,,ii ,cal5d> ,no4 #bgc #aae? ,,congress #a/ ,session ,s4 #baic ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,decemb] #e1 #bjag,mr4 ,isakson1 f ! ,committee on ,vet]ans' ,affairs1 report$ ! foll[+ orig9al bill2 :i* 0 read twice & plac$ on ! cal5d> ,a ,,bill ,to am5d title #ch1 ,unit$ ,/ates ,code1 to improve heal? c>e = vet]ans1 & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,c>+ = our ,vet]ans ,act ( #bjag4 7b7 ,table ( cont5ts ,! table ( cont5ts = ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4 ,sec4 #b4 ,ref]5ces to title #ch1 ,unit$ ,/ates ,code4 ,,title ,i--,develop+ an integrat$ high-p]=m+ network ,subtitle ,a--,e/abli%+ community c>e programs ,sec4 #aja4 ,e/abli%m5t ( ,vet]ans ,community ,c>e ,program4 ,sec4 #ajb4 ,au?orization ( agreem5ts betwe5 ,dep>tm5t ( ,vet]ans ,affairs & non-,dep>tm5t provid]s4 ,sec4 #ajc4 ,con=m+ am5dm5ts = ,/ate vet]ans homes4 ,sec4 #ajd4 ,access guidel9es & /&>ds = quality4 ,sec4 #aje4 ,access to walk-9 c>e4 ,sec4 #ajf4 ,/rategy reg>d+ ! ,dep>tm5t ( ,vet]ans ,affairs ,high-,p]=m+ ,integrat$ ,heal? ,c>e ,network4 ,sec4 #ajg4 ,applicability ( ,directive ( ,(fice ( ,f$]al ,contract ,compliance ,programs4 ,sec4 #ajh4 ,prev5tion ( c]ta9 heal? c>e provid]s f provid+ non-,dep>tm5t heal? c>e s]vices to vet]ans4 ,subtitle ,b--,pay+ provid]s & improv+ collections ,sec4 #aaa4 ,prompt paym5t to provid]s4 ,sec4 #aab4 ,au?ority to pay = au?oriz$ c>e n subject to an agreem5t4 ,sec4 #aac4 ,improvem5t ( au?ority to recov] ! co/ ( s]vices furni%$ = non-s]vice-connect$ disabilities4 ,sec4 #aad4 ,process+ ( claims = reimbursem5t ?r\gh electronic int]face4 ,subtitle ,c--,education & tra9+ programs ,sec4 #aba4 ,education program on heal? c>e options4 ,sec4 #abb4 ,tra9+ program = adm9i/ration ( non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e4 ,sec4 #abc4 ,cont9u+ m$ical education = non-,dep>tm5t m$ical pr(essionals4 ,subtitle ,d--,o!r matt]s relat+ to non-,dep>tm5t ( ,vet]ans ,affairs provid]s ,sec4 #aca4 ,e/abli%m5t ( processes to ensure safe opioid prescrib+ practices by non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e provid]s4 ,sec4 #acb4 ,improv+ in=mation %>+ ) community provid]s4 ,sec4 #acc4 ,compet5cy /&>ds = non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e provid]s4 ,subtitle ,e--,o!r non-,dep>tm5t heal? c>e matt]s ,sec4 #ada4 ,plans = ,use ( ,supplem5tal ,appropriations ,requir$4 ,sec4 #adb4 ,vet]ans ,*oice ,fund flexibility4 ,sec4 #adc4 ,sunset ( ,vet]ans ,*oice ,program4 ,sec4 #add4 ,con=m+ am5dm5ts4 ,,title ,,ii--,improv+ ,dep>tm5t ( ,vet]ans ,affairs heal? c>e deliv]y ,subtitle ,a--,p]sonnel practices ,,"p ,i--,adm9i/ration ,sec4 #bja4 ,lic5sure ( heal? c>e pr(essionals ( ! ,dep>tm5t ( ,vet]ans ,affairs provid+ treatm5t via telem$ic9e4 ,sec4 #bjb4 ,role ( podiatri/s 9 ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #bjc4 ,modification ( treatm5t ( c]tifi$ cl9ical p]fusioni/s ( ! ,dep>tm5t4 ,sec4 #bjd4 ,am5d+ /atutory requirem5ts = ! position ( ! ,*ief ,(fic] ( ! ,readju/m5t ,c\nsel+ ,s]vice4 ,sec4 #bje4 ,te*nical am5dm5t to appo9tm5t & comp5sation sy/em = directors ( m$ical c5t]s & directors ( ,vet]ans ,integrat$ ,s]vice ,networks4 ,sec4 #bjf4 ,id5tification & /aff+ ( c]ta9 heal? c>e vacancies4 ,sec4 #bjg4 ,dep>tm5t ( ,vet]ans ,affairs p]sonnel transp>5cy4 ,sec4 #bjh4 ,program on e/abli%m5t ( pe] speciali/s 9 pati5t align$ c>e team sett+s )9 m$ical c5t]s ( ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #bji4 ,pilot program on increas+ ! use ( m$ical scribes to maximize ! effici5cy ( physicians at m$ical facilities ( ! ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #baj4 ,s5se ( ,congress reg>d+ ,dep>tm5t ( ,vet]ans ,affairs /aff+ levels4 ,,"p ,,ii--,education & tra9+ ,sec4 #baa4 ,graduate m$ical education & resid5cy4 ,sec4 #bab4 ,pilot program to e/abli% or affiliate ) graduate m$ical resid5cy programs at facilities op]at$ by ,indian tribes1 tribal organizations1 & ! ,indian ,heal? ,s]vice 9 rural areas4 ,sec4 #bac4 ,reimbursem5t ( cont9u+ pr(essional education requirem5ts = bo>d c]tifi$ advanc$ practice regi/]$ nurses4 ,sec4 #bad4 ,increase 9 maximum am\nt ( debt t may be r$uc$ "u ,education ,debt ,r$uction ,program ( ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #bae4 ,demon/ration program on tra9+ & employm5t ( alt]native d5tal heal? c>e provid]s = d5tal heal? c>e s]vices = vet]ans 9 rural & o!r und]s]v$ communities4 ,,"p ,,iii--,o!r p]sonnel matt]s ,sec4 #bba4 ,exception on limitation on aw>ds & bonuses = recruitm5t1 relocation1 & ret5tion4 ,sec4 #bbb4 ,annual report on p]=mance aw>ds & bonuses aw>d$ to c]ta9 high-level employees ( ! ,dep>tm5t4 ,sec4 #bbc4 ,au?ority to regulate additional pay = c]ta9 heal? c>e employees ( ! ,dep>tm5t4 ,sec4 #bbd4 ,modification ( pay cap = nurses4 ,subtitle ,b--,improvem5t ( und]s]v$ facilities ( ! ,dep>tm5t ,sec4 #bca4 ,developm5t ( crit]ia = designation ( c]ta9 m$ical facilities ( ! ,dep>tm5t ( ,vet]ans ,affairs z und]s]v$ facilities & plan to address problem ( und]s]v$ facilities4 ,sec4 #bcb4 ,pilot program on tuition reimbursem5t & loan repaym5t = heal? c>e provid]s ( ! ,dep>tm5t ( ,vet]ans ,affairs at und]s]v$ facilities4 ,sec4 #bcc4 ,program to furni% mobile deploym5t teams to und]s]v$ facilities4 ,sec4 #bcd4 ,inclusion ( ,vet ,c5t] employees 9 education debt r$uction program ( ,dep>tm5t ( ,vet]ans ,affairs4 ,subtitle ,c--,con/ruction & leases ,sec4 #bda4 ,def9ition ( major m$ical facility project & major m$ical facility lease4 ,sec4 #bdb4 ,facilitat+ %>+ ( m$ical facilities ) o!r ,f$]al ag5cies4 ,sec4 #bdc4 ,review ( enhanc$ use leases4 ,sec4 #bdd4 ,au?orization ( c]ta9 major m$ical facility projects ( ! ,dep>tm5t ( ,vet]ans ,affairs4 ,subtitle ,d--,o!r heal? c>e matt]s ,sec4 #bea4 ,program on use ( wellness programs z complem5t>y approa* to m5tal heal? c>e = vet]ans & family memb]s ( vet]ans4 ,sec4 #beb4 ,au?orization to provide = op]ations on live donors = purposes ( conduct+ transplant proc$ures = vet]ans4 ,sec4 #bec4 ,s5se ( ! ,s5ate4 ,,title ,,iii--,family c>egiv]s ,sec4 #cja4 ,expansion ( family c>egiv] program ( ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #cjb4 ,implem5tation ( in=mation te*nology sy/em ( ,dep>tm5t ( ,vet]ans ,affairs to assess & improve ! family c>egiv] program4 ,sec4 #cjc4 ,modifications to annual evaluation report on c>egiv] program ( ,dep>tm5t ( ,vet]ans ,affairs4 ,,title ,,iv--,appropriation ( am\nts ,sec4 #dja4 ,appropriation ( am\nts = heal? c>e f ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #djb4 ,appropriation ( am\nts = ,vet]ans ,*oice ,program4 #b4 ,ref]5ces to title #ch1 ,unit$ ,/ates ,code ,except z o!rwise expressly provid$1 :5ev] 9 ?is ,act an am5dm5t or repeal is express$ 9 t]ms ( an am5dm5t to1 or repeal (1 a section or o!r provision1 ! ref]5ce %all be consid]$ to be made to a section or o!r provision ( title #ch1 ,unit$ ,/ates ,code4 ,i ,develop+ an integrat$ high-p]=m+ network ,a ,e/abli%+ community c>e programs #aja4 ,e/abli%m5t ( ,vet]ans ,community ,c>e ,program 7a7 ,e/abli%m5t ( program 7#a7 ,9 g5]al ,section #agjc is am5d$ to read z foll[s3 #agjc4 ,vet]ans ,community ,c>e ,program 7a7 ,9 g5]al 7#a7 ,!re is e/abli%$ a program to furni% hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices to cov]$ vet]ans ?r\gh heal? c>e provid]s specifi$ 9 subsection 7c74 7#b7 ,! ,secret>y %all coord9ate ! furni%+ ( hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices "u ?is section to cov]$ vet]ans1 includ+ coord9ation (1 at a m9imum1 ! foll[+3 7,a7 ,ensur+ ! s*$ul+ ( m$ical appo9tm5ts 9 a timely mann] & ! e/abli%m5t ( a me*anism to receive m$ical records f non-,dep>tm5t provid]s4 7,b7 ,ensur+ cont9uity ( c>e & s]vices4 7,c7 ,ensur+ coord9ation among regional networks if ! cov]$ vet]an accesses c>e & s]vices 9 a diff]5t network ?an ! regional network 9 :i* ! cov]$ vet]an resides4 7,d7 ,ensur+ t cov]$ vet]ans d n exp]i5ce a lapse result+ f errors or delays by ! ,dep>tm5t or its contractors or an unusual or excessive burd5 9 access+ hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices4 7b7 ,cov]$ vet]ans ,= purposes ( ?is section1 a cov]$ vet]an is any vet]an :o-- 7#a7 is enroll$ 9 ! sy/em ( annual pati5t enrollm5t e/abli%$ & op]at$ "u section #agje ( ?is title2 or 7#b7 is n enroll$ 9 su* sy/em b is o!rwise entitl$ to hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices "u subsection 7c77#b7 ( su* section4 7c7 ,heal? c>e provid]s specifi$ ,heal? c>e provid]s specifi$ 9 ?is subsection are ! foll[+3 7#a7 ,any heal? c>e provid] t is p>ticipat+ 9 ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 includ+ any physician furni%+ s]vices "u su* a program4 7#b7 ,! ,dep>tm5t ( ,def5se4 7#c7 ,! ,indian ,heal? ,s]vice4 7#d7 ,any ,f$]ally-qualifi$ heal? c5t] 7z def9$ 9 section #aije7l77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7774 7#e7 ,any heal? c>e provid] n o!rwise cov]$ "u any ( p>agraphs 7#a7 ?r\gh 7#d7 t meets crit]ia e/abli%$ by ! ,secret>y = purposes ( ?is section4 7d7 ,conditions "u :i* c>e is requir$ ,to be furni%$ ?r\gh non-,dep>tm5t provid]s 7#a7 ,! ,secret>y %all1 subject to ! availability ( appropriations1 furni% hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices to a cov]$ vet]an ?r\gh heal? c>e provid]s specifi$ 9 subsection 7c7 if-- 7,a7 ! ,dep>tm5t does n (f] ! c>e or s]vices ! vet]an requires2 7,b7 ! ,dep>tm5t does n op]ate a full-s]vice m$ical facility 9 ! ,/ate 9 :i* ! cov]$ vet]an resides2 7,c7 ! cov]$ vet]an 0 an eligible vet]an "u section #aja7;b77#b77;,b7 ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 z ( ! day be=e ! date ( ! enactm5t ( ! ,c>+ = our ,vet]ans ,act ( #bjag2 or 7,d7 ! cov]$ vet]an & ! cov]$ vet]an's prim>y c>e provid] agree t furni%+ c>e & s]vices ?r\gh a non-,dep>tm5t entity or provid] w\ld be 9 ! be/ m$ical int]e/ ( ! cov]$ vet]an bas$ ^u crit]ia develop$ by ! ,secret>y4 7#b7 ,! ,secret>y %all ensure t ! crit]ia develop$ "u p>agraph 7#a77;,d7 include consid]ation ( ! foll[+3 7,a7 ,! di/ance betwe5 ! cov]$ vet]an & ! facility t provides ! hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices ! vet]an ne$s4 7,b7 ,! nature ( ! hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices requir$4 7,c7 ,! frequ5cy t ! hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices ne$s to be furni%$4 7,d7 ,:e!r an appo9tm5t = ! hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices ! cov]$ vet]an requires is available f a heal? c>e provid] ( ! ,dep>tm5t )9 ! less] (-- 7i7 ! access guidel9es = su* hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices z e/abli%$ by ! ,secret>y2 & 7ii7 a p]iod det]m9$ by a heal? c>e provid] ( ! ,dep>tm5t to be cl9ically necess>y = ! receipt ( su* hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices4 7,e7 ,:e!r ! cov]$ vet]an faces an unusual or excessive burd5 to access hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices f ! ,dep>tm5t m$ical facility :]e a cov]$ vet]an seeks hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices1 :i* %all include consid]ation ( ! foll[+3 7i7 ,:e!r ! cov]$ vet]an faces an excessive driv+ di/ance1 geographical *all5ge1 or environm5tal factor t imp$es ! access ( ! cov]$ vet]an4 7ii7 ,:e!r ! hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices s\ght by ! vet]an is provid$ by a m$ical facility ( ! ,dep>tm5t t is reasonably accessible to a cov]$ vet]an4 7iii7 ,:e!r a m$ical condition ( ! cov]$ vet]an affects ! ability ( ! cov]$ vet]an to travel4 7iv7 ,:e!r !re is compell+ reason1 z det]m9$ by ! ,secret>y1 t ! vet]an ne$s to receive hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices f a m$ical facility o!r ?an a m$ical facility ( ! ,dep>tm5t4 7v7 ,su* o!r consid]ations z ! ,secret>y consid]s appropriate4 7#c7 ,if ! ,secret>y has det]m9$ t ! ,dep>tm5t does n (f] ! c>e or s]vices ! cov]$ vet]an requires "u subp>agraph 7,a7 ( p>agraph 7#a71 t ! ,dep>tm5t does n op]ate a full-s]vice m$ical facility 9 ! ,/ate 9 :i* ! cov]$ vet]an resides "u subp>agraph 7,b7 ( su* p>agraph1 or t ! cov]$ vet]an is describ$ "u subp>agraph 7,c7 ( su* p>agraph1 ! decision to receive hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices "u su* subp>agraphs f a heal? c>e provid] specifi$ 9 subsection 7c7 %all be at ! election ( ! vet]an4 7e7 ,conditions "u :i* c>e is au?oriz$ to be furni%$ ?r\gh non-,dep>tm5t provid]s 7#a7 7,a7 ,! ,secret>y may furni% hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices ?r\gh a heal? c>e provid] specifi$ 9 subsection 7c7 to a cov]$ vet]an s]v$ by a m$ical s]vice l9e ( ! ,dep>tm5t t ! ,secret>y has det]m9$ is n provid+ c>e t meets su* quality & access /&>ds z ! ,secret>y %all develop4 7,b7 ,9 c>ry+ out subp>agraph 7,a71 ! ,secret>y %all-- 7i7 measure access ( ! m$ical s]vice l9e at a facility ( ! ,dep>tm5t :5 comp>$ ) ! same m$ical s]vice l9e at diff]5t ,dep>tm5t facilities2 & 7ii7 measure quality at a m$ical s]vice l9e ( a facility ( ! ,dep>tm5t by comp>+ x ) two or m di/9ct & appropriate quality measures at non-,dep>tm5t m$ical s]vice l9es4 7,c7 7i7 ,! ,secret>y may n concurr5tly furni% hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices "u subp>agraph 7,a7 ) respect to m ?an ?ree m$ical s]vice l9es describ$ 9 su* subp>agraph at any "o heal? c>e facility ( ! ,dep>tm5t4 7ii7 ,! ,secret>y may n concurr5tly furni% hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices "u subp>agraph 7,a7 ) respect to m ?an #cf m$ical s]vice l9es nationally describ$ 9 su* subp>agraph4 7#b7 ,! ,secret>y may limit ! types ( hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices cov]$ vet]ans may receive "u p>agraph 7#a7 because ( an access & quality defici5cy ( a m$ical s]vice l9e 9 t]ms ( ! l5g? ( "t su* c>e & s]vices w be available1 ! location at :i* su* c>e & s]vices w be available1 & ! cl9ical c>e & s]vices t w be available4 7#c7 ,! hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices au?oriz$ "u p>agraph 7#a7 ) respect to a m$ical s]vice l9e %all cease :5 ! rem$iation describ$ 9 subsection 7g7 ) respect to su* m$ical s]vice l9e is complete4 7#d7 ,! ,secret>y %all publi% 9 ! ,f$]al ,regi/]1 & %all take all reasonable /eps to provide direct notice to cov]$ vet]ans affect$ "u ?is subsection1 at lea/ once ea* ye> /at+ ! "t p]iod dur+ :i* su* c>e & s]vices w be available1 ! location or locations :]e su* c>e & s]vices w be available1 & ! cl9ical s]vices available at ea* location "u ?is subsection 9 accordance ) regulations ! ,secret>y %all prescribe4 7#e7 ,:5 ! ,secret>y ex]cises ! au?ority "u p>agraph 7#a71 ! decision to receive c>e or s]vices "u su* p>agraph f a heal? c>e provid] specifi$ 9 subsection 7c7 %all be at ! election ( ! cov]$ vet]an4 7f7 ,review ( decisions ,! review ( any decision "u subsection 7d7 or 7e7 %all be subject to ! ,dep>tm5t's local cl9ical appeals process1 & su* decisions may n be appeal$ to ! ,bo>d ( ,vet]ans' ,appeals4 7g7 ,rem$iation ( m$ical s]vice l9es 7#a7 ,n lat] ?an #cj days aft] det]m9+ "u subsection 7e77#a7 t a m$ical s]vice l9e ( ! ,dep>tm5t is provid+ hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices t does n comply ) ! access guidel9es & meet ! /&>ds ( quality e/abli%$ by ! ,secret>y1 ! ,secret>y %all submit to ,congress an assessm5t ( ! factors t l$ ! ,secret>y to make su* det]m9ation & a plan ) specific actions1 & ! "t to complete !m1 to be tak5 to comply ) su* access guidel9es & meet su* /&>ds ( quality1 includ+ ! foll[+3 7,a7 ,increas+ p]sonnel or tempor>y p]sonnel assi/ance1 includ+ mobile deploym5t teams4 7,b7 ,special hir+ inc5tives1 includ+ ! ,education ,debt ,r$uction ,program "u sub*apt] ,,vii ( *apt] #gf ( ?is title & recruitm5t1 relocation1 & ret5tion inc5tives4 7,c7 ,utiliz+ direct hir+ au?ority4 7,d7 ,provid+ improv$ tra9+ opportunities = /aff4 7,e7 ,acquir+ improv$ equipm5t4 7,f7 ,mak+ /ructural modifications to ! facility us$ by ! m$ical s]vice l9e4 7,g7 ,su* o!r actions z ! ,secret>y consid]s appropriate4 7#b7 ,9 ea* assessm5t submitt$ "u p>agraph 7#a7 ) respect to a m$ical s]vice l9e1 ! ,secret>y %all id5tify ! individuals at ! ,c5tral ,(fice ( ! ,vet]ans ,heal? ,adm9i/ration1 ! facility us$ by ! m$ical s]vice l9e1 & ! c5tral (fice ( ! relevant ,vet]ans ,integrat$ ,s]vice ,network :o are responsible = ov]see+ ! progress ( t m$ical s]vice l9e 9 comply+ ) ! access guidel9es & meet+ ! /&>ds ( quality e/abli%$ by ! ,secret>y4 7#c7 ,n lat] ?an #ahj days aft] submitt+ an assessm5t "u p>agraph 7#a7 ) respect to a m$ical s]vice l9e1 ! ,secret>y %all submit to ,congress a report on ! progress ( t m$ical s]vice l9e 9 comply+ ) ! access guidel9es & meet+ ! /&>ds ( quality e/abli%$ by ! ,secret>y & any o!r measures ! ,secret>y w take to assi/ ! m$ical s]vice l9e 9 comply+ ) su* access guidel9es & meet+ su* /&>ds ( quality4 7#d7 ,n less frequ5tly ?an once ea* ye>1 ! ,secret>y %all-- 7,a7 submit to ,congress an analysis ( ! rem$iation actions & co/s ( su* actions tak5 ) respect to ea* m$ical s]vice l9e ) respect to :i* ! ,secret>y submitt$ an assessm5t & plan "u p>agraph 7#a7 9 ! prec$+ ye>1 includ+ an update on ! progress ( ea* su* m$ical s]vice l9e 9 meet+ ! quality & access /&>ds e/abli%$ by ! ,secret>y & any o!r actions ! ,secret>y is und]tak+ to assi/ ! m$ical s]vice l9e 9 comply+ ) access guidel9es & meet+ /&>ds ( quality z e/abli%$ by ! ,secret>y2 & 7,b7 publi% su* analysis on ! ,int]net website ( ! ,dep>tm5t4 7h7 ,access guidel9es & /&>ds = quality 7#a7 ,! ,secret>y %all e/abli% access guidel9es "u section #agjc;,b ( ?is title & /&>ds = quality "u section #agjc;,c ( ?is title = furni%+ hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices to a cov]$ vet]an = ! purposes ( subsections 7d7 & 7e74 7#b7 ,! ,secret>y %all ensure t ! access guidel9es & /&>ds = quality requir$ by sections #agjc;,b & #agjc;,c ( ?is title provide cov]$ vet]ans1 employees ( ! ,dep>tm5t1 & heal? c>e provid]s 9 ! network e/abli%$ "u subsection 7j7 ) relevant comp>ative in=mation t is cle>1 useful1 & timely1 s t cov]$ vet]ans c make in=m$ decisions reg>d+ _! heal? c>e4 7#c7 ,! ,secret>y %all consult ) all p]t95t ,f$]al entities 7includ+ ! ,dep>tm5t ( ,def5se1 ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 & ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices71 entities 9 ! private sector1 & o!r nongov]nm5tal entities 9 e/abli%+ access guidel9es & /&>ds = quality z requir$ by sections #agjc;,b & #agjc;,c ( ?is title4 7#d7 ,n lat] ?an #bgj days aft] ! date ( ! enactm5t ( ! ,c>+ = our ,vet]ans ,act ( #bjag1 ! ,secret>y %all submit to ! appropriate committees ( ,congress a report detail+ ! access guidel9es & /&>ds = quality e/abli%$ "u sections #agjc;,b & #agjc;,c ( ?is title4 7#e7 ,n lat] ?an ?ree ye>s aft] ! date on :i* ! ,secret>y e/abli%es access guidel9es & /&>ds = quality "u p>agraph 7#a7 & n less frequ5tly ?an once e ?ree ye>s !reaft]1 ! ,secret>y %all-- 7,a7 conduct a review ( su* guidel9es & /&>ds2 & 7,b7 submit to ! appropriate committees ( ,congress a report on ! f9d+s & any modification to ! access guidel9es & /&>ds = quality ) respect to ! review conduct$ "u subp>agraph 7,a74 7#f7 ,! ,secret>y %all ensure heal? c>e provid]s specifi$ "u subsection 7c7 are able to meet ! applicable access guidel9es & /&>ds ( quality e/abli%$ by ! ,secret>y4 7i7 ,ti]$ network 7#a7 ,to promote ! provision ( high-quality & high-value hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices "u ?is section1 ! ,secret>y may develop a ti]$ provid] network ( eligible provid]s bas$ on crit]ia e/abli%$ by ! ,secret>y = purposes ( ?is section4 7#b7 ,9 develop+ a ti]$ provid] network ( eligible provid]s "u p>agraph 7#a71 ! ,secret>y %all n prioritize provid]s 9 a ti] ov] provid]s 9 any o!r ti] 9 a mann] t limits ! *oice ( a cov]$ vet]an 9 select+ a heal? c>e provid] specifi$ 9 subsection 7c7 = receipt ( hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices "u ?is section4 7j7 ,contracts ,to e/abli% networks ( heal? c>e provid]s 7#a7 ,! ,secret>y %all ent] into consolidat$1 competitively bid contracts to e/abli% networks ( heal? c>e provid]s specifi$ 9 p>agraphs 7#a7 & 7#e7 ( subsection 7c7 = purposes ( provid+ suffici5t access to hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices "u ?is section4 7#b7 7,a7 ,! ,secret>y %all1 to ! ext5t practicable1 ensure t cov]$ vet]ans are able to make _! own appo9tm5ts us+ advanc$ te*nology4 7,b7 ,to ! ext5t practicable1 ! ,secret>y %all be responsible = ! s*$ul+ ( appo9tm5ts = hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices "u ?is section4 7#c7 7,a7 ,! ,secret>y may t]m9ate a contract ) an entity ent]$ into "u p>agraph 7#a7 at su* "t & ^u su* notice to ! entity z ! ,secret>y may specify = purposes ( ?is section1 if ! ,secret>y notifies ! appropriate committees ( ,congress t1 at a m9imum-- 7i7 ! entity-- 7,i7 fail$ to comply sub/antially ) ! provisions ( ! contract or ) ! provisions ( ?is section & ! regulations prescrib$ "u ?is section2 7,,ii7 fail$ to comply ) ! access guidel9es or meet ! /&>ds ( quality e/abli%$ by ! ,secret>y2 7,,iii7 is exclud$ f p>ticipation 9 a ,f$]al heal? c>e program 7z def9$ 9 section #aabh;,b7f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7f777 "u section #aabh or #aabh;,a ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g & #acbj;a-#g;a72 7,,iv7 is id5tifi$ z an exclud$ s\rce on ! li/ ma9ta9$ 9 ! ,sy/em = ,aw>d ,managem5t1 or any successor sy/em2 or 7,v7 has be5 convict$ ( a felony or o!r s]i\s (f5se "u ,f$]al or ,/ate law & ! cont9u$ p>ticipation ( ! entity w\ld be detrim5tal to ! be/ int]e/s ( vet]ans or ! ,dep>tm5t2 7ii7 x is reasonable to t]m9ate ! contract bas$ on ! heal? c>e ne$s ( vet]ans2 or 7iii7 x is reasonable to t]m9ate ! contract bas$ on cov]age provid$ by contracts or %>+ agreem5ts ent]$ into "u au?orities o!r ?an ?is section4 7,b7 ,no?+ 9 subp>agraph 7,a7 may be con/ru$ to re/rict ! au?ority ( ! ,secret>y to t]m9ate a contract ent]$ into "u p>agraph 7#a7 "u any o!r provision ( law4 7#d7 ,:5ev] ! ,secret>y provides notice to an entity t ! entity is fail+ to meet contractual obligations ent]$ into "u p>agraph 7#a71 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report on su* failure4 ,su* report %all include ! foll[+3 7,a7 ,an explanation ( ! reasons = provid+ su* notice4 7,b7 ,a description ( ! effect ( su* failure1 includ+ ) respect to co/1 s*$ule1 & requirem5ts4 7,c7 ,a description ( ! actions tak5 by ! ,secret>y to mitigate su* failure4 7,d7 ,a description ( ! actions tak5 by ! contractor to address su* failure4 7,e7 ,a description ( any effect on ! community provid] m>ket = vet]ans 9 ! affect$ area4 7#e7 7,a7 ,! ,secret>y %all in/ruct ea* entity aw>d$ a contract "u p>agraph 7#a7 to recognize & accept1 on an int]im basis1 ! cr$5tials & qualifications ( heal? c>e provid]s :o are au?oriz$ to furni%$ hospital c>e & m$ical s]vices to vet]ans "u a community c>e program ( ! ,dep>tm5t 9 effect z ( ! day be=e ! date ( ! enactm5t ( ! ,c>+ = our ,vet]ans ,act ( #bjag1 includ+ "u ! ,pati5t-,c5t]$ ,community ,c>e ,program & ! ,vet]ans ,*oice ,program "u section #aja ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note71 z qualifi$ provid]s "u ! program e/abli%$ "u ?is section4 7,b7 ,! int]im acceptance p]iod "u subp>agraph 7,a7 %all be det]m9$ by ! ,secret>y bas$ on ! foll[+ crit]ia3 7i7 ,) respect to a heal? c>e provid]1 :5 ! curr5t c]tification agreem5t = ! heal? c>e provid] expires4 7ii7 ,:e!r ! ,dep>tm5t has enact$ c]tification & eligibility crit]ia & regulatory proc$ures by :i* non-,dep>tm5t provid]s w be au?oriz$ "u ?is section4 7#f7 ,! ,secret>y %all e/abli% ?r\gh regulation a sy/em or sy/ems = monitor+ ! quality ( c>e provid$ to cov]$ vet]ans ?r\gh a network "u ?is subsection & = assess+ ! quality ( hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices furni%$ ?r\gh su* network be=e ! r5ewal ( ! contract = su* network4 7k7 ,paym5t rates = c>e & s]vices 7#a7 ,except z provid$ 9 p>agraph 7#b71 & to ! ext5t practicable1 ! rate paid = hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices "u any provision 9 ?is title may n exce$ ! rate paid by ! ,unit$ ,/ates to a provid] ( s]vices 7z def9$ 9 section #ahfa7u7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7u777 or a suppli] 7z def9$ 9 section #ahfa7;d7 ( su* ,act 7#db ,u4,s4,c4 #aciex7d777 "u ! ,m$ic>e program "u title ,,xi or title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq47 = ! same c>e or s]vices4 7#b7 7,a7 ,a high] rate ?an ! rate paid by ! ,unit$ ,/ates z describ$ 9 p>agraph 7#a7 may be negotiat$ ) respect to ! furni%+ ( c>e or s]vices to a cov]$ vet]an :o resides 9 a highly rural area4 7,b7 ,9 ?is p>agraph1 ! t]m highly rural area means an area locat$ 9 a c\nty t has few] ?an sev5 individuals resid+ 9 t c\nty p] squ>e mile4 7#c7 ,) respect to furni%+ c>e or s]vices "u ?is section 9 ,alaska1 ! ,alaska ,fee ,s*$ule ( ! ,dep>tm5t ( ,vet]ans ,affairs %all be foll[$1 except = :5 ano!r paym5t agreem5t1 includ+ a contract or provid] agreem5t1 is 9 effect4 7#d7 ,) respect to furni%+ hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices "u ?is section 9 a ,/ate ) an ,all-,pay] ,model ,agreem5t "u section #ahad7;b77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7b77#c77 t became effective on or aft] ,janu>y #a1 #bjad1 ! ,m$ic>e paym5t rates "u p>agraph 7#b77;,a7 %all be calculat$ bas$ on ! paym5t rates "u su* agreem5t4 7#e7 ,not)/&+ p>agraph 7#a71 ! ,secret>y may incorporate1 to ! greate/ ext5t practicable1 ! use ( value-bas$ reimbursem5t models to promote ! provision ( high-quality c>e4 7#f7 ,) respect to hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices = :i* !re is n a rate paid "u ! ,m$ic>e program z describ$ 9 p>agraph 7#a71 ! rate paid = su* c>e or s]vices %all be det]m9$ by ! ,secret>y4 7l7 ,treatm5t ( o!r heal? c>e plans 7#a7 ,9 any case 9 :i* a cov]$ vet]an is furni%$ hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices "u ?is section = a non-s]vice-connect$ disability describ$ 9 subsection 7a77#b7 ( section #agbi ( ?is title1 ! ,secret>y %all recov] or collect reasonable *>ges = su* c>e or s]vices f a heal? c>e plan describ$ 9 p>agraph 7#b7 9 accordance ) su* section4 7#b7 ,a heal? c>e plan describ$ 9 ?is p>agraph-- 7,a7 is an insurance policy or contract1 m$ical or hospital s]vice agreem5t1 memb]%ip or subscription contract1 or simil> arrangem5t n adm9i/]$ by ! ,secret>y1 "u :i* hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices = individuals are provid$ or ! exp5ses ( su* c>e or s]vices are paid2 & 7,b7 does n include any su* policy1 contract1 agreem5t1 or simil> arrangem5t pursuant to title ,,xviii or ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 or *apt] #ee ( title #aj4 7m7 ,paym5t by vet]an ,a cov]$ vet]an %all n pay a great] am\nt = receiv+ c>e or s]vices "u ?is section ?an ! am\nt ! vet]an w\ld pay = receiv+ ! same or comp>able c>e or s]vices at a m$ical facility ( ! ,dep>tm5t or f a heal? c>e provid] ( ! ,dep>tm5t4 7n7 ,monitor+ ( c>e provid$ 7#a7 7,a7 ,n lat] ?an #edj days aft] ! date ( ! enactm5t ( ! ,c>+ = our ,vet]ans ,act ( #bjag1 & n less frequ5tly ?an annually !reaft]1 ! ,secret>y %all submit to appropriate committees ( ,congress a review ( ! types & frequ5cy ( c>e s\ght "u subsection 7d74 7,b7 ,! review submitt$ "u subp>agraph 7,a7 %all include an assessm5t ( ! foll[+3 7i7 ,! top #be p]c5t ( types ( c>e & s]vices mo/ frequ5tly provid$ "u subsection 7d7 due to ! ,dep>tm5t n (f]+ su* c>e & s]vices4 7ii7 ,! frequ5cy su* c>e & s]vices 7 s\ght by cov]$ vet]ans "u ?is section4 7iii7 ,an analysis ( ! reasons ! ,dep>tm5t 0 unable to provide su* c>e & s]vices4 7iv7 ,any /eps ! ,dep>tm5t took to provide su* c>e & s]vices at a m$ical facility ( ! ,dep>tm5t4 7v7 ,! co/ ( su* c>e & s]vices4 7#b7 ,9 monitor+ ! hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices furni%$ "u ?is section1 ! ,secret>y %all d ! foll[+3 7,a7 ,) respect to hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices furni%$ ?r\gh provid] networks e/abli%$ "u subsection 7j7-- 7i7 compile data on ! types ( hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices furni%$ ?r\gh su* networks & h[ _m pati5ts us$ ea* type ( c>e & s]vice2 7ii7 id5tify gaps 9 hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices furni%$ ?r\gh su* networks2 7iii7 id5tify h[ su* gaps may be fix$ ?r\gh new contracts )9 su* networks or *anges 9 ! mann] 9 :i* hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices are furni%$ ?r\gh su* networks2 7iv7 assess ! total am\nts sp5t by ! ,dep>tm5t on hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices furni%$ ?r\gh su* networks2 7v7 assess ! timel9ess ( ! ,dep>tm5t 9 ref]r+ hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices to su* networks2 & 7vi7 assess ! timel9ess ( su* networks 9-- 7,i7 accept+ ref]rals2 & 7,,ii7 s*$ul+ & complet+ appo9tm5ts4 7,b7 ,report ! numb] ( m$ical s]vice l9es ! ,secret>y has det]m9$ "u subsection 7e77#a7 n to be provid+ hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices t comply ) ! access guidel9es or meet ! /&>ds ( quality e/abli%$ by ! ,secret>y4 7,c7 ,assess ! use ( academic affiliates & c5t]s ( excell5ce ( ! ,dep>tm5t to furni% hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices to cov]$ vet]ans "u ?is section4 7,d7 ,assess ! hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices furni%$ to cov]$ vet]ans "u ?is section by m$ical facilities op]at$ by ,f$]al ag5cies o!r ?an ! ,dep>tm5t4 7#c7 ,n lat] ?an #edj days aft] ! date ( ! enactm5t ( ! ,c>+ = our ,vet]ans ,act ( #bjag & n less frequ5tly ?an once ea* ye> !reaft]1 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report on ! in=mation ga!r$ "u p>agraph 7#b74 7o7 ,prohibition on c]ta9 limitations ,! ,secret>y %all n limit ! types ( hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices cov]$ vet]ans may receive "u ?is section if x is 9 ! be/ int]e/ ( ! vet]an to receive su* hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices1 z det]m9$ by ! vet]an & ! vet]an's heal? c>e provid]4 7p7 ,def9itions ,9 ?is section3 7#a7 ,! t]m appropriate committees ( ,congress means-- 7,a7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,s5ate2 & 7,b7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives4 7#b7 ,! t]m m$ical s]vice l9e means a cl9ic )9 a ,dep>tm5t m$ical c5t]4 4 7#b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #ag is am5d$ by /rik+ ! item relat+ to section #agjc & ins]t+ ! foll[+ new item3 #agjc4 ,vet]ans ,community ,c>e ,program4 4 7b7 ,effective date ,section #agjc ( title #ch1 ,unit$ ,/ates ,code1 z am5d$ by subsection 7a71 %all take effect on ! lat] (-- 7#a7 ! date t is #cj days aft] ! date on :i* ! ,secret>y ( ,vet]ans ,affairs submits ! report requir$ "u section #aja7q77#b7 ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note72 or 7#b7 ! date on :i* ! ,secret>y promulgates regulations pursuant to subsection 7c74 7c7 ,regulations ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all promulgate regulations to c>ry out section #agjc ( title #ch1 ,unit$ ,/ates ,code1 z am5d$ by subsection 7a7 ( ?is section4 7d7 ,cont9uity ( exi/+ agreem5ts 7#a7 ,9 g5]al ,not)/&+ section #agjc ( title #ch1 ,unit$ ,/ates ,code1 z am5d$ by subsection 7a71 ! ,secret>y ( ,vet]ans ,affairs %all cont9ue all contracts1 memor&ums ( und]/&+1 memor&ums ( agreem5ts1 & o!r arrangem5ts t 7 9 effect on ! day be=e ! date ( ! enactm5t ( ?is ,act betwe5 ! ,dep>tm5t ( ,vet]ans ,affairs & ! ,am]ican ,indian & ,alaska ,native heal? c>e sy/ems z e/abli%$ "u ! t]ms ( ! ,dep>tm5t ( ,vet]ans ,affairs & ,indian ,heal? ,s]vice ,memor&um ( ,und]/&+1 sign$ ,octob] #a1 #bjaj1 ! ,national ,reimbursem5t ,agreem5t1 sign$ ,decemb] #e1 #bjab1 & agreem5ts ent]$ into "u sections #ajb & #ajc ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf74 7#b7 ,modifications ,p>agraph 7#a7 %all n be con/ru$ to prohibit ! ,secret>y & ! p>ties to ! contracts1 memor&ums ( und]/&+1 memor&ums ( agreem5ts1 & o!r arrangem5ts describ$ 9 su* p>agraph f mak+ su* *anges to su* contracts1 memor&ums ( und]/&+1 memor&ums ( agreem5ts1 & o!r arrangem5ts z may be o!rwise au?oriz$ pursuant to o!r provisions ( law or ! t]ms ( ! contracts1 memor&ums ( und]/&+1 memor&ums ( agreem5ts1 & o!r arrangem5ts4 #ajb4 ,au?orization ( agreem5ts betwe5 ,dep>tm5t ( ,vet]ans ,affairs & non-,dep>tm5t provid]s 7a7 ,9 g5]al ,sub*apt] ,i ( *apt] #ag is am5d$ by ins]t+ aft] section #agjc ! foll[+ new section3 #agjc;,a4 ,agreem5ts ) eligible entities or provid]s2 c]tification processes 7a7 ,agreem5ts au?oriz$ 7#a7 7,a7 ,:5 hospital c>e1 a m$ical s]vice1 or an ext5d$ c>e s]vice requir$ by a vet]an :o is entitl$ to su* c>e or s]vice "u ?is *apt] is n feasibly available to ! vet]an f a facility ( ! ,dep>tm5t or ?r\gh a contract or %>+ agreem5t ent]$ into pursuant to ano!r provision ( law1 ! ,secret>y may furni% su* c>e or s]vice to su* vet]an by ent]+ into an agreem5t "u ?is section ) an eligible entity or provid] to provide su* hospital c>e1 m$ical s]vice1 or ext5d$ c>e s]vice4 7,b7 ,an agreem5t ent]$ into "u ?is section to provide hospital c>e1 a m$ical s]vice1 or an ext5d$ c>e s]vice %all be kn[n z a ,vet]ans ,c>e ,agreem5t4 7,c7 ,= purposes ( subp>agraph 7,a71 hospital c>e1 a m$ical s]vice1 or an ext5d$ c>e s]vice may be consid]$ n feasibly available to a vet]an f a facility ( ! ,dep>tm5t or ?r\gh a contract or %>+ agreem5t describ$ 9 su* subp>agraph :5 ! ,secret>y det]m9es ! vet]an's m$ical condition1 ! travel involv$1 ! nature ( ! c>e or s]vices requir$1 or a comb9ation ( ^! factors make ! use ( a facility ( ! ,dep>tm5t or a contract or %>+ agreem5t describ$ 9 su* subp>agraph impracticable or inadvisable4 7,d7 ,a ,vet]ans ,c>e ,agreem5t may be ent]$ into by ! ,secret>y or any ,dep>tm5t (ficial au?oriz$ by ! ,secret>y4 7#b7 7,a7 ,subject to subp>agraph 7,b71 ! ,secret>y %all review ea* ,vet]ans ,c>e ,agreem5t ( mat]ial size1 z det]m9$ by ! ,secret>y or set =? 9 p>agraph 7#c71 = hospital c>e1 a m$ical s]vice1 or an ext5d$ c>e s]vice to det]m9e :e!r x is feasible & advisable to provide su* c>e or s]vice )9 a facility ( ! ,dep>tm5t or by contract or %>+ agreem5t ent]$ into pursuant to ano!r provision ( law &1 if s1 take action to d s4 7,b7 7i7 ,! ,secret>y %all review ea* ,vet]ans ,c>e ,agreem5t ( mat]ial size t has be5 9 effect = at lea/ six mon?s )9 ! fir/ two ye>s ( its tak+ effect1 & n less frequ5tly ?an once e f\r ye>s !reaft]4 7ii7 ,if a ,vet]ans ,c>e ,agreem5t has n be5 9 effect = at lea/ six mon?s by ! date ( ! review requir$ by subp>agraph 7,a71 ! agreem5t %all be review$ dur+ ! next cycle requir$ by subp>agraph 7,a71 & su* review %all s]ve z its review )9 ! fir/ two ye>s ( its tak+ effect = purposes ( clause 7i74 7#c7 7,a7 ,9 fiscal ye> #bjah & 9 ea* fiscal ye> !reaft]1 9 addition to su* o!r ,vet]ans ,c>e ,agreem5ts z ! ,secret>y may det]m9e are ( mat]ial size1 a ,vet]ans ,c>e ,agreem5t = ! pur*ase ( ext5d$ c>e s]vices t exce$s #e1jjj1jjj annually %all be consid]$ ( mat]ial size4 7,b7 ,f "t to "t1 ! ,secret>y may publi% a notice 9 ! ,f$]al ,regi/] to adju/ ! doll> am\nt specifi$ 9 subp>agraph 7,a7 to acc\nt = *anges 9 ! co/ ( heal? c>e bas$ ^u recogniz$ heal? c>e m>ket surveys & o!r available data4 7b7 ,eligible entities & provid]s ,= purposes ( ?is section1 an eligible entity or provid] is-- 7#a7 any provid] ( s]vices t has enroll$ & ent]$ into a provid] agreem5t "u section #ahff7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77 & any physician or o!r suppli] :o has enroll$ & ent]$ into a p>ticipation agreem5t "u section #ahdb7;h7 ( su* ,act 7#db ,u4,s4,c4 #acieu7h772 7#b7 any provid] p>ticipat+ "u a ,/ate plan "u title ,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et seq472 or 7#c7 any entity or provid] n describ$ 9 p>agraph 7#a7 or 7#b7 ( ?is subsection t ! ,secret>y det]m9es to be eligible pursuant to ! c]tification process describ$ 9 subsection 7c74 7c7 ,eligible entity or provid] c]tification process ,! ,secret>y %all e/abli% by regulation a process = ! c]tification ( eligible entities or provid]s or rec]tification ( eligible entities or provid]s "u ?is section4 ,su* a process %all1 at a m9imum-- 7#a7 e/abli% deadl9es = actions on applications = c]tification2 7#b7 set =? /&>ds = an approval or d5ial ( c]tification1 duration ( c]tification1 revocation ( an eligible entity or provid]'s c]tification1 & rec]tification ( eligible entities or provid]s2 7#c7 require ! d5ial ( c]tification if ! ,secret>y det]m9es ! eligible entity or provid] is exclud$ f p>ticipation 9 a ,f$]al heal? c>e program "u section #aabh or section #aabh;,a ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g or #acbj;a-#g;a7 or is curr5tly id5tifi$ z an exclud$ s\rce on ! ,sy/em = ,aw>d ,managem5t ,exclusions li/ describ$ 9 "p #i ( title #dh1 ,code ( ,f$]al ,regulations1 & "p #ahj ( title #b ( su* ,code1 or successor regulations2 7#d7 e/abli% proc$ures = scre5+ eligible entities or provid]s accord+ to ! risk ( fraud1 wa/e1 & abuse t are simil> to ! /&>ds "u section #ahff7;j77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7j77#b77;,b77 & section #i4ajd ( title #dh1 ,code ( ,f$]al ,regulations1 or successor regulations2 & 7#e7 incorporate & apply ! re/rictions & p5alties set =? 9 *apt] #ba ( title #da & treat ?is section z a procurem5t program only = purposes ( apply+ su* provisions4 7d7 ,rates ,to ! ext5t practicable1 ! rates paid by ! ,secret>y = hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices provid$ "u a ,vet]ans ,c>e ,agreem5t %all be 9 accordance ) ! rates paid by ! ,unit$ ,/ates "u ! ,m$ic>e program4 7e7 ,t]ms ( ,vet]ans ,c>e ,agreem5ts 7#a7 ,pursuant to regulations promulgat$ "u subsection 7k71 ! ,secret>y may def9e ! requirem5ts = provid]s & entities ent]+ into agreem5ts "u ?is section bas$ ^u su* factors z ! numb] ( pati5ts receiv+ c>e or s]vices1 ! numb] ( employees employ$ by ! entity or provid] furni%+ su* c>e or s]vices1 ! am\nt paid by ! ,secret>y to ! provid] or entity1 or o!r factors z det]m9$ by ! ,secret>y4 7#b7 ,to furni% hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices "u ?is section1 an eligible entity or provid] %all agree-- 7,a7 to accept paym5t at ! rates e/abli%$ 9 regulations prescrib$ "u ?is section2 7,b7 t paym5t by ! ,secret>y "u ?is section on behalf ( a vet]an to a provid] ( s]vices or c>e %all1 unless reject$ & refund$ by ! provid] )9 #cj days ( receipt1 con/itute paym5t 9 full & ext+ui% any liability on ! "p ( ! vet]an = ! treatm5t or c>e provid$1 & no provision ( a contract1 agreem5t1 or assignm5t to ! contr>y %all op]ate to modify1 limit1 or negate ?is requirem5t2 7,c7 to provide only ! c>e & s]vices au?oriz$ by ! ,dep>tm5t "u ?is section & to obta9 ! prior writt5 cons5t ( ! ,dep>tm5t to furni% c>e or s]vices outside ! scope ( su* au?orization2 7,d7 to bill ! ,dep>tm5t 9 accordance ) ! me?odology outl9$ 9 regulations prescrib$ "u ?is section2 7,e7 to n seek to recov] or collect f a heal? plan contract or ?ird p>ty1 z ^? t]ms are def9$ 9 section #agbi ( ?is title1 = any c>e or s]vice t is furni%$ or paid = by ! ,dep>tm5t2 7,f7 to provide m$ical records to ! ,dep>tm5t 9 ! "t frame & =mat specifi$ by ! ,dep>tm5t2 & 7,g7 to meet su* o!r t]ms & conditions1 includ+ quality ( c>e assurance /&>ds1 z ! ,secret>y may specify 9 regulation4 7f7 ,discont9uation or nonr5ewal ( a ,vet]ans ,c>e ,agreem5t 7#a7 ,an eligible entity or provid] may discont9ue a ,vet]ans ,c>e ,agreem5t at su* "t & ^u su* notice to ! ,secret>y z may be provid$ 9 regulations prescrib$ "u ?is section4 7#b7 ,! ,secret>y may discont9ue a ,vet]ans ,c>e ,agreem5t ) an eligible entity or provid] at su* "t & ^u su* reasonable notice to ! eligible entity or provid] z may be specifi$ 9 regulations prescrib$ "u ?is section1 if an (ficial designat$ by ! ,secret>y-- 7,a7 has det]m9$ t ! eligible entity or provid] fail$ to comply sub/antially ) ! provisions ( ! ,vet]ans ,c>e ,agreem5t1 or ) ! provisions ( ?is section or regulations prescrib$ "u ?is section2 7,b7 has det]m9$ ! eligible entity or provid] is exclud$ f p>ticipation 9 a ,f$]al heal? c>e program "u section #aabh or section #aabh;,a ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g or #acbj;a-#g;a7 or is id5tifi$ on ! ,sy/em = ,aw>d ,managem5t ,exclusions li/ z provid$ 9 "p #i ( title #dh1 ,code ( ,f$]al ,regulations1 & "p #ahj ( title #b ( su* ,code1 or successor regulations2 7,c7 has asc]ta9$ t ! eligible entity or provid] has be5 convict$ ( a felony or o!r s]i\s (f5se "u ,f$]al or ,/ate law & det]m9es ! eligible entity or provid]'s cont9u$ p>ticipation w\ld be detrim5tal to ! be/ int]e/s ( vet]ans or ! ,dep>tm5t2 or 7,d7 has det]m9$ t x is reasonable to t]m9ate ! agreem5t bas$ on ! heal? c>e ne$s ( a vet]an4 7g7 ,quality ( c>e ,! ,secret>y %all e/abli% ?r\gh regulation a sy/em or sy/ems = monitor+ ! quality ( c>e provid$ to vet]ans ?r\gh ,vet]ans ,c>e ,agreem5ts & = assess+ ! quality ( hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices furni%$ by eligible entities & provid]s be=e ! r5ewal ( ,vet]ans ,c>e ,agreem5ts4 7h7 ,disputes 7#a7 ,! ,secret>y %all promulgate adm9i/rative proc$ures = eligible entities & provid]s to pres5t all disputes aris+ "u or relat$ to ,vet]ans ,c>e ,agreem5ts4 7#b7 ,su* proc$ures con/itute ! eligible entities' & provid]s' exhau/ive & exclusive adm9i/rative rem$ies4 7#c7 ,eligible entities or provid]s mu/ fir/ exhau/ su* adm9i/rative proc$ures be=e seek+ any judicial review "u section #acdf ( title #bh 7kn[n z ! ,tuck] ,act74 7#d7 ,disputes "u ?is section mu/ p]ta9 to ei!r ! scope ( au?orization "u ! ,vet]ans ,c>e ,agreem5t or claims = paym5t subject to ! ,vet]ans ,c>e ,agreem5t & are n claims = ! purposes ( su* laws t w\ld o!rwise require application ( sections #gaja ?r\gh #gaji ( title #da1 ,unit$ ,/ates ,code4 7i7 ,applicability ( o!r provisions ( law 7#a7 ,a ,vet]ans ,c>e ,agreem5t may be au?oriz$ by ! ,secret>y or any ,dep>tm5t (ficial au?oriz$ by ! ,secret>y1 & su* action %all n be treat$ z-- 7,a7 an aw>d = ! purposes ( su* laws t w\ld o!rwise require ! use ( competitive proc$ures = ! furni%+ ( c>e & s]vices2 or 7,b7 a ,f$]al contract = ! acquisition ( goods or s]vices = purposes ( any provision ( ,f$]al law gov]n+ ,f$]al contracts = ! acquisition ( goods or s]vices4 7#b7 7,a7 ,except z provid$ 9 subp>agraph 7,b71 & unless o!rwise provid$ 9 ?is section or regulations prescrib$ pursuant to ?is section1 an eligible entity or provid] t ent]s into an agreem5t "u ?is section is n subject to1 9 ! c>ry+ out ( ! agreem5t1 any law to :i* provid]s ( s]vices & suppli]s "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 are n subject4 7,b7 ,an eligible entity or provid] t ent]s into an agreem5t "u ?is section is subject to-- 7i7 all laws reg>d+ integrity1 e?ics1 or fraud1 or t subject a p]son to civil or crim9al p5alties2 & 7ii7 all laws t protect aga9/ employm5t discrim9ation or t o!rwise ensure equal employm5t opportunities4 7#c7 ,not)/&+ p>agraph 7#b77;,b77i71 an eligible entity or provid] t ent]s into an agreem5t "u ?is section %all n be treat$ z a ,f$]al contractor or subcontractor = purposes ( *apt] #fg ( title #da 7commonly kn[n z ! ,mc,namara-,o',h>a ,s]vice ,contract ,act ( #aife74 7j7 ,p>ity ( treatm5t ,eligibility = hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices furni%$ to any vet]an pursuant to a ,vet]ans ,c>e ,agreem5t %all be subject to ! same t]ms z ?\gh provid$ 9 a facility ( ! ,dep>tm5t1 & provisions ( ?is *apt] applicable to vet]ans receiv+ su* c>e & s]vices 9 a facility ( ! ,dep>tm5t %all apply to vet]ans treat$ "u ?is section4 7k7 ,rulemak+ ,! ,secret>y %all promulgate regulations to c>ry out ?is section4 4 7b7 ,cl]ical ,am5dm5t ,! table ( sections at ! beg9n+ ( su* *apt] is am5d$ by ins]t+ aft] ! item relat$ to section #agjc ! foll[+ new item3 #agjc;,a4 ,agreem5ts ) eligible entities or provid]s2 c]tification processes4 4 #ajc4 ,con=m+ am5dm5ts = ,/ate vet]ans homes 7a7 ,9 g5]al ,section #agde7;a7 is am5d$-- 7#a7 9 p>agraph 7#a71 by /rik+ 7or agreem5t "u section #agbj7;c77#a7 ( ?is title7 & ins]t+ 7or an agreem5t72 & 7#b7 by add+ at ! end ! foll[+ new p>agraph3 7#d7 7,a7 ,an agreem5t "u ?is section may be au?oriz$ by ! ,secret>y or any ,dep>tm5t (ficial au?oriz$ by ! ,secret>y1 & any su* action is n an aw>d = purposes ( su* laws t w\ld o!rwise require ! use ( competitive proc$ures = ! furni%+ ( hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices4 7,b7 7i7 ,except z provid$ 9 clause 7ii71 & unless o!rwise provid$ 9 ?is section or regulations prescrib$ pursuant to ?is section1 a ,/ate home t ent]s into an agreem5t "u ?is section is n subject to1 9 ! c>ry+ out ( ! agreem5t1 any provision ( law to :i* provid]s ( s]vices & suppli]s "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 are n subject4 7ii7 ,a ,/ate home t ent]s into an agreem5t "u ?is section is subject to-- 7,i7 all provisions ( law reg>d+ integrity1 e?ics1 or fraud1 or t subject a p]son to civil or crim9al p5alties2 & 7,,ii7 all provisions ( law t protect aga9/ employm5t discrim9ation or t o!rwise ensure equal employm5t opportunities4 7iii7 ,not)/&+ subp>agraph 7,b77ii77,i71 a ,/ate home t ent]s into an agreem5t "u ?is section may n be treat$ z a ,f$]al contractor or subcontractor = purposes ( *apt] #fg ( title #da 7kn[n z ! ,mc,namara-,o',h>a ,s]vice ,contract ,act ( #aife74 4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all apply to c>e provid$ on or aft] ! effective date ( regulations issu$ by ! ,secret>y ( ,vet]ans ,affairs to c>ry out ?is section4 #ajd4 ,access guidel9es & /&>ds = quality 7a7 ,9 g5]al ,sub*apt] ,i ( *apt] #ag1 z am5d$ by section #ajb1 is fur!r am5d$ by ins]t+ aft] section #agjc;,a ! foll[+ new sections3 #agjc;,b4 ,access guidel9es ,! ,secret>y %all consult ) all p]t95t ,f$]al entities to exam9e heal? c>e access measurem5ts & e/abli% localiz$ b5*m>k+ guidel9es t c in=m provid] & vet]an cl9ical decisionmak+4 ,! ,secret>y %all e/abli% su* guidel9es = all hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices furni%$ or o!rwise made available "u laws adm9i/]$ by ! ,secret>y1 includ+ ?r\gh non-,dep>tm5t heal? c>e provid]s4 #agjc;,c4 ,/&>ds = quality 7a7 ,9 g5]al 7#a7 ,! ,secret>y %all e/abli% /&>ds = quality1 9 coord9ation or consultation ) entities pursuant to section #agjc7;h77#c7 ( ?is title1 reg>d+ hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices furni%$ by ! ,dep>tm5t pursuant to ?is title1 includ+ ?r\gh non-,dep>tm5t heal? c>e provid]s pursuant to section #agjc ( ?is title4 7#b7 ,9 e/abli%+ /&>ds = quality "u p>agraph 7#a71 ! ,secret>y %all consid] exi/+ heal? quality measures t are appli$ to public & privately sponsor$ heal? c>e sy/ems ) ! purpose ( provid+ cov]$ vet]ans relevant comp>ative in=mation to make in=m$ decisions reg>d+ _! heal? c>e4 7#c7 ,! ,secret>y %all collect & consid] data = purposes ( e/abli%+ ! /&>ds "u p>agraph 7#a74 ,su* data collection %all include-- 7,a7 aft] consultation ) vet]ans s]vice organizations & o!r key /akehold]s on survey developm5t or modification ( an exi/+ survey1 a survey ( vet]ans :o h us$ hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices furni%$ by ! ,vet]ans ,heal? ,adm9i/ration dur+ ! mo/ rec5t two-ye> p]iod to assess ! satisfaction ( ! vet]ans ) s]vice & quality ( c>e2 & 7,b7 datasets t include1 at a m9imum1 elem5ts relat+ to ! foll[+3 7i7 ,timely c>e4 7ii7 ,effective c>e4 7iii7 ,safety1 includ+1 at a m9imum1 complications1 readmissions1 & dea?s4 7iv7 ,effici5cy4 7b7 ,publication & consid]ation ( public comm5ts 7#a7 ,n lat] ?an "o ye> aft] ! date on :i* ! ,secret>y e/abli%es /&>ds = quality "u subsection 7a71 ! ,secret>y %all publi% ! quality rat+ ( m$ical facilities ( ! ,dep>tm5t 9 ! publicly available ,hospital ,comp>e website ?r\gh ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices = ! purpose ( provid+ vet]ans ) in=mation t all[s !m to comp>e p]=mance measure in=mation among ,dep>tm5t & non-,dep>tm5t heal? c>e provid]s4 7#b7 ,n lat] ?an two ye>s aft] ! date on :i* ! ,secret>y e/abli%es /&>ds = quality "u subsection 7a71 ! ,secret>y %all consid] & solicit public comm5t on pot5tial *anges to ! measures us$ 9 su* /&>ds to ensure t !y include ! mo/ up-to-date & applicable indu/ry measures = vet]ans4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #ag1 z am5d$ by section #ajb1 is fur!r am5d$ by ins]t+ aft] ! item relat+ to section #agjc;,a ! foll[+ new items3 #agjc;,b4 ,access guidel9es4#agjc;,c4 ,/&>ds = quality4 4 #aje4 ,access to walk-9 c>e 7a7 ,9 g5]al ,*apt] #ag is am5d$ by ins]t+ aft] section #agbe ! foll[+ new section3 #agbe;,a4 ,access to walk-9 c>e 7a7 ,proc$ures ,to ensure access to walk-9 c>e ,! ,secret>y %all develop proc$ures to ensure t eligible vet]ans are able to access walk-9 c>e f qualify+ non-,dep>tm5t entities or provid]s4 7b7 ,eligible vet]ans ,= purposes ( ?is section1 an eligible vet]an is any individual :o-- 7#a7 is enroll$ 9 ! heal? c>e sy/em e/abli%$ "u section #agje7;a7 ( ?is title2 & 7#b7 has receiv$ c>e "u ?is *apt] )9 ! #bd-mon? p]iod prec$+ ! furni%+ ( walk-9 c>e "u ?is section4 7c7 ,qualify+ non-,dep>tm5t entities or provid]s ,= purposes ( ?is section1 a qualify+ non-,dep>tm5t entity or provid] is a non-,dep>tm5t entity or provid] t has ent]$ into a contract or o!r agreem5t ) ! ,secret>y to furni% s]vices "u ?is section4 7d7 ,f$]ally-qualifi$ heal? c5t]s ,:5ev] practicable1 ! ,secret>y may use a ,f$]ally-qualifi$ heal? c5t] 7z def9$ 9 section #aije7l77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b777 to c>ry out ?is section4 7e7 ,cont9uity ( c>e ,! ,secret>y %all ensure cont9uity ( c>e = ^? vet]ans :o receive walk-9 c>e s]vices "u ?is section1 includ+ ?r\gh ! e/abli%m5t ( a me*anism to receive m$ical records f walk-9 c>e provid]s & provide p]t95t pati5t m$ical records to provid]s ( walk-9 c>e4 7f7 ,copaym5ts 7#a7 7,a7 ,! ,secret>y %all require all eligible vet]ans to pay ! ,unit$ ,/ates a copaym5t = ea* episode ( hospital c>e & m$ical s]vice provid$ "u ?is section if o!rwise requir$ to pay a copaym5t "u ?is title4 7,b7 ,^? n requir$ to pay a copaym5t "u ?is title may access walk-9 c>e )\t a copaym5t = ! fir/ two visits 9 a cal5d> ye>4 ,= any additional visits1 a copaym5t at an am\nt det]m9$ by ! ,secret>y %all be paid4 7,c7 ,= ^? vet]ans requir$ to pay a copaym5t "u title #ch1 !y are requir$ to pay _! regul> copaym5t = _! fir/ two walk-9 c>e visits 9 a cal5d> ye>4 ,= any additional visits1 a high] copaym5t at an am\nt det]m9$ by ! ,secret>y %all be paid4 7#b7 ,aft] ! fir/ two episodes ( c>e furni%$ to a vet]an "u ?is section1 ! ,secret>y may adju/ ! copaym5t requir$ ( ! vet]an "u ?is subsection bas$ ^u ! priority gr\p ( enrollm5t ( ! vet]an1 ! numb] ( episodes ( c>e furni%$ to ! vet]an dur+ a ye>1 & o!r factors ! ,secret>y consid]s appropriate "u ?is section4 7#c7 ,! am\nt or am\nts ( ! copaym5ts requir$ "u ?is subsection %all be prescrib$ by ! ,secret>y by rule4 7#d7 ,section #haec7;c7 ( ?is title %all n apply to ?is subsection4 7g7 ,regulations ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ! ,c>+ = our ,vet]ans ,act ( #bjag1 ! ,secret>y %all promulgate regulations to c>ry out ?is section4 7h7 ,walk-9 c>e def9$ ,9 ?is section1 ! t]m walk-9 c>e means non-em]g5t c>e provid$ by a qualify+ non-,dep>tm5t entity or provid] t furni%es episodic c>e & n longitud9al managem5t ( conditions & is o!rwise def9$ ?r\gh regulations ! ,secret>y %all promulgate4 4 7b7 ,effective date ,section #agbe;,a ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a7 %all take effect on ! date ^u :i* f9al regulations implem5t+ su* section take effect4 7c7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( su* *apt] is am5d$ by ins]t+ aft] ! item relat$ to section #agbe ! foll[+ new item3 #agbe;,a4 ,access to walk-9 c>e4 4 #ajf4 ,/rategy reg>d+ ! ,dep>tm5t ( ,vet]ans ,affairs ,high-,p]=m+ ,integrat$ ,heal? ,c>e ,network 7a7 ,m>ket area assessm5ts 7#a7 ,9 g5]al ,n less frequ5tly ?an e f\r ye>s1 ! ,secret>y ( ,vet]ans ,affairs %all p]=m m>ket area assessm5ts reg>d+ ! heal? c>e s]vices furni%$ "u ! laws adm9i/]$ by ! ,secret>y4 7#b7 ,elem5ts ,ea* m>ket area assessm5t e/abli%$ "u p>agraph 7#a7 %all include ! foll[+3 7,a7 ,an assessm5t ( ! dem& = heal? c>e f ! ,dep>tm5t1 disaggregat$ by geographic m>ket areas z det]m9$ by ! ,secret>y1 includ+ ! numb] ( reque/s = heal? c>e s]vices "u ! laws adm9i/]$ by ! ,secret>y4 7,b7 ,an inv5tory ( ! heal? c>e capacity ( ! ,dep>tm5t ( ,vet]ans ,affairs across ! ,dep>tm5t's sy/em ( facilities4 7,c7 ,an assessm5t ( ! heal? c>e capacity to be provid$ ?r\gh contract$ community c>e provid]s & provid]s :o ent]$ into a provid] agreem5t ) ! ,dep>tm5t "u section #agjc;,a ( title #ch1 ,unit$ ,/ates ,code1 z add$ by section #ajb7;a71 includ+ ! numb] ( provid]s1 ! geographic location ( ! provid]s1 & categories or types ( heal? c>e s]vices provid$ by ! provid]s4 7,d7 ,an assessm5t obta9$ f o!r ,f$]al direct deliv]y sy/ems ( _! capacity to provide heal? c>e to vet]ans4 7,e7 ,an assessm5t ( ! heal? c>e capacity ( non-contract$ provid]s :]e !re is insuffici5t network supply4 7,f7 ,an assessm5t ( ! heal? c>e capacity ( academic affiliates & o!r collaborations ( ! ,dep>tm5t z x relates to provid+ heal? c>e to vet]ans4 7,g7 ,an assessm5t ( ! effects on heal? c>e capacity by ! access guidel9es & /&>ds = quality e/abli%$ "u section #agjc7;h7 ( title #ch1 ,unit$ ,/ates ,code1 z am5d$ by section #aja7;a77#a74 7,h7 ,! numb] ( appo9tm5ts = heal? c>e s]vices "u ! laws adm9i/]$ by ! ,secret>y1 disaggregat$ by-- 7i7 appo9tm5ts at facilities ( ! ,dep>tm5t ( ,vet]ans ,affairs2 & 7ii7 appo9tm5ts ) non-,dep>tm5t heal? c>e provid]s4 7#c7 ,submittal to ,congress ,! ,secret>y %all submit to ! appropriate committees ( ,congress ! m>ket area assessm5ts e/abli%$ 9 p>agraph 7#a74 7#d7 ,use ( m>ket area assessm5ts = integrat$ heal? c>e deliv]y 7,a7 ,9 g5]al ,! ,secret>y %all use ! m>ket area assessm5ts e/abli%$ "u p>agraph 7#a7 9 det]m9+ ! capacity ( ! heal? c>e provid] networks e/abli%$ "u section #agjc7;j7 ( title #ch1 ,unit$ ,/ates ,code1 z am5d$ by section #aja7;a77#a74 7,b7 ,budget ,! ,secret>y %all ensure t ! ,dep>tm5t budget = any fiscal ye> 7z submitt$ ) ! budget ( ! ,presid5t "u section #aaje7;a7 ( title #ca1 ,unit$ ,/ates ,code7 reflects ! f9d+s ( ! ,secret>y ) respect to ! mo/ rec5t m>ket area assessm5ts "u p>agraph 7#a74 7#e7 ,effective date ,! am5dm5ts made by subsection 7a7 %all take effect on ,septemb] #cj1 #bjah4 7b7 ,/rategic plan ,to meet heal? c>e dem& 7#a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act & n less frequ5tly ?an once e f\r ye>s !reaft]1 ! ,secret>y %all submit to ! appropriate committees ( ,congress a /rategic plan t specifies a f\r-ye> =eca/ (-- 7,a7 ! dem& = heal? c>e f ! ,dep>tm5t1 disaggregat$ by geographic area z det]m9$ by ! ,secret>y2 7,b7 ! heal? c>e capacity to be provid$ at ea* m$ical c5t] ( ! ,dep>tm5t2 & 7,c7 ! heal? c>e capacity to be provid$ ?r\gh community c>e provid]s4 7#b7 ,elem5ts ,9 prep>+ ! /rategic plan "u p>agraph 7#a71 ! ,secret>y %all-- 7,a7 consid] ! access guidel9es & /&>ds = quality e/abli%$ "u section #agjc7;h7 ( title #ch1 ,unit$ ,/ates ,code1 z am5d$ by section #aja7;a77#a72 7,b7 consid] ! m>ket area assessm5ts e/abli%$ "u subsection 7a72 7,c7 consid] ! ne$s ( ! ,dep>tm5t bas$ on id5tifi$ s]vices t provide managem5t ( conditions or disord]s relat$ to milit>y s]vice = :i* !re is limit$ exp]i5ce or access 9 ! national m>ket1 ! ov]all heal? ( vet]ans ?r\gh\t _! lifespan1 or o!r s]vices z ! ,secret>y det]m9es appropriate2 7,d7 consult ) key /akehold]s )9 ! ,dep>tm5t1 ! heads ( o!r ,f$]al ag5cies1 & o!r relevant gov]nm5tal & nongov]nm5tal entities1 includ+ ,/ate1 local1 & tribal gov]nm5t (ficials1 memb]s ( ,congress1 vet]ans s]vice organizations1 private sector repres5tatives1 academics1 & o!r policy exp]ts2 7,e7 id5tify em]g+ issues1 tr5ds1 problems1 & opportunities t c\ld affect heal? c>e s]vices furni%$ "u ! laws adm9i/]$ by ! ,secret>y2 7,f7 develop recomm5dations reg>d+ bo? %ort- & long-t]m priorities = heal? c>e s]vices furni%$ "u ! laws adm9i/]$ by ! ,secret>y2 7,g7 aft] consultation ) vet]ans s]vice organizations & o!r key /akehold]s on survey developm5t or modification ( an exi/+ survey1 consid] a survey ( vet]ans :o h us$ hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices furni%$ by ! ,vet]ans ,heal? ,adm9i/ration dur+ ! mo/ rec5t two-ye> p]iod to assess ! satisfaction ( ! vet]ans ) s]vice & quality ( c>e2 & 7,h7 consid] su* o!r matt]s z ! ,secret>y consid]s appropriate4 7c7 ,appropriate committees ( congress def9$ ,9 ?is section1 ! t]m appropriate committees ( ,congress means-- 7#a7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,s5ate2 & 7#b7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives4 #ajg4 ,applicability ( ,directive ( ,(fice ( ,f$]al ,contract ,compliance ,programs 7a7 ,9 g5]al ,not)/&+ ! treatm5t ( c]ta9 laws "u subsection 7i7 ( section #agjc;,a ( title #ch1 ,unit$ ,/ates ,code1 z add$ by section #ajb ( ?is ,act1 ,directive #bjad-ja ( ! ,(fice ( ,f$]al ,contract ,compliance ,programs ( ! ,dep>tm5t ( ,labor 7effective z ( ,may #g1 #bjad7 %all apply to any entity ent]+ into an agreem5t "u su* section #agjc;,a or section #agde ( su* title1 z am5d$ by section #ajc1 9 ! same mann] z su* directive applies to subcontractors "u ! ,,tric>e program = ! duration ( ! moratorium provid$ "u su* directive4 7b7 ,applicability p]iod ,! directive describ$ 9 subsection 7a71 & ! moratorium provid$ "u su* directive1 %all n be alt]$ or resc9d$ be=e ,may #g1 #bjai4 7c7 ,,tric>e program def9$ ,9 ?is section1 ! t]m ,,tric>e program has ! mean+ giv5 t t]m 9 section #ajgb ( title #aj1 ,unit$ ,/ates ,code4 #ajh4 ,prev5tion ( c]ta9 heal? c>e provid]s f provid+ non-,dep>tm5t heal? c>e s]vices to vet]ans 7a7 ,9 g5]al ,on & aft] ! date t is "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all d5y or revoke ! eligibility ( a heal? c>e provid] to provide non-,dep>tm5t heal? c>e s]vices to vet]ans if ! ,secret>y det]m9es t ! heal? c>e provid]-- 7#a7 0 remov$ f employm5t ) ! ,dep>tm5t ( ,vet]ans ,affairs due to conduct t violat$ a policy ( ! ,dep>tm5t relat+ to ! deliv]y ( safe & appropriate heal? c>e2 or 7#b7 violat$ ! requirem5ts ( a m$ical lic5se ( ! heal? c>e provid] t result$ 9 ! loss ( su* m$ical lic5se4 7b7 ,p]missive action ,on & aft] ! date t is "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y may d5y1 revoke1 or susp5d ! eligibility ( a heal? c>e provid] to provide non-,dep>tm5t heal? c>e s]vices if ! ,secret>y det]m9es su* action is necess>y to imm$iately protect ! heal?1 safety1 or welf>e ( vet]ans & ! heal? c>e provid] is "u inve/igation by ! m$ical lic5s+ bo>d ( a ,/ate 9 :i* ! heal? c>e provid] is lic5s$ or practices4 7c7 ,susp5sion ,! ,secret>y %all susp5d ! eligibility ( a heal? c>e provid] to provide non-,dep>tm5t heal? c>e s]vices to vet]ans if ! heal? c>e provid] is susp5d$ f s]v+ z a heal? c>e provid] ( ! ,dep>tm5t4 7d7 ,comptroll] ,g5]al report ,n lat] ?an two ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress a report on ! implem5tation by ! ,secret>y ( ?is section1 includ+ ! foll[+3 7#a7 ,! aggregate numb] ( heal? c>e provid]s d5i$ or susp5d$ "u ?is section f p>ticipation 9 provid+ non-,dep>tm5t heal? c>e s]vices4 7#b7 ,an evaluation ( any impact on access to heal? c>e = pati5ts or /aff+ %ortages 9 programs ( ! ,dep>tm5t provid+ non-,dep>tm5t heal? c>e s]vices4 7#c7 ,an explanation ( ! coord9ation ( ! ,dep>tm5t ) ! m$ical lic5s+ bo>ds ( ,/ates 9 implem5t+ ?is section1 ! am\nt ( involvem5t ( su* bo>ds 9 su* implem5tation1 & ef=ts by ! ,dep>tm5t to address any conc]ns rais$ by su* bo>ds ) respect to su* implem5tation4 7#d7 ,su* recomm5dations z ! ,comptroll] ,g5]al consid]s appropriate reg>d+ h>moniz+ eligibility crit]ia betwe5 heal? c>e provid]s ( ! ,dep>tm5t & heal? c>e provid]s eligible to provide non-,dep>tm5t heal? c>e s]vices4 7e7 ,non-,dep>tm5t heal? c>e s]vices def9$ ,9 ?is section1 ! t]m non-,dep>tm5t heal? c>e s]vices means s]vices-- 7#a7 provid$ "u sub*apt] ,i ( *apt] #ag ( title #ch1 ,unit$ ,/ates ,code1 at non-,dep>tm5t facilities 7z def9$ 9 section #agja ( su* title72 7#b7 provid$ "u section #aja ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note72 7#c7 pur*as$ ?r\gh ! ,m$ical ,community ,c>e acc\nt ( ! ,dep>tm5t2 or 7#d7 pur*as$ ) am\nts deposit$ 9 ! ,vet]ans ,*oice ,fund "u section #hjb ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad4 ,b ,pay+ provid]s & improv+ collections #aaa4 ,prompt paym5t to provid]s 7a7 ,9 g5]al ,sub*apt] ,i ( *apt] #ag is am5d$ by ins]t+ aft] section #agjc;,c1 z add$ by section #ajd ( ?is ,act1 ! foll[+ new section3 #agjc;,d4 ,prompt paym5t /&>d 7a7 ,9 g5]al 7#a7 ,not)/&+ any o!r provision ( ?is title or ( any o!r provision ( law1 ! ,secret>y %all pay = hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices furni%$ by heal? c>e entities or provid]s "u ?is *apt] )9 #de cal5d> days ^u receipt ( a clean pap] claim or #cj cal5d> days ^u receipt ( a clean electronic claim4 7#b7 ,if a claim is d5i$1 ! ,secret>y %all1 )9 #de cal5d> days ( d5ial = a pap] claim & #cj cal5d> days ( d5ial = an electronic claim1 notify ! heal? c>e entity or provid] ( ! reason = d5y+ ! claim & :at1 if any1 additional in=mation is requir$ to process ! claim4 7#c7 ,^u ! receipt ( ! additional in=mation1 ! ,secret>y %all ensure t ! claim is paid1 d5i$1 or o!rwise adjudicat$ )9 #cj cal5d> days f ! receipt ( ! reque/$ in=mation4 7#d7 ,?is section %all only apply to paym5ts made on an invoice basis & %all n apply to capitation or o!r =ms ( p]iodic paym5t to entities or provid]s4 7b7 ,submittal ( claims by heal? c>e entities & provid]s ,a heal? c>e entity or provid] t furni%es hospital c>e1 a m$ical s]vice1 or an ext5d$ c>e s]vice "u ?is *apt] %all submit to ! ,secret>y a claim = paym5t = furni%+ ! hospital c>e1 m$ical s]vice1 or ext5d$ c>e s]vice n lat] ?an #ahj days aft] ! date on :i* ! entity or provid] furni%$ ! hospital c>e1 m$ical s]vice1 or ext5d$ c>e s]vice4 7c7 ,fraudul5t claims 7#a7 ,sections #cgbi ?r\gh #cgcc ( title #ca %all apply to fraudul5t claims = paym5t submitt$ to ! ,secret>y by a heal? c>e entity or provid] "u ?is *apt]4 7#b7 ,pursuant to regulations prescrib$ by ! ,secret>y1 ! ,secret>y %all b> a heal? c>e entity or provid] f furni%+ hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices "u ?is *apt] :5 ! ,secret>y det]m9es ! entity or provid] has submitt$ to ! ,secret>y fraudul5t heal? c>e claims = paym5t by ! ,secret>y4 7d7 ,ov]due claims 7#a7 ,any claim t has n be5 d5i$ ) notice1 made p5d+ ) notice1 or paid to ! heal? c>e entity or provid] by ! ,secret>y %all be ov]due if ! notice or paym5t is n receiv$ by ! entity provid] )9 ! "t p]iods specifi$ 9 subsection 7a74 7#b7 7,a7 ,if a claim is ov]due "u ?is subsection1 ! ,secret>y may1 "u ! requirem5ts e/abli%$ by subsection 7a7 & consi/5t ) ! provisions ( *apt] #ci ( title #ca 7commonly ref]r$ to z ! ,prompt ,paym5t ,act71 require t int]e/ be paid on clean claims4 7,b7 ,int]e/ paid "u subp>agraph 7,a7 %all be comput$ at ! rate ( int]e/ e/abli%$ by ! ,secret>y ( ! ,treasury "u section #cijb ( title #ca & publi%$ 9 ! ,f$]al ,regi/]4 7#c7 ,n less frequ5tly ?an annually1 ! ,secret>y %all submit to ,congress a report on paym5t ( ov]due claims "u ?is subsection1 disaggregat$ by pap] & electronic claims1 t includes ! foll[+3 7,a7 ,! am\nt paid 9 ov]due claims describ$ 9 ?is subsection1 disaggregat$ by ! am\nt ( ! ov]due claim & ! am\nt ( int]e/ paid on su* ov]due claim4 7,b7 ,! numb] ( su* ov]due claims & ! av]age numb] ( days late ea* claim 0 paid1 disaggregat$ by facility ( ! ,dep>tm5t & ,vet]ans ,integrat$ ,s]vice ,network region4 7e7 ,ov]paym5t 7#a7 ,! ,secret>y %all d$uct ! am\nt ( any ov]paym5t f paym5ts due a heal? c>e entity or provid] "u ?is *apt]4 7#b7 ,d$uctions may n be made "u ?is subsection unless ! ,secret>y has made reasonable ef=ts to notify a heal? c>e entity or provid] ( ! "r to dispute ! exi/5ce or am\nt ( su* indebt$ness & ! "r to reque/ a compromise ( su* indebt$ness4 7#c7 ,! ,secret>y %all make a det]m9ation ) respect to any su* dispute or reque/ prior to d$uct+ any ov]paym5t unless ! "t requir$ to make su* a det]m9ation be=e mak+ any d$uctions w\ld jeop>dize ! ,secret>y's ability to recov] ! full am\nt ( su* indebt$ness4 7f7 ,in=mation & docum5tation requir$ 7#a7 ,! ,secret>y %all provide to all heal? c>e entities & provid]s p>ticipat+ 9 a program to furni% hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices "u ?is *apt] a li/ ( in=mation & docum5tation t is requir$ to e/abli% a clean claim "u ?is section4 7#b7 ,! ,secret>y %all consult ) entities 9 ! heal? c>e indu/ry1 9 ! public & private sector1 to det]m9e ! in=mation & docum5tation to include 9 ! li/ "u p>agraph 7#a74 7#c7 ,if ! ,secret>y modifies ! in=mation & docum5tation includ$ 9 ! li/ "u p>agraph 7#a71 ! ,secret>y %all notify all heal? c>e entities & provid]s describ$ 9 p>agraph 7#a7 n lat] ?an #cj days be=e su* modifications take effect4 7g7 ,process+ ( claims ,9 process+ a claim = comp5sation = hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices furni%$ by a heal? c>e entity or provid] "u ?is *apt]1 ! ,secret>y %all act ?r\gh-- 7#a7 a non-,dep>tm5t entity t is "u contract or agreem5t = ! program e/abli%$ "u section #agjc7;a7 ( ?is title2 or 7#b7 a non-,dep>tm5t entity t specializes 9 su* process+ = o!r ,f$]al ag5cy heal? c>e sy/ems4 7h7 ,report on enc\nt] data sy/em 7#a7 ,n lat] ?an #ij days aft] ! date ( ! enactm5t ( ! ,c>+ = our ,vet]ans ,act ( #bjag1 ! ,secret>y %all submit to ! appropriate committees ( ,congress a report on ! feasibility & advisability ( adopt+ a fund+ me*anism simil> to :at is utiliz$ by o!r ,f$]al ag5cies to all[ a contract$ entity to act z a fiscal int]m$i>y = ! ,f$]al ,gov]nm5t to di/ribute1 or pass ?r\gh1 ,f$]al ,gov]nm5t funds = c]ta9 non-und]writt5 hospital c>e1 m$ical s]vices1 or ext5d$ c>e s]vices4 7#b7 ,! ,secret>y may coord9ate ) ! ,dep>tm5t ( ,def5se1 ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 & ! ,dep>tm5t ( ! ,treasury 9 develop+ ! report requir$ by p>agraph 7#a74 7i7 ,def9itions ,9 ?is section3 7#a7 ,! t]m appropriate committees ( ,congress means-- 7,a7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,s5ate2 & 7,b7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives4 7#b7 ,! t]m clean electronic claim means ! transmission ( data = purposes ( paym5t ( cov]$ heal? c>e exp5ses t is submitt$ to ! ,secret>y :i* conta9s sub/antially all ( ! requir$ data elem5ts necess>y = accurate adjudication1 )\t obta9+ additional in=mation f ! entity or provid] t furni%$ ! c>e or s]vice1 submitt$ 9 su* =mat z prescrib$ by ! ,secret>y 9 regulations = ! purpose ( pay+ claims = c>e or s]vices4 7#c7 ,! t]m clean pap] claim means a pap] claim = paym5t ( cov]$ heal? c>e exp5ses t is submitt$ to ! ,secret>y :i* conta9s sub/antially all ( ! requir$ data elem5ts necess>y = accurate adjudication1 )\t obta9+ additional in=mation f ! entity or provid] t furni%$ ! c>e or s]vice1 submitt$ 9 su* =mat z prescrib$ by ! ,secret>y 9 regulations = ! purpose ( pay+ claims = c>e or s]vices4 7#d7 ,! t]m fraudul5t claims means ! int5tional & delib]ate misrepres5tation ( a mat]ial fact or facts by a heal? c>e entity or provid] made to induce ! ,secret>y to pay a claim t 0 n legally payable to t provid]4 ,?is t]m1 z us$ 9 ?is section1 %all n include a good fai? int]pretation by a heal? c>e entity or provid] ( utilization1 m$ical necessity1 cod+1 & bill+ requirem5ts ( ! ,secret>y4 7#e7 ,! t]m heal? c>e entity or provid] includes any non-,dep>tm5t heal? c>e entity or provid]1 b does n include any ,f$]al heal? c>e entity or provid]4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( su* *apt] is am5d$ by ins]t+ aft] ! item relat$ to section #agjc;,c1 z add$ by section #ajd ( ?is ,act1 ! foll[+ new item3 #agjc;,d4 ,prompt paym5t /&>d4 4 #aab4 ,au?ority to pay = au?oriz$ c>e n subject to an agreem5t 7a7 ,9 g5]al ,sub*apt] ,,iv ( *apt] #ha is am5d$ by add+ at ! end ! foll[+ new section3 #haei4 ,au?ority to pay = s]vices au?oriz$ b n subject to an agreem5t 7a7 ,9 g5]al ,if1 9 ! c\rse ( furni%+ hospital c>e1 a m$ical s]vice1 or an ext5d$ c>e s]vice au?oriz$ by ! ,secret>y & pursuant to a contract1 agreem5t1 or o!r arrangem5t ) ! ,secret>y1 a provid] :o is n a p>ty to ! contract1 agreem5t1 or o!r arrangem5t furni%es hospital c>e1 a m$ical s]vice1 or an ext5d$ c>e s]vice t ! ,secret>y consid]s necess>y1 ! ,secret>y may comp5sate ! provid] = ! co/ ( su* c>e or s]vice4 7b7 ,new contracts & agreem5ts ,! ,secret>y %all take reasonable ef=ts to ent] into a contract1 agreem5t1 or o!r arrangem5t ) a provid] describ$ 9 subsection 7a7 to ensure t future c>e & s]vices au?oriz$ by ! ,secret>y & furni%$ by ! provid] are subject to su* a contract1 agreem5t1 or o!r arrangem5t4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( su* *apt] is am5d$ by ins]t+ aft] ! item relat+ to section #haeh ! foll[+ new item3 #haei4 ,au?ority to pay = s]vices au?oriz$ b n subject to an agreem5t4 4 #aac4 ,improvem5t ( au?ority to recov] ! co/ ( s]vices furni%$ = non-s]vice-connect$ disabilities 7a7 ,broad5+ scope ( applicability ,section #agbi is am5d$-- 7#a7 9 subsection 7a7-- 7,a7 9 p>agraph 7#b77;,a7-- 7i7 by /rik+ ! vet]an's & ins]t+ ! individual's2 & 7ii7 by /rik+ ! vet]an & ins]t+ ! individual2 & 7,b7 9 p>agraph 7#c7-- 7i7 9 ! matt] prec$+ subp>agraph 7,a71 by /rik+ ! vet]an & ins]t+ ! individual2 & 7ii7 9 subp>agraph 7,a71 by /rik+ ! vet]an's & ins]t+ ! individual's2 7#b7 9 subsection 7b7-- 7,a7 9 p>agraph 7#a7-- 7i7 by /rik+ ! vet]an & ins]t+ ! individual2 & 7ii7 by /rik+ ! vet]an's & ins]t+ ! individual's2 & 7,b7 9 p>agraph 7#b7-- 7i7 9 subp>agraph 7,a7-- 7,i7 by /rik+ ! vet]an & ins]t+ ! individual2 & 7,,ii7 by /rik+ ! vet]an's & ins]t+ ! individual's2 & 7ii7 9 subp>agraph 7,b7-- 7,i7 9 clause 7i71 by /rik+ ! vet]an & ins]t+ ! individual2 & 7,,ii7 9 clause 7ii7-- 7aa7 by /rik+ ! vet]an & ins]t+ ! individual2 & 7bb7 by /rik+ ! vet]an's ea* place x appe>s & ins]t+ ! individual's2 7#c7 9 subsection 7e71 by /rik+ ,a vet]an & ins]t+ ,an individual2 & 7#d7 9 subsection 7h7-- 7,a7 9 p>agraph 7#a7-- 7i7 9 ! matt] prec$+ subp>agraph 7,a71 by /rik+ a vet]an & ins]t+ an individual2 7ii7 9 subp>agraph 7,a71 by /rik+ ! vet]an & ins]t+ ! individual2 & 7iii7 9 subp>agraph 7,b71 by /rik+ ! vet]an & ins]t+ ! individual2 & 7,b7 9 p>agraph 7#b7-- 7i7 by /rik+ ,a vet]an & ins]t+ ,an individual2 7ii7 by /rik+ a vet]an & ins]t+ an individual2 & 7iii7 by /rik+ ! vet]an & ins]t+ ! individual4 7b7 ,modification ( au?ority ,subsection 7a77#a7 ( su* section is am5d$ by /rik+ 7#a7 ,subject & all t foll[s ?r\gh ! p]iod & ins]t+ ! foll[+3 7#a7 ,subject to ! provisions ( ?is section1 9 any case 9 :i* ! ,unit$ ,/ates is requir$ by law to furni% or pay = c>e or s]vices "u ?is *apt] = a non-s]vice-connect$ disability describ$ 9 p>agraph 7#b7 ( ?is subsection1 ! ,unit$ ,/ates has ! "r to recov] or collect f a ?ird p>ty ! reasonable *>ges ( c>e or s]vices s furni%$ or paid = to ! ext5t t ! recipi5t or provid] ( ! c>e or s]vices w\ld be eligible to receive paym5t = su* c>e or s]vices f su* ?ird p>ty if ! c>e or s]vices _h n be5 furni%$ or paid = by a dep>tm5t or ag5cy ( ! ,unit$ ,/ates4 7c7 ,modification ( eligible individuals ,subp>agraph 7,d7 ( subsection 7a77#b7 ( su* section is am5d$ to read z foll[s3 7,d7 t is incurr$ by an individual :o is entitl$ to c>e 7or paym5t ( ! exp5ses ( c>e7 "u a heal?-plan contract4 4 #aad4 ,process+ ( claims = reimbursem5t ?r\gh electronic int]face ,! ,secret>y ( ,vet]ans ,affairs may ent] into an agreem5t ) a ?ird-p>ty entity to process1 ?r\gh ! use ( an electronic int]face1 claims = reimbursem5t = heal? c>e provid$ "u ! laws adm9i/]$ by ! ,secret>y4 ,c ,education & tra9+ programs #aba4 ,education program on heal? c>e options 7a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all develop & adm9i/] an education program t tea*es vet]ans ab\t _! heal? c>e options ?r\gh ! ,dep>tm5t ( ,vet]ans ,affairs4 7b7 ,elem5ts ,! program "u subsection 7a7 %all-- 7#a7 tea* vet]ans ab\t-- 7,a7 eligibility crit]ia = c>e f ! ,dep>tm5t set =? "u sections #agjc1 z am5d$ by section #aja ( ?is ,act1 & #agaj ( title #ch1 ,unit$ ,/ates ,code2 7,b7 priority gr\ps = enrollm5t 9 ! sy/em ( annual pati5t enrollm5t "u section #agje7;a7 ( su* title2 7,c7 ! copaym5ts & o!r f9ancial obligations1 if any1 requir$ ( c]ta9 individuals = c]ta9 s]vices2 & 7,d7 h[ to utilize ! access guidel9es & /&>ds = quality e/abli%$ "u sections #agjc;,b & #agjc;,c ( su* title4 7#b7 tea* vet]ans ab\t ! int]action betwe5 heal? insurance 7includ+ private insurance1 ,m$ic>e1 ,m$icaid1 ! ,,tric>e program1 ! ,indian ,heal? ,s]vice1 tribal heal? programs1 & o!r =ms ( insurance7 & heal? c>e f ! ,dep>tm5t2 & 7#c7 provide vet]ans ) in=mation on :at to d :5 !y h a compla9t ab\t heal? c>e receiv$ f ! ,dep>tm5t 7:e!r ab\t ! provid]1 ! ,dep>tm5t1 or any o!r type ( compla9t74 7c7 ,accessibility ,9 develop+ ! education program "u ?is section1 ! ,secret>y %all ensure t mat]ials "u su* program are accessible -- 7#a7 to vet]ans :o may n h access to ! ,int]net2 & 7#b7 to vet]ans 9 a mann] t complies ) ! ,am]icans ) ,disabilities ,act ( #aiij 7#db ,u4,s4,c4 #abaja et seq474 7d7 ,annual evaluation & report 7#a7 ,evaluation ,! ,secret>y %all develop a me?od to evaluate ! effectiv5ess ( ! education program "u ?is section & evaluate ! program us+ ! me?od n less frequ5tly ?an once ea* ye>4 7#b7 ,report ,n less frequ5tly ?an once ea* ye>1 ! ,secret>y %all submit to ,congress a report on ! f9d+s ( ! ,secret>y ) respect to ! mo/ rec5t evaluation conduct$ by ! ,secret>y "u p>agraph 7#a74 7e7 ,def9itions ,9 ?is section3 7#a7 ,m$icaid ,! t]m ,m$icaid means ! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#b7 ,m$ic>e ,! t]m ,m$ic>e means ! ,m$ic>e program "u title ,,xviii ( su* ,act 7#db ,u4,s4,c4 #acie et seq474 7#c7 ,tric>e program ,! t]m ,,tric>e program has ! mean+ giv5 t t]m 9 section #ajgb ( title #aj1 ,unit$ ,/ates ,code4 #abb4 ,tra9+ program = adm9i/ration ( non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e 7a7 ,e/abli%m5t ( program ,! ,secret>y ( ,vet]ans ,affairs %all develop & implem5t a tra9+ program to tra9 employees & contractors ( ! ,dep>tm5t ( ,vet]ans ,affairs on h[ to adm9i/] non-,dep>tm5t heal? c>e programs1 includ+ ! foll[+3 7#a7 ,reimbursem5t = non-,dep>tm5t em]g5cy room c>e4 7#b7 ,! ,vet]ans ,community ,c>e ,program "u section #agjc ( su* title1 z am5d$ by section #aja4 7#c7 ,managem5t ( prescriptions pursuant to improvem5ts "u section #aca4 7b7 ,annual evaluation & report ,! ,secret>y %all-- 7#a7 develop a me?od to evaluate ! effectiv5ess ( ! tra9+ program develop$ & implem5t$ "u subsection 7a72 7#b7 evaluate su* program n less frequ5tly ?an once ea* ye>2 & 7#c7 n less frequ5tly ?an once ea* ye>1 submit to ,congress ! f9d+s ( ! ,secret>y ) respect to ! mo/ rec5t evaluation c>ri$ out "u p>agraph 7#b74 #abc4 ,cont9u+ m$ical education = non-,dep>tm5t m$ical pr(essionals 7a7 ,e/abli%m5t ( program 7#a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all e/abli% a program to provide cont9u+ m$ical education mat]ial to non-,dep>tm5t m$ical pr(essionals4 7#b7 ,education provid$ ,! program e/abli%$ "u p>agraph 7#a7 %all include education on ! foll[+3 7,a7 ,id5tify+ & treat+ common m5tal & physical conditions ( vet]ans & family memb]s ( vet]ans4 7,b7 ,! heal? c>e sy/em ( ! ,dep>tm5t ( ,vet]ans ,affairs4 7,c7 ,su* o!r matt]s z ! ,secret>y consid]s appropriate4 7b7 ,mat]ial provid$ ,! cont9u+ m$ical education mat]ial provid$ to non-,dep>tm5t m$ical pr(essionals "u ! program e/abli%$ "u subsection 7a7 %all be ! same mat]ial provid$ to m$ical pr(essionals ( ! ,dep>tm5t to ensure t all m$ical pr(essionals treat+ vet]ans h access to ! same mat]ials1 :i* supports core compet5cies ?r\gh\t ! community4 7c7 ,adm9i/ration ( program 7#a7 ,9 g5]al ,! ,secret>y %all adm9i/] ! program e/abli%$ "u subsection 7a7 to p>ticipat+ non-,dep>tm5t m$ical pr(essionals ?r\gh an ,int]net website ( ! ,dep>tm5t ( ,vet]ans ,affairs4 7#b7 ,curriculum & cr$it provid$ ,! ,secret>y %all det]m9e ! curriculum ( ! program & ! numb] ( h\rs ( cr$it to provide to p>ticipat+ non-,dep>tm5t m$ical pr(essionals = cont9u+ m$ical education4 7#c7 ,accr$itation ,! ,secret>y %all ensure t ! program is accr$it$ 9 z _m ,/ates z practicable4 7#d7 ,consi/5cy ) exi/+ rules ,! ,secret>y %all ensure t ! program is consi/5t ) ! rules & regulations ( ! foll[+3 7,a7 ,! m$ical lic5s+ ag5cy ( ea* ,/ate 9 :i* ! program is accr$it$4 7,b7 ,su* m$ical cr$5tial+ organizations z ! ,secret>y consid]s appropriate4 7#e7 ,us] co/ ,! ,secret>y %all c>ry out ! program at no co/ to p>ticipat+ non-,dep>tm5t m$ical pr(essionals4 7#f7 ,monitor+1 evaluation1 & report ,! ,secret>y %all monitor ! utilization ( ! program e/abli%$ "u subsection 7a71 evaluate its effectiv5ess1 & report to ,congress on utilization & effectiv5ess n less frequ5tly ?an once ea* ye>4 7d7 ,non-,dep>tm5t m$ical pr(essional def9$ ,9 ?is section1 ! t]m non-,dep>tm5t m$ical pr(essional means any individual :o is lic5s$ by an appropriate m$ical au?ority 9 ! ,unit$ ,/ates & is 9 good /&+1 is n an employee ( ! ,dep>tm5t ( ,vet]ans ,affairs1 & provides c>e to vet]ans or family memb]s ( vet]ans "u ! laws adm9i/]$ by ! ,secret>y ( ,vet]ans ,affairs4 ,d ,o!r matt]s relat+ to non-,dep>tm5t ( ,vet]ans ,affairs provid]s #aca4 ,e/abli%m5t ( processes to ensure safe opioid prescrib+ practices by non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e provid]s 7a7 ,receipt & review ( guidel9es ,! ,secret>y ( ,vet]ans ,affairs %all ensure t all cov]$ heal? c>e provid]s are provid$ a copy ( & c]tify t !y h review$ ! evid5ce-bas$ guidel9es = prescrib+ opioids set =? by ! ,opioid ,safety ,initiative ( ! ,dep>tm5t ( ,vet]ans ,affairs "u sections #iaa7;a77#b7 & #iab7;c7 ( ! ,jason ,simcakoski ,memorial & ,promise ,act 7,public ,law #aad-aih2 #ch ,u4,s4,c4 #agja note7 be=e fir/ provid+ c>e "u ! laws adm9i/]$ by ! ,secret>y & at any "t :5 ^? guidel9es are modifi$ !reaft]4 7b7 ,inclusion ( m$ical hi/ory & curr5t m$ications ,! ,secret>y %all implem5t a process to ensure t1 if c>e ( a vet]an by a cov]$ heal? c>e provid] is au?oriz$ "u ! laws adm9i/]$ by ! ,secret>y1 ! docum5t au?oriz+ su* c>e includes ! relevant m$ical hi/ory ( ! vet]an & a li/ ( all m$ications prescrib$ to ! vet]an4 7c7 ,submittal ( prescriptions 7#a7 ,9 g5]al ,except z provid$ 9 p>agraph 7#c71 ! ,secret>y %all require1 to ! maximum ext5t practicable1 ea* non-,dep>tm5t heal? c>e provid] to submit prescriptions = opioids-- 7,a7 to ! ,dep>tm5t = prior au?orization = ! prescrib+ ( a limit$ am\nt ( opioids "u contracts ! ,dep>tm5t has ) retail ph>macies2 or 7,b7 directly to a ph>macy ( ! ,dep>tm5t = disp5s+ ( ! prescriptions4 7#b7 ,responsibility ( ,dep>tm5t = record+ & monitor+ ,9 c>ry+ out p>agraph 7#a7 & ^u ! receipt by ! ,dep>tm5t ( ! prescription = opioids to vet]ans "u laws adm9i/]$ by ! ,secret>y1 ! ,secret>y %all-- 7,a7 ensure ! ,dep>tm5t is responsible = ! record+ ( ! prescription 9 ! electronic heal? record ( ! vet]an2 & 7,b7 enable o!r monitor+ ( ! prescription z outl9$ 9 ! ,opioid ,safety ,initiative ( ! ,dep>tm5t4 7#c7 ,exception 7,a7 ,9 g5]al ,a cov]$ heal? c>e provid] is n requir$ "u p>agraph 7#a77;,b7 to submit an opioid prescription directly to a ph>macy ( ! ,dep>tm5t if-- 7i7 ! heal? c>e provid] det]m9es t !re is an imm$iate m$ical ne$ = ! prescription1 includ+ an urg5t or em]g5t prescription or a prescription disp5s$ z "p ( an opioid treatm5t program t provides (fice-bas$ m$ications2 & 7ii7 7,i7 foll[+ an inquiry into ! matt]1 a ph>macy ( ! ,dep>tm5t notifies ! heal? c>e provid] t x _c fill ! prescription 9 a timely mann]2 or 7,,ii7 ! heal? c>e provid] det]m9es t ! requirem5t "u p>agraph 7#a77;,b7 w\ld impose an undue h>d%ip on ! vet]an1 includ+ ) respect to travel di/ances1 z det]m9$ by ! ,secret>y4 7,b7 ,notification to ,dep>tm5t ,if a cov]$ heal? c>e provid] uses an exception "u subp>agraph 7,a7 ) respect to an opioid prescription = a vet]an1 ! heal? c>e provid] %all1 on ! same day ! prescription is writt51 submit to ! ,secret>y = inclusion 9 ! electronic heal? record ( ! vet]an a notice1 9 su* =m z ! ,secret>y may e/abli%1 provid+ in=mation ab\t ! prescription & describ+ ! reason = ! exception4 7,c7 ,report 7i7 ,9 g5]al ,n less frequ5tly ?an qu>t]ly1 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report evaluat+ ! compliance ( cov]$ heal? c>e provid]s ) ! requirem5ts "u ?is p>agraph & sett+ =? data on ! use by heal? c>e provid]s ( exceptions "u subp>agraph 7,a7 & notices "u subp>agraph 7,b74 7ii7 ,elem5ts ,ea* report requir$ by clause 7i7 %all include ! foll[+ ) respect to ! qu>t] cov]$ by ! report3 7,i7 ,! numb] ( exceptions us$ "u subp>agraph 7,a7 & notices receiv$ "u subp>agraph 7,b74 7,,ii7 ,! rate ( compliance by ! ,dep>tm5t ) ! requirem5t "u subp>agraph 7,b7 to include su* notices 9 ! heal? records ( vet]ans4 7,,iii7 ,! id5tification ( any cov]$ heal? c>e provid]s t1 bas$ on crit]ia prescrib$ by ! ,secret>y1 are det]m9$ by ! ,secret>y to be /ati/ical outli]s reg>d+ ! use ( exceptions "u subp>agraph 7,a74 7d7 ,use ( ,opioid ,safety ,initiative guidel9es 7#a7 ,9 g5]al ,if a director ( a m$ical c5t] ( ! ,dep>tm5t or a ,vet]ans ,integrat$ ,s]vice ,network det]m9es t ! opioid prescrib+ practices ( a cov]$ heal? c>e provid] conflicts ) or is o!rwise inconsi/5t ) ! /&>ds ( appropriate & safe c>e1 z t t]m is us$ 9 section #iac7;d7 ( ! ,jason ,simcakoski ,memorial & ,promise ,act 7,public ,law #aad-aih2 #ch ,u4,s4,c4 #agja note71 ! director %all take su* action z ! director consid]s appropriate to ensure ! safety ( all vet]ans receiv+ c>e f t heal? c>e provid]1 includ+ remov+ or direct+ ! removal ( any su* heal? c>e provid] f provid] networks or o!rwise refus+ to au?orize c>e ( vet]ans by su* heal? c>e provid] 9 any program au?oriz$ "u ! laws adm9i/]$ by ! ,secret>y4 7#b7 ,inclusion 9 contracts ,! ,secret>y %all ensure t any contracts ent]$ into by ! ,secret>y ) ?ird p>ties involv$ 9 adm9i/]+ programs t provide c>e 9 ! community to vet]ans "u ! laws adm9i/]$ by ! ,secret>y specifically grant ! au?ority set =? 9 p>agraph 7#a7 to su* ?ird p>ties & to ! directors describ$ 9 t p>agraph1 z ! case may be4 7e7 ,d5ial or revocation ( eligibility ( non-,dep>tm5t provid]s ,! ,secret>y %all d5y or revoke ! eligibility ( a non-,dep>tm5t heal? c>e provid] to provide heal? c>e to vet]ans "u ! laws adm9i/]$ by ! ,secret>y if ! ,secret>y det]m9es t ! opioid prescrib+ practices ( ! provid]-- 7#a7 violate ! requirem5ts ( a m$ical lic5se ( ! heal? c>e provid]2 or 7#b7 detract f ! ability ( ! heal? c>e provid] to deliv] safe & appropriate heal? c>e4 7f7 ,cov]$ heal? c>e provid] def9$ ,9 ?is section1 ! t]m cov]$ heal? c>e provid] means a non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e provid] :o provides heal? c>e to vet]ans "u ! laws adm9i/]$ by ! ,secret>y ( ,vet]ans ,affairs4 #acb4 ,improv+ in=mation %>+ ) community provid]s ,section #gccb7;b77#b7 is am5d$ by /rik+ subp>agraph 7,h7 & ins]t+ ! foll[+ new subp>agraphs3 7,h7 7i7 ,to a non-,dep>tm5t entity 7includ+ private entities & o!r ,f$]al ag5cies7 = purposes ( provid+ heal? c>e1 includ+ hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices1 to pati5ts4 7ii7 ,an entity to :i* a record is disclos$ "u ?is subp>agraph may n disclose or use su* record = a purpose o!r ?an t = :i* ! disclosure 0 made4 7,i7 ,to a ?ird p>ty 9 ord] to recov] or collect reasonable *>ges = c>e furni%$ to1 or paid on behalf (1 a pati5t 9 connection ) a non-s]vice connect$ disability z p]mitt$ by section #agbi ( ?is title or = a condition = :i* recov]y is au?oriz$ or ) respect to :i* ! ,unit$ ,/ates is deem$ to be a ?ird p>ty b5efici>y "u ! ,act entitl$ ,an ,act to provide = ! recov]y f torti\sly liable ?ird p]sons ( ! co/ ( hospital & m$ical c>e & treatm5t furni%$ by ! ,unit$ ,/ates 7,public ,law #hg-fic2 #db ,u4,s4,c4 #bfea et seq42 commonly kn[n z ! ,f$]al ,m$ical ,c>e ,recov]y ,act74 4 #acc4 ,compet5cy /&>ds = non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e provid]s 7a7 ,e/abli%m5t ( /&>ds & requirem5ts ,! ,secret>y ( ,vet]ans ,affairs %all e/abli% /&>ds & requirem5ts = ! provision ( c>e by non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e provid]s 9 cl9ical areas = :i* ! ,dep>tm5t ( ,vet]ans ,affairs has special exp]tise1 includ+ po/-traumatic /ress disord]1 milit>y sexual trauma-relat$ conditions1 & traumatic bra9 injuries4 7b7 ,condition = eligibility to p>ticipate 9 ,vet]ans ,*oice ,program ,ea* non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e provid] %all meet ! /&>ds & requirem5ts e/abli%$ pursuant to subsection 7a7 be=e ent]+ into a contact ) ! ,dep>tm5t ( ,vet]ans ,affairs to p>ticipate 9 ! ,vet]ans ,*oice ,program "u section #aja ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note74 ,non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e provid]s p>ticipat+ 9 ! ,vet]ans ,*oice ,program %all fulfill tra9+ requirem5ts e/abli%$ by ! ,secret>y on h[ to deliv] evid5ce-bas$ treatm5ts 9 ! cl9ical areas = :i* ! ,dep>tm5t ( ,vet]ans ,affairs has special exp]tise4 ,e ,o!r non-,dep>tm5t heal? c>e matt]s #ada4 ,plans = ,use ( ,supplem5tal ,appropriations ,requir$ ,:5ev] ! ,secret>y submits to ,congress a reque/ = supplem5tal appropriations or any o!r appropriation outside ! /&>d budget process to address a budget>y issue affect+ ! ,dep>tm5t ( ,vet]ans ,affairs1 ! ,secret>y %all1 n lat] ?an #de days be=e ! date on :i* su* budget>y issue w\ld />t affect+ a program or s]vice1 submit to ,congress a ju/ification = ! reque/1 includ+ a plan t details h[ ! ,secret>y int5ds to use ! reque/$ appropriation & h[ long ! reque/$ appropriation is expect$ to meet ! ne$s ( ! ,dep>tm5t & c]tification t ! reque/ 0 made us+ an updat$ & s\nd actu>ial analysis4 #adb4 ,vet]ans ,*oice ,fund flexibility ,section #hjb ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 is am5d$-- 7#a7 9 subsection 7c7-- 7,a7 9 p>agraph 7#a71 by /rik+ by p>agraph 7#c7 & ins]t+ 9 p>agraphs 7#c7 & 7#d72 & 7,b7 by add+ at ! end ! foll[+ new p>agraph3 7#d7 ,p]man5t au?ority = o!r uses ,beg9n+ 9 fiscal ye> #bjai1 am\nts rema9+ 9 ! ,vet]ans ,*oice ,fund may be us$ to furni% hospital c>e1 m$ical s]vices1 & ext5d$ c>e s]vices to individuals pursuant to *apt] #ag ( title #ch1 ,unit$ ,/ates ,code1 at non-,dep>tm5t facilities1 includ+ pursuant to non-,dep>tm5t provid] programs o!r ?an ! program e/abli%$ by section #aja4 ,su* am\nts %all be available 9 addition to am\nts available 9 o!r appropriations acc\nts = su* purposes4 2 & 7#b7 9 subsection 7d77#a71 by /rik+ to subsection 7c77#c7 & ins]t+ to p>agraphs 7#c7 & 7#d7 ( subsection 7c74 #adc4 ,sunset ( ,vet]ans ,*oice ,program ,subsection 7p7 ( section #aja ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 is am5d$ to read z foll[s3 7p7 ,au?ority ,to furni% c>e & s]vices ,! ,secret>y may n use ! au?ority "u ?is section to furni% c>e & s]vices aft] ,decemb] #ca1 #bjah4 4 #add4 ,con=m+ am5dm5ts 7a7 ,9 g5]al 7#a7 ,title #ch ,title #ch1 ,unit$ ,/ates ,code1 is am5d$-- 7,a7 9 section #agab7;a7-- 7i7 9 p>agraph 7#c71 by /rik+ "u clause 7#a71 7#b71 or 7#e7 ( section #agjc7;a7 ( ?is title & ins]t+ or ent]$ an agreem5t2 & 7ii7 9 p>agraph 7#d77;,a71 by /rik+ "u ! provisions ( ?is subsection & section #agjc ( ?is title2 7,b7 9 section #agab;,a7e77#a7-- 7i7 by ins]t+ or agreem5ts aft] contracts2 & 7ii7 by /rik+ 7"u sections #agjc7;a77#b7 & #agaj7;a77#a77;,b7 ( ?is title72 & 7,c7 9 section #bcjc7;a77#b77;,b77i71 by /rik+ ) section #agjc & ins]t+ ) sections #agjc;,a1 #haaa1 & #haec4 7#b7 ,social ,security ,act ,section #ahff7;a77#a77,l7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77,l77 is am5d$ by /rik+ "u section #agjc & ins]t+ "u *apt] #ag4 7#c7 ,vet]ans' ,b5efits ,improvem5ts ,act ( #aiid ,section #ajd7;a77#d77;,a7 ( ! ,vet]ans' ,b5efits ,improvem5ts ,act ( #aiid 7,public ,law #ajc-ddf2 #ch ,u4,s4,c4 #aaag note7 is am5d$ by /rik+ 9 section #agjc & ins]t+ 9 sections #agjc;,a1 #haaa1 & #haec4 7b7 ,effective date ,! am5dm5ts made by subsection 7a7 %all take effect on ! date describ$ 9 section #aja7;b74 ,,ii ,improv+ ,dep>tm5t ( ,vet]ans ,affairs heal? c>e deliv]y ,a ,p]sonnel practices ,i ,adm9i/ration #bja4 ,lic5sure ( heal? c>e pr(essionals ( ! ,dep>tm5t ( ,vet]ans ,affairs provid+ treatm5t via telem$ic9e 7a7 ,9 g5]al ,*apt] #ag is am5d$ by ins]t+ aft] section #agcj;,a ! foll[+ new section3 #agcj;,b4 ,lic5sure ( heal? c>e pr(essionals provid+ treatm5t via telem$ic9e 7a7 ,9 g5]al ,not)/&+ any provision ( law reg>d+ ! lic5sure ( heal? c>e pr(essionals1 a cov]$ heal? c>e pr(essional may practice ! heal? c>e pr(ession ( ! heal? c>e pr(essional at any location 9 any ,/ate1 reg>dless ( :]e ! cov]$ heal? c>e pr(essional or ! pati5t is locat$1 if ! cov]$ heal? c>e pr(essional is us+ telem$ic9e to provide treatm5t to an individual "u ?is *apt]4 7b7 ,cov]$ heal? c>e pr(essionals ,= purposes ( ?is section1 a cov]$ heal? c>e pr(essional is any heal? c>e pr(essional :o-- 7#a7 is an employee ( ! ,dep>tm5t appo9t$ "u ! au?ority "u section #gcjf1 #gdja1 #gdje1 #gdjf1 or #gdjh ( ?is title or title #e2 7#b7 is au?oriz$ by ! ,secret>y to provide heal? c>e "u ?is *apt]2 7#c7 is requir$ to adh]e to all /&>ds ( quality relat+ to ! provision ( m$ic9e 9 accordance ) applicable policies ( ! ,dep>tm5t2 & 7#d7 has an active1 curr5t1 full1 & unre/rict$ lic5se1 regi/ration1 or c]tification 9 a ,/ate to practice ! heal? c>e pr(ession ( ! heal? c>e pr(essional4 7c7 ,prop]ty ( ,f$]al gov]nm5t ,subsection 7a7 %all apply to a cov]$ heal? c>e pr(essional provid+ treatm5t to a pati5t reg>dless ( :e!r ! cov]$ heal? c>e pr(essional or pati5t is locat$ 9 a facility own$ by ! ,f$]al ,gov]nm5t dur+ su* treatm5t4 7d7 ,relation to ,/ate law 7#a7 ,! provisions ( ?is section %all sup]s$e any provisions ( ! law ( any ,/ate to ! ext5t t su* provision ( ,/ate law are inconsi/5t ) ?is section4 7#b7 ,no ,/ate %all d5y or revoke ! lic5se1 regi/ration1 or c]tification ( a cov]$ heal? c>e pr(essional :o o!rwise meets ! qualifications ( ! ,/ate = hold+ ! lic5se1 regi/ration1 or c]tification on ! basis t ! cov]$ heal? c>e pr(essional has engag$ or int5ds to engage 9 activity cov]$ by subsection 7a74 7e7 ,rule ( con/ruction ,no?+ 9 ?is section may be con/ru$ to remove1 limit1 or o!rwise affect any obligation ( a cov]$ heal? c>e pr(essional "u ! ,controll$ ,sub/ances ,act 7#ba ,u4,s4,c4 #hja et seq474 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #ag ( su* title is am5d$ by ins]t+ aft] ! item relat+ to section #agcj;,a ! foll[+ new item3 #agcj;,b4 ,lic5sure ( heal? c>e pr(essionals provid+ treatm5t via telem$ic9e4 4 7c7 ,report on telem$ic9e 7#a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! e>li] ( ! date on :i* s]vices provid$ "u section #agcj;,b ( title #ch1 ,unit$ ,/ates ,code1 z add$ by subsection 7a71 fir/ occur or regulations are promulgat$ to c>ry out su* section1 ! ,secret>y ( ,vet]ans ,affairs %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report on ! effectiv5ess ( ! use ( telem$ic9e by ! ,dep>tm5t ( ,vet]ans ,affairs4 7#b7 ,elem5ts ,! report requir$ by p>agraph 7#a7 %all include an assessm5t ( ! foll[+3 7,a7 ,! satisfaction ( vet]ans ) telem$ic9e furni%$ by ! ,dep>tm5t4 7,b7 ,! satisfaction ( heal? c>e provid]s 9 provid+ telem$ic9e furni%$ by ! ,dep>tm5t4 7,c7 ,! effect ( telem$ic9e furni%$ by ! ,dep>tm5t on ! foll[+3 7i7 ,! ability ( vet]ans to access heal? c>e1 :e!r f ! ,dep>tm5t or f non-,dep>tm5t heal? c>e provid]s4 7ii7 ,! frequ5cy ( use by vet]ans ( telem$ic9e4 7iii7 ,! productivity ( heal? c>e provid]s4 7iv7 ,wait times = an appo9tm5t = ! receipt ( heal? c>e f ! ,dep>tm5t4 7v7 ,! use by vet]ans ( 9-p]son s]vices at ,dep>tm5t facilities & non-,dep>tm5t facilities4 7,d7 ,! types ( appo9tm5ts = ! receipt ( telem$ic9e furni%$ by ! ,dep>tm5t t 7 provid$ dur+ ! "o-ye> p]iod prec$+ ! submittal ( ! report4 7,e7 ,! numb] ( appo9tm5ts = ! receipt ( telem$ic9e furni%$ by ! ,dep>tm5t t 7 reque/$ dur+ su* p]iod1 disaggregat$ by m$ical facility4 7,f7 ,sav+s by ! ,dep>tm5t1 if any1 includ+ travel co/s1 f furni%+ heal? c>e ?r\gh ! use ( telem$ic9e dur+ su* p]iod4 #bjb4 ,role ( podiatri/s 9 ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,inclusion z physician 7#a7 ,9 g5]al ,sub*apt] ,i ( *apt] #gd is am5d$ by add+ at ! end ! foll[+ new section3 #gdac4 ,treatm5t ( podiatri/s2 cl9ical ov]sight /&>ds 7a7 ,podiatri/s ,except z provid$ by subsection 7b71 a doctor ( podiatric m$ic9e :o is appo9t$ z a podiatri/ "u section #gdja7a7 ( ?is title is eligible = any sup]visory position 9 ! ,vet]ans ,heal? ,adm9i/ration to ! same degree t a physician appo9t$ "u su* section is eligible = ! position4 7b7 ,e/abli%m5t ( cl9ical ov]sight /&>ds ,! ,secret>y1 9 consultation ) appropriate /akehold]s1 %all e/abli% /&>ds to ensure t speciali/s appo9t$ 9 ! ,vet]ans ,heal? ,adm9i/ration to sup]visory positions d n provide direct cl9ical ov]sight = purposes ( pe] review or practice evaluation = provid]s ( o!r cl9ical specialties4 4 7#b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #gd is am5d$ by ins]t+ aft] ! item relat+ to section #gdab ! foll[+ new item3 #gdac4 ,treatm5t ( podiatri/s2 cl9ical ov]sight /&>ds4 4 7b7 ,modification & cl>ification ( pay grade 7#a7 ,grade ,! li/ 9 section #gdjd7;b7 ( su* title is am5d$-- 7,a7 by /rik+ ,,physician ,,& ,,d5ti/ ,,s*$ule & ins]t+ ,,physician ,,& ,,surgeon 7,,md_/,,d71 ,,podiatric ,,surgeon 7,,dpm71 ,,& ,,d5ti/ ,,& ,,oral ,,surgeon 7,,dds1 ,,dmd7 ,,s*$ule2 7,b7 by /rik+1 ,physician grade & ins]t+ ,physician & surgeon grade2 & 7,c7 by /rik+ ,,podiatri/1 ,,*iropractor1 ,,& & ins]t+ ,,*iropractor ,,&4 7#b7 ,application ,! am5dm5ts made by p>agraph 7#a7 %all apply ) respect to a pay p]iod ( ! ,dep>tm5t ( ,vet]ans ,affairs beg9n+ on or aft] ! date t is #cj days aft] ! date ( ! enactm5t ( ?is ,act4 #bjc4 ,modification ( treatm5t ( c]tifi$ cl9ical p]fusioni/s ( ! ,dep>tm5t 7a7 ,appo9tm5t ,section #gdja7a7 is am5d$ by ins]t+ c]tifi$ cl9ical p]fusioni/s1 aft] physician assi/ants14 7b7 ,increases 9 rates ( basic pay ,section #gdee7;c77#a7 is am5d$ by ins]t+ c]tifi$ cl9ical p]fusioni/s1 aft] ph>maci/s14 #bjd4 ,am5d+ /atutory requirem5ts = ! position ( ! ,*ief ,(fic] ( ! ,readju/m5t ,c\nsel+ ,s]vice ,section #gcji7;b77#b7 is am5d$-- 7#a7 9 subp>agraph 7,b71 by /rik+ 9 ! ,readju/m5t ,c\nsel+ ,s]vice2 & 7#b7 9 subp>agraph 7,c71 by /rik+ 9 ! ,readju/m5t ,c\nsel+ ,s]vice4 #bje4 ,te*nical am5dm5t to appo9tm5t & comp5sation sy/em = directors ( m$ical c5t]s & directors ( ,vet]ans ,integrat$ ,s]vice ,networks ,section #gdjd7;d7 is am5d$ by /rik+ ,except & ins]t+ ,except = positions describ$ 9 section #gdja7d7 ( ?is title & except4 #bjf4 ,id5tification & /aff+ ( c]ta9 heal? c>e vacancies 7a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all id5tify & fully /aff-- 7#a7 all m5tal heal? vacancies )9 ! ,dep>tm5t ( ,vet]ans ,affairs2 & 7#b7 all prim>y c>e & m5tal heal? vacancies 9 ,pati5t ,align$ ,c>e ,teams ( ! ,dep>tm5t4 7b7 ,report ,n lat] ?an #baj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ,congress a report t specifies-- 7#a7 :e!r ! ,dep>tm5t has compli$ ) ! requirem5ts "u subsection 7a72 & 7#b7 if ! ,secret>y has n compli$ ) su* requirem5ts-- 7,a7 h[ _m vacancies describ$ 9 subsection 7a7 rema92 & 7,b7 :y ! ,dep>tm5t 0 unable to fill su* vacancies4 #bjg4 ,dep>tm5t ( ,vet]ans ,affairs p]sonnel transp>5cy 7a7 ,publication ( /aff+ & vacancies 7#a7 ,website requir$ ,n lat] ?an #cj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all make publicly available on an ,int]net website ( ! ,dep>tm5t ( ,vet]ans ,affairs ! foll[+ in=mation1 :i* %all be display$ by dep>tm5tal compon5t or1 9 ! case ( in=mation relat+ to ,vet]ans ,heal? ,adm9i/ration positions1 by m$ical facility3 7,a7 ,! numb] ( p]sonnel encumb]+ positions4 7,b7 ,! numb] ( accessions & de-accessions ( p]sonnel dur+ ! mon? prec$+ ! date ( ! publication ( ! in=mation4 7,c7 ,! numb] ( vacancies1 by occupation4 7,d7 ,! numb] ( active job po/+s t h be5 fill$ dur+ ! #cj-;day p]iod end+ on ! date ( publication ( ! in=mation1 includ+ ! l5g? ( "t = :i* ea* position 0 po/$ prior to be+ fill$4 7#b7 ,update ( in=mation ,! ,secret>y %all update ! in=mation on ! website requir$ "u p>agraph 7#a7 on a mon?ly basis4 7#c7 ,treatm5t ( contractor positions ,any ,dep>tm5t ( ,vet]ans ,affairs position t is fill$ ?r\gh a contractor employee may n be treat$ z a ,dep>tm5t position = purposes ( ! in=mation requir$ to be publi%$ "u p>agraph 7#a74 7#d7 ,inspector ,g5]al review ,on a semi-annual basis1 ! ,inspector ,g5]al ( ! ,dep>tm5t %all review ! adm9i/ration ( ! website requir$ "u p>agraph 7#a7 & make recomm5dations relat+ to ! improvem5t ( su* adm9i/ration4 7b7 ,report to ,congress ,! ,secret>y ( ,vet]ans ,affairs %all submit to ,congress an annual report on ! /eps ! ,dep>tm5t is tak+ to a*ieve full /aff+ capacity4 ,ea* su* report %all include ! am\nt ( additional funds necess>y to enable ! ,dep>tm5t to rea* full /aff+ capacity4 #bjh4 ,program on e/abli%m5t ( pe] speciali/s 9 pati5t align$ c>e team sett+s )9 m$ical c5t]s ( ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,program requir$ ,! ,secret>y ( ,vet]ans ,affairs %all c>ry out a program to e/abli% n few] ?an two pe] speciali/s 9 pati5t align$ c>e teams at m$ical c5t]s ( ! ,dep>tm5t ( ,vet]ans ,affairs to promote ! use & integration ( s]vices = m5tal heal?1 sub/ance use disord]1 & behavior heal? 9 a prim>y c>e sett+4 7b7 ,timeframe = e/abli%m5t ( program ,! ,secret>y %all c>ry out ! program at m$ical c5t]s ( ! ,dep>tm5t z foll[s3 7#a7 ,n lat] ?an ,decemb] #ca1 #bjah1 at n few] ?an #be m$ical c5t]s ( ! ,dep>tm5t4 7#b7 ,n lat] ?an ,decemb] #ca1 #bjai1 at n few] ?an #ej m$ical c5t]s ( ! ,dep>tm5t4 7c7 ,selection ( locations 7#a7 ,9 g5]al ,! ,secret>y %all select m$ical c5t]s = ! program z foll[s3 7,a7 ,n few] ?an five %all be m$ical c5t]s ( ! ,dep>tm5t t are designat$ by ! ,secret>y z polytrauma c5t]s4 7,b7 ,n few] ?an t5 %all be m$ical c5t]s ( ! ,dep>tm5t t are n designat$ by ! ,secret>y z polytrauma c5t]s4 7#b7 ,consid]ations ,9 select+ m$ical c5t]s = ! program "u p>agraph 7#a71 ! ,secret>y %all consid] ! feasibility & advisability ( select+ m$ical c5t]s 9 ! foll[+ areas3 7,a7 ,rural areas & o!r areas t are und]s]v$ by ! ,dep>tm5t4 7,b7 ,areas t are n 9 close proximity to an active duty milit>y in/allation4 7,c7 ,areas repres5t+ diff]5t geographic locations1 su* z c5sus tracts e/abli%$ by ! ,bureau ( ! ,c5sus4 7d7 ,g5d]-,specific s]vices ,9 c>ry+ out ! program at ea* location select$ "u subsection 7c71 ! ,secret>y %all ensure t-- 7#a7 ! ne$s ( female vet]ans are specifically consid]$ & address$2 & 7#b7 female pe] speciali/s are made available to female vet]ans :o are treat$ at ea* location4 7e7 ,engagem5t ) community provid]s ,at ea* location select$ "u subsection 7c71 ! ,secret>y %all consid] ways 9 :i* pe] speciali/s c conduct outrea* to heal? c>e provid]s 9 ! community :o are kn[n to be s]v+ vet]ans to engage ) ^? provid]s & vet]ans s]v$ by ^? provid]s4 7f7 ,reports 7#a7 ,p]iodic reports 7,a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 & n less frequ5tly ?an once e #ahj days !reaft] until ! ,secret>y det]m9es t ! program is be+ c>ri$ out at ! la/ location to be select$ "u subsection 7c71 ! ,secret>y %all submit to ,congress a report on ! program4 7,b7 ,elem5ts ,ea* report requir$ by subp>agraph 7,a7 %all1 ) respect to ! #ahj-;day p]iod prec$+ ! submittal ( ! report1 include ! foll[+3 7i7 ,! f9d+s & conclusions ( ! ,secret>y ) respect to ! program4 7ii7 ,an assessm5t ( ! b5efits ( ! program to vet]ans & family memb]s ( vet]ans4 7iii7 ,an assessm5t ( ! effectiv5ess ( pe] speciali/s 9 engag+ "u subsection 7e7 ) heal? c>e provid]s 9 ! community & vet]ans s]v$ by ^? provid]s4 7#b7 ,f9al report ,n lat] ?an #ahj days aft] ! ,secret>y det]m9es t ! program is be+ c>ri$ out at ! la/ location to be select$ "u subsection 7c71 ! ,secret>y %all submit to ,congress a report detail+ ! recomm5dations ( ! ,secret>y z to ! feasibility & advisability ( exp&+ ! program to additional locations4 #bji4 ,pilot program on increas+ ! use ( m$ical scribes to maximize ! effici5cy ( physicians at m$ical facilities ( ! ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,9 g5]al ,comm5c+ n lat] ?an #abj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all c>ry out a pilot program to increase ! use ( m$ical scribes to maximize ! effici5cy ( physicians at m$ical facilities ( ! ,dep>tm5t ( ,vet]ans ,affairs4 7b7 ,duration ,! ,secret>y %all c>ry out ! pilot program dur+ ! #ah-mon? p]iod beg9n+ on ! date ( ! comm5cem5t ( ! pilot program4 7c7 ,locations ,! ,secret>y %all c>ry out ! pilot program at n few] ?an five m$ical facilities ( ! ,dep>tm5t-- 7#a7 at :i* ! ,secret>y has det]m9$ !re is a high volume ( pati5ts2 or 7#b7 t are locat$ 9 rural areas & at :i* ! ,secret>y has det]m9$ !re is a %ortage ( physicians & ea* physician has a high caseload4 7d7 ,contracts 7#a7 ,9 g5]al ,9 c>ry+ out ! pilot program1 ! ,secret>y %all ent] into a contract ) "o or m appropriate nongov]nm5tal entities describ$ 9 p>agraph 7#b74 7#b7 ,appropriate nongov]nm5tal entities describ$ ,an appropriate nongov]nm5tal entity describ$ 9 ?is p>agraph is an entity t tra9s & employs pr(essional m$ical scribes :o specialize 9 ! collection ( m$ical data & data entry into electronic heal? records4 7e7 ,collection ( data 7#a7 ,9 g5]al ,! ,secret>y %all collect data on ! pilot program to det]m9e ! effectiv5ess ( ! pilot program 9 increas+ ! effici5cy ( physicians at m$ical facilities ( ! ,dep>tm5t4 7#b7 ,elem5ts ,! data collect$ "u p>agraph 7#a7 %all include ! foll[+ ) respect to ea* m$ical facility p>ticipat+ 9 ! pilot program3 7,a7 ,! av]age wait "t = a vet]an to receive c>e f a physician at su* m$ical facility be=e implem5tation ( ! pilot program4 7,b7 ,! av]age wait "t = a vet]an to receive c>e f su* a physician aft] implem5tation ( ! pilot program4 7,c7 ,! av]age numb] ( pati5ts t su* a physician is able to see on a daily basis be=e implem5tation ( ! pilot program4 7,d7 ,! av]age numb] ( pati5ts t su* a physician is able to see on a daily basis aft] implem5tation ( ! pilot program4 7,e7 ,! av]age am\nt ( "t su* a physician sp5ds on docum5tation on a daily basis be=e implem5tation ( ! pilot program4 7,f7 ,! av]age am\nt ( "t su* a physician sp5ds on docum5tation on a daily basis aft] implem5tation ( ! pilot program4 7,g7 ,! satisfaction & ret5tion scores ( ea* su* physician be=e implem5tation ( ! pilot program4 7,h7 ,! satisfaction & ret5tion scores ( ea* su* physician aft] implem5tation ( ! pilot program4 7,i7 ,! pati5t satisfaction scores = ea* su* physician be=e implem5tation ( ! pilot program4 7,j7 ,! pati5t satisfaction scores = ea* su* physician aft] implem5tation ( ! pilot program4 7,k7 ,! pati5t satisfaction scores = _! heal? c>e exp]i5ce be=e implem5tation ( ! pilot program4 7,l7 ,! pati5t satisfaction scores = _! heal? c>e exp]i5ce aft] implem5tation ( ! pilot program4 7f7 ,report 7#a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! comm5cem5t ( ! pilot program1 & n less frequ5tly ?an once e #ahj days !reaft] = ! duration ( ! pilot program1 ! ,secret>y %all submit to ,congress a report on ! pilot program4 7#b7 ,elem5ts ,ea* report requir$ by p>agraph 7#a7 %all include ! foll[+3 7,a7 ,! numb] ( m$ical facilities ( ! ,dep>tm5t t are p>ticipat+ 9 ! pilot program4 7,b7 ,) respect to ea* su* m$ical facility1 an assessm5t ( ! effects t p>ticipation 9 ! pilot program has _h on ! foll[+-- 7i7 ,maximiz+ ! effici5cy ( physicians at su* m$ical facility4 7ii7 ,r$uc+ av]age wait times = appo9tm5ts4 7iii7 ,improv+ access ( pati5ts to electronic m$ical records4 7iv7 ,mitigat+ physician %ortages by increas+ ! productivity ( physicians4 7,c7 ,all data collect$ "u subsection 7e74 7,d7 ,su* recomm5dations z ! ,secret>y may h ) respect to ! ext5sion or expansion ( ! pilot program4 7g7 ,m$ical scribe def9$ ,9 ?is section1 ! t]m m$ical scribe means a memb] ( ! m$ical team hir$ & tra9$ specifically & exclusively to p]=m docum5tation 9 an electronic heal? record to maximize ! productivity ( a physician4 #baj4 ,s5se ( ,congress reg>d+ ,dep>tm5t ( ,vet]ans ,affairs /aff+ levels 7a7 ,f9d+s ,congress makes ! foll[+ f9d+s3 7#a7 ,! ,dep>tm5t ( ,vet]ans ,affairs ne$s to fill at lea/ #ce1jjj positions4 7#b7 ,prolong$ p]sonnel vacancies 9 ! ,dep>tm5t result 9 /aff+ %ortages t cause vet]ans to receive delay$ b5efits & s]vices4 7b7 ,s5se ( ,congress ,x is ! s5se ( ,congress t ! ,dep>tm5t %\ld make ! resolution ( /aff+ %ortages a top priority4 ,,ii ,education & tra9+ #baa4 ,graduate m$ical education & resid5cy 7a7 ,increase 9 numb] ( graduate m$ical education resid5cy positions 7#a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all increase ! numb] ( graduate m$ical education resid5cy positions at cov]$ facilities by up to #a1ejj positions 9 ! #aj-ye> p]iod beg9n+ on ! date ( ! enactm5t ( ?is ,act4 7#b7 ,cov]$ facilities ,= purposes ( ?is section1 a cov]$ facility is any ( ! foll[+3 7,a7 ,a facility ( ! ,dep>tm5t ( ,vet]ans ,affairs4 7,b7 ,a facility op]at$ by an ,indian tribe or a tribal organization1 z ^? t]ms are def9$ 9 section #d ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #ecjd74 7,c7 ,a facility op]at$ by ! ,indian ,heal? ,s]vice4 7,d7 ,a ,f$]ally-qualifi$ heal? c5t]1 z def9$ 9 section #aije7l77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b774 7,e7 ,a community heal? c5t]4 7,f7 ,a facility op]at$ by ! ,dep>tm5t ( ,def5se4 7,g7 ,su* o!r heal? c>e facility z ! ,secret>y consid]s appropriate = purposes ( ?is section4 7#c7 ,/ip5ds & b5efits ,! ,secret>y may pay /ip5ds & provide b5efits = resid5ts 9 positions "u p>agraph 7#a71 reg>dless ( :e!r !y h be5 assign$ 9 a ,dep>tm5t facility4 7#d7 ,p>amet]s = location1 affiliate sponsor1 & duration ,:5 det]m9+ *>act]i/ics ( resid5cy positions "u p>agraph 7#a71 ! ,secret>y %all consid] ! ext5t to :i* !re is a cl9ical ne$ = provid]s1 z det]m9$ by ! foll[+3 7,a7 ,! ratio ( vet]ans to heal? c>e provid]s ( ! ,dep>tm5t = a /&>diz$ geographic area surr\nd+ a facility1 includ+ a sep>ate ratio = g5]al practition]s & speciali/s4 7,b7 ,:e!r ! local community is m$ically und]s]v$4 7,c7 ,:e!r ! facility is locat$ 9 a rural or remote area4 7,d7 ,su* o!r crit]ia z ! ,secret>y consid]s important 9 det]m9+ :i* facilities are n adequately s]v+ area vet]ans4 7#e7 ,p>amet]s = types ( specialties ,:5 det]m9+ ! types ( specialties to be includ$ 9 resid5cy positions "u p>agraph 7#a71 ! ,secret>y %all consid] ! foll[+3 7,a7 ,! types ( specialties t improve ! quality & cov]age ( m$ical s]vices provid$ to vet]ans4 7,b7 ,! range ( cl9ical specialties cov]$ by provid]s 9 /&>diz$ geographic areas surr\nd+ facilities4 7,c7 ,:e!r ! specialty is includ$ 9 ! mo/ rec5t /aff+ %ortage det]m9ation ( ! ,dep>tm5t "u section #gdab ( title #ch1 ,unit$ ,/ates ,code4 7b7 ,application ,to p>ticipate ,to p>ticipate z a resid5t 9 "o ( ! positions increas$ "u subsection 7a77#a71 an individual %all submit to ! ,secret>y an application !re= toge!r ) an agreem5t describ$ 9 subsection 7d7 "u :i* ! p>ticipant agrees to s]ve a p]iod ( obligat$ s]vice 9 ! ,vet]ans ,heal? ,adm9i/ration z provid$ 9 ! agreem5t 9 return = paym5t ( /ip5d & b5efit support z provid$ 9 ! agreem5t4 7c7 ,selection 7#a7 ,9 g5]al ,an individual becomes a p>ticipant 9 a resid5cy program "u ?is section ^u ! ,secret>y's approval ( ! individual's application "u subsection 7b7 & ! ,secret>y's acceptance ( ! agreem5t "u subsection 7d7 7if requir$74 7#b7 ,notice ,^u ! ,secret>y's approval ( an individual's p>ticipation 9 ! program "u p>agraph 7#a71 ! ,secret>y %all promptly notify ! individual ( t approval4 ,su* notice %all be 9 writ+4 7d7 ,agreem5t 7#a7 ,9 g5]al ,an agreem5t betwe5 ! ,secret>y & a resid5t 9 a position "u subsection 7a77#a7 %all be 9 writ+ & %all be sign$ by ! resid5t conta9+ su* t]ms z ! ,secret>y may specify4 7#b7 ,requirem5ts ,! agreem5t mu/ specify ! t]ms ( ! s]vice obligation result+ f p>ticipat+ z a resid5t "u ?is section1 includ+ by requir+ a s]vice obligation equal to ! numb] ( ye>s ( /ip5d & b5efit support4 7e7 ,conditions ( employm5t ,! ,secret>y may prescribe ! conditions ( employm5t ( individuals appo9t$ to positions "u subsection 7a77#a71 includ+ necess>y tra9+1 & ! cu/om>y am\nt & t]ms ( pay = su* positions dur+ ! p]iod ( su* employm5t & tra9+4 7f7 ,obligat$ s]vice 7#a7 ,9 g5]al ,ea* individual appo9t$ to a position "u subsection 7a77#a7 %all provide s]vice z a full-"t employee ( ! ,dep>tm5t = ! p]iod ( obligat$ s]vice provid$ 9 ! agreem5t ( ! p>ticipant ent]$ into "u subsection 7d74 ,su* s]vice %all be provid$ 9 ! full-"t cl9ical practice ( su* p>ticipant's pr(ession or 9 ano!r heal? c>e position 9 an assignm5t or location det]m9$ by ! ,secret>y4 7#b7 ,comm5cem5t date ,n lat] ?an #fj days be=e ! date on :i* an individual comm5ces s]v+ 9 a position "u subsection 7a77#a71 ! ,secret>y %all notify ! individual ( su* date4 ,su* date %all be ! fir/ day ( ! individual's p]iod ( obligat$ s]vice4 7g7 ,brea* ( agreem5t3 liability 7#a7 ,p5alty ,an individual appo9t$ "u ?is section to a position "u subsection 7a77#a7 7o!r ?an an individual :o is liable "u p>agraph 7#b77 :o fails to accept paym5t1 or in/ructs ! educational in/itution 9 :i* ! individual is enroll$ n to accept paym5t1 9 :ole or 9 "p1 = a resid5cy "u ! agreem5t ent]$ into "u subsection 7d7 ( ?is title %all be liable to ! ,unit$ ,/ates = liquidat$ damages 9 ! am\nt ( #a1ejj4 ,su* liability is 9 addition to any p]iod ( obligat$ s]vice or o!r obligation or liability "u ! agreem5t4 7#b7 ,liability 7,a7 ,9 g5]al ,an individual appo9t$ to a position "u subsection 7a77#a7 %all be liable to ! ,unit$ ,/ates = ! am\nt :i* has be5 paid to or on behalf ( ! individual "u ! agreem5t if any ( ! foll[+ occurs3 7i7 ,! individual is dismiss$ f ! position = discipl9>y reasons4 7ii7 ,! individual volunt>ily t]m9ates ! resid5cy be=e ! completion ( su* c\rse ( tra9+4 7iii7 ,! individual loses ! individual's lic5se1 regi/ration1 or c]tification to practice ! individual's heal? c>e pr(ession 9 a ,/ate4 7,b7 ,liability supplants s]vice obligation ,liability "u ?is p>agraph is 9 lieu ( any s]vice obligation aris+ "u ! individual's agreem5t "u subsection 7d74 7h7 ,recov]y 7#a7 ,9 g5]al ,if an individual brea*es ! individuals's agreem5t "u subsection 7d7 by fail+ 7= any reason7 to complete su* individual's p]iod ( obligat$ s]vice1 ! ,unit$ ,/ates %all be entitl$ to recov] f ! individual an am\nt equal to ! product (-- 7,a7 ?ree2 7,b7 ! sum (-- 7i7 ! am\nts paid "u ?is section to or on behalf ( ! individual2 & 7ii7 ! int]e/ on su* am\nts t w\ld be payable if at ! "t ! am\nts 7 paid !y 7 loans be>+ int]e/ at ! maximum legal prevail+ rate1 z det]m9$ by ! ,treasur] ( ! ,unit$ ,/ates2 & 7,c7 ! quoti5t (-- 7i7 ! diff]5ce betwe5-- 7,i7 ! total numb] ( mon?s 9 ! individual's p]iod ( obligat$ s]vice2 & 7,,ii7 ! numb] ( mon?s ( su* p]iod s]v$ by ! individual2 & 7ii7 ! total numb] ( mon?s 9 ! individual's p]iod ( obligat$ s]vice4 7#b7 ,p]iod ( recov]y ,any am\nt :i* ! ,unit$ ,/ates is entitl$ to recov] "u ?is subsection %all be paid to ! ,unit$ ,/ates n lat] ?an ! date t is "o ye> aft] ! date ( ! brea* ( ! agreem5t4 7i7 ,annual report 7#a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act & n less frequ5tly ?an once ea* ye> !reaft]1 ! ,secret>y %all submit to ! appropriate committees ( ,congress a report on ! implem5tation ( ?is section dur+ ! previ\s ye>4 7#b7 ,cont5ts ,ea* report submitt$ "u p>agraph 7#a7 %all include1 = ! p]iod cov]$ by ! report1 ! foll[+3 7,a7 ,! numb] ( positions describ$ 9 subsection 7a7 t 7 fill$4 7,b7 ,! location ( ea* su* position4 7,c7 ,! academic affiliate associat$ ) ea* su* position4 7,d7 ,a description ( ! *all5ges fac$ 9 fill+ ! positions describ$ 9 subsection 7a7 & ! actions ! ,secret>y has tak5 to address su* *all5ges4 7#c7 ,appropriate committees ( ,congress def9$ ,9 ?is subsection1 ! t]m appropriate committees ( ,congress means-- 7,a7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,s5ate2 & 7,b7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives4 #bab4 ,pilot program to e/abli% or affiliate ) graduate m$ical resid5cy programs at facilities op]at$ by ,indian tribes1 tribal organizations1 & ! ,indian ,heal? ,s]vice 9 rural areas 7a7 ,pilot program requir$ ,! ,secret>y ( ,vet]ans ,affairs1 9 consultation ) ! ,director ( ! ,indian ,heal? ,s]vice & su* o!r p]sons z ! ,secret>y consid]s appropriate1 %all c>ry out a pilot program-- 7#a7 to e/abli% graduate m$ical education resid5cy tra9+ programs at cov]$ facilities2 or 7#b7 to affiliate ) e/abli%$ programs describ$ 9 p>agraph 7#a74 7b7 ,cov]$ facilities ,= purposes ( ! pilot program1 a cov]$ facility is any facility-- 7#a7 7,a7 describ$ 9 subp>agraph 7,b7 or 7,c7 ( section #baa7;a77#b72 or 7,b7 ) an agreem5t ) ! ,dep>tm5t describ$ 9 section #aja7;d77#a72 & 7#b7 locat$ 9 a rural or remote area4 7c7 ,locations 7#a7 ,9 g5]al ,! ,secret>y %all c>ry out ! pilot program at n m ?an five cov]$ facilities t h be5 select$ by ! ,secret>y = purposes ( ! pilot program4 7#b7 ,crit]ia ,! ,secret>y %all e/abli% crit]ia = select+ cov]$ facilities "u p>agraph 7#a74 7d7 ,duration ,! ,secret>y %all c>ry out ! pilot program dur+ ! eight-ye> p]iod beg9n+ on ! date t is #ahj days aft] ! date ( ! enactm5t ( ?is ,act4 7e7 ,reimbursem5t ( co/s ,! ,secret>y %all reimburse ea* cov]$ facility p>ticipat+ 9 ! pilot program = ! foll[+ co/s associat$ ) ! pilot program3 7#a7 ,curriculum developm5t4 7#b7 ,recruitm5t1 tra9+1 sup]vision1 & ret5tion ( resid5ts & faculty4 7#c7 ,accr$itation ( programs ( education "u ! pilot program by ! ,accr$itation ,c\ncil = ,graduate ,m$ical ,education 7,,acgme7 or ! ,am]ican ,o/eopa?ic ,association 7,,aoa74 7#d7 ,! portion ( faculty sal>ies attributable to activities relat+ to c>ry+ out ! pilot program4 7#e7 ,paym5t = exp5ses relat+ to provid+ m$ical education "u ! pilot program4 7#f7 ,/ip5ds & b5efits4 7f7 ,p]iod ( obligat$ s]vice 7#a7 ,9 g5]al ,! ,secret>y %all ent] into an agreem5t ) ea* individual :o p>ticipates 9 ! pilot program "u :i* su* individual agrees to s]ve "u ! same t]ms z e/abli%$ "u section #baa4 7#b7 ,loan repaym5t ,dur+ ! p]iod ( obligat$ s]vice ( an individual "u p>agraph 7#a71 ! individual-- 7,a7 %all be deem$ to be an eligible individual "u subsection 7b7 ( section #ajh ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afaf;a7 = purposes ( p>ticipation 9 ! ,indian ,heal? ,s]vice ,loan ,repaym5t ,program "u su* section dur+ ! portion ( su* p]iod t ! individual s]ves at a cov]$ facility2 & 7,b7 %all be deem$ to be an eligible individual "u section #gfhb7;a7 ( title #ch1 ,unit$ ,/ates ,code1 = purposes ( p>ticipation 9 ! ,dep>tm5t ( ,vet]ans ,affairs ,education ,debt ,r$uction ,program "u sub*apt] ,,vii ( *apt] #gf ( su* title dur+ ! portion ( su* p]iod t ! individual s]ves at a facility ( ! ,dep>tm5t4 7#c7 ,concurr5t s]vice ,any p]iod ( obligat$ s]vice requir$ ( an individual "u p>agraph 7#a7 %all be s]v$-- 7,a7 ) respect to s]vice at a cov]$ facility1 concurr5tly ) any p]iod ( obligat$ s]vice requir$ ( ! individual by ! ,indian ,heal? ,s]vice2 & 7,b7 ) respect to s]vice at a facility ( ! ,dep>tm5t ( ,vet]ans ,affairs1 concurr5tly ) any p]iod ( obligat$ s]vice requir$ ( ! individual by ! ,dep>tm5t4 7g7 ,treatm5t ( p>ticipants ,a resid5cy position into :i* a p>ticipant 9 ! pilot program is plac$ z "p ( ! pilot program %all be consid]$ a position ref]r$ to 9 section #baa7;a77#a7 = purposes ( ! limitation on numb] ( new positions au?oriz$ "u su* section4 7h7 ,report ,n lat] ?an ?ree ye>s be=e ! date on :i* ! pilot program t]m9ates1 ! ,secret>y ( ,vet]ans ,affairs %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report on ! feasibility & advisability (-- 7#a7 exp&+ ! pilot program to additional locations2 & 7#b7 mak+ ! pilot program or any aspect ( ! pilot program p]man5t4 #bac4 ,reimbursem5t ( cont9u+ pr(essional education requirem5ts = bo>d c]tifi$ advanc$ practice regi/]$ nurses 7a7 ,9 g5]al ,section #gdaa is am5d$ to read z foll[s3 #gdaa4 ,reimbursem5t ( cont9u+ pr(essional education exp5ses ,! ,secret>y %all reimburse any full-"t bo>d-c]tifi$ advanc$ practice regi/]$ nurse1 physician1 or d5ti/ appo9t$ "u section #gdja7a7 ( ?is title = exp5ses incurr$1 up to #a1jjj p] ye>1 = cont9u+ pr(essional education4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #gd is am5d$ by /rik+ ! item relat+ to section #gdaa & ins]t+ ! foll[+ new item3 #gdaa4 ,reimbursem5t ( cont9u+ pr(essional education exp5ses4 4 #bad4 ,increase 9 maximum am\nt ( debt t may be r$uc$ "u ,education ,debt ,r$uction ,program ( ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,increase 9 am\nt ,section #gfhc7;d77#a7 is am5d$-- 7#a7 by /rik+ #abj1jjj & ins]t+ #bdj1jjj2 & 7#b7 by /rik+ #bd1jjj & ins]t+ #dh1jjj4 7b7 ,/udy 7#a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all-- 7,a7 conduct a /udy on ! dem& = education debt r$uction "u sub*apt] ,,vii ( *apt] #gf ( title #ch1 ,unit$ ,/ates ,code2 & 7,b7 submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report on ! f9d+s ( ! ,secret>y ) respect to ! /udy c>ri$ out "u subp>agraph 7,a74 7#b7 ,consid]ations ,9 c>ry+ out ! /udy requir$ by p>agraph 7#a77;,a71 ! ,secret>y %all consid] ! foll[+3 7,a7 ,! total numb] ( vacancies )9 ! ,vet]ans ,heal? ,adm9i/ration ^: applicants are eligible to p>ticipate 9 ! ,education ,debt ,r$uction ,program pursuant to section #gfhb7;a7 ( su* title4 7,b7 ,! types ( m$ical pr(essionals 9 greate/ dem& 9 ! ,unit$ ,/ates4 7,c7 ,projections by ! ,secret>y ( ! numb]s & types ( m$ical pr(essions t meet ! ne$s ( vet]ans4 #bae4 ,demon/ration program on tra9+ & employm5t ( alt]native d5tal heal? c>e provid]s = d5tal heal? c>e s]vices = vet]ans 9 rural & o!r und]s]v$ communities 7a7 ,demon/ration program au?oriz$ ,! ,secret>y ( ,vet]ans ,affairs may c>ry out a demon/ration program to e/abli% programs to tra9 & employ alt]native d5tal heal? c>e provid]s 9 ord] to increase access to d5tal heal? c>e s]vices = vet]ans :o are entitl$ to su* s]vices f ! ,dep>tm5t ( ,vet]ans ,affairs & reside 9 rural & o!r und]s]v$ communities4 7b7 ,priority ,! ,secret>y %all prioritize ! e/abli%m5t ( programs "u ! demon/ration program "u ?is section 9 ,/ates t d n h a facility ( ! ,dep>tm5t t (f]s on-site d5tal s]vices4 7c7 ,teleheal? ,= purposes ( alt]native d5tal heal? c>e provid]s & o!r d5tal c>e provid]s :o are lic5s$ to provide cl9ical c>e1 d5tal s]vices provid$ "u ! demon/ration program "u ?is section may be adm9i/]$ by su* provid]s ?r\gh teleheal?-enabl$ collaboration & sup]vision :5 appropriate & feasible4 7d7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to ! ,secret>y su* sums z are necess>y to c>ry out ! demon/ration program "u ?is section4 7e7 ,alt]native d5tal heal? c>e provid]s def9$ ,9 ?is section1 ! t]m alt]native d5tal heal? c>e provid]s has ! mean+ giv5 t t]m 9 section #cdj;,g-#a7;a77#b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bef;g-#a7;a77#b774 ,,iii ,o!r p]sonnel matt]s #bba4 ,exception on limitation on aw>ds & bonuses = recruitm5t1 relocation1 & ret5tion ,section #gje7;a7 ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #gjc note7 is am5d$1 9 ! matt] prec$+ p>agraph 7#a71 by ins]t+ o!r ?an recruitm5t1 relocation1 or ret5tion inc5tives1 aft] title #ch1 ,unit$ ,/ates ,code14 #bbb4 ,annual report on p]=mance aw>ds & bonuses aw>d$ to c]ta9 high-level employees ( ! ,dep>tm5t 7a7 ,9 g5]al ,*apt] #g is am5d$ by add+ at ! end ! foll[+ new section3 #gbf4 ,annual report on p]=mance aw>ds & bonuses aw>d$ to c]ta9 high-level employees 7a7 ,9 g5]al ,n lat] ?an #cj days aft] ! end ( ea* fiscal ye>1 ! ,secret>y %all submit to ! appropriate committees ( ,congress a report t conta9s1 = ! mo/ rec5t fiscal ye> end+ be=e ! submittal ( ! report1 a description ( ! p]=mance aw>ds & bonuses aw>d$ to ,regional ,(fice ,directors ( ! ,dep>tm5t1 ,directors ( ,m$ical ,c5t]s ( ! ,dep>tm5t1 & ,directors ( ,vet]ans ,integrat$ ,s]vice ,networks4 7b7 ,elem5ts ,ea* report submitt$ "u subsection 7a7 %all include ! foll[+ ) respect to ea* p]=mance aw>d or bonus aw>d$ to an individual describ$ 9 su* subsection3 7#a7 ,! am\nt ( ea* aw>d or bonus4 7#b7 ,! job title ( ! individual aw>d$ ! aw>d or bonus4 7#c7 ,! location :]e ! individual aw>d$ ! aw>d or bonus works4 7c7 ,appropriate committees ( ,congress ,9 ?is section1 ! t]m appropriate committees ( ,congress means-- 7#a7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,s5ate2 & 7#b7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #g is am5d$ by ins]t+ aft] ! item relat+ to section #gbe ! foll[+ new item3 #gbf4 ,annual report on p]=mance aw>ds & bonuses aw>d$ to c]ta9 high-level employees4 4 #bbc4 ,au?ority to regulate additional pay = c]ta9 heal? c>e employees ( ! ,dep>tm5t ,section #gded is am5d$ by add+ at ! end ! foll[+ new subsection3 7d7 ,9 ?is section1 ! t]m comp5sation includes all comp5sation e>n$ by employees :5 p]=m+ duties au?oriz$ by ! ,secret>y or :5 ! employee is approv$ to use annual1 sick1 family m$ical1 milit>y1 or c\rt leave or dur+ any o!r paid abs5ce = :i* pay is n already regulat$4 4 #bbd4 ,modification ( pay cap = nurses ,p>agraph 7#b7 ( section #gdea7;c7 is am5d$ to read z foll[s3 7#b7 7,a7 ,! maximum rate ( basic pay = any grade = heal?-c>e p]sonnel positions ref]r$ to 9 p>agraphs 7#a7 & 7#c7 ( section #gdja ( ?is title 7o!r ?an ! positions ( physician1 d5ti/1 & regi/]$ nurse7 may n exce$ ! rate ( basic pay e/abli%$ = positions 9 level ,,iv ( ! ,executive ,s*$ule "u section #ecae ( title #e4 7,b7 ,pursuant to an adju/m5t "u subsection 7d71 ! maximum rate ( basic pay = a regi/]$ nurse s]v+ z a nurse executive or a grade = ! position ( c]tifi$ regi/]$ nurse ane/heti/ may exce$ ! rate ( basic pay e/abli%$ = positions 9 level ,,iv ( ! ,executive ,s*$ule "u section #ecae ( title #e b may n exce$ ! rate ( basic pay e/abli%$ = positions 9 level ,i ( ! ,executive ,s*$ule "u section #ecab ( title #e4 7,c7 ,pursuant to an adju/m5t "u subsection 7d71 ! maximum rate ( basic pay = all regi/]$ nurses n describ$ 9 subp>agraph 7,b7 may exce$ ! rate ( basic pay e/abli%$ = positions 9 level ,,iv ( ! ,executive ,s*$ule "u section #ecae ( title #e b may n exce$ ! rate ( basic pay e/abli%$ = positions 9 level ,,iii ( ! ,executive ,s*$ule "u section #ecad ( title #e4 4 ,b ,improvem5t ( und]s]v$ facilities ( ! ,dep>tm5t #bca4 ,developm5t ( crit]ia = designation ( c]ta9 m$ical facilities ( ! ,dep>tm5t ( ,vet]ans ,affairs z und]s]v$ facilities & plan to address problem ( und]s]v$ facilities 7a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all develop crit]ia to designate m$ical c5t]s1 ambulatory c>e facilities1 & community bas$ outpati5t cl9ics ( ! ,dep>tm5t ( ,vet]ans ,affairs z und]s]v$ facilities4 7b7 ,consid]ation ,crit]ia develop$ "u subsection 7a7 %all include consid]ation ( ! foll[+ ) respect to a facility3 7#a7 ,! ratio ( vet]ans to heal? c>e provid]s ( ! ,dep>tm5t ( ,vet]ans ,affairs = a /&>diz$ geographic area surr\nd+ ! facility1 includ+ a sep>ate ratio = g5]al practition]s & speciali/s4 7#b7 ,! range ( cl9ical specialties cov]$ by su* provid]s 9 su* area4 7#c7 ,:e!r ! local community is m$ically und]s]v$4 7#d7 ,! type1 numb]1 & age ( op5 consults4 7#e7 ,:e!r ! facility is meet+ ! wait-"t goals ( ! ,dep>tm5t4 7#f7 ,su* o!r crit]ia z ! ,secret>y consid]s important 9 det]m9+ :i* facilities are n adequately s]v+ area vet]ans4 7c7 ,analysis ( facilities ,n less frequ5tly ?an annually1 directors ( ,vet]ans ,integrat$ ,s]vice ,networks ( ! ,dep>tm5t %all p]=m an analysis to det]m9e :i* facilities )9 t ,vet]ans ,integrat$ ,s]vice ,network qualify z und]s]v$ facilities pursuant to crit]ia develop$ "u subsection 7a74 7d7 ,annual plan ,to address und]s]v$ facilities 7#a7 ,plan requir$ ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act & n less frequ5tly ?an once ea* ye>1 ! ,secret>y %all submit to ,congress a plan to address ! problem ( und]s]v$ facilities ( ! ,dep>tm5t1 z designat$ pursuant to crit]ia develop$ "u subsection 7a74 7#b7 ,cont5ts ,ea* plan submitt$ "u p>agraph 7#a7 %all address ! foll[+3 7,a7 ,increas+ p]sonnel or tempor>y p]sonnel assi/ance1 includ+ mobile deploym5t teams furni%$ "u section #bcc4 7,b7 ,provid+ special hir+ inc5tives1 includ+ "u ! ,education ,debt ,r$uction ,program "u sub*apt] ,,vii ( *apt] #gf ( title #ch1 ,unit$ ,/ates ,code1 & recruitm5t1 relocation1 & ret5tion inc5tives4 7,c7 ,us+ direct hir+ au?ority4 7,d7 ,improv+ tra9+ opportunities = /aff4 7,e7 ,su* o!r actions z ! ,secret>y consid]s appropriate4 #bcb4 ,pilot program on tuition reimbursem5t & loan repaym5t = heal? c>e provid]s ( ! ,dep>tm5t ( ,vet]ans ,affairs at und]s]v$ facilities 7a7 ,9 g5]al ,n lat] ?an #ij days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all comm5ce a pilot program to assess ! feasibility & advisability ( provid+ inc5tives to individuals to "w at und]s]v$ facilities ( ! ,vet]ans ,heal? ,adm9i/ration by provid+ tuition reimbursem5t & loan repaym5t to m$ical /ud5ts & heal? c>e provid]s :o commit to s]v+ 9 und]s]v$ facilities select$ "u subsection 7c74 7b7 ,duration ,! ,secret>y %all c>ry out ! pilot program dur+ ! six-ye> p]iod beg9n+ on ! date ( ! comm5cem5t ( ! pilot program4 7c7 ,selection ( locations 7#a7 ,9 g5]al ,! ,secret>y %all select n few] ?an ?ree m$ical c5t]s & sev5 ambulatory c>e facilities or community bas$ outpati5t cl9ics ( ! ,dep>tm5t to p>ticipate 9 ! pilot program4 7#b7 ,rural & highly rural areas ,n few] ?an two ( ! m$ical c5t]s & five ( ! ambulatory c>e facilities or community bas$ outpati5t cl9ics select$ "u p>agraph 7#a7 %all be 9 ,/ates or ,unit$ ,/ates t]ritories t are among ! t5 ,/ates or ,unit$ ,/ates t]ritories )-- 7,a7 ! highe/ p]c5tage ( l& designat$ z highly rural pursuant to ! rural-urban commut+ area codes set =? by ! ,dep>tm5t ( ,agriculture2 or 7,b7 ! highe/ p]c5tage ( enroll$ vet]ans liv+ 9 rural1 highly rural1 or insul> isl& areas4 7#c7 ,/ates ,facilities select$ "u p>agraph 7#a7 %all be locat$ 9 n few] ?an eight diff]5t ,/ates4 7d7 ,use ( am\nts ,( ! am\nts us$ to provide tuition reimbursem5t or loan repaym5t "u ! pilot program-- 7#a7 "o-half %all be us$ to provide tuition reimbursem5t or loan repaym5t = individuals practic+ 9 a g5]al practice position2 & 7#b7 "o-half %all be us$ to provide tuition reimbursem5t or loan repaym5t = individuals practic+-- 7,a7 9 a speciali/ position2 or 7,b7 9 an occupation1 o!r ?an a position describ$ 9 p>agraph 7#a71 includ$ 9 ! mo/ rec5t /aff+ %ortage det]m9ation ( ! ,dep>tm5t "u section #gdab ( title #ch1 ,unit$ ,/ates ,code4 7e7 ,tuition reimbursem5t ,"u ! pilot program1 ! ,secret>y may provide to an individual att5d+ m$ical s*ool & seek+ a degree z a ,doctor ( ,m$ic9e or a ,doctor ( ,o/eopa?ic ,m$ic9e full tuition reimbursem5t 9 ex*ange = a five-ye> commitm5t to s]ve at an und]s]v$ facility select$ "u subsection 7c74 7f7 ,/ud5t loan repaym5t ,"u ! pilot program1 9 ex*ange = a ?ree-ye> commitm5t to s]ve at an und]s]v$ facility select$ "u subsection 7c71 ! ,secret>y may provide-- 7#a7 to an individual curr5tly s]v+ z a heal? c>e provid] at an und]s]v$ facility1 an am\nt n to exce$ #cj1jjj to apply to any rema9+ /ud5t loan debt ( ! individual2 & 7#b7 to an individual o!r ?an an individual describ$ 9 p>agraph 7#a71 an am\nt n to exce$ #ej1jjj to apply to any rema9+ /ud5t loan debt ( ! individual4 7g7 ,brea* ,an individual :o p>ticipates 9 ! pilot program & fails to satisfy a p]iod ( obligat$ s]vice "u subsection 7d7 or 7e7 %all be liable to ! ,unit$ ,/ates1 9 lieu ( su* obligat$ s]vice1 = ! am\nt t has be5 paid or is payable to or on behalf ( ! individual "u ! pilot program1 r$uc$ by ! proportion t ! numb] ( days s]v$ = completion ( ! p]iod ( obligat$ s]vice be>s to ! total numb] ( days 9 ! p]iod ( obligat$ s]vice ( su* individual4 7h7 ,exp$it$ hir+ ,! ,secret>y %all ensure t ! hir+ ( individuals to s]ve 9 ! ,dep>tm5t "u ! pilot program is conduct$ 9 an exp$it$ mann]4 7i7 ,cont9uation 9 pilot program ,an individual p>ticipat+ 9 ! pilot program 9 an occupation includ$ 9 a /aff+ %ortage det]m9ation ( ! ,dep>tm5t "u section #gdab ( title #ch1 ,unit$ ,/ates ,code1 may cont9ue p>ticipat+ 9 ! pilot program not)/&+ t ! occupation is no long] includ$ 9 su* det]m9ation "u su* section4 7j7 ,annual report 7#a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act & n less frequ5tly ?an once ea* ye> !reaft]1 ! ,secret>y %all submit to ,congress a report on ! pilot program4 7#b7 ,cont5ts ,ea* report submitt$ "u p>agraph 7#a7 %all include ! foll[+3 7,a7 ,! numb] ( p>ticipants1 includ+ numb] receiv+ tuition reimbursem5t & /ud5t loan repaym5t4 7,b7 ,! numb] ( facilities :]e p>ticipants are locat$4 7,c7 ,! numb] ( individuals :o h appli$ to p>ticipate 9 ! pilot program4 7,d7 ,a li/ ( ! five mo/ common occupations ( ! p>ticipants 9 ! pilot program1 o!r ?an g5]al practice4 7k7 ,def9itions ,9 ?is section3 7#a7 ,enroll$ vet]an ,! t]m enroll$ vet]an means a vet]an :o is enroll$ 9 ! sy/em ( annual pati5t enrollm5t e/abli%$ & op]at$ "u section #agje7;a7 ( title #ch1 ,unit$ ,/ates ,code4 7#b7 ,und]s]v$ facility ,! t]m und]s]v$ facility means a m$ical c5t]1 ambulatory c>e facility1 or community bas$ outpati5t cl9ic ( ! ,dep>tm5t ( ,vet]ans ,affairs designat$ by ! ,secret>y ( ,vet]ans ,affairs pursuant to crit]ia develop$ "u section #bca4 #bcc4 ,program to furni% mobile deploym5t teams to und]s]v$ facilities 7a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all e/abli% a program to furni% mobile deploym5t teams ( m$ical p]sonnel to und]s]v$ facilities4 7b7 ,elem5ts ,9 furni%+ mobile deploym5t teams "u subsection 7a71 ! ,secret>y %all consid] ! foll[+ elem5ts3 7#a7 ,! m$ical positions ( greate/ ne$ at und]s]v$ facilities4 7#b7 ,! size & composition ( teams to be deploy$4 7#c7 ,su* o!r elem5ts z ! ,secret>y consid]s necess>y = effective ov]sight ( ! program e/abli%$ "u subsection 7a74 7c7 ,use ( annual analysis ,! ,secret>y %all use ! results ( ! annual analysis conduct$ "u section #bca7;c7 to =m mobile deploym5t teams "u subsection 7a7 t are compos$ ( ! mo/ ne$$ m$ical p]sonnel = und]s]v$ facilities4 7d7 ,und]s]v$ facility def9$ ,9 ?is section1 ! t]m und]s]v$ facility means a m$ical c5t]1 ambulatory c>e facility1 or community bas$ outpati5t cl9ic ( ! ,dep>tm5t ( ,vet]ans ,affairs designat$ by ! ,secret>y ( ,vet]ans ,affairs pursuant to crit]ia develop$ "u section #bca4 #bcd4 ,inclusion ( ,vet ,c5t] employees 9 education debt r$uction program ( ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all ensure t cl9ical /aff work+ at ,vet ,c5t]s are eligible to p>ticipate 9 ! education debt r$uction program ( ! ,dep>tm5t ( ,vet]ans ,affairs "u sub*apt] ,,vii ( *apt] #gf ( title #ch1 ,unit$ ,/ates ,code4 7b7 ,report ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report on ! numb] ( p>ticipants 9 ! education debt r$uction program ( ! ,dep>tm5t "u su* sub*apt] :o "w at ,vet ,c5t]s4 7c7 ,vet ,c5t] def9$ ,9 ?is section1 ! t]m ,vet ,c5t] has ! mean+ giv5 t t]m 9 section #agab;,a7h7 ( title #ch1 ,unit$ ,/ates ,code4 ,c ,con/ruction & leases #bda4 ,def9ition ( major m$ical facility project & major m$ical facility lease 7a7 ,modification ( def9ition ( m$ical facility ,section #haja7c7 is am5d$ by /rik+ ,secret>y & all t foll[s ?r\gh nurs+ home1 & ins]t+ ,secret>y1 or z o!rwise au?oriz$ by law1 = ! provision ( heal?-c>e s]vices 7includ+ hospital1 outpati5t cl9ic1 nurs+ home14 7b7 ,modification ( def9itions ( major m$ical facility project & major m$ical facility lease ,p>agraph 7#c7 ( section #hajd7;a7 is am5d$ to read z foll[s3 7#c7 ,= purposes ( ?is subsection3 7,a7 ,! t]m major m$ical facility project means a project = ! con/ruction1 alt]ation1 or acquisition ( a m$ical facility involv+ a total exp5diture ( m ?an #bj1jjj1jjj1 b su* t]m does n include an acquisition by ex*ange1 non-recurr+ ma9t5ance projects ( ! ,dep>tm5t1 or ! con/ruction1 alt]ation1 or acquisition ( a %>$ ,f$]al m$ical facility = :i* ! ,dep>tm5t's e/imat$ %>e ( ! project co/s does n exce$ #bj1jjj1jjj4 7,b7 ,! t]m major m$ical facility lease means a lease = space = use z a new m$ical facility at an av]age annual r5tal equal to or great] ?an ! doll> ?re%old = leases procur$ ?r\gh ! ,g5]al ,s]vices ,adm9i/ration "u section #ccjg7;a77#b7 ( title #dj1 :i* %all be subject to annual adju/m5t 9 accordance ) section #ccjg7;h7 ( su* title4 4 #bdb4 ,facilitat+ %>+ ( m$ical facilities ) o!r ,f$]al ag5cies 7a7 ,9 g5]al ,sub*apt] ,i ( *apt] #ha is am5d$ by ins]t+ aft] section #haaa;,a ! foll[+ new section3 #haaa;,b4 ,au?ority to plan1 design1 con/ruct1 or lease a %>$ m$ical facility 7a7 ,9 g5]al 7#a7 ,! ,secret>y may ent] into agreem5ts ) o!r ,f$]al ag5cies = ! plann+1 design+1 con/ruct+1 or leas+ ( %>$ m$ical facilities ) ! goal ( improv+ access to1 & quality & co/ effectiv5ess (1 heal? c>e provid$ by ! ,dep>tm5t & o!r ,f$]al ag5cies4 7#b7 ,facilities plann$1 design$1 con/ruct$1 or leas$ "u p>agraph 7#a7 %all be manag$ by ! ,"u ,secret>y = ,heal?4 7b7 ,transf] ( am\nts to o!r ,f$]al ag5cies 7#a7 ,! ,secret>y may transf] to ano!r ,f$]al ag5cy am\nts appropriat$ to ! ,dep>tm5t = ,con/ruction1 ,m9or ,projects = use = ! plann+1 design1 or con/ruction ( a %>$ m$ical facility if ! e/imat$ %>e ( ! project co/s to be borne by ! ,dep>tm5t does n exce$ ! ?re%old = a major m$ical facility project "u section #hajd7;a77#c77;,a7 ( ?is title4 7#b7 ,! ,secret>y may transf] to ano!r ,f$]al ag5cy am\nts appropriat$ to ! ,dep>tm5t = ,con/ruction1 ,major ,projects = use = ! plann+1 design1 or con/ruction ( a %>$ m$ical facility if-- 7,a7 ! e/imat$ %>e ( ! project co/s to be borne by ! ,dep>tm5t is m ?an ! ?re%old = a major m$ical facility project "u subsection 7a77#c77;,a7 ( section #hajd ( ?is title2 & 7,b7 ! requirem5ts = su* a project "u su* section h be5 met4 7#c7 ,! ,secret>y may transf] to ano!r ,f$]al ag5cy am\nts appropriat$ to ! applicable appropriations acc\nt ( ! ,dep>tm5t = ! purpose ( leas+ space = a %>$ m$ical facility if ! e/imat$ %>e ( ! lease co/s to be borne by ! ,dep>tm5t does n exce$ ! ?re%old = a major m$ical facility lease "u section #hajd7;a77#c77;,b7 ( ?is title4 7c7 ,transf] ( am\nts to ,dep>tm5t 7#a7 ,am\nts transf]r$ to ! ,dep>tm5t by ano!r ,f$]al ag5cy = ! necess>y exp5ses ( plann+1 design+1 or con/ruct+ a %>$ m$ical facility = :i* ! e/imat$ %>e ( ! project co/s to be borne by ! ,dep>tm5t does n exce$ ! ?re%old = a major m$ical facility project "u section #hajd7;a77#c77;,a7 ( ?is title may be deposit$ 9 ! ,con/ruction1 ,m9or ,projects acc\nt ( ! ,dep>tm5t & us$ = su* necess>y exp5ses4 7#b7 ,am\nts transf]r$ to ! ,dep>tm5t by ano!r ,f$]al ag5cy = ! necess>y exp5ses ( plann+1 design+1 or con/ruct+ a %>$ m$ical facility = :i* ! e/imat$ %>e ( ! project co/s to be borne by ! ,dep>tm5t is m ?an ! ?re%old = a major m$ical facility project "u section #hajd7;a77#c77;,a7 ( ?is title may be deposit$ 9 ! ,con/ruction1 ,major ,projects acc\nt ( ! ,dep>tm5t & us$ = su* necess>y exp5ses if ! requirem5ts = su* project "u section #hajd ( ?is title h be5 met4 7#c7 ,am\nts transf]r$ to ! ,dep>tm5t by ano!r ,f$]al ag5cy = ! purpose ( leas+ space = a %>$ m$ical facility may be cr$it$ to ! applicable appropriations acc\nt ( ! ,dep>tm5t & %all be available )\t fiscal ye> limitation4 7#d7 ,am\nts transf]r$ "u p>agraphs 7#a7 & 7#b7 %all be available = ! same "t p]iod z am\nts 9 ! acc\nt to :i* ^? am\nts are transf]r$4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( su* *apt] is am5d$ by ins]t+ aft] ! item relat+ to section #haaa;,a ! foll[+ new item3 #haaa;,b4 ,au?ority to plan1 design1 con/ruct1 or lease a %>$ m$ical facility44 #bdc4 ,review ( enhanc$ use leases ,section #hafb7;b77#f7 is am5d$ to read z foll[s3 7#f7 ,! ,(fice ( ,managem5t & ,budget %all review ea* enhanc$-use lease be=e ! lease goes into effect to det]m9e :e!r ! lease is 9 compliance ) p>agraph 7#e74 4 #bdd4 ,au?orization ( c]ta9 major m$ical facility projects ( ! ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,au?orization ,! ,secret>y ( ,vet]ans ,affairs may c>ry out ! foll[+ major m$ical facility project1 to be c>ri$ out 9 an am\nt n to exce$ ! am\nt specifi$ = t project3 ,con/ruction ( ! new ,ea/ ,bay ,community ,bas$ ,outpati5t ,cl9ic & all associat$ site "w1 utilities1 p>k+1 & l&scap+1 con/ruction ( ! ,c5tral ,valley ,eng9e]+ & ,logi/ics support facility1 & enhanc$ flood pla9 mitigation at ! ,c5tral ,valley & ,ea/ ,bay ,community ,bas$ ,outpati5t ,cl9ics z "p ( ! realignm5t ( m$ical facilities 9 ,liv]more1 ,cali=nia1 9 an am\nt n to exce$ #aag1cjj1jjj4 7b7 ,au?orization ( appropriations = con/ruction ,!re is au?oriz$ to be appropriat$ to ! ,secret>y ( ,vet]ans ,affairs = fiscal ye> #bjah or ! ye> 9 :i* funds are appropriat$ = ! ,con/ruction1 ,major ,projects acc\nt1 #aag1cjj1jjj = ! project au?oriz$ 9 subsection 7a74 7c7 ,submittal ( in=mation ,n lat] ?an #ij days aft] ! date ( ! enactm5t ( ?is ,act1 = ! project au?oriz$ 9 section 7a71 ! ,secret>y ( ,vet]ans ,affairs %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives ! foll[+ in=mation3 7#a7 ,a l9e item acc\nt+ ( exp5ditures relat+ to con/ruction managem5t c>ri$ out by ! ,dep>tm5t ( ,vet]ans ,affairs = su* project4 7#b7 ,! future am\nts t are budget$ to be obligat$ = con/ruction managem5t c>ri$ out by ! ,dep>tm5t = su* project4 7#c7 ,a ju/ification = ! exp5ditures describ$ 9 p>agraph 7#a7 & ! future am\nts describ$ 9 p>agraph 7#b74 7#d7 ,any agreem5t ent]$ into by ! ,secret>y reg>d+ a non-,dep>tm5t ( ,vet]ans ,affairs ,f$]al entity provid+ managem5t s]vices relat+ to su* project1 includ+ reimbursem5t agreem5ts & ! co/s to ! ,dep>tm5t = su* s]vices4 ,d ,o!r heal? c>e matt]s #bea4 ,program on use ( wellness programs z complem5t>y approa* to m5tal heal? c>e = vet]ans & family memb]s ( vet]ans 7a7 ,program requir$ 7#a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all c>ry out a program ?r\gh ! aw>d ( grants to public or private nonpr(it entities to assess ! feasibility & advisability ( us+ wellness programs to complem5t ! provision ( m5tal heal? c>e to vet]ans & family memb]s eligible = c\nsel+ "u section #agab;,a7a77#a77;,c7 ( title #ch1 ,unit$ ,/ates ,code4 7#b7 ,matt]s to be address$ ,! program %all be c>ri$ out s z to assess ! foll[+3 7,a7 ,means ( improv+ coord9ation betwe5 ,f$]al1 ,/ate1 local1 & community provid]s ( heal? c>e 9 ! provision ( m5tal heal? c>e to vet]ans & family memb]s describ$ 9 p>agraph 7#a74 7,b7 ,means ( enhanc+ outrea*1 & coord9ation ( outrea*1 by & among provid]s ( heal? c>e ref]r$ to 9 subp>agraph 7,a7 on ! m5tal heal? c>e s]vices available to vet]ans & family memb]s describ$ 9 p>agraph 7#a74 7,c7 ,means ( us+ wellness programs ( provid]s ( heal? c>e ref]r$ to 9 subp>agraph 7,a7 z complem5ts to ! provision by ! ,dep>tm5t ( ,vet]ans ,affairs ( m5tal heal? c>e to vet]ans & family memb]s describ$ 9 p>agraph 7#a74 7,d7 ,:e!r wellness programs describ$ 9 subp>agraph 7,c7 are effective 9 enhanc+ ! quality ( life & well-be+ ( vet]ans & family memb]s describ$ 9 p>agraph 7#a74 7,e7 ,:e!r wellness programs describ$ 9 subp>agraph 7,c7 are effective 9 increas+ ! adh]5ce ( vet]ans describ$ 9 p>agraph 7#a7 to ! prim>y m5tal heal? s]vices provid$ su* vet]ans by ! ,dep>tm5t4 7,f7 ,:e!r wellness programs describ$ 9 subp>agraph 7,c7 h an impact on ! s5se ( wellbe+ ( vet]ans describ$ 9 p>agraph 7#a7 :o receive prim>y m5tal heal? s]vices f ! ,dep>tm5t4 7,g7 ,:e!r wellness programs describ$ 9 subp>agraph 7,c7 are effective 9 enc\rag+ vet]ans receiv+ heal? c>e f ! ,dep>tm5t to adopt a m heal?y life/yle4 7b7 ,duration ,! ,secret>y %all c>ry out ! program = a p]iod ( ?ree ye>s beg9n+ on ! date t is "o ye> aft] ! date ( ! enactm5t ( ?is ,act4 7c7 ,locations ,! ,secret>y %all c>ry out ! program at facilities ( ! ,dep>tm5t provid+ m5tal heal? c>e s]vices to vet]ans & family memb]s describ$ 9 subsection 7a77#a74 7d7 ,grant proposals 7#a7 ,9 g5]al ,a public or private nonpr(it entity seek+ ! aw>d ( a grant "u ?is section %all submit an application !re= to ! ,secret>y 9 su* =m & 9 su* mann] z ! ,secret>y may require4 7#b7 ,application cont5ts ,ea* application submitt$ "u p>agraph 7#a7 %all include ! foll[+3 7,a7 ,a plan to coord9ate activities "u ! program1 to ! ext5t possible1 ) ,f$]al1 ,/ate1 & local provid]s ( s]vices = vet]ans to enhance ! foll[+3 7i7 ,aw>5ess by vet]ans ( b5efits & heal? c>e s]vices provid$ by ! ,dep>tm5t4 7ii7 ,outrea* ef=ts to increase ! use by vet]ans ( s]vices provid$ by ! ,dep>tm5t4 7iii7 ,educational ef=ts to in=m vet]ans ( ! b5efits ( a heal?y & active life/yle4 7,b7 ,a /atem5t ( und]/&+ f ! entity submitt+ ! application t1 if select$1 su* entity w be requir$ to report to ! ,secret>y p]iodically on /&>diz$ data & o!r p]=mance data necess>y to evaluate individual outcomes & to facilitate evaluations among entities p>ticipat+ 9 ! program4 7,c7 ,o!r requirem5ts t ! ,secret>y may prescribe4 7e7 ,grant uses 7#a7 ,9 g5]al ,a public or private nonpr(it entity aw>d$ a grant "u ?is section %all use ! aw>d = purposes prescrib$ by ! ,secret>y4 7#b7 ,eligible vet]ans & family ,9 c>ry+ out ! purposes prescrib$ by ! ,secret>y 9 p>agraph 7#a71 a public or private nonpr(it entity aw>d$ a grant "u ?is section %all use ! aw>d to furni% s]vices only to individuals specifi$ 9 section #agab;,a7a77#a77;,c7 ( title #ch1 ,unit$ ,/ates ,code4 7f7 ,reports 7#a7 ,p]iodic reports 7,a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! date ( ! comm5cem5t ( ! program1 & e #ahj days !reaft]1 ! ,secret>y %all submit to ,congress a report on ! program4 7,b7 ,report elem5ts ,ea* report requir$ by subp>agraph 7,a7 %all include ! foll[+3 7i7 ,! f9d+s & conclusions ( ! ,secret>y ) respect to ! program dur+ ! #ahj-;day p]iod prec$+ ! report4 7ii7 ,an assessm5t ( ! b5efits ( ! program to vet]ans & _! family memb]s dur+ ! #ahj-;day p]iod prec$+ ! report4 7#b7 ,f9al report ,n lat] ?an #ahj days aft] ! end ( ! program1 ! ,secret>y %all submit to ,congress a report detail+ ! recomm5dations ( ! ,secret>y z to ! advisability ( cont9u+ or exp&+ ! program4 7g7 ,wellness def9$ ,9 ?is section1 ! t]m wellness has ! mean+ giv5 t t]m 9 regulations prescrib$ by ! ,secret>y4 #beb4 ,au?orization to provide = op]ations on live donors = purposes ( conduct+ transplant proc$ures = vet]ans 7a7 ,9 g5]al ,sub*apt] ,,viii ( *apt] #ag is am5d$ by add+ at ! end ! foll[+ new section3 #aghh4 ,transplant proc$ures ) live donors & relat$ s]vices 7a7 ,9 g5]al ,subject to subsections 7b7 & 7c71 9 a case 9 :i* a vet]an is eligible = a transplant proc$ure f ! ,dep>tm5t1 ! ,secret>y may provide = an op]ation on a live donor to c>ry out su* proc$ure = su* vet]an1 not)/&+ t ! live donor may n be eligible = heal? c>e f ! ,dep>tm5t4 7b7 ,o!r s]vices ,subject to ! availability ( appropriations = su* purpose1 ! ,secret>y %all furni% to a live donor any c>e or s]vices be=e & aft] conduct+ ! transplant proc$ure "u subsection 7a7 t may be requir$ 9 connection ) su* proc$ure4 7c7 ,use ( non-,dep>tm5t facilities ,9 c>ry+ out ?is section1 ! ,secret>y may provide = ! op]ation describ$ 9 subsection 7a7 on a live donor & furni% to ! live donor ! c>e & s]vices describ$ 9 subsection 7b7 at a non-,dep>tm5t facility pursuant to an agreem5t ent]$ into by ! ,secret>y "u ?is *apt]4 ,! live donor %all be deem$ to be an individual eligible = hospital c>e & m$ical s]vices at a non-,dep>tm5t facility pursuant to su* an agreem5t solely = ! purposes ( receiv+ su* op]ation1 c>e1 & s]vices at ! non-,dep>tm5t facility4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #ag is am5d$ by ins]t+ aft] ! item relat+ to section #aghg ! foll[+ new item3 #aghh4 ,transplant proc$ures ) live donors & relat$ s]vices4 4 #bec4 ,s5se ( ! ,s5ate ,x is ! s5se ( ! ,s5ate t-- 7#a7 a /rong & fully res\rc$ ,vet]ans ,heal? ,adm9i/ration is necess>y to effectively s]ve our vet]ans community2 7#b7 vet]ans ov]:elm+ly report t !y are satisfi$ ) ! c>e !y receive at facilities op]at$ by ! ,adm9i/ration2 7#c7 rese>* has %[n t ! ,adm9i/ration produces z good or bett] outcomes = its pati5ts ?an private heal? c>e sy/ems2 & 7#d7 ! ,s5ate opposes any ef=t t w\ld weak5 ! ,adm9i/ration or put ! ,adm9i/ration on a pa? t[>d privatization4 ,,iii ,family c>egiv]s #cja4 ,expansion ( family c>egiv] program ( ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,family c>egiv] program 7#a7 ,expansion ( eligibility 7,a7 ,9 g5]al ,subp>agraph 7,b7 ( subsection 7a77#b7 ( section #agbj;,g is am5d$ to read z foll[s3 7,b7 = assi/ance provid$ "u ?is subsection-- 7i7 be=e ! date on :i* ! ,secret>y submits to ,congress a c]tification t ! ,dep>tm5t has fully implem5t$ ! in=mation te*nology sy/em requir$ by section #cjb7;a7 ( ! ,c>+ = our ,vet]ans ,act ( #bjag1 has a s]i\s injury 7includ+ traumatic bra9 injury1 psy*ological trauma1 or o!r m5tal disord]7 incurr$ or aggravat$ 9 ! l9e ( duty 9 ! active milit>y1 naval1 or air s]vice on or aft] ,septemb] #aa1 #bjja2 7ii7 dur+ ! two-ye> p]iod beg9n+ on ! date on :i* ! ,secret>y submitt$ to ,congress ! c]tification describ$ 9 clause 7i71 has a s]i\s injury 7includ+ traumatic bra9 injury1 psy*ological trauma1 or o!r m5tal disord]7 incurr$ or aggravat$ 9 ! l9e ( duty 9 ! active milit>y1 naval1 or air s]vice-- 7,i7 on or be=e ,may #g1 #aige2 or 7,,ii7 on or aft] ,septemb] #aa1 #bjja2 or 7iii7 aft] ! date t is two ye>s aft] ! date on :i* ! ,secret>y submits to ,congress ! c]tification describ$ 9 clause 7i71 has a s]i\s injury 7includ+ traumatic bra9 injury1 psy*ological trauma1 or o!r m5tal disord]7 incurr$ or aggravat$ 9 ! l9e ( duty 9 ! active milit>y1 naval1 or air s]vice2 & 4 7,b7 ,publication 9 ,f$]al ,regi/] ,n lat] ?an #cj days aft] ! date on :i* ! ,secret>y ( ,vet]ans ,affairs submits to ,congress ! c]tification describ$ 9 subsection 7a77#b77;,b77i7 ( section #agbj;,g ( su* title1 z am5d$ by subp>agraph 7,a7 ( ?is p>agraph1 ! ,secret>y %all publi% ! date specifi$ 9 su* subsection 9 ! ,f$]al ,regi/]4 7#b7 ,expansion ( ne$$ s]vices 9 eligibility crit]ia ,subsection 7a77#b77;,c7 ( su* section is am5d$-- 7,a7 9 clause 7ii71 by /rik+ 2 or & ins]t+ a semicolon2 7,b7 by r$esignat+ clause 7iii7 z clause 7iv72 & 7,c7 by ins]t+ aft] clause 7ii7 ! foll[+ new clause 7iii73 7iii7 a ne$ = regul> or ext5sive in/ruction or sup]vision )\t :i* ! ability ( ! vet]an to function 9 daily life w\ld be s]i\sly impair$2 or 4 7#c7 ,expansion ( s]vices provid$ ,subsection 7a77#c77;,a77ii7 ( su* section is am5d$-- 7,a7 9 subclause 7,,iv71 by /rik+ 2 & & ins]t+ a semicolon2 7,b7 9 subclause 7,v71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+ new subclause3 7,,vi7 ?r\gh ! use ( contracts )1 or ! provision ( grants to1 public or private entities-- 7aa7 f9ancial plann+ s]vices relat+ to ! ne$s ( injur$ vet]ans & _! c>egiv]s2 & 7bb7 legal s]vices1 includ+ legal advice & consultation1 relat+ to ! ne$s ( injur$ vet]ans & _! c>egiv]s4 4 7#d7 ,modification ( /ip5d calculation ,subsection 7a77#c77;,c7 ( su* section is am5d$-- 7,a7 by r$esignat+ clause 7iii7 z clause 7iv72 & 7,b7 by ins]t+ aft] clause 7ii7 ! foll[+ new clause 7iii73 7iii7 ,9 det]m9+ ! am\nt & degree ( p]sonal c>e s]vices provid$ "u clause 7i7 ) respect to an eligible vet]an ^: ne$ = p]sonal c>e s]vices is bas$ 9 :ole or 9 "p on a ne$ = sup]vision or protection "u p>agraph 7#b77;,c77ii7 or regul> in/ruction or sup]vision "u p>agraph 7#b77;,c77iii71 ! ,secret>y %all take into acc\nt ! foll[+3 7,i7 ,! assessm5t by ! family c>egiv] ( ! ne$s & limitations ( ! vet]an4 7,,ii7 ,! ext5t to :i* ! vet]an c function safely & indep5d5tly 9 ! abs5ce ( su* sup]vision1 protection1 or in/ruction4 7,,iii7 ,! am\nt ( "t requir$ = ! family c>egiv] to provide su* sup]vision1 protection1 or in/ruction to ! vet]an4 4 7#e7 ,p]iodic evaluation ( ne$ = c]ta9 s]vices ,subsection 7a77#c7 ( su* section is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,d7 ,9 provid+ in/ruction1 prep>ation1 & tra9+ "u subp>agraph 7,a77i77,i7 & te*nical support "u subp>agraph 7,a77i77,,ii7 to ea* family c>egiv] :o is approv$ z a provid] ( p]sonal c>e s]vices = an eligible vet]an "u p>agraph 7#f71 ! ,secret>y %all p]iodically evaluate ! ne$s ( ! eligible vet]an & ! skills ( ! family c>egiv] ( su* vet]an to det]m9e if additional in/ruction1 prep>ation1 tra9+1 or te*nical support "u ^? subp>agraphs is necess>y4 4 7#f7 ,use ( prim>y c>e teams ,subsection 7a77#e7 ( su* section is am5d$1 9 ! matt] prec$+ subp>agraph 7,a71 by ins]t+ 79 collaboration ) ! prim>y c>e team = ! eligible vet]an to ! maximum ext5t practicable7 aft] evaluate4 7#g7 ,assi/ance = family c>egiv]s ,subsection 7a7 ( su* section is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#aa7 7,a7 ,9 provid+ assi/ance "u ?is subsection to family c>egiv]s ( eligible vet]ans1 ! ,secret>y may ent] into contracts1 provid] agreem5ts1 & memor&a ( und]/&+ ) ,f$]al ag5cies1 ,/ates1 & private1 nonpr(it1 & o!r entities to provide su* assi/ance to su* family c>egiv]s4 7,b7 ,! ,secret>y may provide assi/ance "u ?is p>agraph only if su* assi/ance is reasonably accessible to ! family c>egiv] & is sub/antially equival5t or bett] 9 quality to simil> s]vices provid$ by ! ,dep>tm5t4 7,c7 ,! ,secret>y may provide fair comp5sation to ,f$]al ag5cies1 ,/ates1 & o!r entities t provide assi/ance "u ?is p>agraph4 4 7b7 ,modification ( def9ition ( p]sonal c>e s]vices ,subsection 7d77#d7 ( su* section is am5d$-- 7#a7 9 subp>agraph 7,a71 by /rik+ indep5d5t2 7#b7 by r$esignat+ subp>agraph 7,b7 z subp>agraph 7,d72 & 7#c7 by ins]t+ aft] subp>agraph 7,a7 ! foll[+ new subp>agraphs3 7,b7 ,sup]vision or protection bas$ on symptoms or residuals ( neurological or o!r impairm5t or injury4 7,c7 ,regul> or ext5sive in/ruction or sup]vision )\t :i* ! ability ( ! vet]an to function 9 daily life w\ld be s]i\sly impair$4 4 #cjb4 ,implem5tation ( in=mation te*nology sy/em ( ,dep>tm5t ( ,vet]ans ,affairs to assess & improve ! family c>egiv] program 7a7 ,implem5tation ( new sy/em 7#a7 ,9 g5]al ,n lat] ?an ,june #a1 #bjah1 ! ,secret>y ( ,vet]ans ,affairs %all implem5t an in=mation te*nology sy/em t fully supports ! ,program & all[s = data assessm5t & compreh5sive monitor+ ( ! ,program4 7#b7 ,elem5ts ( sy/em ,! in=mation te*nology sy/em requir$ to be implem5t$ "u p>agraph 7#a7 %all include ! foll[+3 7,a7 ,! ability to easily retrieve data t w all[ all aspects ( ! ,program 7at ! m$ical c5t] & aggregate levels7 & ! workload tr5ds = ! ,program to be assess$ & compreh5sively monitor$4 7,b7 ,! ability to manage data ) respect to a numb] ( c>egiv]s t is m ?an ! numb] ( c>egiv]s t ! ,secret>y expects to apply = ! ,program4 7,c7 ,! ability to integrate ! sy/em ) o!r relevant in=mation te*nology sy/ems ( ! ,vet]ans ,heal? ,adm9i/ration4 7b7 ,assessm5t ( ,program ,n lat] ?an #ahj days aft] implem5t+ ! sy/em describ$ 9 subsection 7a71 ! ,secret>y %all1 ?r\gh ! ,"u ,secret>y = ,heal?1 use data f ! sy/em & o!r relevant data to conduct an assessm5t ( h[ key aspects ( ! ,program are /ructur$ & c>ri$ out4 7c7 ,ongo+ monitor+ ( & modifications to ,program 7#a7 ,monitor+ ,! ,secret>y %all use ! sy/em implem5t$ "u subsection 7a7 to monitor & assess ! workload ( ! ,program1 includ+ monitor+ & assessm5t ( data on-- 7,a7 ! /atus ( applications1 appeals1 & home visits 9 connection ) ! ,program2 & 7,b7 ! use by c>egiv]s p>ticipat+ 9 ! ,program ( o!r support s]vices "u ! ,program su* z respite c>e4 7#b7 ,modifications ,bas$ on ! monitor+ & assessm5t conduct$ "u p>agraph 7#a71 ! ,secret>y %all id5tify & implem5t su* modifications to ! ,program z ! ,secret>y consid]s necess>y to ensure ! ,program is function+ z int5d$ & provid+ vet]ans & c>egiv]s p>ticipat+ 9 ! ,program ) s]vices 9 a timely mann]4 7d7 ,reports 7#a7 ,initial report 7,a7 ,9 g5]al ,n lat] ?an #ij days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate1 ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives1 & ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates a report t includes-- 7i7 ! /atus ( ! plann+1 developm5t1 & deploym5t ( ! sy/em requir$ to be implem5t$ "u subsection 7a71 includ+ any *anges 9 ! timel9e = ! implem5tation ( ! sy/em2 & 7ii7 an assessm5t ( ! ne$s ( family c>egiv]s ( vet]ans describ$ 9 subp>agraph 7,b71 ! res\rces ne$$ = ! inclusion ( su* family c>egiv]s 9 ! ,program1 & su* *anges to ! ,program z ! ,secret>y consid]s necess>y to ensure ! successful expansion ( ! ,program to include su* family c>egiv]s4 7,b7 ,vet]ans describ$ ,vet]ans describ$ 9 ?is subp>agraph are vet]ans :o are eligible = ! ,program "u clause 7ii7 or 7iii7 ( section #agbj;,g7a77#b77;,b7 ( title #ch1 ,unit$ ,/ates ,code1 z am5d$ by section #cja7;a77#a7 ( ?is ,act1 solely due to a s]i\s injury 7includ+ traumatic bra9 injury1 psy*ological trauma1 or o!r m5tal disord]7 incurr$ or aggravat$ 9 ! l9e ( duty 9 ! active milit>y1 naval1 or air s]vice be=e ,septemb] #aa1 #bjja4 7#b7 ,notification by ,comptroll] ,g5]al ,! ,comptroll] ,g5]al %all review ! report submitt$ "u p>agraph 7#a7 & notify ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives ) respect to ! progress ( ! ,secret>y 9-- 7,a7 fully implem5t+ ! sy/em requir$ "u subsection 7a72 & 7,b7 implem5t+ a process = us+ su* sy/em to monitor & assess ! ,program "u subsection 7c77#a7 & modify ! ,program z consid]$ necess>y "u subsection 7c77#b74 7#c7 ,f9al report 7,a7 ,9 g5]al ,n lat] ?an ,june #a1 #bjai1 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate1 ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives1 & ! ,comptroll] ,g5]al a report on ! implem5tation ( subsections 7a7 ?r\gh 7c74 7,b7 ,elem5ts ,! report requir$ by subp>agraph 7,a7 %all include ! foll[+3 7i7 ,a c]tification by ! ,secret>y ) respect to :e!r ! in=mation te*nology sy/em describ$ 9 subsection 7a7 has be5 implem5t$4 7ii7 ,a description ( h[ ! ,secret>y has implem5t$ su* sy/em4 7iii7 ,a description ( ! modifications to ! ,program1 if any1 t 7 id5tifi$ & implem5t$ "u subsection 7c77#b74 7iv7 ,a description ( h[ ! ,secret>y is us+ su* sy/em to monitor ! workload ( ! ,program4 7e7 ,def9itions ,9 ?is section3 7#a7 ,active milit>y1 naval1 or air s]vice ,! t]m active milit>y1 naval1 or air s]vice has ! mean+ giv5 t t]m 9 section #aja ( title #ch1 ,unit$ ,/ates ,code4 7#b7 ,program ,! t]m ,program means ! program ( compreh5sive assi/ance = family c>egiv]s "u section #agbj;,g7a7 ( title #ch1 ,unit$ ,/ates ,code1 z am5d$ by section #cja ( ?is ,act4 #cjc4 ,modifications to annual evaluation report on c>egiv] program ( ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,b>ri]s to c>e & s]vices ,subp>agraph 7,a77iv7 ( section #aja7;c77#b7 ( ! ,c>egiv]s & ,vet]ans ,omnibus ,heal? ,s]vices ,act ( #bjaj 7,public ,law #aaa-afc2 #ch ,u4,s4,c4 #agbj;,g note7 is am5d$ by ins]t+ 1 includ+ a description ( any b>ri]s to access+ & receiv+ c>e & s]vices "u su* programs be=e ! semicolon4 7b7 ,suffici5cy ( tra9+ = family c>egiv] program ,subp>agraph 7,b7 ( su* section is am5d$-- 7#a7 9 clause 7i71 by /rik+ 2 & & ins]t+ a semicolon2 7#b7 9 clause 7ii71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7#c7 by add+ at ! end ! foll[+ new clause3 7iii7 an evaluation ( ! suffici5cy & consi/5cy ( ! tra9+ provid$ to family c>egiv]s "u su* program 9 prep>+ family c>egiv]s to provide c>e to vet]ans "u su* program4 4 ,,iv ,appropriation ( am\nts #dja4 ,appropriation ( am\nts = heal? c>e f ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,9 g5]al ,!re is au?oriz$ to be appropriat$1 & is appropriat$1 to ! ,secret>y ( ,vet]ans ,affairs1 out ( any funds 9 ! ,treasury n o!rwise appropriat$1 #a1jjj1jjj1jjj to c>ry out subsection 7c74 7b7 ,availability ( am\nts ,! am\nt appropriat$ "u subsection 7a7 %all be available = obligation or exp5diture )\t fiscal ye> limitation4 7c7 ,use ( am\nts ,! am\nt appropriat$ "u subsection 7a7 %all be us$ by ! ,secret>y to c>ry out ! foll[+3 7#a7 ,sub*apt]s ,,ii & ,,vii ( *apt] #gf ( title #ch1 ,unit$ ,/ates ,code2 7#b7 ,! program to increase ! numb] ( graduate m$ical education resid5cy positions ( ! ,dep>tm5t "u sections #baa & #bab2 & 7#c7 ,section #bba4 7d7 ,fund+ plan ,n lat] ?an #fj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ! appropriate committees ( ,congress a fund+ plan describ+ h[ ! ,secret>y int5ds to use ! am\nt appropriat$ "u subsection 7a74 7e7 ,supplem5t n supplant ,am\nts appropriat$ "u subsection 7a7 = purposes ( c>ry+ out sub*apt]s ,,ii & ,,vii ( *apt] #gf ( title #ch1 ,unit$ ,/ates ,code1 %all supplem5t1 n supplant1 am\nts o!rwise made available to ! ,secret>y to c>ry out su* sub*apt]s4 7f7 ,report ,n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ! appropriate committees ( ,congress a report on h[ ! ,secret>y has obligat$ ! am\nt appropriat$ "u subsection 7a7 z ( ! date ( ! submittal ( ! report4 7g7 ,appropriate committees ( congress def9$ ,9 ?is section1 ! t]m appropriate committees ( ,congress means-- 7#a7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,s5ate2 & 7#b7 ! ,committee on ,vet]ans' ,affairs & ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives4 #djb4 ,appropriation ( am\nts = ,vet]ans ,*oice ,program 7a7 ,9 g5]al ,!re is au?oriz$ to be appropriat$1 & is appropriat$1 to ! ,secret>y ( ,vet]ans ,affairs1 out ( any funds 9 ! ,treasury n o!rwise appropriat$1 #d1jjj1jjj1jjj to be deposit$ 9 ! ,vet]ans ,*oice ,fund "u section #hjb ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note74 7b7 ,availability ,! am\nt appropriat$ "u subsection 7a7 %all rema9 available until exp5d$ pursuant to section #hjb7;c77#d7 ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 z add$ by section #adb4 ,decemb] #e1 #bjag,read twice & plac$ on ! cal5d>