establish standards for quality1 in coordination or consultation with entities pursuant to section #agjc7;h77#c7 of this title1 regarding hospital care1 medical services1 and extended care services furnished by the ,department pursuant to this title1 including through non-,department health care providers pursuant to section #agjc of this title4 7#b7 ,in establishing standards for quality under paragraph 7#a71 the ,secretary shall consider existing health quality measures that are applied to public and privately sponsored health care systems with the purpose of providing covered veterans relevant comparative information to make informed decisions regarding their health care4 7#c7 ,the ,secretary shall collect and consider data for purposes of establishing the standards under paragraph 7#a74 ,such data collection shall include-- 7,a7 after consultation with veterans service organizations and other key stakeholders on survey development or modification of an existing survey1 a survey of veterans who have used hospital care1 medical services1 or extended care services furnished by the ,veterans ,health ,administration during the most recent two-year period to assess the satisfaction of the veterans with service and quality of care2 and 7,b7 datasets that include1 at a minimum1 elements relating to the following3 7i7 ,timely care4 7ii7 ,effective care4 7iii7 ,safety1 including1 at a minimum1 complications1 readmissions1 and deaths4 7iv7 ,efficiency4 7b7 ,publication and consideration of public comments 7#a7 ,not later than one year after the date on which the ,secretary establishes standards for quality under subsection 7a71 the ,secretary shall publish the quality rating of medical facilities of the ,department in the publicly available ,hospital ,compare website through the ,centers for ,medicare ,medicaid ,services for the purpose of providing veterans with information that allows them to compare performance measure information among ,department and non-,department health care providers4 7#b7 ,not later than two years after the date on which the ,secretary establishes standards for quality under subsection 7a71 the ,secretary shall consider and solicit public comment on potential changes to the measures used in such standards to ensure that they include the most up-to-date and applicable industry measures for veterans4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag1 as amended by section #ajb1 is further amended by inserting after the item relating to section #agjc;,a the following new items3 #agjc;,b4 ,access guidelines4#agjc;,c4 ,standards for quality4 4 #aje4 ,access to walk-in care 7a7 ,in general ,chapter #ag is amended by inserting after section #agbe the following new section3 #agbe;,a4 ,access to walk-in care 7a7 ,procedures ,to ensure access to walk-in care ,the ,secretary shall develop procedures to ensure that eligible veterans are able to access walk-in care from qualifying non-,department entities or providers4 7b7 ,eligible veterans ,for purposes of this section1 an eligible veteran is any individual who-- 7#a7 is enrolled in the health care system established under section #agje7;a7 of this title2 and 7#b7 has received care under this chapter within the #bd-month period preceding the furnishing of walk-in care under this section4 7c7 ,qualifying non-,department entities or providers ,for purposes of this section1 a qualifying non-,department entity or provider is a non-,department entity or provider that has entered into a contract or other agreement with the ,secretary to furnish services under this section4 7d7 ,federally-qualified health centers ,whenever practicable1 the ,secretary may use a ,federally-qualified health center 7as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b777 to carry out this section4 7e7 ,continuity of care ,the ,secretary shall ensure continuity of care for those veterans who receive walk-in care services under this section1 including through the establishment of a mechanism to receive medical records from walk-in care providers and provide pertinent patient medical records to providers of walk-in care4 7f7 ,copayments 7#a7 7,a7 ,the ,secretary shall require all eligible veterans to pay the ,united ,states a copayment for each episode of hospital care and medical service provided under this section if otherwise required to pay a copayment under this title4 7,b7 ,those not required to pay a copayment under this title may access walk-in care without a copayment for the first two visits in a calendar year4 ,for any additional visits1 a copayment at an amount determined by the ,secretary shall be paid4 7,c7 ,for those veterans required to pay a copayment under title #ch1 they are required to pay their regular copayment for their first two walk-in care visits in a calendar year4 ,for any additional visits1 a higher copayment at an amount determined by the ,secretary shall be paid4 7#b7 ,after the first two episodes of care furnished to a veteran under this section1 the ,secretary may adjust the copayment required of the veteran under this subsection based upon the priority group of enrollment of the veteran1 the number of episodes of care furnished to the veteran during a year1 and other factors the ,secretary considers appropriate under this section4 7#c7 ,the amount or amounts of the copayments required under this subsection shall be prescribed by the ,secretary by rule4 7#d7 ,section #haec7;c7 of this title shall not apply to this subsection4 7g7 ,regulations ,not later than one year after the date of the enactment of the ,caring for our ,veterans ,act of #bjag1 the ,secretary shall promulgate regulations to carry out this section4 7h7 ,walk-in care defined ,in this section1 the term walk-in care means non-emergent care provided by a qualifying non-,department entity or provider that furnishes episodic care and not longitudinal management of conditions and is otherwise defined through regulations the ,secretary shall promulgate4 4 7b7 ,effective date ,section #agbe;,a of title #ch1 ,united ,states ,code1 as added by subsection 7a7 shall take effect on the date upon which final regulations implementing such section take effect4 7c7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item related to section #agbe the following new item3 #agbe;,a4 ,access to walk-in care4 4 #ajf4 ,strategy regarding the ,department of ,veterans ,affairs ,high-,performing ,integrated ,health ,care ,network 7a7 ,market area assessments 7#a7 ,in general ,not less frequently than every four years1 the ,secretary of ,veterans ,affairs shall perform market area assessments regarding the health care services furnished under the laws administered by the ,secretary4 7#b7 ,elements ,each market area assessment established under paragraph 7#a7 shall include the following3 7,a7 ,an assessment of the demand for health care from the ,department1 disaggregated by geographic market areas as determined by the ,secretary1 including the number of requests for health care services under the laws administered by the ,secretary4 7,b7 ,an inventory of the health care capacity of the ,department of ,veterans ,affairs across the ,department's system of facilities4 7,c7 ,an assessment of the health care capacity to be provided through contracted community care providers and providers who entered into a provider agreement with the ,department under section #agjc;,a of title #ch1 ,united ,states ,code1 as added by section #ajb7;a71 including the number of providers1 the geographic location of the providers1 and categories or types of health care services provided by the providers4 7,d7 ,an assessment obtained from other ,federal direct delivery systems of their capacity to provide health care to veterans4 7,e7 ,an assessment of the health care capacity of non-contracted providers where there is insufficient network supply4 7,f7 ,an assessment of the health care capacity of academic affiliates and other collaborations of the ,department as it relates to providing health care to veterans4 7,g7 ,an assessment of the effects on health care capacity by the access guidelines and standards for quality established under section #agjc7;h7 of title #ch1 ,united ,states ,code1 as amended by section #aja7;a77#a74 7,h7 ,the number of appointments for health care services under the laws administered by the ,secretary1 disaggregated by-- 7i7 appointments at facilities of the ,department of ,veterans ,affairs2 and 7ii7 appointments with non-,department health care providers4 7#c7 ,submittal to ,congress ,the ,secretary shall submit to the appropriate committees of ,congress the market area assessments established in paragraph 7#a74 7#d7 ,use of market area assessments for integrated health care delivery 7,a7 ,in general ,the ,secretary shall use the market area assessments established under paragraph 7#a7 in determining the capacity of the health care provider networks established under section #agjc7;j7 of title #ch1 ,united ,states ,code1 as amended by section #aja7;a77#a74 7,b7 ,budget ,the ,secretary shall ensure that the ,department budget for any fiscal year 7as submitted with the budget of the ,president under section #aaje7;a7 of title #ca1 ,united ,states ,code7 reflects the findings of the ,secretary with respect to the most recent market area assessments under paragraph 7#a74 7#e7 ,effective date ,the amendments made by subsection 7a7 shall take effect on ,september #cj1 #bjah4 7b7 ,strategic plan ,to meet health care demand 7#a7 ,in general ,not later than one year after the date of the enactment of this ,act and not less frequently than once every four years thereafter1 the ,secretary shall submit to the appropriate committees of ,congress a strategic plan that specifies a four-year forecast of-- 7,a7 the demand for health care from the ,department1 disaggregated by geographic area as determined by the ,secretary2 7,b7 the health care capacity to be provided at each medical center of the ,department2 and 7,c7 the health care capacity to be provided through community care providers4 7#b7 ,elements ,in preparing the strategic plan under paragraph 7#a71 the ,secretary shall-- 7,a7 consider the access guidelines and standards for quality established under section #agjc7;h7 of title #ch1 ,united ,states ,code1 as amended by section #aja7;a77#a72 7,b7 consider the market area assessments established under subsection 7a72 7,c7 consider the needs of the ,department based on identified services that provide management of conditions or disorders related to military service for which there is limited experience or access in the national market1 the overall health of veterans throughout their lifespan1 or other services as the ,secretary determines appropriate2 7,d7 consult with key stakeholders within the ,department1 the heads of other ,federal agencies1 and other relevant governmental and nongovernmental entities1 including ,state1 local1 and tribal government officials1 members of ,congress1 veterans service organizations1 private sector representatives1 academics1 and other policy experts2 7,e7 identify emerging issues1 trends1 problems1 and opportunities that could affect health care services furnished under the laws administered by the ,secretary2 7,f7 develop recommendations regarding both short- and long-term priorities for health care services furnished under the laws administered by the ,secretary2 7,g7 after consultation with veterans service organizations and other key stakeholders on survey development or modification of an existing survey1 consider a survey of veterans who have used hospital care1 medical services1 or extended care services furnished by the ,veterans ,health ,administration during the most recent two-year period to assess the satisfaction of the veterans with service and quality of care2 and 7,h7 consider such other matters as the ,secretary considers appropriate4 7c7 ,appropriate committees of congress defined ,in this section1 the term appropriate committees of ,congress means-- 7#a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7#b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 #ajg4 ,applicability of ,directive of ,office of ,federal ,contract ,compliance ,programs 7a7 ,in general ,notwithstanding the treatment of certain laws under subsection 7i7 of section #agjc;,a of title #ch1 ,united ,states ,code1 as added by section #ajb of this ,act1 ,directive #bjad-ja of the ,office of ,federal ,contract ,compliance ,programs of the ,department of ,labor 7effective as of ,may #g1 #bjad7 shall apply to any entity entering into an agreement under such section #agjc;,a or section #agde of such title1 as amended by section #ajc1 in the same manner as such directive applies to subcontractors under the ,,tricare program for the duration of the moratorium provided under such directive4 7b7 ,applicability period ,the directive described in subsection 7a71 and the moratorium provided under such directive1 shall not be altered or rescinded before ,may #g1 #bjai4 7c7 ,,tricare program defined ,in this section1 the term ,,tricare program has the meaning given that term in section #ajgb of title #aj1 ,united ,states ,code4 #ajh4 ,prevention of certain health care providers from providing non-,department health care services to veterans 7a7 ,in general ,on and after the date that is one year after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall deny or revoke the eligibility of a health care provider to provide non-,department health care services to veterans if the ,secretary determines that the health care provider-- 7#a7 was removed from employment with the ,department of ,veterans ,affairs due to conduct that violated a policy of the ,department relating to the delivery of safe and appropriate health care2 or 7#b7 violated the requirements of a medical license of the health care provider that resulted in the loss of such medical license4 7b7 ,permissive action ,on and after the date that is one year after the date of the enactment of this ,act1 the ,secretary may deny1 revoke1 or suspend the eligibility of a health care provider to provide non-,department health care services if the ,secretary determines such action is necessary to immediately protect the health1 safety1 or welfare of veterans and the health care provider is under investigation by the medical licensing board of a ,state in which the health care provider is licensed or practices4 7c7 ,suspension ,the ,secretary shall suspend the eligibility of a health care provider to provide non-,department health care services to veterans if the health care provider is suspended from serving as a health care provider of the ,department4 7d7 ,comptroller ,general report ,not later than two years after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report on the implementation by the ,secretary of this section1 including the following3 7#a7 ,the aggregate number of health care providers denied or suspended under this section from participation in providing non-,department health care services4 7#b7 ,an evaluation of any impact on access to health care for patients or staffing shortages in programs of the ,department providing non-,department health care services4 7#c7 ,an explanation of the coordination of the ,department with the medical licensing boards of ,states in implementing this section1 the amount of involvement of such boards in such implementation1 and efforts by the ,department to address any concerns raised by such boards with respect to such implementation4 7#d7 ,such recommendations as the ,comptroller ,general considers appropriate regarding harmonizing eligibility criteria between health care providers of the ,department and health care providers eligible to provide non-,department health care services4 7e7 ,non-,department health care services defined ,in this section1 the term non-,department health care services means services-- 7#a7 provided under subchapter ,i of chapter #ag of title #ch1 ,united ,states ,code1 at non-,department facilities 7as defined in section #agja of such title72 7#b7 provided under section #aja of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note72 7#c7 purchased through the ,medical ,community ,care account of the ,department2 or 7#d7 purchased with amounts deposited in the ,veterans ,choice ,fund under section #hjb of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad4 ,b ,paying providers and improving collections #aaa4 ,prompt payment to providers 7a7 ,in general ,subchapter ,i of chapter #ag is amended by inserting after section #agjc;,c1 as added by section #ajd of this ,act1 the following new section3 #agjc;,d4 ,prompt payment standard 7a7 ,in general 7#a7 ,notwithstanding any other provision of this title or of any other provision of law1 the ,secretary shall pay for hospital care1 medical services1 or extended care services furnished by health care entities or providers under this chapter within #de calendar days upon receipt of a clean paper claim or #cj calendar days upon receipt of a clean electronic claim4 7#b7 ,if a claim is denied1 the ,secretary shall1 within #de calendar days of denial for a paper claim and #cj calendar days of denial for an electronic claim1 notify the health care entity or provider of the reason for denying the claim and what1 if any1 additional information is required to process the claim4 7#c7 ,upon the receipt of the additional information1 the ,secretary shall ensure that the claim is paid1 denied1 or otherwise adjudicated within #cj calendar days from the receipt of the requested information4 7#d7 ,this section shall only apply to payments made on an invoice basis and shall not apply to capitation or other forms of periodic payment to entities or providers4 7b7 ,submittal of claims by health care entities and providers ,a health care entity or provider that furnishes hospital care1 a medical service1 or an extended care service under this chapter shall submit to the ,secretary a claim for payment for furnishing the hospital care1 medical service1 or extended care service not later than #ahj days after the date on which the entity or provider furnished the hospital care1 medical service1 or extended care service4 7c7 ,fraudulent claims 7#a7 ,sections #cgbi through #cgcc of title #ca shall apply to fraudulent claims for payment submitted to the ,secretary by a health care entity or provider under this chapter4 7#b7 ,pursuant to regulations prescribed by the ,secretary1 the ,secretary shall bar a health care entity or provider from furnishing hospital care1 medical services1 and extended care services under this chapter when the ,secretary determines the entity or provider has submitted to the ,secretary fraudulent health care claims for payment by the ,secretary4 7d7 ,overdue claims 7#a7 ,any claim that has not been denied with notice1 made pending with notice1 or paid to the health care entity or provider by the ,secretary shall be overdue if the notice or payment is not received by the entity provider within the time periods specified in subsection 7a74 7#b7 7,a7 ,if a claim is overdue under this subsection1 the ,secretary may1 under the requirements established by subsection 7a7 and consistent with the provisions of chapter #ci of title #ca 7commonly referred to as the ,prompt ,payment ,act71 require that interest be paid on clean claims4 7,b7 ,interest paid under subparagraph 7,a7 shall be computed at the rate of interest established by the ,secretary of the ,treasury under section #cijb of title #ca and published in the ,federal ,register4 7#c7 ,not less frequently than annually1 the ,secretary shall submit to ,congress a report on payment of overdue claims under this subsection1 disaggregated by paper and electronic claims1 that includes the following3 7,a7 ,the amount paid in overdue claims described in this subsection1 disaggregated by the amount of the overdue claim and the amount of interest paid on such overdue claim4 7,b7 ,the number of such overdue claims and the average number of days late each claim was paid1 disaggregated by facility of the ,department and ,veterans ,integrated ,service ,network region4 7e7 ,overpayment 7#a7 ,the ,secretary shall deduct the amount of any overpayment from payments due a health care entity or provider under this chapter4 7#b7 ,deductions may not be made under this subsection unless the ,secretary has made reasonable efforts to notify a health care entity or provider of the right to dispute the existence or amount of such indebtedness and the right to request a compromise of such indebtedness4 7#c7 ,the ,secretary shall make a determination with respect to any such dispute or request prior to deducting any overpayment unless the time required to make such a determination before making any deductions would jeopardize the ,secretary's ability to recover the full amount of such indebtedness4 7f7 ,information and documentation required 7#a7 ,the ,secretary shall provide to all health care entities and providers participating in a program to furnish hospital care1 medical services1 or extended care services under this chapter a list of information and documentation that is required to establish a clean claim under this section4 7#b7 ,the ,secretary shall consult with entities in the health care industry1 in the public and private sector1 to determine the information and documentation to include in the list under paragraph 7#a74 7#c7 ,if the ,secretary modifies the information and documentation included in the list under paragraph 7#a71 the ,secretary shall notify all health care entities and providers described in paragraph 7#a7 not later than #cj days before such modifications take effect4 7g7 ,processing of claims ,in processing a claim for compensation for hospital care1 medical services1 or extended care services furnished by a health care entity or provider under this chapter1 the ,secretary shall act through-- 7#a7 a non-,department entity that is under contract or agreement for the program established under section #agjc7;a7 of this title2 or 7#b7 a non-,department entity that specializes in such processing for other ,federal agency health care systems4 7h7 ,report on encounter data system 7#a7 ,not later than #ij days after the date of the enactment of the ,caring for our ,veterans ,act of #bjag1 the ,secretary shall submit to the appropriate committees of ,congress a report on the feasibility and advisability of adopting a funding mechanism similar to what is utilized by other ,federal agencies to allow a contracted entity to act as a fiscal intermediary for the ,federal ,government to distribute1 or pass through1 ,federal ,government funds for certain non-underwritten hospital care1 medical services1 or extended care services4 7#b7 ,the ,secretary may coordinate with the ,department of ,defense1 the ,department of ,health and ,human ,services1 and the ,department of the ,treasury in developing the report required by paragraph 7#a74 7i7 ,definitions ,in this section3 7#a7 ,the term appropriate committees of ,congress means-- 7,a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7,b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 7#b7 ,the term clean electronic claim means the transmission of data for purposes of payment of covered health care expenses that is submitted to the ,secretary which contains substantially all of the required data elements necessary for accurate adjudication1 without obtaining additional information from the entity or provider that furnished the care or service1 submitted in such format as prescribed by the ,secretary in regulations for the purpose of paying claims for care or services4 7#c7 ,the term clean paper claim means a paper claim for payment of covered health care expenses that is submitted to the ,secretary which contains substantially all of the required data elements necessary for accurate adjudication1 without obtaining additional information from the entity or provider that furnished the care or service1 submitted in such format as prescribed by the ,secretary in regulations for the purpose of paying claims for care or services4 7#d7 ,the term fraudulent claims means the intentional and deliberate misrepresentation of a material fact or facts by a health care entity or provider made to induce the ,secretary to pay a claim that was not legally payable to that provider4 ,this term1 as used in this section1 shall not include a good faith interpretation by a health care entity or provider of utilization1 medical necessity1 coding1 and billing requirements of the ,secretary4 7#e7 ,the term health care entity or provider includes any non-,department health care entity or provider1 but does not include any ,federal health care entity or provider4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item related to section #agjc;,c1 as added by section #ajd of this ,act1 the following new item3 #agjc;,d4 ,prompt payment standard4 4 #aab4 ,authority to pay for authorized care not subject to an agreement 7a7 ,in general ,subchapter ,,iv of chapter #ha is amended by adding at the end the following new section3 #haei4 ,authority to pay for services authorized but not subject to an agreement 7a7 ,in general ,if1 in the course of furnishing hospital care1 a medical service1 or an extended care service authorized by the ,secretary and pursuant to a contract1 agreement1 or other arrangement with the ,secretary1 a provider who is not a party to the contract1 agreement1 or other arrangement furnishes hospital care1 a medical service1 or an extended care service that the ,secretary considers necessary1 the ,secretary may compensate the provider for the cost of such care or service4 7b7 ,new contracts and agreements ,the ,secretary shall take reasonable efforts to enter into a contract1 agreement1 or other arrangement with a provider described in subsection 7a7 to ensure that future care and services authorized by the ,secretary and furnished by the provider are subject to such a contract1 agreement1 or other arrangement4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item relating to section #haeh the following new item3 #haei4 ,authority to pay for services authorized but not subject to an agreement4 4 #aac4 ,improvement of authority to recover the cost of services furnished for non-service-connected disabilities 7a7 ,broadening scope of applicability ,section #agbi is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#b77;,a7-- 7i7 by striking the veteran's and inserting the individual's2 and 7ii7 by striking the veteran and inserting the individual2 and 7,b7 in paragraph 7#c7-- 7i7 in the matter preceding subparagraph 7,a71 by striking the veteran and inserting the individual2 and 7ii7 in subparagraph 7,a71 by striking the veteran's and inserting the individual's2 7#b7 in subsection 7b7-- 7,a7 in paragraph 7#a7-- 7i7 by striking the veteran and inserting the individual2 and 7ii7 by striking the veteran's and inserting the individual's2 and 7,b7 in paragraph 7#b7-- 7i7 in subparagraph 7,a7-- 7,i7 by striking the veteran and inserting the individual2 and 7,,ii7 by striking the veteran's and inserting the individual's2 and 7ii7 in subparagraph 7,b7-- 7,i7 in clause 7i71 by striking the veteran and inserting the individual2 and 7,,ii7 in clause 7ii7-- 7aa7 by striking the veteran and inserting the individual2 and 7bb7 by striking the veteran's each place it appears and inserting the individual's2 7#c7 in subsection 7e71 by striking ,a veteran and inserting ,an individual2 and 7#d7 in subsection 7h7-- 7,a7 in paragraph 7#a7-- 7i7 in the matter preceding subparagraph 7,a71 by striking a veteran and inserting an individual2 7ii7 in subparagraph 7,a71 by striking the veteran and inserting the individual2 and 7iii7 in subparagraph 7,b71 by striking the veteran and inserting the individual2 and 7,b7 in paragraph 7#b7-- 7i7 by striking ,a veteran and inserting ,an individual2 7ii7 by striking a veteran and inserting an individual2 and 7iii7 by striking the veteran and inserting the individual4 7b7 ,modification of authority ,subsection 7a77#a7 of such section is amended by striking 7#a7 ,subject and all that follows through the period and inserting the following3 7#a7 ,subject to the provisions of this section1 in any case in which the ,united ,states is required by law to furnish or pay for care or services under this chapter for a non-service-connected disability described in paragraph 7#b7 of this subsection1 the ,united ,states has the right to recover or collect from a third party the reasonable charges of care or services so furnished or paid for to the extent that the recipient or provider of the care or services would be eligible to receive payment for such care or services from such third party if the care or services had not been furnished or paid for by a department or agency of the ,united ,states4 7c7 ,modification of eligible individuals ,subparagraph 7,d7 of subsection 7a77#b7 of such section is amended to read as follows3 7,d7 that is incurred by an individual who is entitled to care 7or payment of the expenses of care7 under a health-plan contract4 4 #aad4 ,processing of claims for reimbursement through electronic interface ,the ,secretary of ,veterans ,affairs may enter into an agreement with a third-party entity to process1 through the use of an electronic interface1 claims for reimbursement for health care provided under the laws administered by the ,secretary4 ,c ,education and training programs #aba4 ,education program on health care options 7a7 ,in general ,the ,secretary of ,veterans ,affairs shall develop and administer an education program that teaches veterans about their health care options through the ,department of ,veterans ,affairs4 7b7 ,elements ,the program under subsection 7a7 shall-- 7#a7 teach veterans about-- 7,a7 eligibility criteria for care from the ,department set forth under sections #agjc1 as amended by section #aja of this ,act1 and #agaj of title #ch1 ,united ,states ,code2 7,b7 priority groups for enrollment in the system of annual patient enrollment under section #agje7;a7 of such title2 7,c7 the copayments and other financial obligations1 if any1 required of certain individuals for certain services2 and 7,d7 how to utilize the access guidelines and standards for quality established under sections #agjc;,b and #agjc;,c of such title4 7#b7 teach veterans about the interaction between health insurance 7including private insurance1 ,medicare1 ,medicaid1 the ,,tricare program1 the ,indian ,health ,service1 tribal health programs1 and other forms of insurance7 and health care from the ,department2 and 7#c7 provide veterans with information on what to do when they have a complaint about health care received from the ,department 7whether about the provider1 the ,department1 or any other type of complaint74 7c7 ,accessibility ,in developing the education program under this section1 the ,secretary shall ensure that materials under such program are accessible -- 7#a7 to veterans who may not have access to the ,internet2 and 7#b7 to veterans in a manner that complies with the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abaja et seq474 7d7 ,annual evaluation and report 7#a7 ,evaluation ,the ,secretary shall develop a method to evaluate the effectiveness of the education program under this section and evaluate the program using the method not less frequently than once each year4 7#b7 ,report ,not less frequently than once each year1 the ,secretary shall submit to ,congress a report on the findings of the ,secretary with respect to the most recent evaluation conducted by the ,secretary under paragraph 7#a74 7e7 ,definitions ,in this section3 7#a7 ,medicaid ,the term ,medicaid means the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#b7 ,medicare ,the term ,medicare means the ,medicare program under title ,,xviii of such ,act 7#db ,u4,s4,c4 #acie et seq474 7#c7 ,tricare program ,the term ,,tricare program has the meaning given that term in section #ajgb of title #aj1 ,united ,states ,code4 #abb4 ,training program for administration of non-,department of ,veterans ,affairs health care 7a7 ,establishment of program ,the ,secretary of ,veterans ,affairs shall develop and implement a training program to train employees and contractors of the ,department of ,veterans ,affairs on how to administer non-,department health care programs1 including the following3 7#a7 ,reimbursement for non-,department emergency room care4 7#b7 ,the ,veterans ,community ,care ,program under section #agjc of such title1 as amended by section #aja4 7#c7 ,management of prescriptions pursuant to improvements under section #aca4 7b7 ,annual evaluation and report ,the ,secretary shall-- 7#a7 develop a method to evaluate the effectiveness of the training program developed and implemented under subsection 7a72 7#b7 evaluate such program not less frequently than once each year2 and 7#c7 not less frequently than once each year1 submit to ,congress the findings of the ,secretary with respect to the most recent evaluation carried out under paragraph 7#b74 #abc4 ,continuing medical education for non-,department medical professionals 7a7 ,establishment of program 7#a7 ,in general ,the ,secretary of ,veterans ,affairs shall establish a program to provide continuing medical education material to non-,department medical professionals4 7#b7 ,education provided ,the program established under paragraph 7#a7 shall include education on the following3 7,a7 ,identifying and treating common mental and physical conditions of veterans and family members of veterans4 7,b7 ,the health care system of the ,department of ,veterans ,affairs4 7,c7 ,such other matters as the ,secretary considers appropriate4 7b7 ,material provided ,the continuing medical education material provided to non-,department medical professionals under the program established under subsection 7a7 shall be the same material provided to medical professionals of the ,department to ensure that all medical professionals treating veterans have access to the same materials1 which supports core competencies throughout the community4 7c7 ,administration of program 7#a7 ,in general ,the ,secretary shall administer the program established under subsection 7a7 to participating non-,department medical professionals through an ,internet website of the ,department of ,veterans ,affairs4 7#b7 ,curriculum and credit provided ,the ,secretary shall determine the curriculum of the program and the number of hours of credit to provide to participating non-,department medical professionals for continuing medical education4 7#c7 ,accreditation ,the ,secretary shall ensure that the program is accredited in as many ,states as practicable4 7#d7 ,consistency with existing rules ,the ,secretary shall ensure that the program is consistent with the rules and regulations of the following3 7,a7 ,the medical licensing agency of each ,state in which the program is accredited4 7,b7 ,such medical credentialing organizations as the ,secretary considers appropriate4 7#e7 ,user cost ,the ,secretary shall carry out the program at no cost to participating non-,department medical professionals4 7#f7 ,monitoring1 evaluation1 and report ,the ,secretary shall monitor the utilization of the program established under subsection 7a71 evaluate its effectiveness1 and report to ,congress on utilization and effectiveness not less frequently than once each year4 7d7 ,non-,department medical professional defined ,in this section1 the term non-,department medical professional means any individual who is licensed by an appropriate medical authority in the ,united ,states and is in good standing1 is not an employee of the ,department of ,veterans ,affairs1 and provides care to veterans or family members of veterans under the laws administered by the ,secretary of ,veterans ,affairs4 ,d ,other matters relating to non-,department of ,veterans ,affairs providers #aca4 ,establishment of processes to ensure safe opioid prescribing practices by non-,department of ,veterans ,affairs health care providers 7a7 ,receipt and review of guidelines ,the ,secretary of ,veterans ,affairs shall ensure that all covered health care providers are provided a copy of and certify that they have reviewed the evidence-based guidelines for prescribing opioids set forth by the ,opioid ,safety ,initiative of the ,department of ,veterans ,affairs under sections #iaa7;a77#b7 and #iab7;c7 of the ,jason ,simcakoski ,memorial and ,promise ,act 7,public ,law #aad-aih2 #ch ,u4,s4,c4 #agja note7 before first providing care under the laws administered by the ,secretary and at any time when those guidelines are modified thereafter4 7b7 ,inclusion of medical history and current medications ,the ,secretary shall implement a process to ensure that1 if care of a veteran by a covered health care provider is authorized under the laws administered by the ,secretary1 the document authorizing such care includes the relevant medical history of the veteran and a list of all medications prescribed to the veteran4 7c7 ,submittal of prescriptions 7#a7 ,in general ,except as provided in paragraph 7#c71 the ,secretary shall require1 to the maximum extent practicable1 each non-,department health care provider to submit prescriptions for opioids-- 7,a7 to the ,department for prior authorization for the prescribing of a limited amount of opioids under contracts the ,department has with retail pharmacies2 or 7,b7 directly to a pharmacy of the ,department for dispensing of the prescriptions4 7#b7 ,responsibility of ,department for recording and monitoring ,in carrying out paragraph 7#a7 and upon the receipt by the ,department of the prescription for opioids to veterans under laws administered by the ,secretary1 the ,secretary shall-- 7,a7 ensure the ,department is responsible for the recording of the prescription in the electronic health record of the veteran2 and 7,b7 enable other monitoring of the prescription as outlined in the ,opioid ,safety ,initiative of the ,department4 7#c7 ,exception 7,a7 ,in general ,a covered health care provider is not required under paragraph 7#a77;,b7 to submit an opioid prescription directly to a pharmacy of the ,department if-- 7i7 the health care provider determines that there is an immediate medical need for the prescription1 including an urgent or emergent prescription or a prescription dispensed as part of an opioid treatment program that provides office-based medications2 and 7ii7 7,i7 following an inquiry into the matter1 a pharmacy of the ,department notifies the health care provider that it cannot fill the prescription in a timely manner2 or 7,,ii7 the health care provider determines that the requirement under paragraph 7#a77;,b7 would impose an undue hardship on the veteran1 including with respect to travel distances1 as determined by the ,secretary4 7,b7 ,notification to ,department ,if a covered health care provider uses an exception under subparagraph 7,a7 with respect to an opioid prescription for a veteran1 the health care provider shall1 on the same day the prescription is written1 submit to the ,secretary for inclusion in the electronic health record of the veteran a notice1 in such form as the ,secretary may establish1 providing information about the prescription and describing the reason for the exception4 7,c7 ,report 7i7 ,in general ,not less frequently than quarterly1 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report evaluating the compliance of covered health care providers with the requirements under this paragraph and setting forth data on the use by health care providers of exceptions under subparagraph 7,a7 and notices under subparagraph 7,b74 7ii7 ,elements ,each report required by clause 7i7 shall include the following with respect to the quarter covered by the report3 7,i7 ,the number of exceptions used under subparagraph 7,a7 and notices received under subparagraph 7,b74 7,,ii7 ,the rate of compliance by the ,department with the requirement under subparagraph 7,b7 to include such notices in the health records of veterans4 7,,iii7 ,the identification of any covered health care providers that1 based on criteria prescribed by the ,secretary1 are determined by the ,secretary to be statistical outliers regarding the use of exceptions under subparagraph 7,a74 7d7 ,use of ,opioid ,safety ,initiative guidelines 7#a7 ,in general ,if a director of a medical center of the ,department or a ,veterans ,integrated ,service ,network determines that the opioid prescribing practices of a covered health care provider conflicts with or is otherwise inconsistent with the standards of appropriate and safe care1 as that term is used in section #iac7;d7 of the ,jason ,simcakoski ,memorial and ,promise ,act 7,public ,law #aad-aih2 #ch ,u4,s4,c4 #agja note71 the director shall take such action as the director considers appropriate to ensure the safety of all veterans receiving care from that health care provider1 including removing or directing the removal of any such health care provider from provider networks or otherwise refusing to authorize care of veterans by such health care provider in any program authorized under the laws administered by the ,secretary4 7#b7 ,inclusion in contracts ,the ,secretary shall ensure that any contracts entered into by the ,secretary with third parties involved in administering programs that provide care in the community to veterans under the laws administered by the ,secretary specifically grant the authority set forth in paragraph 7#a7 to such third parties and to the directors described in that paragraph1 as the case may be4 7e7 ,denial or revocation of eligibility of non-,department providers ,the ,secretary shall deny or revoke the eligibility of a non-,department health care provider to provide health care to veterans under the laws administered by the ,secretary if the ,secretary determines that the opioid prescribing practices of the provider-- 7#a7 violate the requirements of a medical license of the health care provider2 or 7#b7 detract from the ability of the health care provider to deliver safe and appropriate health care4 7f7 ,covered health care provider defined ,in this section1 the term covered health care provider means a non-,department of ,veterans ,affairs health care provider who provides health care to veterans under the laws administered by the ,secretary of ,veterans ,affairs4 #acb4 ,improving information sharing with community providers ,section #gccb7;b77#b7 is amended by striking subparagraph 7,h7 and inserting the following new subparagraphs3 7,h7 7i7 ,to a non-,department entity 7including private entities and other ,federal agencies7 for purposes of providing health care1 including hospital care1 medical services1 and extended care services1 to patients4 7ii7 ,an entity to which a record is disclosed under this subparagraph may not disclose or use such record for a purpose other than that for which the disclosure was made4 7,i7 ,to a third party in order to recover or collect reasonable charges for care furnished to1 or paid on behalf of1 a patient in connection with a non-service connected disability as permitted by section #agbi of this title or for a condition for which recovery is authorized or with respect to which the ,united ,states is deemed to be a third party beneficiary under the ,act entitled ,an ,act to provide for the recovery from tortiously liable third persons of the cost of hospital and medical care and treatment furnished by the ,united ,states 7,public ,law #hg-fic2 #db ,u4,s4,c4 #bfea et seq42 commonly known as the ,federal ,medical ,care ,recovery ,act74 4 #acc4 ,competency standards for non-,department of ,veterans ,affairs health care providers 7a7 ,establishment of standards and requirements ,the ,secretary of ,veterans ,affairs shall establish standards and requirements for the provision of care by non-,department of ,veterans ,affairs health care providers in clinical areas for which the ,department of ,veterans ,affairs has special expertise1 including post-traumatic stress disorder1 military sexual trauma-related conditions1 and traumatic brain injuries4 7b7 ,condition for eligibility to participate in ,veterans ,choice ,program ,each non-,department of ,veterans ,affairs health care provider shall meet the standards and requirements established pursuant to subsection 7a7 before entering into a contact with the ,department of ,veterans ,affairs to participate in the ,veterans ,choice ,program under section #aja of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note74 ,non-,department of ,veterans ,affairs health care providers participating in the ,veterans ,choice ,program shall fulfill training requirements established by the ,secretary on how to deliver evidence-based treatments in the clinical areas for which the ,department of ,veterans ,affairs has special expertise4 ,e ,other non-,department health care matters #ada4 ,plans for ,use of ,supplemental ,appropriations ,required ,whenever the ,secretary submits to ,congress a request for supplemental appropriations or any other appropriation outside the standard budget process to address a budgetary issue affecting the ,department of ,veterans ,affairs1 the ,secretary shall1 not later than #de days before the date on which such budgetary issue would start affecting a program or service1 submit to ,congress a justification for the request1 including a plan that details how the ,secretary intends to use the requested appropriation and how long the requested appropriation is expected to meet the needs of the ,department and certification that the request was made using an updated and sound actuarial analysis4 #adb4 ,veterans ,choice ,fund flexibility ,section #hjb of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 is amended-- 7#a7 in subsection 7c7-- 7,a7 in paragraph 7#a71 by striking by paragraph 7#c7 and inserting in paragraphs 7#c7 and 7#d72 and 7,b7 by adding at the end the following new paragraph3 7#d7 ,permanent authority for other uses ,beginning in fiscal year #bjai1 amounts remaining in the ,veterans ,choice ,fund may be used to furnish hospital care1 medical services1 and extended care services to individuals pursuant to chapter #ag of title #ch1 ,united ,states ,code1 at non-,department facilities1 including pursuant to non-,department provider programs other than the program established by section #aja4 ,such amounts shall be available in addition to amounts available in other appropriations accounts for such purposes4 2 and 7#b7 in subsection 7d77#a71 by striking to subsection 7c77#c7 and inserting to paragraphs 7#c7 and 7#d7 of subsection 7c74 #adc4 ,sunset of ,veterans ,choice ,program ,subsection 7p7 of section #aja of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 is amended to read as follows3 7p7 ,authority ,to furnish care and services ,the ,secretary may not use the authority under this section to furnish care and services after ,december #ca1 #bjah4 4 #add4 ,conforming amendments 7a7 ,in general 7#a7 ,title #ch ,title #ch1 ,united ,states ,code1 is amended-- 7,a7 in section #agab7;a7-- 7i7 in paragraph 7#c71 by striking under clause 7#a71 7#b71 or 7#e7 of section #agjc7;a7 of this title and inserting or entered an agreement2 and 7ii7 in paragraph 7#d77;,a71 by striking under the provisions of this subsection and section #agjc of this title2 7,b7 in section #agab;,a7e77#a7-- 7i7 by inserting or agreements after contracts2 and 7ii7 by striking 7under sections #agjc7;a77#b7 and #agaj7;a77#a77;,b7 of this title72 and 7,c7 in section #bcjc7;a77#b77;,b77i71 by striking with section #agjc and inserting with sections #agjc;,a1 #haaa1 and #haec4 7#b7 ,social ,security ,act ,section #ahff7;a77#a77,l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77,l77 is amended by striking under section #agjc and inserting under chapter #ag4 7#c7 ,veterans' ,benefits ,improvements ,act of #aiid ,section #ajd7;a77#d77;,a7 of the ,veterans' ,benefits ,improvements ,act of #aiid 7,public ,law #ajc-ddf2 #ch ,u4,s4,c4 #aaag note7 is amended by striking in section #agjc and inserting in sections #agjc;,a1 #haaa1 and #haec4 7b7 ,effective date ,the amendments made by subsection 7a7 shall take effect on the date described in section #aja7;b74 ,,ii ,improving ,department of ,veterans ,affairs health care delivery ,a ,personnel practices ,i ,administration #bja4 ,licensure of health care professionals of the ,department of ,veterans ,affairs providing treatment via telemedicine 7a7 ,in general ,chapter #ag is amended by inserting after section #agcj;,a the following new section3 #agcj;,b4 ,licensure of health care professionals providing treatment via telemedicine 7a7 ,in general ,notwithstanding any provision of law regarding the licensure of health care professionals1 a covered health care professional may practice the health care profession of the health care professional at any location in any ,state1 regardless of where the covered health care professional or the patient is located1 if the covered health care professional is using telemedicine to provide treatment to an individual under this chapter4 7b7 ,covered health care professionals ,for purposes of this section1 a covered health care professional is any health care professional who-- 7#a7 is an employee of the ,department appointed under the authority under section #gcjf1 #gdja1 #gdje1 #gdjf1 or #gdjh of this title or title #e2 7#b7 is authorized by the ,secretary to provide health care under this chapter2 7#c7 is required to adhere to all standards of quality relating to the provision of medicine in accordance with applicable policies of the ,department2 and 7#d7 has an active1 current1 full1 and unrestricted license1 registration1 or certification in a ,state to practice the health care profession of the health care professional4 7c7 ,property of ,federal government ,subsection 7a7 shall apply to a covered health care professional providing treatment to a patient regardless of whether the covered health care professional or patient is located in a facility owned by the ,federal ,government during such treatment4 7d7 ,relation to ,state law 7#a7 ,the provisions of this section shall supersede any provisions of the law of any ,state to the extent that such provision of ,state law are inconsistent with this section4 7#b7 ,no ,state shall deny or revoke the license1 registration1 or certification of a covered health care professional who otherwise meets the qualifications of the ,state for holding the license1 registration1 or certification on the basis that the covered health care professional has engaged or intends to engage in activity covered by subsection 7a74 7e7 ,rule of construction ,nothing in this section may be construed to remove1 limit1 or otherwise affect any obligation of a covered health care professional under the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hja et seq474 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag of such title is amended by inserting after the item relating to section #agcj;,a the following new item3 #agcj;,b4 ,licensure of health care professionals providing treatment via telemedicine4 4 7c7 ,report on telemedicine 7#a7 ,in general ,not later than one year after the earlier of the date on which services provided under section #agcj;,b of title #ch1 ,united ,states ,code1 as added by subsection 7a71 first occur or regulations are promulgated to carry out such section1 the ,secretary of ,veterans ,affairs shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on the effectiveness of the use of telemedicine by the ,department of ,veterans ,affairs4 7#b7 ,elements ,the report required by paragraph 7#a7 shall include an assessment of the following3 7,a7 ,the satisfaction of veterans with telemedicine furnished by the ,department4 7,b7 ,the satisfaction of health care providers in providing telemedicine furnished by the ,department4 7,c7 ,the effect of telemedicine furnished by the ,department on the following3 7i7 ,the ability of veterans to access health care1 whether from the ,department or from non-,department health care providers4 7ii7 ,the frequency of use by veterans of telemedicine4 7iii7 ,the productivity of health care providers4 7iv7 ,wait times for an appointment for the receipt of health care from the ,department4 7v7 ,the use by veterans of in-person services at ,department facilities and non-,department facilities4 7,d7 ,the types of appointments for the receipt of telemedicine furnished by the ,department that were provided during the one-year period preceding the submittal of the report4 7,e7 ,the number of appointments for the receipt of telemedicine furnished by the ,department that were requested during such period1 disaggregated by medical facility4 7,f7 ,savings by the ,department1 if any1 including travel costs1 from furnishing health care through the use of telemedicine during such period4 #bjb4 ,role of podiatrists in ,department of ,veterans ,affairs 7a7 ,inclusion as physician 7#a7 ,in general ,subchapter ,i of chapter #gd is amended by adding at the end the following new section3 #gdac4 ,treatment of podiatrists2 clinical oversight standards 7a7 ,podiatrists ,except as provided by subsection 7b71 a doctor of podiatric medicine who is appointed as a podiatrist under section #gdja7a7 of this title is eligible for any supervisory position in the ,veterans ,health ,administration to the same degree that a physician appointed under such section is eligible for the position4 7b7 ,establishment of clinical oversight standards ,the ,secretary1 in consultation with appropriate stakeholders1 shall establish standards to ensure that specialists appointed in the ,veterans ,health ,administration to supervisory positions do not provide direct clinical oversight for purposes of peer review or practice evaluation for providers of other clinical specialties4 4 7#b7 ,clerical amendment ,the table of sections at the beginning of chapter #gd is amended by inserting after the item relating to section #gdab the following new item3 #gdac4 ,treatment of podiatrists2 clinical oversight standards4 4 7b7 ,modification and clarification of pay grade 7#a7 ,grade ,the list in section #gdjd7;b7 of such title is amended-- 7,a7 by striking ,,physician ,,and ,,dentist ,,schedule and inserting ,,physician ,,and ,,surgeon 7,,md_/,,do71 ,,podiatric ,,surgeon 7,,dpm71 ,,and ,,dentist ,,and ,,oral ,,surgeon 7,,dds1 ,,dmd7 ,,schedule2 7,b7 by striking1 ,physician grade and inserting ,physician and surgeon grade2 and 7,c7 by striking ,,podiatrist1 ,,chiropractor1 ,,and and inserting ,,chiropractor ,,and4 7#b7 ,application ,the amendments made by paragraph 7#a7 shall apply with respect to a pay period of the ,department of ,veterans ,affairs beginning on or after the date that is #cj days after the date of the enactment of this ,act4 #bjc4 ,modification of treatment of certified clinical perfusionists of the ,department 7a7 ,appointment ,section #gdja7a7 is amended by inserting certified clinical perfusionists1 after physician assistants14 7b7 ,increases in rates of basic pay ,section #gdee7;c77#a7 is amended by inserting certified clinical perfusionists1 after pharmacists14 #bjd4 ,amending statutory requirements for the position of the ,chief ,officer of the ,readjustment ,counseling ,service ,section #gcji7;b77#b7 is amended-- 7#a7 in subparagraph 7,b71 by striking in the ,readjustment ,counseling ,service2 and 7#b7 in subparagraph 7,c71 by striking in the ,readjustment ,counseling ,service4 #bje4 ,technical amendment to appointment and compensation system for directors of medical centers and directors of ,veterans ,integrated ,service ,networks ,section #gdjd7;d7 is amended by striking ,except and inserting ,except for positions described in section #gdja7d7 of this title and except4 #bjf4 ,identification and staffing of certain health care vacancies 7a7 ,in general ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall identify and fully staff-- 7#a7 all mental health vacancies within the ,department of ,veterans ,affairs2 and 7#b7 all primary care and mental health vacancies in ,patient ,aligned ,care ,teams of the ,department4 7b7 ,report ,not later than #baj days after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report that specifies-- 7#a7 whether the ,department has complied with the requirements under subsection 7a72 and 7#b7 if the ,secretary has not complied with such requirements-- 7,a7 how many vacancies described in subsection 7a7 remain2 and 7,b7 why the ,department was unable to fill such vacancies4 #bjg4 ,department of ,veterans ,affairs personnel transparency 7a7 ,publication of staffing and vacancies 7#a7 ,website required ,not later than #cj days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall make publicly available on an ,internet website of the ,department of ,veterans ,affairs the following information1 which shall be displayed by departmental component or1 in the case of information relating to ,veterans ,health ,administration positions1 by medical facility3 7,a7 ,the number of personnel encumbering positions4 7,b7 ,the number of accessions and de-accessions of personnel during the month preceding the date of the publication of the information4 7,c7 ,the number of vacancies1 by occupation4 7,d7 ,the number of active job postings that have been filled during the #cj-;day period ending on the date of publication of the information1 including the length of time for which each position was posted prior to being filled4 7#b7 ,update of information ,the ,secretary shall update the information on the website required under paragraph 7#a7 on a monthly basis4 7#c7 ,treatment of contractor positions ,any ,department of ,veterans ,affairs position that is filled through a contractor employee may not be treated as a ,department position for purposes of the information required to be published under paragraph 7#a74 7#d7 ,inspector ,general review ,on a semi-annual basis1 the ,inspector ,general of the ,department shall review the administration of the website required under paragraph 7#a7 and make recommendations relating to the improvement of such administration4 7b7 ,report to ,congress ,the ,secretary of ,veterans ,affairs shall submit to ,congress an annual report on the steps the ,department is taking to achieve full staffing capacity4 ,each such report shall include the amount of additional funds necessary to enable the ,department to reach full staffing capacity4 #bjh4 ,program on establishment of peer specialists in patient aligned care team settings within medical centers of ,department of ,veterans ,affairs 7a7 ,program required ,the ,secretary of ,veterans ,affairs shall carry out a program to establish not fewer than two peer specialists in patient aligned care teams at medical centers of the ,department of ,veterans ,affairs to promote the use and integration of services for mental health1 substance use disorder1 and behavior health in a primary care setting4 7b7 ,timeframe for establishment of program ,the ,secretary shall carry out the program at medical centers of the ,department as follows3 7#a7 ,not later than ,december #ca1 #bjah1 at not fewer than #be medical centers of the ,department4 7#b7 ,not later than ,december #ca1 #bjai1 at not fewer than #ej medical centers of the ,department4 7c7 ,selection of locations 7#a7 ,in general ,the ,secretary shall select medical centers for the program as follows3 7,a7 ,not fewer than five shall be medical centers of the ,department that are designated by the ,secretary as polytrauma centers4 7,b7 ,not fewer than ten shall be medical centers of the ,department that are not designated by the ,secretary as polytrauma centers4 7#b7 ,considerations ,in selecting medical centers for the program under paragraph 7#a71 the ,secretary shall consider the feasibility and advisability of selecting medical centers in the following areas3 7,a7 ,rural areas and other areas that are underserved by the ,department4 7,b7 ,areas that are not in close proximity to an active duty military installation4 7,c7 ,areas representing different geographic locations1 such as census tracts established by the ,bureau of the ,census4 7d7 ,gender-,specific services ,in carrying out the program at each location selected under subsection 7c71 the ,secretary shall ensure that-- 7#a7 the needs of female veterans are specifically considered and addressed2 and 7#b7 female peer specialists are made available to female veterans who are treated at each location4 7e7 ,engagement with community providers ,at each location selected under subsection 7c71 the ,secretary shall consider ways in which peer specialists can conduct outreach to health care providers in the community who are known to be serving veterans to engage with those providers and veterans served by those providers4 7f7 ,reports 7#a7 ,periodic reports 7,a7 ,in general ,not later than #ahj days after the date of the enactment of this ,act1 and not less frequently than once every #ahj days thereafter until the ,secretary determines that the program is being carried out at the last location to be selected under subsection 7c71 the ,secretary shall submit to ,congress a report on the program4 7,b7 ,elements ,each report required by subparagraph 7,a7 shall1 with respect to the #ahj-;day period preceding the submittal of the report1 include the following3 7i7 ,the findings and conclusions of the ,secretary with respect to the program4 7ii7 ,an assessment of the benefits of the program to veterans and family members of veterans4 7iii7 ,an assessment of the effectiveness of peer specialists in engaging under subsection 7e7 with health care providers in the community and veterans served by those providers4 7#b7 ,final report ,not later than #ahj days after the ,secretary determines that the program is being carried out at the last location to be selected under subsection 7c71 the ,secretary shall submit to ,congress a report detailing the recommendations of the ,secretary as to the feasibility and advisability of expanding the program to additional locations4 #bji4 ,pilot program on increasing the use of medical scribes to maximize the efficiency of physicians at medical facilities of the ,department of ,veterans ,affairs 7a7 ,in general ,commencing not later than #abj days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall carry out a pilot program to increase the use of medical scribes to maximize the efficiency of physicians at medical facilities of the ,department of ,veterans ,affairs4 7b7 ,duration ,the ,secretary shall carry out the pilot program during the #ah-month period beginning on the date of the commencement of the pilot program4 7c7 ,locations ,the ,secretary shall carry out the pilot program at not fewer than five medical facilities of the ,department-- 7#a7 at which the ,secretary has determined there is a high volume of patients2 or 7#b7 that are located in rural areas and at which the ,secretary has determined there is a shortage of physicians and each physician has a high caseload4 7d7 ,contracts 7#a7 ,in general ,in carrying out the pilot program1 the ,secretary shall enter into a contract with one or more appropriate nongovernmental entities described in paragraph 7#b74 7#b7 ,appropriate nongovernmental entities described ,an appropriate nongovernmental entity described in this paragraph is an entity that trains and employs professional medical scribes who specialize in the collection of medical data and data entry into electronic health records4 7e7 ,collection of data 7#a7 ,in general ,the ,secretary shall collect data on the pilot program to determine the effectiveness of the pilot program in increasing the efficiency of physicians at medical facilities of the ,department4 7#b7 ,elements ,the data collected under paragraph 7#a7 shall include the following with respect to each medical facility participating in the pilot program3 7,a7 ,the average wait time for a veteran to receive care from a physician at such medical facility before implementation of the pilot program4 7,b7 ,the average wait time for a veteran to receive care from such a physician after implementation of the pilot program4 7,c7 ,the average number of patients that such a physician is able to see on a daily basis before implementation of the pilot program4 7,d7 ,the average number of patients that such a physician is able to see on a daily basis after implementation of the pilot program4 7,e7 ,the average amount of time such a physician spends on documentation on a daily basis before implementation of the pilot program4 7,f7 ,the average amount of time such a physician spends on documentation on a daily basis after implementation of the pilot program4 7,g7 ,the satisfaction and retention scores of each such physician before implementation of the pilot program4 7,h7 ,the satisfaction and retention scores of each such physician after implementation of the pilot program4 7,i7 ,the patient satisfaction scores for each such physician before implementation of the pilot program4 7,j7 ,the patient satisfaction scores for each such physician after implementation of the pilot program4 7,k7 ,the patient satisfaction scores for their health care experience before implementation of the pilot program4 7,l7 ,the patient satisfaction scores for their health care experience after implementation of the pilot program4 7f7 ,report 7#a7 ,in general ,not later than #ahj days after the commencement of the pilot program1 and not less frequently than once every #ahj days thereafter for the duration of the pilot program1 the ,secretary shall submit to ,congress a report on the pilot program4 7#b7 ,elements ,each report required by paragraph 7#a7 shall include the following3 7,a7 ,the number of medical facilities of the ,department that are participating in the pilot program4 7,b7 ,with respect to each such medical facility1 an assessment of the effects that participation in the pilot program has had on the following-- 7i7 ,maximizing the efficiency of physicians at such medical facility4 7ii7 ,reducing average wait times for appointments4 7iii7 ,improving access of patients to electronic medical records4 7iv7 ,mitigating physician shortages by increasing the productivity of physicians4 7,c7 ,all data collected under subsection 7e74 7,d7 ,such recommendations as the ,secretary may have with respect to the extension or expansion of the pilot program4 7g7 ,medical scribe defined ,in this section1 the term medical scribe means a member of the medical team hired and trained specifically and exclusively to perform documentation in an electronic health record to maximize the productivity of a physician4 #baj4 ,sense of ,congress regarding ,department of ,veterans ,affairs staffing levels 7a7 ,findings ,congress makes the following findings3 7#a7 ,the ,department of ,veterans ,affairs needs to fill at least #ce1jjj positions4 7#b7 ,prolonged personnel vacancies in the ,department result in staffing shortages that cause veterans to receive delayed benefits and services4 7b7 ,sense of ,congress ,it is the sense of ,congress that the ,department should make the resolution of staffing shortages a top priority4 ,,ii ,education and training #baa4 ,graduate medical education and residency 7a7 ,increase in number of graduate medical education residency positions 7#a7 ,in general ,the ,secretary of ,veterans ,affairs shall increase the number of graduate medical education residency positions at covered facilities by up to #a1ejj positions in the #aj-year period beginning on the date of the enactment of this ,act4 7#b7 ,covered facilities ,for purposes of this section1 a covered facility is any of the following3 7,a7 ,a facility of the ,department of ,veterans ,affairs4 7,b7 ,a facility operated by an ,indian tribe or a tribal organization1 as those terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd74 7,c7 ,a facility operated by the ,indian ,health ,service4 7,d7 ,a ,federally-qualified health center1 as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b774 7,e7 ,a community health center4 7,f7 ,a facility operated by the ,department of ,defense4 7,g7 ,such other health care facility as the ,secretary considers appropriate for purposes of this section4 7#c7 ,stipends and benefits ,the ,secretary may pay stipends and provide benefits for residents in positions under paragraph 7#a71 regardless of whether they have been assigned in a ,department facility4 7#d7 ,parameters for location1 affiliate sponsor1 and duration ,when determining characteristics of residency positions under paragraph 7#a71 the ,secretary shall consider the extent to which there is a clinical need for providers1 as determined by the following3 7,a7 ,the ratio of veterans to health care providers of the ,department for a standardized geographic area surrounding a facility1 including a separate ratio for general practitioners and specialists4 7,b7 ,whether the local community is medically underserved4 7,c7 ,whether the facility is located in a rural or remote area4 7,d7 ,such other criteria as the ,secretary considers important in determining which facilities are not adequately serving area veterans4 7#e7 ,parameters for types of specialties ,when determining the types of specialties to be included in residency positions under paragraph 7#a71 the ,secretary shall consider the following3 7,a7 ,the types of specialties that improve the quality and coverage of medical services provided to veterans4 7,b7 ,the range of clinical specialties covered by providers in standardized geographic areas surrounding facilities4 7,c7 ,whether the specialty is included in the most recent staffing shortage determination of the ,department under section #gdab of title #ch1 ,united ,states ,code4 7b7 ,application ,to participate ,to participate as a resident in one of the positions increased under subsection 7a77#a71 an individual shall submit to the ,secretary an application therefor together with an agreement described in subsection 7d7 under which the participant agrees to serve a period of obligated service in the ,veterans ,health ,administration as provided in the agreement in return for payment of stipend and benefit support as provided in the agreement4 7c7 ,selection 7#a7 ,in general ,an individual becomes a participant in a residency program under this section upon the ,secretary's approval of the individual's application under subsection 7b7 and the ,secretary's acceptance of the agreement under subsection 7d7 7if required74 7#b7 ,notice ,upon the ,secretary's approval of an individual's participation in the program under paragraph 7#a71 the ,secretary shall promptly notify the individual of that approval4 ,such notice shall be in writing4 7d7 ,agreement 7#a7 ,in general ,an agreement between the ,secretary and a resident in a position under subsection 7a77#a7 shall be in writing and shall be signed by the resident containing such terms as the ,secretary may specify4 7#b7 ,requirements ,the agreement must specify the terms of the service obligation resulting from participating as a resident under this section1 including by requiring a service obligation equal to the number of years of stipend and benefit support4 7e7 ,conditions of employment ,the ,secretary may prescribe the conditions of employment of individuals appointed to positions under subsection 7a77#a71 including necessary training1 and the customary amount and terms of pay for such positions during the period of such employment and training4 7f7 ,obligated service 7#a7 ,in general ,each individual appointed to a position under subsection 7a77#a7 shall provide service as a full-time employee of the ,department for the period of obligated service provided in the agreement of the participant entered into under subsection 7d74 ,such service shall be provided in the full-time clinical practice of such participant's profession or in another health care position in an assignment or location determined by the ,secretary4 7#b7 ,commencement date ,not later than #fj days before the date on which an individual commences serving in a position under subsection 7a77#a71 the ,secretary shall notify the individual of such date4 ,such date shall be the first day of the individual's period of obligated service4 7g7 ,breach of agreement3 liability 7#a7 ,penalty ,an individual appointed under this section to a position under subsection 7a77#a7 7other than an individual who is liable under paragraph 7#b77 who fails to accept payment1 or instructs the educational institution in which the individual is enrolled not to accept payment1 in whole or in part1 for a residency under the agreement entered into under subsection 7d7 of this title shall be liable to the ,united ,states for liquidated damages in the amount of #a1ejj4 ,such liability is in addition to any period of obligated service or other obligation or liability under the agreement4 7#b7 ,liability 7,a7 ,in general ,an individual appointed to a position under subsection 7a77#a7 shall be liable to the ,united ,states for the amount which has been paid to or on behalf of the individual under the agreement if any of the following occurs3 7i7 ,the individual is dismissed from the position for disciplinary reasons4 7ii7 ,the individual voluntarily terminates the residency before the completion of such course of training4 7iii7 ,the individual loses the individual's license1 registration1 or certification to practice the individual's health care profession in a ,state4 7,b7 ,liability supplants service obligation ,liability under this paragraph is in lieu of any service obligation arising under the individual's agreement under subsection 7d74 7h7 ,recovery 7#a7 ,in general ,if an individual breaches the individuals's agreement under subsection 7d7 by failing 7for any reason7 to complete such individual's period of obligated service1 the ,united ,states shall be entitled to recover from the individual an amount equal to the product of-- 7,a7 three2 7,b7 the sum of-- 7i7 the amounts paid under this section to or on behalf of the individual2 and 7ii7 the interest on such amounts that would be payable if at the time the amounts were paid they were loans bearing interest at the maximum legal prevailing rate1 as determined by the ,treasurer of the ,united ,states2 and 7,c7 the quotient of-- 7i7 the difference between-- 7,i7 the total number of months in the individual's period of obligated service2 and 7,,ii7 the number of months of such period served by the individual2 and 7ii7 the total number of months in the individual's period of obligated service4 7#b7 ,period of recovery ,any amount which the ,united ,states is entitled to recover under this subsection shall be paid to the ,united ,states not later than the date that is one year after the date of the breach of the agreement4 7i7 ,annual report 7#a7 ,in general ,not later than one year after the date of the enactment of this ,act and not less frequently than once each year thereafter1 the ,secretary shall submit to the appropriate committees of ,congress a report on the implementation of this section during the previous year4 7#b7 ,contents ,each report submitted under paragraph 7#a7 shall include1 for the period covered by the report1 the following3 7,a7 ,the number of positions described in subsection 7a7 that were filled4 7,b7 ,the location of each such position4 7,c7 ,the academic affiliate associated with each such position4 7,d7 ,a description of the challenges faced in filling the positions described in subsection 7a7 and the actions the ,secretary has taken to address such challenges4 7#c7 ,appropriate committees of ,congress defined ,in this subsection1 the term appropriate committees of ,congress means-- 7,a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7,b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 #bab4 ,pilot program to establish or affiliate with graduate medical residency programs at facilities operated by ,indian tribes1 tribal organizations1 and the ,indian ,health ,service in rural areas 7a7 ,pilot program required ,the ,secretary of ,veterans ,affairs1 in consultation with the ,director of the ,indian ,health ,service and such other persons as the ,secretary considers appropriate1 shall carry out a pilot program-- 7#a7 to establish graduate medical education residency training programs at covered facilities2 or 7#b7 to affiliate with established programs described in paragraph 7#a74 7b7 ,covered facilities ,for purposes of the pilot program1 a covered facility is any facility-- 7#a7 7,a7 described in subparagraph 7,b7 or 7,c7 of section #baa7;a77#b72 or 7,b7 with an agreement with the ,department described in section #aja7;d77#a72 and 7#b7 located in a rural or remote area4 7c7 ,locations 7#a7 ,in general ,the ,secretary shall carry out the pilot program at not more than five covered facilities that have been selected by the ,secretary for purposes of the pilot program4 7#b7 ,criteria ,the ,secretary shall establish criteria for selecting covered facilities under paragraph 7#a74 7d7 ,duration ,the ,secretary shall carry out the pilot program during the eight-year period beginning on the date that is #ahj days after the date of the enactment of this ,act4 7e7 ,reimbursement of costs ,the ,secretary shall reimburse each covered facility participating in the pilot program for the following costs associated with the pilot program3 7#a7 ,curriculum development4 7#b7 ,recruitment1 training1 supervision1 and retention of residents and faculty4 7#c7 ,accreditation of programs of education under the pilot program by the ,accreditation ,council for ,graduate ,medical ,education 7,,acgme7 or the ,american ,osteopathic ,association 7,,aoa74 7#d7 ,the portion of faculty salaries attributable to activities relating to carrying out the pilot program4 7#e7 ,payment for expenses relating to providing medical education under the pilot program4 7#f7 ,stipends and benefits4 7f7 ,period of obligated service 7#a7 ,in general ,the ,secretary shall enter into an agreement with each individual who participates in the pilot program under which such individual agrees to serve under the same terms as established under section #baa4 7#b7 ,loan repayment ,during the period of obligated service of an individual under paragraph 7#a71 the individual-- 7,a7 shall be deemed to be an eligible individual under subsection 7b7 of section #ajh of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afaf;a7 for purposes of participation in the ,indian ,health ,service ,loan ,repayment ,program under such section during the portion of such period that the individual serves at a covered facility2 and 7,b7 shall be deemed to be an eligible individual under section #gfhb7;a7 of title #ch1 ,united ,states ,code1 for purposes of participation in the ,department of ,veterans ,affairs ,education ,debt ,reduction ,program under subchapter ,,vii of chapter #gf of such title during the portion of such period that the individual serves at a facility of the ,department4 7#c7 ,concurrent service ,any period of obligated service required of an individual under paragraph 7#a7 shall be served-- 7,a7 with respect to service at a covered facility1 concurrently with any period of obligated service required of the individual by the ,indian ,health ,service2 and 7,b7 with respect to service at a facility of the ,department of ,veterans ,affairs1 concurrently with any period of obligated service required of the individual by the ,department4 7g7 ,treatment of participants ,a residency position into which a participant in the pilot program is placed as part of the pilot program shall be considered a position referred to in section #baa7;a77#a7 for purposes of the limitation on number of new positions authorized under such section4 7h7 ,report ,not later than three years before the date on which the pilot program terminates1 the ,secretary of ,veterans ,affairs shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on the feasibility and advisability of-- 7#a7 expanding the pilot program to additional locations2 and 7#b7 making the pilot program or any aspect of the pilot program permanent4 #bac4 ,reimbursement of continuing professional education requirements for board certified advanced practice registered nurses 7a7 ,in general ,section #gdaa is amended to read as follows3 #gdaa4 ,reimbursement of continuing professional education expenses ,the ,secretary shall reimburse any full-time board-certified advanced practice registered nurse1 physician1 or dentist appointed under section #gdja7a7 of this title for expenses incurred1 up to #a1jjj per year1 for continuing professional education4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #gd is amended by striking the item relating to section #gdaa and inserting the following new item3 #gdaa4 ,reimbursement of continuing professional education expenses4 4 #bad4 ,increase in maximum amount of debt that may be reduced under ,education ,debt ,reduction ,program of ,department of ,veterans ,affairs 7a7 ,increase in amount ,section #gfhc7;d77#a7 is amended-- 7#a7 by striking #abj1jjj and inserting #bdj1jjj2 and 7#b7 by striking #bd1jjj and inserting #dh1jjj4 7b7 ,study 7#a7 ,in general ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall-- 7,a7 conduct a study on the demand for education debt reduction under subchapter ,,vii of chapter #gf of title #ch1 ,united ,states ,code2 and 7,b7 submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on the findings of the ,secretary with respect to the study carried out under subparagraph 7,a74 7#b7 ,considerations ,in carrying out the study required by paragraph 7#a77;,a71 the ,secretary shall consider the following3 7,a7 ,the total number of vacancies within the ,veterans ,health ,administration whose applicants are eligible to participate in the ,education ,debt ,reduction ,program pursuant to section #gfhb7;a7 of such title4 7,b7 ,the types of medical professionals in greatest demand in the ,united ,states4 7,c7 ,projections by the ,secretary of the numbers and types of medical professions that meet the needs of veterans4 #bae4 ,demonstration program on training and employment of alternative dental health care providers for dental health care services for veterans in rural and other underserved communities 7a7 ,demonstration program authorized ,the ,secretary of ,veterans ,affairs may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to increase access to dental health care services for veterans who are entitled to such services from the ,department of ,veterans ,affairs and reside in rural and other underserved communities4 7b7 ,priority ,the ,secretary shall prioritize the establishment of programs under the demonstration program under this section in ,states that do not have a facility of the ,department that offers on-site dental services4 7c7 ,telehealth ,for purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care1 dental services provided under the demonstration program under this section may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible4 7d7 ,authorization of appropriations ,there are authorized to be appropriated to the ,secretary such sums as are necessary to carry out the demonstration program under this section4 7e7 ,alternative dental health care providers defined ,in this section1 the term alternative dental health care providers has the meaning given that term in section #cdj;,g-#a7;a77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;g-#a7;a77#b774 ,,iii ,other personnel matters #bba4 ,exception on limitation on awards and bonuses for recruitment1 relocation1 and retention ,section #gje7;a7 of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #gjc note7 is amended1 in the matter preceding paragraph 7#a71 by inserting other than recruitment1 relocation1 or retention incentives1 after title #ch1 ,united ,states ,code14 #bbb4 ,annual report on performance awards and bonuses awarded to certain high-level employees of the ,department 7a7 ,in general ,chapter #g is amended by adding at the end the following new section3 #gbf4 ,annual report on performance awards and bonuses awarded to certain high-level employees 7a7 ,in general ,not later than #cj days after the end of each fiscal year1 the ,secretary shall submit to the appropriate committees of ,congress a report that contains1 for the most recent fiscal year ending before the submittal of the report1 a description of the performance awards and bonuses awarded to ,regional ,office ,directors of the ,department1 ,directors of ,medical ,centers of the ,department1 and ,directors of ,veterans ,integrated ,service ,networks4 7b7 ,elements ,each report submitted under subsection 7a7 shall include the following with respect to each performance award or bonus awarded to an individual described in such subsection3 7#a7 ,the amount of each award or bonus4 7#b7 ,the job title of the individual awarded the award or bonus4 7#c7 ,the location where the individual awarded the award or bonus works4 7c7 ,appropriate committees of ,congress ,in this section1 the term appropriate committees of ,congress means-- 7#a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7#b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #g is amended by inserting after the item relating to section #gbe the following new item3 #gbf4 ,annual report on performance awards and bonuses awarded to certain high-level employees4 4 #bbc4 ,authority to regulate additional pay for certain health care employees of the ,department ,section #gded is amended by adding at the end the following new subsection3 7d7 ,in this section1 the term compensation includes all compensation earned by employees when performing duties authorized by the ,secretary or when the employee is approved to use annual1 sick1 family medical1 military1 or court leave or during any other paid absence for which pay is not already regulated4 4 #bbd4 ,modification of pay cap for nurses ,paragraph 7#b7 of section #gdea7;c7 is amended to read as follows3 7#b7 7,a7 ,the maximum rate of basic pay for any grade for health-care personnel positions referred to in paragraphs 7#a7 and 7#c7 of section #gdja of this title 7other than the positions of physician1 dentist1 and registered nurse7 may not exceed the rate of basic pay established for positions in level ,,iv of the ,executive ,schedule under section #ecae of title #e4 7,b7 ,pursuant to an adjustment under subsection 7d71 the maximum rate of basic pay for a registered nurse serving as a nurse executive or a grade for the position of certified registered nurse anesthetist may exceed the rate of basic pay established for positions in level ,,iv of the ,executive ,schedule under section #ecae of title #e but may not exceed the rate of basic pay established for positions in level ,i of the ,executive ,schedule under section #ecab of title #e4 7,c7 ,pursuant to an adjustment under subsection 7d71 the maximum rate of basic pay for all registered nurses not described in subparagraph 7,b7 may exceed the rate of basic pay established for positions in level ,,iv of the ,executive ,schedule under section #ecae of title #e but may not exceed the rate of basic pay established for positions in level ,,iii of the ,executive ,schedule under section #ecad of title #e4 4 ,b ,improvement of underserved facilities of the ,department #bca4 ,development of criteria for designation of certain medical facilities of the ,department of ,veterans ,affairs as underserved facilities and plan to address problem of underserved facilities 7a7 ,in general ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall develop criteria to designate medical centers1 ambulatory care facilities1 and community based outpatient clinics of the ,department of ,veterans ,affairs as underserved facilities4 7b7 ,consideration ,criteria developed under subsection 7a7 shall include consideration of the following with respect to a facility3 7#a7 ,the ratio of veterans to health care providers of the ,department of ,veterans ,affairs for a standardized geographic area surrounding the facility1 including a separate ratio for general practitioners and specialists4 7#b7 ,the range of clinical specialties covered by such providers in such area4 7#c7 ,whether the local community is medically underserved4 7#d7 ,the type1 number1 and age of open consults4 7#e7 ,whether the facility is meeting the wait-time goals of the ,department4 7#f7 ,such other criteria as the ,secretary considers important in determining which facilities are not adequately serving area veterans4 7c7 ,analysis of facilities ,not less frequently than annually1 directors of ,veterans ,integrated ,service ,networks of the ,department shall perform an analysis to determine which facilities within that ,veterans ,integrated ,service ,network qualify as underserved facilities pursuant to criteria developed under subsection 7a74 7d7 ,annual plan ,to address underserved facilities 7#a7 ,plan required ,not later than one year after the date of the enactment of this ,act and not less frequently than once each year1 the ,secretary shall submit to ,congress a plan to address the problem of underserved facilities of the ,department1 as designated pursuant to criteria developed under subsection 7a74 7#b7 ,contents ,each plan submitted under paragraph 7#a7 shall address the following3 7,a7 ,increasing personnel or temporary personnel assistance1 including mobile deployment teams furnished under section #bcc4 7,b7 ,providing special hiring incentives1 including under the ,education ,debt ,reduction ,program under subchapter ,,vii of chapter #gf of title #ch1 ,united ,states ,code1 and recruitment1 relocation1 and retention incentives4 7,c7 ,using direct hiring authority4 7,d7 ,improving training opportunities for staff4 7,e7 ,such other actions as the ,secretary considers appropriate4 #bcb4 ,pilot program on tuition reimbursement and loan repayment for health care providers of the ,department of ,veterans ,affairs at underserved facilities 7a7 ,in general ,not later than #ij days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall commence a pilot program to assess the feasibility and advisability of providing incentives to individuals to work at underserved facilities of the ,veterans ,health ,administration by providing tuition reimbursement and loan repayment to medical students and health care providers who commit to serving in underserved facilities selected under subsection 7c74 7b7 ,duration ,the ,secretary shall carry out the pilot program during the six-year period beginning on the date of the commencement of the pilot program4 7c7 ,selection of locations 7#a7 ,in general ,the ,secretary shall select not fewer than three medical centers and seven ambulatory care facilities or community based outpatient clinics of the ,department to participate in the pilot program4 7#b7 ,rural and highly rural areas ,not fewer than two of the medical centers and five of the ambulatory care facilities or community based outpatient clinics selected under paragraph 7#a7 shall be in ,states or ,united ,states territories that are among the ten ,states or ,united ,states territories with-- 7,a7 the highest percentage of land designated as highly rural pursuant to the rural-urban commuting area codes set forth by the ,department of ,agriculture2 or 7,b7 the highest percentage of enrolled veterans living in rural1 highly rural1 or insular island areas4 7#c7 ,states ,facilities selected under paragraph 7#a7 shall be located in not fewer than eight different ,states4 7d7 ,use of amounts ,of the amounts used to provide tuition reimbursement or loan repayment under the pilot program-- 7#a7 one-half shall be used to provide tuition reimbursement or loan repayment for individuals practicing in a general practice position2 and 7#b7 one-half shall be used to provide tuition reimbursement or loan repayment for individuals practicing-- 7,a7 in a specialist position2 or 7,b7 in an occupation1 other than a position described in paragraph 7#a71 included in the most recent staffing shortage determination of the ,department under section #gdab of title #ch1 ,united ,states ,code4 7e7 ,tuition reimbursement ,under the pilot program1 the ,secretary may provide to an individual attending medical school and seeking a degree as a ,doctor of ,medicine or a ,doctor of ,osteopathic ,medicine full tuition reimbursement in exchange for a five-year commitment to serve at an underserved facility selected under subsection 7c74 7f7 ,student loan repayment ,under the pilot program1 in exchange for a three-year commitment to serve at an underserved facility selected under subsection 7c71 the ,secretary may provide-- 7#a7 to an individual currently serving as a health care provider at an underserved facility1 an amount not to exceed #cj1jjj to apply to any remaining student loan debt of the individual2 and 7#b7 to an individual other than an individual described in paragraph 7#a71 an amount not to exceed #ej1jjj to apply to any remaining student loan debt of the individual4 7g7 ,breach ,an individual who participates in the pilot program and fails to satisfy a period of obligated service under subsection 7d7 or 7e7 shall be liable to the ,united ,states1 in lieu of such obligated service1 for the amount that has been paid or is payable to or on behalf of the individual under the pilot program1 reduced by the proportion that the number of days served for completion of the period of obligated service bears to the total number of days in the period of obligated service of such individual4 7h7 ,expedited hiring ,the ,secretary shall ensure that the hiring of individuals to serve in the ,department under the pilot program is conducted in an expedited manner4 7i7 ,continuation in pilot program ,an individual participating in the pilot program in an occupation included in a staffing shortage determination of the ,department under section #gdab of title #ch1 ,united ,states ,code1 may continue participating in the pilot program notwithstanding that the occupation is no longer included in such determination under such section4 7j7 ,annual report 7#a7 ,in general ,not later than one year after the date of the enactment of this ,act and not less frequently than once each year thereafter1 the ,secretary shall submit to ,congress a report on the pilot program4 7#b7 ,contents ,each report submitted under paragraph 7#a7 shall include the following3 7,a7 ,the number of participants1 including number receiving tuition reimbursement and student loan repayment4 7,b7 ,the number of facilities where participants are located4 7,c7 ,the number of individuals who have applied to participate in the pilot program4 7,d7 ,a list of the five most common occupations of the participants in the pilot program1 other than general practice4 7k7 ,definitions ,in this section3 7#a7 ,enrolled veteran ,the term enrolled veteran means a veteran who is enrolled in the system of annual patient enrollment established and operated under section #agje7;a7 of title #ch1 ,united ,states ,code4 7#b7 ,underserved facility ,the term underserved facility means a medical center1 ambulatory care facility1 or community based outpatient clinic of the ,department of ,veterans ,affairs designated by the ,secretary of ,veterans ,affairs pursuant to criteria developed under section #bca4 #bcc4 ,program to furnish mobile deployment teams to underserved facilities 7a7 ,in general ,the ,secretary of ,veterans ,affairs shall establish a program to furnish mobile deployment teams of medical personnel to underserved facilities4 7b7 ,elements ,in furnishing mobile deployment teams under subsection 7a71 the ,secretary shall consider the following elements3 7#a7 ,the medical positions of greatest need at underserved facilities4 7#b7 ,the size and composition of teams to be deployed4 7#c7 ,such other elements as the ,secretary considers necessary for effective oversight of the program established under subsection 7a74 7c7 ,use of annual analysis ,the ,secretary shall use the results of the annual analysis conducted under section #bca7;c7 to form mobile deployment teams under subsection 7a7 that are composed of the most needed medical personnel for underserved facilities4 7d7 ,underserved facility defined ,in this section1 the term underserved facility means a medical center1 ambulatory care facility1 or community based outpatient clinic of the ,department of ,veterans ,affairs designated by the ,secretary of ,veterans ,affairs pursuant to criteria developed under section #bca4 #bcd4 ,inclusion of ,vet ,center employees in education debt reduction program of ,department of ,veterans ,affairs 7a7 ,in general ,the ,secretary of ,veterans ,affairs shall ensure that clinical staff working at ,vet ,centers are eligible to participate in the education debt reduction program of the ,department of ,veterans ,affairs under subchapter ,,vii of chapter #gf of title #ch1 ,united ,states ,code4 7b7 ,report ,not later than one year after the date of the enactment of this ,act1 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on the number of participants in the education debt reduction program of the ,department under such subchapter who work at ,vet ,centers4 7c7 ,vet ,center defined ,in this section1 the term ,vet ,center has the meaning given that term in section #agab;,a7h7 of title #ch1 ,united ,states ,code4 ,c ,construction and leases #bda4 ,definition of major medical facility project and major medical facility lease 7a7 ,modification of definition of medical facility ,section #haja7c7 is amended by striking ,secretary and all that follows through nursing home1 and inserting ,secretary1 or as otherwise authorized by law1 for the provision of health-care services 7including hospital1 outpatient clinic1 nursing home14 7b7 ,modification of definitions of major medical facility project and major medical facility lease ,paragraph 7#c7 of section #hajd7;a7 is amended to read as follows3 7#c7 ,for purposes of this subsection3 7,a7 ,the term major medical facility project means a project for the construction1 alteration1 or acquisition of a medical facility involving a total expenditure of more than #bj1jjj1jjj1 but such term does not include an acquisition by exchange1 non-recurring maintenance projects of the ,department1 or the construction1 alteration1 or acquisition of a shared ,federal medical facility for which the ,department's estimated share of the project costs does not exceed #bj1jjj1jjj4 7,b7 ,the term major medical facility lease means a lease for space for use as a new medical facility at an average annual rental equal to or greater than the dollar threshold for leases procured through the ,general ,services ,administration under section #ccjg7;a77#b7 of title #dj1 which shall be subject to annual adjustment in accordance with section #ccjg7;h7 of such title4 4 #bdb4 ,facilitating sharing of medical facilities with other ,federal agencies 7a7 ,in general ,subchapter ,i of chapter #ha is amended by inserting after section #haaa;,a the following new section3 #haaa;,b4 ,authority to plan1 design1 construct1 or lease a shared medical facility 7a7 ,in general 7#a7 ,the ,secretary may enter into agreements with other ,federal agencies for the planning1 designing1 constructing1 or leasing of shared medical facilities with the goal of improving access to1 and quality and cost effectiveness of1 health care provided by the ,department and other ,federal agencies4 7#b7 ,facilities planned1 designed1 constructed1 or leased under paragraph 7#a7 shall be managed by the ,under ,secretary for ,health4 7b7 ,transfer of amounts to other ,federal agencies 7#a7 ,the ,secretary may transfer to another ,federal agency amounts appropriated to the ,department for ,construction1 ,minor ,projects for use for the planning1 design1 or construction of a shared medical facility if the estimated share of the project costs to be borne by the ,department does not exceed the threshold for a major medical facility project under section #hajd7;a77#c77;,a7 of this title4 7#b7 ,the ,secretary may transfer to another ,federal agency amounts appropriated to the ,department for ,construction1 ,major ,projects for use for the planning1 design1 or construction of a shared medical facility if-- 7,a7 the estimated share of the project costs to be borne by the ,department is more than the threshold for a major medical facility project under subsection 7a77#c77;,a7 of section #hajd of this title2 and 7,b7 the requirements for such a project under such section have been met4 7#c7 ,the ,secretary may transfer to another ,federal agency amounts appropriated to the applicable appropriations account of the ,department for the purpose of leasing space for a shared medical facility if the estimated share of the lease costs to be borne by the ,department does not exceed the threshold for a major medical facility lease under section #hajd7;a77#c77;,b7 of this title4 7c7 ,transfer of amounts to ,department 7#a7 ,amounts transferred to the ,department by another ,federal agency for the necessary expenses of planning1 designing1 or constructing a shared medical facility for which the estimated share of the project costs to be borne by the ,department does not exceed the threshold for a major medical facility project under section #hajd7;a77#c77;,a7 of this title may be deposited in the ,construction1 ,minor ,projects account of the ,department and used for such necessary expenses4 7#b7 ,amounts transferred to the ,department by another ,federal agency for the necessary expenses of planning1 designing1 or constructing a shared medical facility for which the estimated share of the project costs to be borne by the ,department is more than the threshold for a major medical facility project under section #hajd7;a77#c77;,a7 of this title may be deposited in the ,construction1 ,major ,projects account of the ,department and used for such necessary expenses if the requirements for such project under section #hajd of this title have been met4 7#c7 ,amounts transferred to the ,department by another ,federal agency for the purpose of leasing space for a shared medical facility may be credited to the applicable appropriations account of the ,department and shall be available without fiscal year limitation4 7#d7 ,amounts transferred under paragraphs 7#a7 and 7#b7 shall be available for the same time period as amounts in the account to which those amounts are transferred4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item relating to section #haaa;,a the following new item3 #haaa;,b4 ,authority to plan1 design1 construct1 or lease a shared medical facility44 #bdc4 ,review of enhanced use leases ,section #hafb7;b77#f7 is amended to read as follows3 7#f7 ,the ,office of ,management and ,budget shall review each enhanced-use lease before the lease goes into effect to determine whether the lease is in compliance with paragraph 7#e74 4 #bdd4 ,authorization of certain major medical facility projects of the ,department of ,veterans ,affairs 7a7 ,authorization ,the ,secretary of ,veterans ,affairs may carry out the following major medical facility project1 to be carried out in an amount not to exceed the amount specified for that project3 ,construction of the new ,east ,bay ,community ,based ,outpatient ,clinic and all associated site work1 utilities1 parking1 and landscaping1 construction of the ,central ,valley ,engineering and ,logistics support facility1 and enhanced flood plain mitigation at the ,central ,valley and ,east ,bay ,community ,based ,outpatient ,clinics as part of the realignment of medical facilities in ,livermore1 ,california1 in an amount not to exceed #aag1cjj1jjj4 7b7 ,authorization of appropriations for construction ,there is authorized to be appropriated to the ,secretary of ,veterans ,affairs for fiscal year #bjah or the year in which funds are appropriated for the ,construction1 ,major ,projects account1 #aag1cjj1jjj for the project authorized in subsection 7a74 7c7 ,submittal of information ,not later than #ij days after the date of the enactment of this ,act1 for the project authorized in section 7a71 the ,secretary of ,veterans ,affairs shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives the following information3 7#a7 ,a line item accounting of expenditures relating to construction management carried out by the ,department of ,veterans ,affairs for such project4 7#b7 ,the future amounts that are budgeted to be obligated for construction management carried out by the ,department for such project4 7#c7 ,a justification for the expenditures described in paragraph 7#a7 and the future amounts described in paragraph 7#b74 7#d7 ,any agreement entered into by the ,secretary regarding a non-,department of ,veterans ,affairs ,federal entity providing management services relating to such project1 including reimbursement agreements and the costs to the ,department for such services4 ,d ,other health care matters #bea4 ,program on use of wellness programs as complementary approach to mental health care for veterans and family members of veterans 7a7 ,program required 7#a7 ,in general ,the ,secretary of ,veterans ,affairs shall carry out a program through the award of grants to public or private nonprofit entities to assess the feasibility and advisability of using wellness programs to complement the provision of mental health care to veterans and family members eligible for counseling under section #agab;,a7a77#a77;,c7 of title #ch1 ,united ,states ,code4 7#b7 ,matters to be addressed ,the program shall be carried out so as to assess the following3 7,a7 ,means of improving coordination between ,federal1 ,state1 local1 and community providers of health care in the provision of mental health care to veterans and family members described in paragraph 7#a74 7,b7 ,means of enhancing outreach1 and coordination of outreach1 by and among providers of health care referred to in subparagraph 7,a7 on the mental health care services available to veterans and family members described in paragraph 7#a74 7,c7 ,means of using wellness programs of providers of health care referred to in subparagraph 7,a7 as complements to the provision by the ,department of ,veterans ,affairs of mental health care to veterans and family members described in paragraph 7#a74 7,d7 ,whether wellness programs described in subparagraph 7,c7 are effective in enhancing the quality of life and well-being of veterans and family members described in paragraph 7#a74 7,e7 ,whether wellness programs described in subparagraph 7,c7 are effective in increasing the adherence of veterans described in paragraph 7#a7 to the primary mental health services provided such veterans by the ,department4 7,f7 ,whether wellness programs described in subparagraph 7,c7 have an impact on the sense of wellbeing of veterans described in paragraph 7#a7 who receive primary mental health services from the ,department4 7,g7 ,whether wellness programs described in subparagraph 7,c7 are effective in encouraging veterans receiving health care from the ,department to adopt a more healthy lifestyle4 7b7 ,duration ,the ,secretary shall carry out the program for a period of three years beginning on the date that is one year after the date of the enactment of this ,act4 7c7 ,locations ,the ,secretary shall carry out the program at facilities of the ,department providing mental health care services to veterans and family members described in subsection 7a77#a74 7d7 ,grant proposals 7#a7 ,in general ,a public or private nonprofit entity seeking the award of a grant under this section shall submit an application therefor to the ,secretary in such form and in such manner as the ,secretary may require4 7#b7 ,application contents ,each application submitted under paragraph 7#a7 shall include the following3 7,a7 ,a plan to coordinate activities under the program1 to the extent possible1 with ,federal1 ,state1 and local providers of services for veterans to enhance the following3 7i7 ,awareness by veterans of benefits and health care services provided by the ,department4 7ii7 ,outreach efforts to increase the use by veterans of services provided by the ,department4 7iii7 ,educational efforts to inform veterans of the benefits of a healthy and active lifestyle4 7,b7 ,a statement of understanding from the entity submitting the application that1 if selected1 such entity will be required to report to the ,secretary periodically on standardized data and other performance data necessary to evaluate individual outcomes and to facilitate evaluations among entities participating in the program4 7,c7 ,other requirements that the ,secretary may prescribe4 7e7 ,grant uses 7#a7 ,in general ,a public or private nonprofit entity awarded a grant under this section shall use the award for purposes prescribed by the ,secretary4 7#b7 ,eligible veterans and family ,in carrying out the purposes prescribed by the ,secretary in paragraph 7#a71 a public or private nonprofit entity awarded a grant under this section shall use the award to furnish services only to individuals specified in section #agab;,a7a77#a77;,c7 of title #ch1 ,united ,states ,code4 7f7 ,reports 7#a7 ,periodic reports 7,a7 ,in general ,not later than #ahj days after the date of the commencement of the program1 and every #ahj days thereafter1 the ,secretary shall submit to ,congress a report on the program4 7,b7 ,report elements ,each report required by subparagraph 7,a7 shall include the following3 7i7 ,the findings and conclusions of the ,secretary with respect to the program during the #ahj-;day period preceding the report4 7ii7 ,an assessment of the benefits of the program to veterans and their family members during the #ahj-;day period preceding the report4 7#b7 ,final report ,not later than #ahj days after the end of the program1 the ,secretary shall submit to ,congress a report detailing the recommendations of the ,secretary as to the advisability of continuing or expanding the program4 7g7 ,wellness defined ,in this section1 the term wellness has the meaning given that term in regulations prescribed by the ,secretary4 #beb4 ,authorization to provide for operations on live donors for purposes of conducting transplant procedures for veterans 7a7 ,in general ,subchapter ,,viii of chapter #ag is amended by adding at the end the following new section3 #aghh4 ,transplant procedures with live donors and related services 7a7 ,in general ,subject to subsections 7b7 and 7c71 in a case in which a veteran is eligible for a transplant procedure from the ,department1 the ,secretary may provide for an operation on a live donor to carry out such procedure for such veteran1 notwithstanding that the live donor may not be eligible for health care from the ,department4 7b7 ,other services ,subject to the availability of appropriations for such purpose1 the ,secretary shall furnish to a live donor any care or services before and after conducting the transplant procedure under subsection 7a7 that may be required in connection with such procedure4 7c7 ,use of non-,department facilities ,in carrying out this section1 the ,secretary may provide for the operation described in subsection 7a7 on a live donor and furnish to the live donor the care and services described in subsection 7b7 at a non-,department facility pursuant to an agreement entered into by the ,secretary under this chapter4 ,the live donor shall be deemed to be an individual eligible for hospital care and medical services at a non-,department facility pursuant to such an agreement solely for the purposes of receiving such operation1 care1 and services at the non-,department facility4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag is amended by inserting after the item relating to section #aghg the following new item3 #aghh4 ,transplant procedures with live donors and related services4 4 #bec4 ,sense of the ,senate ,it is the sense of the ,senate that-- 7#a7 a strong and fully resourced ,veterans ,health ,administration is necessary to effectively serve our veterans community2 7#b7 veterans overwhelmingly report that they are satisfied with the care they receive at facilities operated by the ,administration2 7#c7 research has shown that the ,administration produces as good or better outcomes for its patients than private health care systems2 and 7#d7 the ,senate opposes any effort that would weaken the ,administration or put the ,administration on a path toward privatization4 ,,iii ,family caregivers #cja4 ,expansion of family caregiver program of ,department of ,veterans ,affairs 7a7 ,family caregiver program 7#a7 ,expansion of eligibility 7,a7 ,in general ,subparagraph 7,b7 of subsection 7a77#b7 of section #agbj;,g is amended to read as follows3 7,b7 for assistance provided under this subsection-- 7i7 before the date on which the ,secretary submits to ,congress a certification that the ,department has fully implemented the information technology system required by section #cjb7;a7 of the ,caring for our ,veterans ,act of #bjag1 has a serious injury 7including traumatic brain injury1 psychological trauma1 or other mental disorder7 incurred or aggravated in the line of duty in the active military1 naval1 or air service on or after ,september #aa1 #bjja2 7ii7 during the two-year period beginning on the date on which the ,secretary submitted to ,congress the certification described in clause 7i71 has a serious injury 7including traumatic brain injury1 psychological trauma1 or other mental disorder7 incurred or aggravated in the line of duty in the active military1 naval1 or air service-- 7,i7 on or before ,may #g1 #aige2 or 7,,ii7 on or after ,september #aa1 #bjja2 or 7iii7 after the date that is two years after the date on which the ,secretary submits to ,congress the certification described in clause 7i71 has a serious injury 7including traumatic brain injury1 psychological trauma1 or other mental disorder7 incurred or aggravated in the line of duty in the active military1 naval1 or air service2 and 4 7,b7 ,publication in ,federal ,register ,not later than #cj days after the date on which the ,secretary of ,veterans ,affairs submits to ,congress the certification described in subsection 7a77#b77;,b77i7 of section #agbj;,g of such title1 as amended by subparagraph 7,a7 of this paragraph1 the ,secretary shall publish the date specified in such subsection in the ,federal ,register4 7#b7 ,expansion of needed services in eligibility criteria ,subsection 7a77#b77;,c7 of such section is amended-- 7,a7 in clause 7ii71 by striking 2 or and inserting a semicolon2 7,b7 by redesignating clause 7iii7 as clause 7iv72 and 7,c7 by inserting after clause 7ii7 the following new clause 7iii73 7iii7 a need for regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired2 or 4 7#c7 ,expansion of services provided ,subsection 7a77#c77;,a77ii7 of such section is amended-- 7,a7 in subclause 7,,iv71 by striking 2 and and inserting a semicolon2 7,b7 in subclause 7,v71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following new subclause3 7,,vi7 through the use of contracts with1 or the provision of grants to1 public or private entities-- 7aa7 financial planning services relating to the needs of injured veterans and their caregivers2 and 7bb7 legal services1 including legal advice and consultation1 relating to the needs of injured veterans and their caregivers4 4 7#d7 ,modification of stipend calculation ,subsection 7a77#c77;,c7 of such section is amended-- 7,a7 by redesignating clause 7iii7 as clause 7iv72 and 7,b7 by inserting after clause 7ii7 the following new clause 7iii73 7iii7 ,in determining the amount and degree of personal care services provided under clause 7i7 with respect to an eligible veteran whose need for personal care services is based in whole or in part on a need for supervision or protection under paragraph 7#b77;,c77ii7 or regular instruction or supervision under paragraph 7#b77;,c77iii71 the ,secretary shall take into account the following3 7,i7 ,the assessment by the family caregiver of the needs and limitations of the veteran4 7,,ii7 ,the extent to which the veteran can function safely and independently in the absence of such supervision1 protection1 or instruction4 7,,iii7 ,the amount of time required for the family caregiver to provide such supervision1 protection1 or instruction to the veteran4 4 7#e7 ,periodic evaluation of need for certain services ,subsection 7a77#c7 of such section is amended by adding at the end the following new subparagraph3 7,d7 ,in providing instruction1 preparation1 and training under subparagraph 7,a77i77,i7 and technical support under subparagraph 7,a77i77,,ii7 to each family caregiver who is approved as a provider of personal care services for an eligible veteran under paragraph 7#f71 the ,secretary shall periodically evaluate the needs of the eligible veteran and the skills of the family caregiver of such veteran to determine if additional instruction1 preparation1 training1 or technical support under those subparagraphs is necessary4 4 7#f7 ,use of primary care teams ,subsection 7a77#e7 of such section is amended1 in the matter preceding subparagraph 7,a71 by inserting 7in collaboration with the primary care team for the eligible veteran to the maximum extent practicable7 after evaluate4 7#g7 ,assistance for family caregivers ,subsection 7a7 of such section is amended by adding at the end the following new paragraph3 7#aa7 7,a7 ,in providing assistance under this subsection to family caregivers of eligible veterans1 the ,secretary may enter into contracts1 provider agreements1 and memoranda of understanding with ,federal agencies1 ,states1 and private1 nonprofit1 and other entities to provide such assistance to such family caregivers4 7,b7 ,the ,secretary may provide assistance under this paragraph only if such assistance is reasonably accessible to the family caregiver and is substantially equivalent or better in quality to similar services provided by the ,department4 7,c7 ,the ,secretary may provide fair compensation to ,federal agencies1 ,states1 and other entities that provide assistance under this paragraph4 4 7b7 ,modification of definition of personal care services ,subsection 7d77#d7 of such section is amended-- 7#a7 in subparagraph 7,a71 by striking independent2 7#b7 by redesignating subparagraph 7,b7 as subparagraph 7,d72 and 7#c7 by inserting after subparagraph 7,a7 the following new subparagraphs3 7,b7 ,supervision or protection based on symptoms or residuals of neurological or other impairment or injury4 7,c7 ,regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired4 4 #cjb4 ,implementation of information technology system of ,department of ,veterans ,affairs to assess and improve the family caregiver program 7a7 ,implementation of new system 7#a7 ,in general ,not later than ,june #a1 #bjah1 the ,secretary of ,veterans ,affairs shall implement an information technology system that fully supports the ,program and allows for data assessment and comprehensive monitoring of the ,program4 7#b7 ,elements of system ,the information technology system required to be implemented under paragraph 7#a7 shall include the following3 7,a7 ,the ability to easily retrieve data that will allow all aspects of the ,program 7at the medical center and aggregate levels7 and the workload trends for the ,program to be assessed and comprehensively monitored4 7,b7 ,the ability to manage data with respect to a number of caregivers that is more than the number of caregivers that the ,secretary expects to apply for the ,program4 7,c7 ,the ability to integrate the system with other relevant information technology systems of the ,veterans ,health ,administration4 7b7 ,assessment of ,program ,not later than #ahj days after implementing the system described in subsection 7a71 the ,secretary shall1 through the ,under ,secretary for ,health1 use data from the system and other relevant data to conduct an assessment of how key aspects of the ,program are structured and carried out4 7c7 ,ongoing monitoring of and modifications to ,program 7#a7 ,monitoring ,the ,secretary shall use the system implemented under subsection 7a7 to monitor and assess the workload of the ,program1 including monitoring and assessment of data on-- 7,a7 the status of applications1 appeals1 and home visits in connection with the ,program2 and 7,b7 the use by caregivers participating in the ,program of other support services under the ,program such as respite care4 7#b7 ,modifications ,based on the monitoring and assessment conducted under paragraph 7#a71 the ,secretary shall identify and implement such modifications to the ,program as the ,secretary considers necessary to ensure the ,program is functioning as intended and providing veterans and caregivers participating in the ,program with services in a timely manner4 7d7 ,reports 7#a7 ,initial report 7,a7 ,in general ,not later than #ij days after the date of the enactment of this ,act1 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate1 the ,committee on ,veterans' ,affairs of the ,house of ,representatives1 and the ,comptroller ,general of the ,united ,states a report that includes-- 7i7 the status of the planning1 development1 and deployment of the system required to be implemented under subsection 7a71 including any changes in the timeline for the implementation of the system2 and 7ii7 an assessment of the needs of family caregivers of veterans described in subparagraph 7,b71 the resources needed for the inclusion of such family caregivers in the ,program1 and such changes to the ,program as the ,secretary considers necessary to ensure the successful expansion of the ,program to include such family caregivers4 7,b7 ,veterans described ,veterans described in this subparagraph are veterans who are eligible for the ,program under clause 7ii7 or 7iii7 of section #agbj;,g7a77#b77;,b7 of title #ch1 ,united ,states ,code1 as amended by section #cja7;a77#a7 of this ,act1 solely due to a serious injury 7including traumatic brain injury1 psychological trauma1 or other mental disorder7 incurred or aggravated in the line of duty in the active military1 naval1 or air service before ,september #aa1 #bjja4 7#b7 ,notification by ,comptroller ,general ,the ,comptroller ,general shall review the report submitted under paragraph 7#a7 and notify the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives with respect to the progress of the ,secretary in-- 7,a7 fully implementing the system required under subsection 7a72 and 7,b7 implementing a process for using such system to monitor and assess the ,program under subsection 7c77#a7 and modify the ,program as considered necessary under subsection 7c77#b74 7#c7 ,final report 7,a7 ,in general ,not later than ,june #a1 #bjai1 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate1 the ,committee on ,veterans' ,affairs of the ,house of ,representatives1 and the ,comptroller ,general a report on the implementation of subsections 7a7 through 7c74 7,b7 ,elements ,the report required by subparagraph 7,a7 shall include the following3 7i7 ,a certification by the ,secretary with respect to whether the information technology system described in subsection 7a7 has been implemented4 7ii7 ,a description of how the ,secretary has implemented such system4 7iii7 ,a description of the modifications to the ,program1 if any1 that were identified and implemented under subsection 7c77#b74 7iv7 ,a description of how the ,secretary is using such system to monitor the workload of the ,program4 7e7 ,definitions ,in this section3 7#a7 ,active military1 naval1 or air service ,the term active military1 naval1 or air service has the meaning given that term in section #aja of title #ch1 ,united ,states ,code4 7#b7 ,program ,the term ,program means the program of comprehensive assistance for family caregivers under section #agbj;,g7a7 of title #ch1 ,united ,states ,code1 as amended by section #cja of this ,act4 #cjc4 ,modifications to annual evaluation report on caregiver program of ,department of ,veterans ,affairs 7a7 ,barriers to care and services ,subparagraph 7,a77iv7 of section #aja7;c77#b7 of the ,caregivers and ,veterans ,omnibus ,health ,services ,act of #bjaj 7,public ,law #aaa-afc2 #ch ,u4,s4,c4 #agbj;,g note7 is amended by inserting 1 including a description of any barriers to accessing and receiving care and services under such programs before the semicolon4 7b7 ,sufficiency of training for family caregiver program ,subparagraph 7,b7 of such section is amended-- 7#a7 in clause 7i71 by striking 2 and and inserting a semicolon2 7#b7 in clause 7ii71 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following new clause3 7iii7 an evaluation of the sufficiency and consistency of the training provided to family caregivers under such program in preparing family caregivers to provide care to veterans under such program4 4 ,,iv ,appropriation of amounts #dja4 ,appropriation of amounts for health care from ,department of ,veterans ,affairs 7a7 ,in general ,there is authorized to be appropriated1 and is appropriated1 to the ,secretary of ,veterans ,affairs1 out of any funds in the ,treasury not otherwise appropriated1 #a1jjj1jjj1jjj to carry out subsection 7c74 7b7 ,availability of amounts ,the amount appropriated under subsection 7a7 shall be available for obligation or expenditure without fiscal year limitation4 7c7 ,use of amounts ,the amount appropriated under subsection 7a7 shall be used by the ,secretary to carry out the following3 7#a7 ,subchapters ,,ii and ,,vii of chapter #gf of title #ch1 ,united ,states ,code2 7#b7 ,the program to increase the number of graduate medical education residency positions of the ,department under sections #baa and #bab2 and 7#c7 ,section #bba4 7d7 ,funding plan ,not later than #fj days after the date of the enactment of this ,act1 the ,secretary shall submit to the appropriate committees of ,congress a funding plan describing how the ,secretary intends to use the amount appropriated under subsection 7a74 7e7 ,supplement not supplant ,amounts appropriated under subsection 7a7 for purposes of carrying out subchapters ,,ii and ,,vii of chapter #gf of title #ch1 ,united ,states ,code1 shall supplement1 not supplant1 amounts otherwise made available to the ,secretary to carry out such subchapters4 7f7 ,report ,not later than one year after the date of the enactment of this ,act1 the ,secretary shall submit to the appropriate committees of ,congress a report on how the ,secretary has obligated the amount appropriated under subsection 7a7 as of the date of the submittal of the report4 7g7 ,appropriate committees of congress defined ,in this section1 the term appropriate committees of ,congress means-- 7#a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7#b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 #djb4 ,appropriation of amounts for ,veterans ,choice ,program 7a7 ,in general ,there is authorized to be appropriated1 and is appropriated1 to the ,secretary of ,veterans ,affairs1 out of any funds in the ,treasury not otherwise appropriated1 #d1jjj1jjj1jjj to be deposited in the ,veterans ,choice ,fund under section #hjb of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note74 7b7 ,availability ,the amount appropriated under subsection 7a7 shall remain available until expended pursuant to section #hjb7;c77#d7 of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 as added by section #adb4 ,december #e1 #bjag,read twice and placed on the calendar