#aaeth ,,congress #b;d ,session ,in the ,house of ,representatives1 ,u4 ,s41 ,may #af1 #bjah ,,amendment3 ,that the bill from the ,senate 7,s4 #bcgb7 entitled ,an ,act to amend title #ch1 ,united ,states ,code1 to provide outer burial receptacles for remains buried in ,national ,parks1 and for other purposes41 do pass with the following ,strike out all after the enacting clause and insert3 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,john ,s4 ,mc,cain ,,iii1 ,daniel ,k4 ,akaka1 and ,samuel ,r4 ,johnson ,,va ,maintaining ,internal ,systems and ,strengthening ,integrated ,outside ,networks ,act of #bjah or the ,,va ,,mission ,act of #bjah4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,title ,i--,caring for our ,veterans ,sec4 #ajj4 ,short title2 references to title #ch1 ,united ,states ,code4 ,subtitle ,a--,developing an ,integrated ,high-,performing ,network ,chapter #a--;,establishing ,community ,care ,programs ,sec4 #aja4 ,establishment of ,veterans ,community ,care ,program4 ,sec4 #ajb4 ,authorization of agreements between ,department of ,veterans ,affairs and non-,department providers4 ,sec4 #ajc4 ,conforming amendments for ,state veterans homes4 ,sec4 #ajd4 ,access standards and standards for quality4 ,sec4 #aje4 ,access to walk-in care4 ,sec4 #ajf4 ,strategy regarding the ,department of ,veterans ,affairs ,high-,performing ,integrated ,health ,care ,network4 ,sec4 #ajg4 ,applicability of ,directive of ,office of ,federal ,contract ,compliance ,programs4 ,sec4 #ajh4 ,prevention of certain health care providers from providing non-,department health care services to veterans4 ,sec4 #aji4 ,remediation of medical service lines4 ,chapter #b--,paying ,providers and ,improving ,collections ,sec4 #aaa4 ,prompt payment to providers4 ,sec4 #aab4 ,authority to pay for authorized care not subject to an agreement4 ,sec4 #aac4 ,improvement of authority to recover the cost of services furnished for non-service-connected disabilities4 ,sec4 #aad4 ,processing of claims for reimbursement through electronic interface4 ,chapter #c--;,education and ,training ,programs ,sec4 #aba4 ,education program on health care options4 ,sec4 #abb4 ,training program for administration of non-,department of ,veterans ,affairs health care4 ,sec4 #abc4 ,continuing medical education for non-,department medical professionals4 ,chapter #d--,other ,matters ,relating to ,non-,department of ,veterans ,affairs ,providers ,sec4 #aca4 ,establishment of processes to ensure safe opioid prescribing practices by non-,department of ,veterans ,affairs health care providers4 ,sec4 #acb4 ,improving information sharing with community providers4 ,sec4 #acc4 ,competency standards for non-,department of ,veterans ,affairs health care providers4 ,sec4 #acd4 ,department of ,veterans ,affairs participation in national network of ,state-based prescription drug monitoring programs4 ,chapter #e--,other ,non-,department ,health ,care ,matters ,sec4 #ada4 ,plans for ,use of ,supplemental ,appropriations ,required4 ,sec4 #adb4 ,veterans ,choice ,fund flexibility4 ,sec4 #adc4 ,sunset of ,veterans ,choice ,program4 ,sec4 #add4 ,conforming amendments4 ,subtitle ,b--,improving ,department of ,veterans ,affairs ,health ,care ,delivery ,sec4 #aea4 ,licensure of health care professionals of the ,department of ,veterans ,affairs providing treatment via telemedicine4 ,sec4 #aeb4 ,authority for ,department of ,veterans ,affairs ,center for ,innovation for ,care and ,payment4 ,sec4 #aec4 ,authorization to provide for operations on live donors for purposes of conducting transplant procedures for veterans4 ,subtitle ,c--,family ,caregivers ,sec4 #afa4 ,expansion of family caregiver program of ,department of ,veterans ,affairs4 ,sec4 #afb4 ,implementation of information technology system of ,department of ,veterans ,affairs to assess and improve the family caregiver program4 ,sec4 #afc4 ,modifications to annual evaluation report on caregiver program of ,department of ,veterans ,affairs4 ,title ,,ii--,,va ,asset and ,infrastructure ,review ,subtitle ,a--,asset and ,infrastructure ,review ,sec4 #bja4 ,short title4 ,sec4 #bjb4 ,the ,commission4 ,sec4 #bjc4 ,procedure for making recommendations4 ,sec4 #bjd4 ,actions regarding infrastructure and facilities of the ,veterans ,health ,administration4 ,sec4 #bje4 ,implementation4 ,sec4 #bjf4 ,department of ,veterans ,affairs ,asset and ,infrastructure ,review ,account4 ,sec4 #bjg4 ,congressional consideration of ,commission report4 ,sec4 #bjh4 ,other matters4 ,sec4 #bji4 ,definitions4 ,subtitle ,b--,other ,infrastructure ,matters ,sec4 #baa4 ,improvement to training of construction personnel4 ,sec4 #bab4 ,review of enhanced use leases4 ,sec4 #bac4 ,assessment of health care furnished by the ,department to veterans who live in the ,pacific territories4 ,title ,,iii--,improvements to ,recruitment of ,health ,care ,professionals ,sec4 #cja4 ,designated scholarships for physicians and dentists under ,department of ,veterans ,affairs ,health ,professional ,scholarship ,program4 ,sec4 #cjb4 ,increase in maximum amount of debt that may be reduced under ,education ,debt ,reduction ,program of ,department of ,veterans ,affairs4 ,sec4 #cjc4 ,establishing the ,department of ,veterans ,affairs ,specialty ,education ,loan ,repayment ,program4 ,sec4 #cjd4 ,veterans healing veterans medical access and scholarship program4 ,sec4 #cje4 ,bonuses for recruitment1 relocation1 and retention4 ,sec4 #cjf4 ,inclusion of ,vet ,center employees in ,education ,debt ,reduction ,program of ,department of ,veterans ,affairs4 ,title ,,iv--,health ,care in ,underserved ,areas ,sec4 #dja4 ,development of criteria for designation of certain medical facilities of the ,department of ,veterans ,affairs as underserved facilities and plan to address problem of underserved facilities4 ,sec4 #djb4 ,pilot program to furnish mobile deployment teams to underserved facilities4 ,sec4 #djc4 ,pilot program on graduate medical education and residency4 ,title ,v--,other ,matters ,sec4 #eja4 ,annual report on performance awards and bonuses awarded to certain high-level employees of the department4 ,sec4 #ejb4 ,role of podiatrists in ,department of ,veterans ,affairs4 ,sec4 #ejc4 ,definition of major medical facility project4 ,sec4 #ejd4 ,authorization of certain major medical facility projects of the ,department of ,veterans ,affairs4 ,sec4 #eje4 ,department of ,veterans ,affairs personnel transparency4 ,sec4 #ejf4 ,program on establishment of peer specialists in patient aligned care team settings within medical centers of ,department of ,veterans ,affairs4 ,sec4 #ejg4 ,department of ,veterans ,affairs medical scribe pilot program4 ,sec4 #ejh4 ,extension of requirement to collect fees for housing loans guaranteed by ,secretary of ,veterans ,affairs4 ,sec4 #eji4 ,extension of reduction in amount of pension furnished by ,department of ,veterans ,affairs for certain veterans covered by ,medicaid plans for services furnished by nursing facilities4 ,sec4 #eaj4 ,appropriation of amounts4 ,sec4 #eaa4 ,technical correction4 ,sec4 #eab4 ,budgetary effects4 ,i ,caring for our ,veterans #ajj4 ,short title2 references to title #ch1 ,united ,states ,code 7a7 ,short title ,this title may be cited as the ,caring for ,our ,veterans ,act of #bjah4 7b7 ,references to title #ch1 ,united ,states ,code ,except as otherwise expressly provided1 whenever in this title an amendment or repeal is expressed in terms of an amendment to1 or repeal of1 a section or other provision1 the reference shall be considered to be made to a section or other provision of title #ch1 ,united ,states ,code4 ,a ,developing an ,integrated ,high-,performing ,network #a ,establishing ,community ,care ,programs #aja4 ,establishment of ,veterans ,community ,care ,program 7a7 ,establishment of program 7#a7 ,in general ,section #agjc is amended to read as follows3 #agjc4 ,veterans ,community ,care ,program 7a7 ,in general 7#a7 ,there is established a program to furnish hospital care1 medical services1 and extended care services to covered veterans through health care providers specified in subsection 7c74 7#b7 ,the ,secretary shall coordinate the furnishing of hospital care1 medical services1 and extended care services under this section to covered veterans1 including coordination of1 at a minimum1 the following3 7,a7 ,ensuring the scheduling of medical appointments in a timely manner and the establishment of a mechanism to receive medical records from non-,department providers4 7,b7 ,ensuring continuity of care and services4 7,c7 ,ensuring coordination among regional networks if the covered veteran accesses care and services in a different network than the regional network in which the covered veteran resides4 7,d7 ,ensuring that covered veterans do not experience a lapse in care resulting from errors or delays by the ,department or its contractors or an unusual or excessive burden in accessing hospital care1 medical services1 or extended care services4 7#c7 ,a covered veteran may only receive care or services under this section upon the authorization of such care or services by the ,secretary4 7b7 ,covered veterans ,for purposes of this section1 a covered veteran is any veteran who-- 7#a7 is enrolled in the system of annual patient enrollment established and operated under section #agje of this title2 or 7#b7 is not enrolled in such system but is otherwise entitled to hospital care1 medical services1 or extended care services under subsection 7c77#b7 of such section4 7c7 ,health care providers specified ,health care providers specified in this subsection are the following3 7#a7 ,any health care provider that is participating in the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 including any physician furnishing services under such a program4 7#b7 ,the ,department of ,defense4 7#c7 ,the ,indian ,health ,service4 7#d7 ,any ,federally-qualified health center 7as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7774 7#e7 ,any health care provider not otherwise covered under any of paragraphs 7#a7 through 7#d7 that meets criteria established by the ,secretary for purposes of this section4 7d7 ,conditions under which care is required ,to be furnished through non-,department providers 7#a7 ,the ,secretary shall1 subject to the availability of appropriations1 furnish hospital care1 medical services1 and extended care services to a covered veteran through health care providers specified in subsection 7c7 if-- 7,a7 the ,department does not offer the care or services the veteran requires2 7,b7 the ,department does not operate a full-service medical facility in the ,state in which the covered veteran resides2 7,c7 7i7 the covered veteran was an eligible veteran under section #aja7;b77#b77;,b7 of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 as of the day before the date of the enactment of the ,caring for ,our ,veterans ,act of #bjah2 7ii7 continues to reside in a location that would qualify the veteran for eligibility under such section2 and 7iii7 either-- 7,i7 resides in one of the five ,states with the lowest population density as determined by data from the #bjaj decennial census2 or 7,,ii7 resides in a ,state not described in subclause 7,i7 and-- 7aa7 received care or services under this title in the year preceding the enactment of the ,caring for ,our ,veterans ,act of #bjah2 and 7bb7 is seeking care or services within #b years of the date of the enactment of the ,caring for ,our ,veterans ,act of #bjah2 7,d7 the covered veteran has contacted the ,department to request care or services and the ,department is not able to furnish such care or services in a manner that complies with designated access standards developed by the ,secretary under section #agjc;,b of this title2 or 7,e7 the covered veteran and the covered veteran's referring clinician agree that furnishing care and services through a non-,department entity or provider would be in the best medical interest of the covered veteran based upon criteria developed by the ,secretary4 7#b7 ,the ,secretary shall ensure that the criteria developed under paragraph 7#a77;,e7 include consideration of the following3 7,a7 ,the distance between the covered veteran and the facility that provides the hospital care1 medical services1 or extended care services the veteran needs4 7,b7 ,the nature of the hospital care1 medical services1 or extended care services required4 7,c7 ,the frequency that the hospital care1 medical services1 or extended care services needs to be furnished4 7,d7 ,the timeliness of available appointments for the hospital care1 medical services1 or extended care services the veteran needs4 7,e7 ,whether the covered veteran faces an unusual or excessive burden to access hospital care1 medical services1 or extended care services from the ,department medical facility where a covered veteran seeks hospital care1 medical services1 or extended care services1 which shall include consideration of the following3 7i7 ,whether the covered veteran faces an excessive driving distance1 geographical challenge1 or environmental factor that impedes the access of the covered veteran4 7ii7 ,whether the hospital care1 medical services1 or extended care services sought by the veteran is provided by a medical facility of the ,department that is reasonably accessible to a covered veteran4 7iii7 ,whether a medical condition of the covered veteran affects the ability of the covered veteran to travel4 7iv7 ,whether there is compelling reason1 as determined by the ,secretary1 that the veteran needs to receive hospital care1 medical services1 or extended care services from a medical facility other than a medical facility of the ,department4 7v7 ,such other considerations as the ,secretary considers appropriate4 7#c7 ,if the ,secretary has determined that the ,department does not offer the care or services the covered veteran requires under subparagraph 7,a7 of paragraph 7#a71 that the ,department does not operate a full-service medical facility in the ,state in which the covered veteran resides under subparagraph 7,b7 of such paragraph1 that the covered veteran is described under subparagraph 7,c7 of such paragraph1 or that the ,department is not able to furnish care or services in a manner that complies with designated access standards developed by the ,secretary under section #agjc;,b of this title under subparagraph 7,d7 of such paragraph1 the decision to receive hospital care1 medical services1 or extended care services under such subparagraphs from a health care provider specified in subsection 7c7 shall be at the election of the veteran4 7e7 ,conditions under which care is authorized ,to be furnished through non-,department providers 7#a7 7,a7 ,the ,secretary may furnish hospital care1 medical services1 or extended care services through a health care provider specified in subsection 7c7 to a covered veteran served by a medical service line of the ,department that the ,secretary has determined is not providing care that complies with the standards for quality the ,secretary shall establish under section #agjc;,c4 7,b7 ,in carrying out subparagraph 7,a71 the ,secretary shall-- 7i7 measure timeliness of the medical service line at a facility of the ,department when compared with the same medical service line at different ,department facilities2 and 7ii7 measure quality at a medical service line of a facility of the ,department by comparing it with two or more distinct and appropriate quality measures at non-,department medical service lines4 7,c7 7i7 ,the ,secretary may not concurrently furnish hospital care1 medical services1 or extended care services under subparagraph 7,a7 with respect to more than three medical service lines described in such subparagraph at any one health care facility of the ,department4 7ii7 ,the ,secretary may not concurrently furnish hospital care1 medical services1 or extended care services under subparagraph 7,a7 with respect to more than #cf medical service lines nationally described in such subparagraph4 7#b7 ,the ,secretary may limit the types of hospital care1 medical services1 or extended care services covered veterans may receive under paragraph 7#a7 in terms of the length of time such care and services will be available1 the location at which such care and services will be available1 and the clinical care and services that will be available4 7#c7 7,a7 ,except as provided for in subparagraph 7,b71 the hospital care1 medical services1 and extended care services authorized under paragraph 7#a7 with respect to a medical service line shall cease when the remediation described in section #agjf;,a with respect to such medical service line is complete4 7,b7 ,the ,secretary shall ensure continuity and coordination of care for any veteran who elects to receive care or services under paragraph 7#a7 from a health care provider specified in subsection 7c7 through the completion of an episode of care4 7#d7 ,the ,secretary shall publish in the ,federal ,register1 and shall take all reasonable steps to provide direct notice to covered veterans affected under this subsection1 at least once each year stating the time period during which such care and services will be available1 the location or locations where such care and services will be available1 and the clinical services available at each location under this subsection in accordance with regulations the ,secretary shall prescribe4 7#e7 ,when the ,secretary exercises the authority under paragraph 7#a71 the decision to receive care or services under such paragraph from a health care provider specified in subsection 7c7 shall be at the election of the covered veteran4 7f7 ,review of decisions ,the review of any decision under subsection 7d7 or 7e7 shall be subject to the ,department's clinical appeals process1 and such decisions may not be appealed to the ,board of ,veterans' ,appeals4 7g7 ,tiered network 7#a7 ,to promote the provision of high-quality and high-value hospital care1 medical services1 and extended care services under this section1 the ,secretary may develop a tiered provider network of eligible providers based on criteria established by the ,secretary for purposes of this section4 7#b7 ,in developing a tiered provider network of eligible providers under paragraph 7#a71 the ,secretary shall not prioritize providers in a tier over providers in any other tier in a manner that limits the choice of a covered veteran in selecting a health care provider specified in subsection 7c7 for receipt of hospital care1 medical services1 or extended care services under this section4 7h7 ,contracts ,to establish networks of health care providers 7#a7 ,the ,secretary shall enter into consolidated1 competitively bid contracts to establish networks of health care providers specified in paragraphs 7#a7 and 7#e7 of subsection 7c7 for purposes of providing sufficient access to hospital care1 medical services1 or extended care services under this section4 7#b7 7,a7 ,the ,secretary shall1 to the extent practicable1 ensure that covered veterans are able to make their own appointments using advanced technology4 7,b7 ,to the extent practicable1 the ,secretary shall be responsible for the scheduling of appointments for hospital care1 medical services1 and extended care services under this section4 7#c7 7,a7 ,the ,secretary may terminate a contract with an entity entered into under paragraph 7#a7 at such time and upon such notice to the entity as the ,secretary may specify for purposes of this section1 if the ,secretary notifies the appropriate committees of ,congress that1 at a minimum-- 7i7 the entity-- 7,i7 failed to comply substantially with the provisions of the contract or with the provisions of this section and the regulations prescribed under this section2 7,,ii7 failed to comply with the access standards or the standards for quality established by the ,secretary2 7,,iii7 is excluded from participation in a ,federal health care program 7as defined in section #aabh;,b7f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7f777 under section #aabh or #aabh;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g and #acbj;a-#g;a72 7,,iv7 is identified as an excluded source on the list maintained in the ,system for ,award ,management1 or any successor system2 or 7,v7 has been convicted of a felony or other serious offense under ,federal or ,state law and the continued participation of the entity would be detrimental to the best interests of veterans or the ,department2 7ii7 it is reasonable to terminate the contract based on the health care needs of veterans2 or 7iii7 it is reasonable to terminate the contract based on coverage provided by contracts or sharing agreements entered into under authorities other than this section4 7,b7 ,nothing in subparagraph 7,a7 may be construed to restrict the authority of the ,secretary to terminate a contract entered into under paragraph 7#a7 under any other provision of law4 7#d7 ,whenever the ,secretary provides notice to an entity that the entity is failing to meet contractual obligations entered into under paragraph 7#a71 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on such failure4 ,such report shall include the following3 7,a7 ,an explanation of the reasons for providing such notice4 7,b7 ,a description of the effect of such failure1 including with respect to cost1 schedule1 and requirements4 7,c7 ,a description of the actions taken by the ,secretary to mitigate such failure4 7,d7 ,a description of the actions taken by the contractor to address such failure4 7,e7 ,a description of any effect on the community provider market for veterans in the affected area4 7#e7 7,a7 ,the ,secretary shall instruct each entity awarded a contract under paragraph 7#a7 to recognize and accept1 on an interim basis1 the credentials and qualifications of health care providers who are authorized to furnish hospital care and medical services to veterans under a community care program of the ,department in effect as of the day before the date of the enactment of the ,caring for ,our ,veterans ,act of #bjah1 including under the ,patient-,centered ,community ,care ,program and the ,veterans ,choice ,program under section #aja of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note71 as qualified providers under the program established under this section4 7,b7 ,the interim acceptance period under subparagraph 7,a7 shall be determined by the ,secretary based on the following criteria3 7i7 ,with respect to a health care provider1 when the current certification agreement for the health care provider expires4 7ii7 ,whether the ,department has enacted certification and eligibility criteria and regulatory procedures by which non-,department providers will be authorized under this section4 7#f7 ,the ,secretary shall establish a system or systems for monitoring the quality of care provided to covered veterans through a network under this subsection and for assessing the quality of hospital care1 medical services1 and extended care services furnished through such network before the renewal of the contract for such network4 7i7 ,payment rates for care and services 7#a7 ,except as provided in paragraph 7#b71 and to the extent practicable1 the rate paid for hospital care1 medical services1 or extended care services under any provision in this title may not exceed the rate paid by the ,united ,states to a provider of services 7as defined in section #ahfa7u7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7u777 or a supplier 7as defined in section #ahfa7;d7 of such ,act 7#db ,u4,s4,c4 #aciex7d777 under the ,medicare program under title ,,xi or title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq471 including section #ahcd of such ,act 7#db ,u4,s4,c4 #aciem71 for the same care or services4 7#b7 7,a7 ,a higher rate than the rate paid by the ,united ,states as described in paragraph 7#a7 may be negotiated with respect to the furnishing of care or services to a covered veteran who resides in a highly rural area4 7,b7 ,in this paragraph1 the term highly rural area means an area located in a county that has fewer than seven individuals residing in that county per square mile4 7#c7 ,with respect to furnishing care or services under this section in ,alaska1 the ,alaska ,fee ,schedule of the ,department of ,veterans ,affairs shall be followed1 except for when another payment agreement1 including a contract or provider agreement1 is in effect4 7#d7 ,with respect to furnishing hospital care1 medical services1 or extended care services under this section in a ,state with an ,all-,payer ,model ,agreement under section #ahad7;b77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7b77#c77 that became effective on or after ,january #a1 #bjad1 the ,medicare payment rates under paragraph 7#b77;,a7 shall be calculated based on the payment rates under such agreement4 7#e7 ,notwithstanding paragraph 7#a71 the ,secretary may incorporate1 to the extent practicable1 the use of value-based reimbursement models to promote the provision of high-quality care4 7#f7 ,with respect to hospital care1 medical services1 or extended care services for which there is not a rate paid under the ,medicare program as described in paragraph 7#a71 the rate paid for such care or services shall be determined by the ,secretary4 7j7 ,treatment of other health plan contracts ,in any case in which a covered veteran is furnished hospital care1 medical services1 or extended care services under this section for a non-service-connected disability described in subsection 7a77#b7 of section #agbi of this title1 the ,secretary shall recover or collect reasonable charges for such care or services from a health plan contract described in section #agbi in accordance with such section4 7k7 ,payment by veteran ,a covered veteran shall not pay a greater amount for receiving care or services under this section than the amount the veteran would pay for receiving the same or comparable care or services at a medical facility of the ,department or from a health care provider of the ,department4 7l7 ,transplant authority for improved access 7#a7 ,in the case of a covered veteran described in paragraph 7#b71 the ,secretary shall determine whether to authorize an organ or bone marrow transplant for that covered veteran at a non-,department facility4 7#b7 ,a covered veteran described in this paragraph-- 7,a7 requires an organ or bone marrow transplant2 and 7,b7 has1 in the opinion of the primary care provider of the veteran1 a medically compelling reason to travel outside the region of the ,organ ,procurement and ,transplantation ,network1 established under section #cgb of the ,national ,organ ,transplantation ,act 7,public ,law #ih-ejg2 #db ,u4,s4,c4 #bgd71 in which the veteran resides1 to receive such transplant4 7m7 ,monitoring of care provided 7#a7 7,a7 ,not later than #edj days after the date of the enactment of the ,caring for ,our ,veterans ,act of #bjah1 and not less frequently than annually thereafter1 the ,secretary shall submit to appropriate committees of ,congress a review of the types and frequency of care sought under subsection 7d74 7,b7 ,the review submitted under subparagraph 7,a7 shall include an assessment of the following3 7i7 ,the top #be percent of types of care and services most frequently provided under subsection 7d7 due to the ,department not offering such care and services4 7ii7 ,the frequency such care and services were sought by covered veterans under this section4 7iii7 ,an analysis of the reasons the ,department was unable to provide such care and services4 7iv7 ,any steps the ,department took to provide such care and services at a medical facility of the ,department4 7v7 ,the cost of such care and services4 7#b7 ,in monitoring the hospital care1 medical services1 and extended care services furnished under this section1 the ,secretary shall do the following3 7,a7 ,with respect to hospital care1 medical services1 and extended care services furnished through provider networks established under subsection 7i7-- 7i7 compile data on the types of hospital care1 medical services1 and extended care services furnished through such networks and how many patients used each type of care and service2 7ii7 identify gaps in hospital care1 medical services1 or extended care services furnished through such networks2 7iii7 identify how such gaps may be fixed through new contracts within such networks or changes in the manner in which hospital care1 medical services1 or extended care services are furnished through such networks2 7iv7 assess the total amounts spent by the ,department on hospital care1 medical services1 and extended care services furnished through such networks2 7v7 assess the timeliness of the ,department in referring hospital care1 medical services1 and extended care services to such networks2 and 7vi7 assess the timeliness of such networks in-- 7,i7 accepting referrals2 and 7,,ii7 scheduling and completing appointments4 7,b7 ,report the number of medical service lines the ,secretary has determined under subsection 7e77#a7 not to be providing hospital care1 medical services1 or extended care services that comply with the standards for quality established by the ,secretary4 7,c7 ,assess the use of academic affiliates and centers of excellence of the ,department to furnish hospital care1 medical services1 and extended care services to covered veterans under this section4 7,d7 ,assess the hospital care1 medical services1 and extended care services furnished to covered veterans under this section by medical facilities operated by ,federal agencies other than the ,department4 7#c7 ,not later than #edj days after the date of the enactment of the ,caring for ,our ,veterans ,act of #bjah and not less frequently than once each year thereafter1 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on the information gathered under paragraph 7#b74 7n7 ,prohibition on certain limitations 7#a7 ,the ,secretary shall not limit the types of hospital care1 medical services1 or extended care services covered veterans may receive under this section if it is in the best medical interest of the veteran to receive such hospital care1 medical services1 or extended care services1 as determined by the veteran and the veteran's health care provider4 7#b7 ,no provision in this section may be construed to alter or modify any other provision of law establishing specific eligibility criteria for certain hospital care1 medical services1 or extended care services4 7o7 ,definitions ,in this section3 7#a7 ,the term appropriate committees of ,congress means-- 7,a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7,b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 7#b7 ,the term medical service line means a clinic within a ,department medical center4 4 7#b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag is amended by striking the item relating to section #agjc and inserting the following new item3 #agjc4 ,veterans ,community ,care ,program4 4 7b7 ,effective date ,section #agjc of title #ch1 ,united ,states ,code1 as amended by subsection 7a71 shall take effect on the later of-- 7#a7 the date that is #cj days after the date on which the ,secretary of ,veterans ,affairs submits the report required under section #aja7q77#b7 of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note72 or 7#b7 the date on which the ,secretary promulgates regulations pursuant to subsection 7c74 7c7 ,regulations 7#a7 ,in general ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall promulgate regulations to carry out section #agjc of title #ch1 ,united ,states ,code1 as amended by subsection 7a7 of this section4 7#b7 ,updates 7,a7 ,periodic ,before promulgating the regulations required under paragraph 7#a71 the ,secretary shall provide to the appropriate committees of ,congress periodic updates to confirm the progress of the ,secretary toward developing such regulations4 7,b7 ,first update ,the first update under subparagraph 7,a7 shall occur no later than #abj days from the date of the enactment of this ,act4 7,c7 ,appropriate committees of ,congress defined ,in this paragraph1 the term appropriate committees of ,congress means-- 7i7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7ii7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 7d7 ,continuity of existing agreements 7#a7 ,in general ,notwithstanding section #agjc of title #ch1 ,united ,states ,code1 as amended by subsection 7a71 the ,secretary of ,veterans ,affairs shall continue all contracts1 memorandums of understanding1 memorandums of agreements1 and other arrangements that were in effect on the day before the date of the enactment of this ,act between the ,department of ,veterans ,affairs and the ,american ,indian and ,alaska ,native health care systems as established under the terms of the ,department of ,veterans ,affairs and ,indian ,health ,service ,memorandum of ,understanding1 signed ,october #a1 #bjaj1 the ,national ,reimbursement ,agreement1 signed ,december #e1 #bjab1 arrangements under section #dje of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afde71 and agreements entered into under sections #ajb and #ajc of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf74 7#b7 ,modifications ,paragraph 7#a7 shall not be construed to prohibit the ,secretary and the parties to the contracts1 memorandums of understanding1 memorandums of agreements1 and other arrangements described in such paragraph from making such changes to such contracts1 memorandums of understanding1 memorandums of agreements1 and other arrangements as may be otherwise authorized pursuant to other provisions of law or the terms of the contracts1 memorandums of understanding1 memorandums of agreements1 and other arrangements4 #ajb4 ,authorization of agreements between ,department of ,veterans ,affairs and non-,department providers 7a7 ,in general ,subchapter ,i of chapter #ag is amended by inserting after section #agjc the following new section3 #agjc;,a4 ,agreements with eligible entities or providers2 certification processes 7a7 ,agreements authorized 7#a7 7,a7 ,when hospital care1 a medical service1 or an extended care service required by a veteran who is entitled to such care or service under this chapter is not feasibly available to the veteran from a facility of the ,department or through a contract or sharing agreement entered into pursuant to another provision of law1 the ,secretary may furnish such care or service to such veteran through an agreement under this section with an eligible entity or provider to provide such hospital care1 medical service1 or extended care service4 7,b7 ,an agreement entered into under this section to provide hospital care1 a medical service1 or an extended care service shall be known as a ,veterans ,care ,agreement4 7,c7 ,for purposes of subparagraph 7,a71 hospital care1 a medical service1 or an extended care service may be considered not feasibly available to a veteran from a facility of the ,department or through a contract or sharing agreement described in such subparagraph when the ,secretary determines the veteran's medical condition1 the travel involved1 the nature of the care or services required1 or a combination of these factors make the use of a facility of the ,department or a contract or sharing agreement described in such subparagraph impracticable or inadvisable4 7,d7 ,a ,veterans ,care ,agreement may be entered into by the ,secretary or any ,department official authorized by the ,secretary4 7#b7 7,a7 ,subject to subparagraph 7,b71 the ,secretary shall review each ,veterans ,care ,agreement of material size1 as determined by the ,secretary or set forth in paragraph 7#c71 for hospital care1 a medical service1 or an extended care service to determine whether it is feasible and advisable to provide such care or service within a facility of the ,department or by contract or sharing agreement entered into pursuant to another provision of law and1 if so1 take action to do so4 7,b7 7i7 ,the ,secretary shall review each ,veterans ,care ,agreement of material size that has been in effect for at least #f months within the first #b years of its taking effect1 and not less frequently than once every #d years thereafter4 7ii7 ,if a ,veterans ,care ,agreement has not been in effect for at least #f months by the date of the review required by subparagraph 7,a71 the agreement shall be reviewed during the next cycle required by subparagraph 7,a71 and such review shall serve as its review within the first #b years of its taking effect for purposes of clause 7i74 7#c7 7,a7 ,in fiscal year #bjai and in each fiscal year thereafter1 in addition to such other ,veterans ,care ,agreements as the ,secretary may determine are of material size1 a ,veterans ,care ,agreement for the purchase of extended care services that exceeds #e1jjj1jjj annually shall be considered of material size4 7,b7 ,from time to time1 the ,secretary may publish a notice in the ,federal ,register to adjust the dollar amount specified in subparagraph 7,a7 to account for changes in the cost of health care based upon recognized health care market surveys and other available data4 7b7 ,eligible entities and providers ,for purposes of this section1 an eligible entity or provider is-- 7#a7 any provider of services that has enrolled and entered into a provider agreement under section #ahff7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77 and any physician or other supplier who has enrolled and entered into a participation agreement under section #ahdb7;h7 of such ,act 7#db ,u4,s4,c4 #acieu7h772 7#b7 any provider participating under a ,state plan under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq472 7#c7 an ,aging and ,disability ,resource ,center1 an area agency on aging1 or a ,state agency 7as defined in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb772 7#d7 a center for independent living 7as defined in section #gjb of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gif;a772 or 7#e7 any entity or provider not described in paragraph 7#a7 or 7#b7 of this subsection that the ,secretary determines to be eligible pursuant to the certification process described in subsection 7c74 7c7 ,eligible entity or provider certification process ,the ,secretary shall establish by regulation a process for the certification of eligible entities or providers or recertification of eligible entities or providers under this section4 ,such a process shall1 at a minimum-- 7#a7 establish deadlines for actions on applications for certification2 7#b7 set forth standards for an approval or denial of certification1 duration of certification1 revocation of an eligible entity or provider's certification1 and recertification of eligible entities or providers2 7#c7 require the denial of certification if the ,secretary determines the eligible entity or provider is excluded from participation in a ,federal health care program under section #aabh or section #aabh;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g or #acbj;a-#g;a7 or is currently identified as an excluded source on the ,system for ,award ,management ,exclusions list described in part #i of title #dh1 ,code of ,federal ,regulations1 and part #ahj of title #b of such ,code1 or successor regulations2 7#d7 establish procedures for screening eligible entities or providers according to the risk of fraud1 waste1 and abuse that are similar to the standards under section #ahff7;j77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7j77#b77;,b77 and section #i4ajd of title #dh1 ,code of ,federal ,regulations1 or successor regulations2 and 7#e7 incorporate and apply the restrictions and penalties set forth in chapter #ba of title #da and treat this section as a procurement program only for purposes of applying such provisions4 7d7 ,rates ,to the extent practicable1 the rates paid by the ,secretary for hospital care1 medical services1 and extended care services provided under a ,veterans ,care ,agreement shall be in accordance with the rates paid by the ,united ,states under section #agjc7;i7 of this title4 7e7 ,terms of ,veterans ,care ,agreements 7#a7 ,pursuant to regulations promulgated under subsection 7k71 the ,secretary may define the requirements for providers and entities entering into agreements under this section based upon such factors as the number of patients receiving care or services1 the number of employees employed by the entity or provider furnishing such care or services1 the amount paid by the ,secretary to the provider or entity1 or other factors as determined by the ,secretary4 7#b7 ,to furnish hospital care1 medical services1 or extended care services under this section1 an eligible entity or provider shall agree-- 7,a7 to accept payment at the rates established in regulations prescribed under this section2 7,b7 that payment by the ,secretary under this section on behalf of a veteran to a provider of services or care shall1 unless rejected and refunded by the provider within #cj days of receipt1 constitute payment in full and extinguish any liability on the part of the veteran for the treatment or care provided1 and no provision of a contract1 agreement1 or assignment to the contrary shall operate to modify1 limit1 or negate this requirement2 7,c7 to provide only the care and services authorized by the ,department under this section and to obtain the prior written consent of the ,department to furnish care or services outside the scope of such authorization2 7,d7 to bill the ,department in accordance with the methodology outlined in regulations prescribed under this section2 7,e7 to not seek to recover or collect from a health plan contract or third party1 as those terms are defined in section #agbi of this title1 for any care or service that is furnished or paid for by the ,department2 7,f7 to provide medical records to the ,department in the time frame and format specified by the ,department2 and 7,g7 to meet such other terms and conditions1 including quality of care assurance standards1 as the ,secretary may specify in regulation4 7f7 ,discontinuation or nonrenewal of a ,veterans ,care ,agreement 7#a7 ,an eligible entity or provider may discontinue a ,veterans ,care ,agreement at such time and upon such notice to the ,secretary as may be provided in regulations prescribed under this section4 7#b7 ,the ,secretary may discontinue a ,veterans ,care ,agreement with an eligible entity or provider at such time and upon such reasonable notice to the eligible entity or provider as may be specified in regulations prescribed under this section1 if an official designated by the ,secretary-- 7,a7 has determined that the eligible entity or provider failed to comply substantially with the provisions of the ,veterans ,care ,agreement1 or with the provisions of this section or regulations prescribed under this section2 7,b7 has determined the eligible entity or provider is excluded from participation in a ,federal health care program under section #aabh or section #aabh;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g or #acbj;a-#g;a7 or is identified on the ,system for ,award ,management ,exclusions list as provided in part #i of title #dh1 ,code of ,federal ,regulations1 and part #ahj of title #b of such ,code1 or successor regulations2 7,c7 has ascertained that the eligible entity or provider has been convicted of a felony or other serious offense under ,federal or ,state law and determines the eligible entity or provider's continued participation would be detrimental to the best interests of veterans or the ,department2 or 7,d7 has determined that it is reasonable to terminate the agreement based on the health care needs of a veteran4 7g7 ,quality of care ,the ,secretary shall establish a system or systems for monitoring the quality of care provided to veterans through ,veterans ,care ,agreements and for assessing the quality of hospital care1 medical services1 and extended care services furnished by eligible entities and providers before the renewal of ,veterans ,care ,agreements4 7h7 ,disputes 7#a7 ,the ,secretary shall promulgate administrative procedures for eligible entities and providers to present all disputes arising under or related to ,veterans ,care ,agreements4 7#b7 ,such procedures constitute the eligible entities' and providers' exhaustive and exclusive administrative remedies4 7#c7 ,eligible entities or providers must first exhaust such administrative procedures before seeking any judicial review under section #acdf of title #bh 7known as the ,tucker ,act74 7#d7 ,disputes under this section must pertain to either the scope of authorization under the ,veterans ,care ,agreement or claims for payment subject to the ,veterans ,care ,agreement and are not claims for the purposes of such laws that would otherwise require application of sections #gaja through #gaji of title #da1 ,united ,states ,code4 7i7 ,applicability of other provisions of law 7#a7 ,a ,veterans ,care ,agreement may be authorized by the ,secretary or any ,department official authorized by the ,secretary1 and such action shall not be treated as-- 7,a7 an award for the purposes of such laws that would otherwise require the use of competitive procedures for the furnishing of care and services2 or 7,b7 a ,federal contract for the acquisition of goods or services for purposes of any provision of ,federal law governing ,federal contracts for the acquisition of goods or services except section #dgjf7;d7 of title #da4 7#b7 7,a7 ,except as provided in the agreement itself1 in subparagraph 7,b71 and unless otherwise provided in this section or regulations prescribed pursuant to this section1 an eligible entity or provider that enters into an agreement under this section is not subject to1 in the carrying out of the agreement1 any law to which providers of services and suppliers under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 are not subject4 7,b7 ,an eligible entity or provider that enters into an agreement under this section is subject to-- 7i7 all laws regarding integrity1 ethics1 or fraud1 or that subject a person to civil or criminal penalties2 and 7ii7 all laws that protect against employment discrimination or that otherwise ensure equal employment opportunities4 7#c7 ,notwithstanding paragraph 7#b77;,b77i71 an eligible entity or provider that enters into an agreement under this section shall not be treated as a ,federal contractor or subcontractor for purposes of chapter #fg of title #da 7commonly known as the ,mc,namara-,o',hara ,service ,contract ,act of #aife74 7j7 ,parity of treatment ,eligibility for hospital care1 medical services1 and extended care services furnished to any veteran pursuant to a ,veterans ,care ,agreement shall be subject to the same terms as though provided in a facility of the ,department1 and provisions of this chapter applicable to veterans receiving such care and services in a facility of the ,department shall apply to veterans treated under this section4 7k7 ,rulemaking ,the ,secretary shall promulgate regulations to carry out this section4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item relating to section #agjc the following new item3 #agjc;,a4 ,agreements with eligible entities or providers2 certification processes4 4 #ajc4 ,conforming amendments for ,state veterans homes 7a7 ,in general ,section #agde7;a7 is amended-- 7#a7 in paragraph 7#a71 by striking 7or agreement under section #agbj7;c77#a7 of this title7 and inserting 7or an agreement72 and 7#b7 by adding at the end the following new paragraph3 7#d7 7,a7 ,an agreement under this section may be authorized by the ,secretary or any ,department official authorized by the ,secretary1 and any such action is not an award for purposes of such laws that would otherwise require the use of competitive procedures for the furnishing of hospital care1 medical services1 and extended care services4 7,b7 7i7 ,except as provided in the agreement itself1 in clause 7ii71 and unless otherwise provided in this section or regulations prescribed pursuant to this section1 a ,state home that enters into an agreement under this section is not subject to1 in the carrying out of the agreement1 any provision of law to which providers of services and suppliers under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 are not subject4 7ii7 ,a ,state home that enters into an agreement under this section is subject to-- 7,i7 all provisions of law regarding integrity1 ethics1 or fraud1 or that subject a person to civil or criminal penalties2 7,,ii7 all provisions of law that protect against employment discrimination or that otherwise ensure equal employment opportunities2 and 7,,iii7 all provisions in subchapter ,v of chapter #ag of this title4 7iii7 ,notwithstanding subparagraph 7,b77ii77,i71 a ,state home that enters into an agreement under this section may not be treated as a ,federal contractor or subcontractor for purposes of chapter #fg of title #da 7known as the ,mc,namara-,o',hara ,service ,contract ,act of #aife74 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply to care provided on or after the effective date of regulations issued by the ,secretary of ,veterans ,affairs to carry out this section4 #ajd4 ,access standards and standards for quality 7a7 ,in general ,subchapter ,i of chapter #ag1 as amended by section #ajb1 is further amended by inserting after section #agjc;,a the following new sections3 #agjc;,b4 ,access standards 7a7 7#a7 ,the ,secretary shall establish access standards for furnishing hospital care1 medical services1 or extended care services to covered veterans for the purposes of section #agjc7;d74 7#b7 ,the ,secretary shall ensure that the access standards established under paragraph 7#a7 define such categories of care to cover all care and services within the medical benefits package of the ,department of ,veterans ,affairs4 7b7 ,the ,secretary shall ensure that the access standards provide covered veterans1 employees of the ,department1 and health care providers in the network established under section #agjc7;h7 with relevant comparative information that is clear1 useful1 and timely1 so that covered veterans can make informed decisions regarding their health care4 7c7 ,the ,secretary shall consult with all pertinent ,federal entities 7including the ,department of ,defense1 the ,department of ,health and ,human ,services1 and the ,centers for ,medicare ,medicaid ,services71 entities in the private sector1 and other nongovernmental entities in establishing access standards4 7d7 7#a7 ,not later than #bgj days after the date of the enactment of the ,caring for ,our ,veterans ,act of #bjah1 the ,secretary shall submit to the appropriate committees of ,congress a report detailing the access standards4 7#b7 7,a7 ,before submitting the report required under paragraph 7#a71 the ,secretary shall provide periodic updates to the appropriate committees of ,congress to confirm the ,department's progress towards developing the access standards required by this section4 7,b7 ,the first update under subparagraph 7,a7 shall occur no later than #abj days from the date of the enactment of the ,caring for ,our ,veterans ,act of #bjah4 7#c7 ,not later than #edj days after the date on which the ,secretary implements the access standards established under subsection 7a71 the ,secretary shall submit to the appropriate committees of ,congress a report detailing the implementation of and compliance with such access standards by ,department and non-,department entities or providers4 7e7 ,not later than #c years after the date on which the ,secretary establishes access standards under subsection 7a7 and not less frequently than once every #c years thereafter1 the ,secretary shall-- 7#a7 conduct a review of such standards2 and 7#b7 submit to the appropriate committees of ,congress a report on the findings and any modification to the access standards with respect to the review conducted under paragraph 7#a74 7f7 ,the ,secretary shall ensure health care providers specified under section #agjc7;c7 are able to comply with the applicable access standards established by the ,secretary4 7g7 ,the ,secretary shall publish in the ,federal ,register and on an internet website of the ,department the designated access standards established under this section for purposes of section #agjc7;d77#a77;,d74 7h7 7#a7 ,consistent with paragraphs 7#a77;,d7 and 7#c7 of section #agjc7;d71 covered veterans may contact the ,department at any time to request a determination regarding whether they are eligible to receive care and services from a non-,department entity or provider based on the ,department being unable to furnish such care and services in a manner that complies with the designated access standards established under this section4 7#b7 ,the ,secretary shall establish a process to review such requests from covered veterans to determine whether-- 7,a7 the requested care is clinically necessary2 and 7,b7 the ,department is able to provide such care in a manner that complies with designated access standards established under this section4 7#c7 ,the ,secretary shall promptly respond to any such request by a covered veteran4 7i7 7#a7 ,the term appropriate committees of ,congress means-- 7,a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7,b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 7#b7 ,the term covered veterans refers to veterans described in section #agjc7;b7 of this title4 #agjc;,c4 ,standards for quality 7a7 ,in general 7#a7 ,the ,secretary shall establish standards for quality regarding hospital care1 medical services1 and extended care services furnished by the ,department pursuant to this title1 including through non-,department health care providers pursuant to section #agjc of this title4 7#b7 ,in establishing standards for quality under paragraph 7#a71 the ,secretary shall consider existing health quality measures that are applied to public and privately sponsored health care systems with the purpose of providing covered veterans relevant comparative information to make informed decisions regarding their health care4 7#c7 ,the ,secretary shall collect and consider data for purposes of establishing the standards under paragraph 7#a74 ,such data collection shall include-- 7,a7 after consultation with veterans service organizations and other key stakeholders on survey development or modification of an existing survey1 a survey of veterans who have used hospital care1 medical services1 or extended care services furnished by the ,veterans ,health ,administration during the most recent #b-year period to assess the satisfaction of the veterans with service and quality of care2 and 7,b7 datasets that include1 at a minimum1 elements relating to the following3 7i7 ,timely care4 7ii7 ,effective care4 7iii7 ,safety1 including1 at a minimum1 complications1 readmissions1 and deaths4 7iv7 ,efficiency4 7#d7 ,the ,secretary shall consult with all pertinent ,federal entities 7including the ,department of ,defense1 the ,department of ,health and ,human ,services1 and the ,centers for ,medicare ,medicaid ,services71 entities in the private sector1 and other nongovernmental entities in establishing standards for quality4 7#e7 7,a7 ,not later than #bgj days after the date of the enactment of the ,caring for ,our ,veterans ,act of #bjah1 the ,secretary shall submit to the appropriate committees of ,congress a report detailing the standards for quality4 7,b7 7i7 ,before submitting the report required under subparagraph 7,a71 the ,secretary shall provide periodic updates to the appropriate committees of ,congress to confirm the ,department's progress towards developing the standards for quality required by this section4 7ii7 ,the first update under clause 7i7 shall occur no later than #abj days from the date of the enactment of the ,caring for ,our ,veterans ,act of #bjah4 7b7 ,publication and consideration of public comments 7#a7 ,not later than #a year after the date on which the ,secretary establishes standards for quality under subsection 7a71 the ,secretary shall publish the quality rating of medical facilities of the ,department in the publicly available ,hospital ,compare website through the ,centers for ,medicare ,medicaid ,services for the purpose of providing veterans with information that allows them to compare performance measure information among ,department and non-,department health care providers4 7#b7 ,not later than #b years after the date on which the ,secretary establishes standards for quality under subsection 7a71 the ,secretary shall consider and solicit public comment on potential changes to the measures used in such standards to ensure that they include the most up-to-date and applicable industry measures for veterans4 7c7 7#a7 ,the term appropriate committees of ,congress means-- 7,a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7,b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 7#b7 ,the term covered veterans refers to veterans described in section #agjc7;b7 of this title4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag1 as amended by section #ajb1 is further amended by inserting after the item relating to section #agjc;,a the following new items3 #agjc;,b4 ,access standards4 #agjc;,c4 ,standards for quality4 4 #aje4 ,access to walk-in care 7a7 ,in general ,chapter #ag is amended by inserting after section #agbe the following new section3 #agbe;,a4 ,access to walk-in care 7a7 ,procedures ,to ensure access to walk-,in care ,the ,secretary shall develop procedures to ensure that eligible veterans are able to access walk-in care from qualifying non-,department entities or providers4 7b7 ,eligible veterans ,for purposes of this section1 an eligible veteran is any individual who-- 7#a7 is enrolled in the health care system established under section #agje7;a7 of this title2 and 7#b7 has received care under this chapter within the #bd-month period preceding the furnishing of walk-in care under this section4 7c7 ,qualifying non-,department entities or providers ,for purposes of this section1 a qualifying non-,department entity or provider is a non-,department entity or provider that has entered into a contract or other agreement with the ,secretary to furnish services under this section4 7d7 ,federally-,qualified health centers ,whenever practicable1 the ,secretary may use a ,federally-qualified health center 7as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b777 to carry out this section4 7e7 ,continuity of care ,the ,secretary shall ensure continuity of care for those eligible veterans who receive walk-in care services under this section1 including through the establishment of a mechanism to receive medical records from walk-in care providers and provide pertinent patient medical records to providers of walk-in care4 7f7 ,copayments 7#a7 7,a7 ,the ,secretary may require an eligible veteran to pay the ,united ,states a copayment for each episode of hospital care or medical services provided under this section if the eligible veteran would be required to pay a copayment under this title4 7,b7 ,an eligible veteran not required to pay a copayment under this title may access walk-in care without a copayment for the first two visits in a calendar year4 ,for any additional visits1 a copayment at an amount determined by the ,secretary may be required4 7,c7 ,an eligible veteran required to pay a copayment under this title may be required to pay a regular copayment for the first two walk-in care visits in a calendar year4 ,for any additional visits1 a higher copayment at an amount determined by the ,secretary may be required4 7#b7 ,after the first two episodes of care furnished to an eligible veteran under this section1 the ,secretary may adjust the copayment required of the veteran under this subsection based upon the priority group of enrollment of the eligible veteran1 the number of episodes of care furnished to the eligible veteran during a year1 and other factors the ,secretary considers appropriate under this section4 7#c7 ,the amount or amounts of the copayments required under this subsection shall be prescribed by the ,secretary by rule4 7#d7 ,section #haec7;c7 of this title shall not apply to this subsection4 7g7 ,regulations ,not later than #a year after the date of the enactment of the ,caring for ,our ,veterans ,act of #bjah1 the ,secretary shall promulgate regulations to carry out this section4 7h7 ,walk-,in care defined ,in this section1 the term walk-in care means non-emergent care provided by a qualifying non-,department entity or provider that furnishes episodic care and not longitudinal management of conditions and is otherwise defined through regulations the ,secretary shall promulgate4 4 7b7 ,effective date ,section #agbe;,a of title #ch1 ,united ,states ,code1 as added by subsection 7a7 shall take effect on the date upon which final regulations implementing such section take effect4 7c7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item relating to section #agbe the following new item3 #agbe;,a4 ,access to walk-in care4 4 #ajf4 ,strategy regarding the ,department of ,veterans ,affairs ,high-,performing ,integrated ,health ,care ,network 7a7 ,in general ,subchapter ,,ii of chapter #gc is amended by inserting after section #gccj;,b the following new section3 #gccj;,c4 ,quadrennial ,veterans ,health ,administration review 7a7 ,market area assessments 7#a7 ,not less frequently than every #d years1 the ,secretary of ,veterans ,affairs shall perform market area assessments regarding the health care services furnished under the laws administered by the ,secretary4 7#b7 ,each market area assessment established under paragraph 7#a7 shall include the following3 7,a7 ,an assessment of the demand for health care from the ,department1 disaggregated by geographic market areas as determined by the ,secretary1 including the number of requests for health care services under the laws administered by the ,secretary4 7,b7 ,an inventory of the health care capacity of the ,department of ,veterans ,affairs across the ,department's system of facilities4 7,c7 ,an assessment of the health care capacity to be provided through contracted community care providers and providers who entered into a provider agreement with the ,department under section #agjc;,a of title #ch1 as added by section #ajb1 including the number of providers1 the geographic location of the providers1 and categories or types of health care services provided by the providers4 7,d7 ,an assessment obtained from other ,federal direct delivery systems of their capacity to provide health care to veterans4 7,e7 ,an assessment of the health care capacity of non-contracted providers where there is insufficient network supply4 7,f7 ,an assessment of the health care capacity of academic affiliates and other collaborations of the ,department as it relates to providing health care to veterans4 7,g7 ,an assessment of the effects on health care capacity of the access standards and standards for quality established under sections #agjc;,b and #agjc;,c of this title4 7,h7 ,the number of appointments for health care services under the laws administered by the ,secretary1 disaggregated by-- 7i7 appointments at facilities of the ,department of ,veterans ,affairs2 and 7ii7 appointments with non-,department health care providers4 7#c7 7,a7 ,the ,secretary shall submit to the appropriate committees of ,congress the market area assessments established in paragraph 7#a74 7,b7 ,the ,secretary also shall submit to the appropriate committees of ,congress the market area assessments completed by or being performed on the day before the date of the enactment of the ,caring for ,our ,veterans ,act of #bjah4 7#d7 7,a7 ,the ,secretary shall use the market area assessments established under paragraph 7#a7 to-- 7i7 determine the capacity of the health care provider networks established under section #agjc7;h7 of this title2 7ii7 inform the ,department budget1 in accordance with subparagraph 7,b72 and 7iii7 inform and assess the appropriateness of the access standards established under section #agjc;,b of this title and standards for quality under section #agjc;,c and to make recommendations for any changes to such standards4 7,b7 ,the ,secretary shall ensure that the ,department budget for any fiscal year 7as submitted with the budget of the ,president under section #aaje7;a7 of title #ca7 reflects the findings of the ,secretary with respect to the most recent market area assessments under paragraph 7#a7 and health care utilization data from the ,department and non-,department entities or providers furnishing care and services to covered veterans as described in section #agjc7;b74 7b7 ,strategic plan ,to meet health care demand 7#a7 ,not later than #a year after the date of the enactment of the ,caring for ,our ,veterans ,act of #bjah and not less frequently than once every #d years thereafter1 the ,secretary shall submit to the appropriate committees of ,congress a strategic plan that specifies a #d-year forecast of-- 7,a7 the demand for health care from the ,department1 disaggregated by geographic area as determined by the ,secretary2 7,b7 the health care capacity to be provided at each medical center of the ,department2 and 7,c7 the health care capacity to be provided through community care providers4 7#b7 ,in preparing the strategic plan under paragraph 7#a71 the ,secretary shall-- 7,a7 assess the access standards and standards for quality established under sections #agjc;,b and #agjc;,c of this title2 7,b7 assess the market area assessments established under subsection 7a72 7,c7 assess the needs of the ,department based on identified services that provide management of conditions or disorders related to military service for which there is limited experience or access in the national market1 the overall health of veterans throughout their lifespan1 or other services as the ,secretary determines appropriate2 7,d7 consult with key stakeholders within the ,department1 the heads of other ,federal agencies1 and other relevant governmental and nongovernmental entities1 including ,state1 local1 and tribal government officials1 members of ,congress1 veterans service organizations1 private sector representatives1 academics1 and other policy experts2 7,e7 identify emerging issues1 trends1 problems1 and opportunities that could affect health care services furnished under the laws administered by the ,secretary2 7,f7 develop recommendations regarding both short- and long-term priorities for health care services furnished under the laws administered by the ,secretary2 7,g7 after consultation with veterans service organizations and other key stakeholders on survey development or modification of an existing survey1 consider a survey of veterans who have used hospital care1 medical services1 or extended care services furnished by the ,veterans ,health ,administration during the most recent #b-year period to assess the satisfaction of the veterans with service and quality of care2 7,h7 conduct a comprehensive examination of programs and policies of the ,department regarding the delivery of health care services and the demand of health care services for veterans in future years2 7,i7 assess the remediation of medical service lines of the ,department as described in section #agjf;,a in conjunction with the utilization of non-,department entities or providers to offset remediation2 and 7,j7 consider such other matters as the ,secretary considers appropriate4 7c7 ,responsibilities ,the ,secretary shall be responsible for-- 7#a7 overseeing the transformation and organizational change across the ,department to achieve such high performing integrated health care network2 7#b7 developing the capital infrastructure planning and procurement processes1 whether minor or major construction projects or leases2 and 7#c7 developing a multi-year budget process that is capable of forecasting future year budget requirements and projecting the cost of delivering health care services under a high-performing integrated health care network4 7d7 ,appropriate committees of ,congress defined ,in this section1 the term appropriate committees of ,congress means-- 7#a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7#b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item relating to section #gccj;,b the following new item3 #gccj;,c4 ,quadrennial ,veterans ,health ,administration review4 4 #ajg4 ,applicability of ,directive of ,office of ,federal ,contract ,compliance ,programs 7a7 ,in general ,notwithstanding the treatment of certain laws under subsection 7i7 of section #agjc;,a of title #ch1 ,united ,states ,code1 as added by section #ajb of this title1 ,directive #bjad-ja of the ,office of ,federal ,contract ,compliance ,programs of the ,department of ,labor 7effective as of ,may #g1 #bjad7 shall apply to any entity entering into an agreement under such section #agjc;,a or section #agde of such title1 as amended by section #ajc1 in the same manner as such directive applies to subcontractors under the ,,tricare program for the duration of the moratorium provided under such directive4 7b7 ,applicability period ,the directive described in subsection 7a71 and the moratorium provided under such directive1 shall not be altered or rescinded before ,may #g1 #bjai4 7c7 ,,tricare program defined ,in this section1 the term ,,tricare program has the meaning given that term in section #ajgb of title #aj1 ,united ,states ,code4 #ajh4 ,prevention of certain health care providers from providing non-,department health care services to veterans 7a7 ,in general ,on and after the date that is #a year after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall deny or revoke the eligibility of a health care provider to provide non-,department health care services to veterans if the ,secretary determines that the health care provider-- 7#a7 was removed from employment with the ,department of ,veterans ,affairs due to conduct that violated a policy of the ,department relating to the delivery of safe and appropriate health care2 or 7#b7 violated the requirements of a medical license of the health care provider that resulted in the loss of such medical license4 7b7 ,permissive action ,on and after the date that is #a year after the date of the enactment of this ,act1 the ,secretary may deny1 revoke1 or suspend the eligibility of a health care provider to provide non-,department health care services if the ,secretary determines such action is necessary to immediately protect the health1 safety1 or welfare of veterans and the health care provider is under investigation by the medical licensing board of a ,state in which the health care provider is licensed or practices4 7c7 ,suspension ,the ,secretary shall suspend the eligibility of a health care provider to provide non-,department health care services to veterans if the health care provider is suspended from serving as a health care provider of the ,department4 7d7 ,comptroller ,general report ,not later than #b years after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report on the implementation by the ,secretary of this section1 including the following3 7#a7 ,the aggregate number of health care providers denied or suspended under this section from participation in providing non-,department health care services4 7#b7 ,an evaluation of any impact on access to health care for patients or staffing shortages in programs of the ,department providing non-,department health care services4 7#c7 ,an explanation of the coordination of the ,department with the medical licensing boards of ,states in implementing this section1 the amount of involvement of such boards in such implementation1 and efforts by the ,department to address any concerns raised by such boards with respect to such implementation4 7#d7 ,such recommendations as the ,comptroller ,general considers appropriate regarding harmonizing eligibility criteria between health care providers of the ,department and health care providers eligible to provide non-,department health care services4 7e7 ,non-,department health care services defined ,in this section1 the term non-,department health care services means services-- 7#a7 provided under subchapter ,i of chapter #ag of title #ch1 ,united ,states ,code1 at non-,department facilities 7as defined in section #agja of such title72 7#b7 provided under section #aja of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note72 7#c7 purchased through the ,medical ,community ,care account of the ,department2 or 7#d7 purchased with amounts deposited in the ,veterans ,choice ,fund under section #hjb of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad4 #aji4 ,remediation of medical service lines 7a7 ,in general ,subchapter ,i of chapter #ag is amended by inserting after section #agjf the following new section3 #agjf;,a4 ,remediation of medical service lines 7a7 ,in general ,not later than #cj days after determining under section #agjc7;e77#a7 that a medical service line of the ,department is providing hospital care1 medical services1 or extended care services that does not comply with the standards for quality established by the ,secretary1 the ,secretary shall submit to ,congress an assessment of the factors that led the ,secretary to make such determination and a plan with specific actions1 and the time to complete them1 to be taken to comply with such standards for quality1 including the following3 7#a7 ,increasing personnel or temporary personnel assistance1 including mobile deployment teams4 7#b7 ,special hiring incentives1 including the ,education ,debt ,reduction ,program under subchapter ,,vii of chapter #gf of this title and recruitment1 relocation1 and retention incentives4 7#c7 ,utilizing direct hiring authority4 7#d7 ,providing improved training opportunities for staff4 7#e7 ,acquiring improved equipment4 7#f7 ,making structural modifications to the facility used by the medical service line4 7#g7 ,such other actions as the ,secretary considers appropriate4 7b7 ,responsible parties ,in each assessment submitted under subsection 7a7 with respect to a medical service line1 the ,secretary shall identify the individuals at the ,central ,office of the ,veterans ,health ,administration1 the facility used by the medical service line1 and the central office of the relevant ,veterans ,integrated ,service ,network who are responsible for overseeing the progress of that medical service line in complying with the standards for quality established by the ,secretary4 7c7 ,interim reports ,not later than #ahj days after submitting an assessment under subsection 7a7 with respect to a medical service line1 the ,secretary shall submit to ,congress a report on the progress of that medical service line in complying with the standards for quality established by the ,secretary and any other measures the ,secretary will take to assist the medical service line in complying with such standards for quality4 7d7 ,annual reports ,not less frequently than once each year1 the ,secretary shall-- 7#a7 submit to ,congress an analysis of the remediation actions and costs of such actions taken with respect to each medical service line with respect to which the ,secretary submitted an assessment and plan under paragraph 7#a7 in the preceding year1 including an update on the progress of each such medical service line in complying with the standards for quality and timeliness established by the ,secretary and any other actions the ,secretary is undertaking to assist the medical service line in complying with standards for quality as established by the ,secretary2 and 7#b7 publish such analysis on the internet website of the ,department4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item relating to section #agjf the following new item3 #agjf;,a4 ,remediation of medical service lines4 4 #b ,paying ,providers and ,improving ,collections #aaa4 ,prompt payment to providers 7a7 ,in general ,subchapter ,i of chapter #ag is amended by inserting after section #agjc;,c1 as added by section #ajd of this title1 the following new section3 #agjc;,d4 ,prompt payment standard 7a7 ,in general 7#a7 ,notwithstanding any other provision of this title or of any other provision of law1 the ,secretary shall pay for hospital care1 medical services1 or extended care services furnished by health care entities or providers under this chapter within #de calendar days upon receipt of a clean paper claim or #cj calendar days upon receipt of a clean electronic claim4 7#b7 ,if a claim is denied1 the ,secretary shall1 within #de calendar days of denial for a paper claim and #cj calendar days of denial for an electronic claim1 notify the health care entity or provider of the reason for denying the claim and what1 if any1 additional information is required to process the claim4 7#c7 ,upon the receipt of the additional information1 the ,secretary shall ensure that the claim is paid1 denied1 or otherwise adjudicated within #cj calendar days from the receipt of the requested information4 7#d7 ,this section shall only apply to payments made on an invoice basis and shall not apply to capitation or other forms of periodic payment to entities or providers4 7b7 ,submittal of claims by health care entities and providers ,a health care entity or provider that furnishes hospital care1 a medical service1 or an extended care service under this chapter shall submit to the ,secretary a claim for payment for furnishing the hospital care1 medical service1 or extended care service not later than #ahj days after the date on which the entity or provider furnished the hospital care1 medical service1 or extended care service4 7c7 ,fraudulent claims 7#a7 ,sections #cgbi through #cgcc of title #ca shall apply to fraudulent claims for payment submitted to the ,secretary by a health care entity or provider under this chapter4 7#b7 ,pursuant to regulations prescribed by the ,secretary1 the ,secretary shall bar a health care entity or provider from furnishing hospital care1 medical services1 and extended care services under this chapter when the ,secretary determines the entity or provider has submitted to the ,secretary fraudulent health care claims for payment by the ,secretary4 7d7 ,overdue claims 7#a7 ,any claim that has not been denied with notice1 made pending with notice1 or paid to the health care entity or provider by the ,secretary shall be overdue if the notice or payment is not received by the entity provider within the time periods specified in subsection 7a74 7#b7 7,a7 ,if a claim is overdue under this subsection1 the ,secretary may1 under the requirements established by subsection 7a7 and consistent with the provisions of chapter #ci of title #ca 7commonly referred to as the ,prompt ,payment ,act71 require that interest be paid on clean claims4 7,b7 ,interest paid under subparagraph 7,a7 shall be computed at the rate of interest established by the ,secretary of the ,treasury under section #cijb of title #ca and published in the ,federal ,register4 7#c7 ,not less frequently than annually1 the ,secretary shall submit to ,congress a report on payment of overdue claims under this subsection1 disaggregated by paper and electronic claims1 that includes the following3 7,a7 ,the amount paid in overdue claims described in this subsection1 disaggregated by the amount of the overdue claim and the amount of interest paid on such overdue claim4 7,b7 ,the number of such overdue claims and the average number of days late each claim was paid1 disaggregated by facility of the ,department and ,veterans ,integrated ,service ,network region4 7e7 ,overpayment 7#a7 ,the ,secretary shall deduct the amount of any overpayment from payments due a health care entity or provider under this chapter4 7#b7 ,deductions may not be made under this subsection unless the ,secretary has made reasonable efforts to notify a health care entity or provider of the right to dispute the existence or amount of such indebtedness and the right to request a compromise of such indebtedness4 7#c7 ,the ,secretary shall make a determination with respect to any such dispute or request prior to deducting any overpayment unless the time required to make such a determination before making any deductions would jeopardize the ,secretary's ability to recover the full amount of such indebtedness4 7f7 ,information and documentation required 7#a7 ,the ,secretary shall provide to all health care entities and providers participating in a program to furnish hospital care1 medical services1 or extended care services under this chapter a list of information and documentation that is required to establish a clean claim under this section4 7#b7 ,the ,secretary shall consult with entities in the health care industry1 in the public and private sector1 to determine the information and documentation to include in the list under paragraph 7#a74 7#c7 ,if the ,secretary modifies the information and documentation included in the list under paragraph 7#a71 the ,secretary shall notify all health care entities and providers described in paragraph 7#a7 not later than #cj days before such modifications take effect4 7g7 ,processing of claims 7#a7 ,in processing a claim for compensation for hospital care1 medical services1 or extended care services furnished by a non-,department health care entity or provider under this chapter1 the ,secretary may act through-- 7,a7 a non-,department entity that is under contract or agreement for the program established under section #agjc7;a7 of this title2 or 7,b7 a non-,department entity that specializes in such processing for other ,federal agency health care systems4 7#b7 ,the ,secretary shall seek to contract with a third party to conduct a review of claims described in paragraph 7#c7 that includes-- 7,a7 a feasibility assessment to determine the capacity of the ,department to process such claims in a timely manner2 and 7,b7 a cost benefit analysis comparing the capacity of the ,department to a third party entity capable of processing such claims4 7#c7 ,the review required under paragraph 7#b7 shall apply to claims for hospital care1 medical services1 or extended care services furnished under section #agjc of this ,act1 as amended by the ,caring for ,our ,veterans ,act of #bjah1 that are processed by the ,department4 7h7 ,report on encounter data system 7#a7 ,not later than #ij days after the date of the enactment of the ,caring for ,our ,veterans ,act of #bjah1 the ,secretary shall submit to the appropriate committees of ,congress a report on the feasibility and advisability of adopting a funding mechanism similar to what is utilized by other ,federal agencies to allow a contracted entity to act as a fiscal intermediary for the ,federal ,government to distribute1 or pass through1 ,federal ,government funds for certain non-underwritten hospital care1 medical services1 or extended care services4 7#b7 ,the ,secretary may coordinate with the ,department of ,defense1 the ,department of ,health and ,human ,services1 and the ,department of the ,treasury in developing the report required by paragraph 7#a74 7i7 ,definitions ,in this section3 7#a7 ,the term appropriate committees of ,congress means-- 7,a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7,b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 7#b7 ,the term clean electronic claim means the transmission of data for purposes of payment of covered health care expenses that is submitted to the ,secretary which contains substantially all of the required data elements necessary for accurate adjudication1 without obtaining additional information from the entity or provider that furnished the care or service1 submitted in such format as prescribed by the ,secretary in regulations for the purpose of paying claims for care or services4 7#c7 ,the term clean paper claim means a paper claim for payment of covered health care expenses that is submitted to the ,secretary which contains substantially all of the required data elements necessary for accurate adjudication1 without obtaining additional information from the entity or provider that furnished the care or service1 submitted in such format as prescribed by the ,secretary in regulations for the purpose of paying claims for care or services4 7#d7 ,the term fraudulent claims means the knowing misrepresentation of a material fact or facts by a health care entity or provider made to induce the ,secretary to pay a claim that was not legally payable to that provider4 7#e7 ,the term health care entity or provider includes any non-,department health care entity or provider1 but does not include any ,federal health care entity or provider4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item relating to section #agjc;,c1 as added by section #ajd of this title1 the following new item3 #agjc;,d4 ,prompt payment standard4 4 #aab4 ,authority to pay for authorized care not subject to an agreement 7a7 ,in general ,subchapter ,,iv of chapter #ha is amended by adding at the end the following new section3 #haei4 ,authority to pay for services authorized but not subject to an agreement 7a7 ,in general ,if1 in the course of furnishing hospital care1 a medical service1 or an extended care service authorized by the ,secretary and pursuant to a contract1 agreement1 or other arrangement with the ,secretary1 a provider who is not a party to the contract1 agreement1 or other arrangement furnishes hospital care1 a medical service1 or an extended care service that the ,secretary considers necessary1 the ,secretary may compensate the provider for the cost of such care or service4 7b7 ,new contracts and agreements ,the ,secretary shall take reasonable efforts to enter into a contract1 agreement1 or other arrangement with a provider described in subsection 7a7 to ensure that future care and services authorized by the ,secretary and furnished by the provider are subject to such a contract1 agreement1 or other arrangement4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item relating to section #haeh the following new item3 #haei4 ,authority to pay for services authorized but not subject to an agreement4 4 #aac4 ,improvement of authority to recover the cost of services furnished for non-service-connected disabilities 7a7 ,broadening scope of applicability ,section #agbi is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#b77;,a7-- 7i7 by striking the veteran's and inserting the individual's2 and 7ii7 by striking the veteran and inserting the individual2 and 7,b7 in paragraph 7#c7-- 7i7 in the matter preceding subparagraph 7,a71 by striking the veteran and inserting the individual2 and 7ii7 in subparagraph 7,a71 by striking the veteran's and inserting the individual's2 7#b7 in subsection 7b7-- 7,a7 in paragraph 7#a7-- 7i7 by striking the veteran and inserting the individual2 and 7ii7 by striking the veteran's and inserting the individual's2 and 7,b7 in paragraph 7#b7-- 7i7 in subparagraph 7,a7-- 7,i7 by striking the veteran and inserting the individual2 and 7,,ii7 by striking the veteran's and inserting the individual's2 and 7ii7 in subparagraph 7,b7-- 7,i7 in clause 7i71 by striking the veteran and inserting the individual2 and 7,,ii7 in clause 7ii7-- 7aa7 by striking the veteran and inserting the individual2 and 7bb7 by striking the veteran's each place it appears and inserting the individual's2 7#c7 in subsection 7e71 by striking ,a veteran and inserting ,an individual2 and 7#d7 in subsection 7h7-- 7,a7 in paragraph 7#a7-- 7i7 in the matter preceding subparagraph 7,a71 by striking a veteran and inserting an individual2 7ii7 in subparagraph 7,a71 by striking the veteran and inserting the individual2 and 7iii7 in subparagraph 7,b71 by striking the veteran and inserting the individual2 and 7,b7 in paragraph 7#b7-- 7i7 by striking ,a veteran and inserting ,an individual2 7ii7 by striking a veteran and inserting an individual2 and 7iii7 by striking the veteran and inserting the individual4 7b7 ,modification of authority ,subsection 7a77#a7 of such section is amended by striking 7#a7 ,subject and all that follows through the period and inserting the following3 7#a7 ,subject to the provisions of this section1 in any case in which the ,united ,states is required by law to furnish or pay for care or services under this chapter for a non-service-connected disability described in paragraph 7#b7 of this subsection1 the ,united ,states has the right to recover or collect from a third party the reasonable charges of care or services so furnished or paid for to the extent that the recipient or provider of the care or services would be eligible to receive payment for such care or services from such third party if the care or services had not been furnished or paid for by a department or agency of the ,united ,states44 7c7 ,modification of eligible individuals ,subparagraph 7,d7 of subsection 7a77#b7 of such section is amended to read as follows3 7,d7 that is incurred by an individual who is entitled to care 7or payment of the expenses of care7 under a health-plan contract4 4 #aad4 ,processing of claims for reimbursement through electronic interface ,the ,secretary of ,veterans ,affairs may enter into an agreement with a third-party entity to process1 through the use of an electronic interface1 claims for reimbursement for health care provided under the laws administered by the ,secretary4 #c ,education and ,training ,programs #aba4 ,education program on health care options 7a7 ,in general ,the ,secretary of ,veterans ,affairs shall develop and administer an education program that teaches veterans about their health care options through the ,department of ,veterans ,affairs4 7b7 ,elements ,the program under subsection 7a7 shall-- 7#a7 teach veterans about-- 7,a7 eligibility criteria for care from the ,department set forth under sections #agjc1 as amended by section #aja of this title1 and #agaj of title #ch1 ,united ,states ,code2 7,b7 priority groups for enrollment in the system of annual patient enrollment under section #agje7;a7 of such title2 7,c7 the copayments and other financial obligations1 if any1 required of certain individuals for certain services2 and 7,d7 how to utilize the access standards and standards for quality established under sections #agjc;,b and #agjc;,c of such title2 7#b7 teach veterans about the interaction between health insurance 7including private insurance1 ,medicare1 ,medicaid1 the ,,tricare program1 the ,indian ,health ,service1 tribal health programs1 and other forms of insurance7 and health care from the ,department2 and 7#c7 provide veterans with information on what to do when they have a complaint about health care received from the ,department 7whether about the provider1 the ,department1 or any other type of complaint74 7c7 ,accessibility ,in developing the education program under this section1 the ,secretary shall ensure that materials under such program are accessible-- 7#a7 to veterans who may not have access to the internet2 and 7#b7 to veterans in a manner that complies with the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abaja et seq474 7d7 ,annual evaluation and report 7#a7 ,evaluation ,the ,secretary shall develop a method to evaluate the effectiveness of the education program under this section and evaluate the program using the method not less frequently than once each year4 7#b7 ,report ,not less frequently than once each year1 the ,secretary shall submit to ,congress a report on the findings of the ,secretary with respect to the most recent evaluation conducted by the ,secretary under paragraph 7#a74 7e7 ,definitions ,in this section3 7#a7 ,medicaid ,the term ,medicaid means the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#b7 ,medicare ,the term ,medicare means the ,medicare program under title ,,xviii of such ,act 7#db ,u4,s4,c4 #acie et seq474 7#c7 ,tricare program ,the term ,,tricare program has the meaning given that term in section #ajgb of title #aj1 ,united ,states ,code4 #abb4 ,training program for administration of non-,department of ,veterans ,affairs health care 7a7 ,establishment of program ,the ,secretary of ,veterans ,affairs shall develop and implement a training program to train employees and contractors of the ,department of ,veterans ,affairs on how to administer non-,department health care programs1 including the following3 7#a7 ,reimbursement for non-,department emergency room care4 7#b7 ,the ,veterans ,community ,care ,program under section #agjc of such title1 as amended by section #aja4 7#c7 ,management of prescriptions pursuant to improvements under section #aca4 7b7 ,annual evaluation and report ,the ,secretary shall-- 7#a7 develop a method to evaluate the effectiveness of the training program developed and implemented under subsection 7a72 7#b7 evaluate such program not less frequently than once each year2 and 7#c7 not less frequently than once each year1 submit to ,congress the findings of the ,secretary with respect to the most recent evaluation carried out under paragraph 7#b74 #abc4 ,continuing medical education for non-,department medical professionals 7a7 ,establishment of program 7#a7 ,in general ,the ,secretary of ,veterans ,affairs shall establish a program to provide continuing medical education material to non-,department medical professionals4 7#b7 ,education provided ,the program established under paragraph 7#a7 shall include education on the following3 7,a7 ,identifying and treating common mental and physical conditions of veterans and family members of veterans4 7,b7 ,the health care system of the ,department of ,veterans ,affairs4 7,c7 ,such other matters as the ,secretary considers appropriate4 7b7 ,material provided ,the continuing medical education material provided to non-,department medical professionals under the program established under subsection 7a7 shall be the same material provided to medical professionals of the ,department to ensure that all medical professionals treating veterans have access to the same materials1 which supports core competencies throughout the community4 7c7 ,administration of program 7#a7 ,in general ,the ,secretary shall administer the program established under subsection 7a7 to participating non-,department medical professionals through an internet website of the ,department of ,veterans ,affairs4 7#b7 ,curriculum and credit provided ,the ,secretary shall determine the curriculum of the program and the number of hours of credit to provide to participating non-,department medical professionals for continuing medical education4 7#c7 ,accreditation ,the ,secretary shall ensure that the program is accredited in as many ,states as practicable4 7#d7 ,consistency with existing rules ,the ,secretary shall ensure that the program is consistent with the rules and regulations of the following3 7,a7 ,the medical licensing agency of each ,state in which the program is accredited4 7,b7 ,such medical credentialing organizations as the ,secretary considers appropriate4 7#e7 ,user cost ,the ,secretary shall carry out the program at no cost to participating non-,department medical professionals4 7#f7 ,monitoring1 evaluation1 and report ,the ,secretary shall monitor the utilization of the program established under subsection 7a71 evaluate its effectiveness1 and report to ,congress on utilization and effectiveness not less frequently than once each year4 7d7 ,non-,department medical professional defined ,in this section1 the term non-,department medical professional means any individual who is licensed by an appropriate medical authority in the ,united ,states and is in good standing1 is not an employee of the ,department of ,veterans ,affairs1 and provides care to veterans or family members of veterans under the laws administered by the ,secretary of ,veterans ,affairs4 #d ,other ,matters ,relating to ,non-,department of ,veterans ,affairs ,providers #aca4 ,establishment of processes to ensure safe opioid prescribing practices by non-,department of ,veterans ,affairs health care providers 7a7 ,receipt and review of guidelines ,the ,secretary of ,veterans ,affairs shall ensure that all covered health care providers are provided a copy of and certify that they have reviewed the evidence-based guidelines for prescribing opioids set forth by the ,opioid ,safety ,initiative of the ,department of ,veterans ,affairs4 7b7 ,inclusion of medical history and current medications ,the ,secretary shall implement a process to ensure that1 if care of a veteran by a covered health care provider is authorized under the laws administered by the ,secretary1 the document authorizing such care includes the available and relevant medical history of the veteran and a list of all medications prescribed to the veteran as known by the ,department4 7c7 ,submittal of medical records and prescriptions 7#a7 ,in general ,the ,secretary shall1 consistent with section #agjc7;a77#b77;,a71 as amended by section #aja of this title1 and section #agjc;,a7e77#b77;,f71 as added by section #ajb of this title1 require each covered health care provider to submit medical records of any care or services furnished1 including records of any prescriptions for opioids1 to the ,department in the timeframe and format specified by the ,secretary4 7#b7 ,responsibility of department for recording and monitoring ,in carrying out paragraph 7#a7 and upon the receipt by the ,department of the medical records described in paragraph 7#a71 the ,secretary shall-- 7,a7 ensure the ,department is responsible for the recording of the prescription in the electronic health record of the veteran2 and 7,b7 enable other monitoring of the prescription as outlined in the ,opioid ,safety ,initiative of the ,department4 7#c7 ,report ,not less frequently than annually1 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report evaluating the compliance of covered health care providers with the requirements under this section4 7d7 ,use of opioid safety initiative guidelines 7#a7 ,in general ,if the ,secretary determines that the opioid prescribing practices of a covered health care provider1 when treating covered veterans1 satisfy a condition described in paragraph 7#c71 the ,secretary shall take such action as the ,secretary considers appropriate to ensure the safety of all veterans receiving care from that health care provider1 including removing or directing the removal of any such health care provider from provider networks or otherwise refusing to authorize care of veterans by such health care provider in any program authorized under the laws administered by the ,secretary4 7#b7 ,inclusion in contracts ,the ,secretary shall ensure that any contracts1 agreements1 or other arrangements entered into by the ,secretary with third parties involved in administering programs that provide care in the community to veterans under the laws administered by the ,secretary specifically grant the authority set forth in paragraph 7#a7 to such third parties and to the ,secretary1 as the case may be4 7#c7 ,conditions for exclusion or limitation ,the ,secretary shall take such action as is considered appropriate under paragraph 7#a7 when the opioid prescribing practices of a covered health care provider when treating covered veterans-- 7,a7 conflict with or are otherwise inconsistent with the standards of appropriate and safe care2 7,b7 violate the requirements of a medical license of the health care provider2 or 7,c7 may place at risk the veterans receiving health care from the provider4 7e7 ,covered health care provider defined ,in this section1 the term covered health care provider means a non-,department of ,veterans ,affairs health care provider who provides health care to veterans under the laws administered by the ,secretary of ,veterans ,affairs1 but does not include a health care provider employed by another agency of the ,federal ,government4 #acb4 ,improving information sharing with community providers ,section #gccb7;b77#b7 is amended by striking subparagraph 7,h7 and inserting the following new subparagraphs3 7,h7 7i7 ,to a non-,department entity 7including private entities and other ,federal agencies7 for purposes of providing health care1 including hospital care1 medical services1 and extended care services1 to patients or performing other health care-related activities or functions4 7ii7 ,an entity to which a record is disclosed under this subparagraph may not disclose or use such record for a purpose other than that for which the disclosure was made or as permitted by law4 7,i7 ,to a third party in order to recover or collect reasonable charges for care furnished to1 or paid on behalf of1 a patient in connection with a non-service connected disability as permitted by section #agbi of this title or for a condition for which recovery is authorized or with respect to which the ,united ,states is deemed to be a third party beneficiary under the ,act entitled ,an ,act to provide for the recovery from tortiously liable third persons of the cost of hospital and medical care and treatment furnished by the ,united ,states 7,public ,law #hg-fic2 #db ,u4,s4,c4 #bfea et seq42 commonly known as the ,federal ,medical ,care ,recovery ,act74 4 #acc4 ,competency standards for non-,department of ,veterans ,affairs health care providers 7a7 ,establishment of standards and requirements ,the ,secretary of ,veterans ,affairs shall establish standards and requirements for the provision of care by non-,department of ,veterans ,affairs health care providers in clinical areas for which the ,department of ,veterans ,affairs has special expertise1 including post-traumatic stress disorder1 military sexual trauma-related conditions1 and traumatic brain injuries4 7b7 ,condition for eligibility ,to furnish care 7#a7 ,each non-,department of ,veterans ,affairs health care provider shall1 to the extent practicable as determined by the ,secretary or otherwise provided for in paragraph 7#b71 meet the standards and requirements established pursuant to subsection 7a7 before furnishing care pursuant to a contract1 agreement1 or other arrangement with the ,department of ,veterans ,affairs4 ,non-,department of ,veterans ,affairs health care providers furnishing care pursuant to a contract1 agreement1 or other arrangement shall1 to the extent practicable as determined by the ,secretary1 fulfill training requirements established by the ,secretary on how to deliver evidence-based treatments in the clinical areas for which the ,department of ,veterans ,affairs has special expertise4 7#b7 ,each non-,department of ,veterans ,affairs health care provider who enters into a contract1 agreement1 or other arrangement after the effective date identified in subsection 7c7 shall1 to the extent practicable1 meet the standards and requirements established pursuant to subsection 7a7 within #f months of the contract1 agreement1 or other arrangement taking effect4 7c7 ,effective date ,this section shall take effect on the day that is #a year after the date of the enactment of this ,act4 #acd4 ,department of ,veterans ,affairs participation in national network of ,state-based prescription drug monitoring programs 7a7 ,in general ,chapter #ag is amended by inserting after section #agcj;,a the following new section3 #agcj;,b4 ,access to ,state prescription drug monitoring programs 7a7 ,access to programs 7#a7 ,any licensed health care provider or delegate of such a provider shall be considered an authorized recipient or user for the purpose of querying and receiving data from the national network of ,state-based prescription drug monitoring programs to support the safe and effective prescribing of controlled substances to covered patients4 7#b7 ,under the authority granted by paragraph 7#a7-- 7,a7 licensed health care providers or delegates of such providers shall query such network in accordance with applicable regulations and policies of the ,veterans ,health ,administration2 and 7,b7 notwithstanding any general or specific provision of law1 rule1 or regulation of a ,state1 no ,state may restrict the access of licensed health care providers or delegates of such providers from accessing that ,state's prescription drug monitoring programs4 7#c7 ,no ,state shall deny or revoke the license1 registration1 or certification of a licensed health care provider or delegate who otherwise meets that ,state's qualifications for holding the license1 registration1 or certification on the basis that the licensed health care provider or delegate queried or received data1 or attempted to query or receive data1 from the national network of ,state-based prescription drug monitoring programs under this section4 7b7 ,covered patients ,for purposes of this section1 a covered patient is a patient who-- 7#a7 receives a prescription for a controlled substance2 and 7#b7 is not receiving palliative care or enrolled in hospice care4 7c7 ,definitions ,in this section3 7#a7 ,the term controlled substance has the meaning given such term in section #ajb7f7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hjb7f774 7#b7 ,the term delegate means a person or automated system accessing the national network of ,state-based prescription monitoring programs at the direction or under the supervision of a licensed health care provider4 7#c7 ,the term licensed health care provider means a health care provider employed by the ,department who is licensed1 certified1 or registered within any ,state to fill or prescribe medications within the scope of his or her practice as a ,department employee4 7#d7 ,the term national network of ,state-based prescription monitoring programs means an interconnected nation-wide system that facilitates the transfer to ,state prescription drug monitoring program data across ,state lines4 7#e7 ,the term ,state means a ,state1 as defined in section #aja7bj7 of this title1 or a political subdivision of a ,state4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag of such title is amended by inserting after the item relating to section #agcj;,a the following new item3 #agcj;,b4 ,access to ,state prescription drug monitoring programs4 4 #e ,other ,non-,department ,health ,care ,matters #ada4 ,plans for ,use of ,supplemental ,appropriations ,required ,whenever the ,secretary submits to ,congress a request for supplemental appropriations or any other appropriation outside the standard budget process to address a budgetary issue affecting the ,department of ,veterans ,affairs1 the ,secretary shall1 not later than #de days before the date on which such budgetary issue would start affecting a program or service1 submit to ,congress a justification for the request1 including a plan that details how the ,secretary intends to use the requested appropriation and how long the requested appropriation is expected to meet the needs of the ,department and certification that the request was made using an updated and sound actuarial analysis4 #adb4 ,veterans ,choice ,fund flexibility ,section #hjb of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 is amended-- 7#a7 in subsection 7c7-- 7,a7 in paragraph 7#a71 by striking by paragraph 7#c7 and inserting in paragraphs 7#c7 and 7#d72 and 7,b7 by adding at the end the following new paragraph3 7#d7 ,permanent authority for other uses ,beginning on ,march #a1 #bjai1 amounts remaining in the ,veterans ,choice ,fund may be used to furnish hospital care1 medical services1 and extended care services to individuals pursuant to chapter #ag of title #ch1 ,united ,states ,code1 at non-,department facilities1 including pursuant to non-,department provider programs other than the program established by section #aja4 ,such amounts shall be available in addition to amounts available in other appropriations accounts for such purposes4 2 and 7#b7 in subsection 7d77#a71 by striking to subsection 7c77#c7 and inserting to paragraphs 7#c7 and 7#d7 of subsection 7c74 #adc4 ,sunset of ,veterans ,choice ,program ,subsection 7p7 of section #aja of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 is amended to read as follows3 7p7 ,authority ,to furnish care and services ,the ,secretary may not use the authority under this section to furnish care and services after the date that is #a year after the date of the enactment of the ,caring for ,our ,veterans ,act of #bjah4 4 #add4 ,conforming amendments 7a7 ,in general 7#a7 ,title #ch ,title #ch1 ,united ,states ,code1 is amended-- 7,a7 in section #agab7;a7-- 7i7 in paragraph 7#c71 by striking under clause 7#a71 7#b71 or 7#e7 of section #agjc7;a7 of this title and inserting or entered an agreement2 and 7ii7 in paragraph 7#d77;,a71 by striking under the provisions of this subsection and section #agjc of this title2 7,b7 in section #agab;,a7e77#a7-- 7i7 by inserting or agreements after contracts2 and 7ii7 by striking 7under sections #agjc7;a77#b7 and #agaj7;a77#a77;,b7 of this title72 and 7,c7 in section #bcjc7;a77#b77;,b77i71 by striking with section #agjc and inserting with sections #agjc;,a1 #haaa1 and #haec4 7#b7 ,social ,security ,act ,section #ahff7;a77#a77,l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77,l77 is amended by striking under section #fjc and inserting under chapter #ag4 7#c7 ,veterans' ,benefits ,improvements ,act of #aiid ,section #ajd7;a77#d77;,a7 of the ,veterans' ,benefits ,improvements ,act of #aiid 7,public ,law #ajc-ddf2 #ch ,u4,s4,c4 #aaag note7 is amended by striking in section #agjc and inserting in sections #agjc;,a1 #haaa1 and #haec4 7b7 ,effective date ,the amendments made by subsection 7a7 shall take effect on the date described in section #aja7;b74 ,b ,improving ,department of ,veterans ,affairs ,health ,care ,delivery #aea4 ,licensure of health care professionals of the ,department of ,veterans ,affairs providing treatment via telemedicine 7a7 ,in general ,chapter #ag is amended by inserting after section #agcj;,b1 as added by section #acd1 the following new section3 #agcj;,c4 ,licensure of health care professionals providing treatment via telemedicine 7a7 ,in general ,notwithstanding any provision of law regarding the licensure of health care professionals1 a covered health care professional may practice the health care profession of the health care professional at any location in any ,state1 regardless of where the covered health care professional or the patient is located1 if the covered health care professional is using telemedicine to provide treatment to an individual under this chapter4 7b7 ,covered health care professionals ,for purposes of this section1 a covered health care professional is any health care professional who-- 7#a7 is an employee of the ,department appointed under the authority under section #gcjf1 #gdja1 #gdje1 #gdjf1 or #gdjh of this title or title #e2 7#b7 is authorized by the ,secretary to provide health care under this chapter2 7#c7 is required to adhere to all standards for quality relating to the provision of medicine in accordance with applicable policies of the ,department2 and 7#d7 has an active1 current1 full1 and unrestricted license1 registration1 or certification in a ,state to practice the health care profession of the health care professional4 7c7 ,property of ,federal ,government ,subsection 7a7 shall apply to a covered health care professional providing treatment to a patient regardless of whether the covered health care professional or patient is located in a facility owned by the ,federal ,government during such treatment4 7d7 ,relation to ,state law 7#a7 ,the provisions of this section shall supersede any provisions of the law of any ,state to the extent that such provision of ,state law are inconsistent with this section4 7#b7 ,no ,state shall deny or revoke the license1 registration1 or certification of a covered health care professional who otherwise meets the qualifications of the ,state for holding the license1 registration1 or certification on the basis that the covered health care professional has engaged or intends to engage in activity covered by subsection 7a74 7e7 ,rule of construction ,nothing in this section may be construed to remove1 limit1 or otherwise affect any obligation of a covered health care professional under the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hja et seq474 7f7 ,state defined ,in this section1 the term ,state means a ,state1 as defined in section #aja7bj7 of this title1 or a political subdivision of a ,state4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag of such title is amended by inserting after the item relating to section #agcj;,b1 as added by section #acd1 the following new item3 #agcj;,c4 ,licensure of health care professionals providing treatment via telemedicine4 4 7c7 ,report on telemedicine 7#a7 ,in general ,not later than #a year after the earlier of the date on which services provided under section #agcj;,b of title #ch1 ,united ,states ,code1 as added by subsection 7a71 first occur or regulations are promulgated to carry out such section1 the ,secretary of ,veterans ,affairs shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on the effectiveness of the use of telemedicine by the ,department of ,veterans ,affairs4 7#b7 ,elements ,the report required by paragraph 7#a7 shall include an assessment of the following3 7,a7 ,the satisfaction of veterans with telemedicine furnished by the ,department4 7,b7 ,the satisfaction of health care providers in providing telemedicine furnished by the ,department4 7,c7 ,the effect of telemedicine furnished by the ,department on the following3 7i7 ,the ability of veterans to access health care1 whether from the ,department or from non-,department health care providers4 7ii7 ,the frequency of use by veterans of telemedicine4 7iii7 ,the productivity of health care providers4 7iv7 ,wait times for an appointment for the receipt of health care from the ,department4 7v7 ,the use by veterans of in-person services at ,department facilities and non-,department facilities4 7,d7 ,the types of appointments for the receipt of telemedicine furnished by the ,department that were provided during the #a-year period preceding the submittal of the report4 7,e7 ,the number of appointments for the receipt of telemedicine furnished by the ,department that were requested during such period1 disaggregated by medical facility4 7,f7 ,savings by the ,department1 if any1 including travel costs1 from furnishing health care through the use of telemedicine during such period4 #aeb4 ,authority for ,department of ,veterans ,affairs ,center for ,innovation for ,care and ,payment 7a7 ,in general ,subchapter ,i of chapter #ag1 as amended by this title1 is further amended by inserting after section #agjc;,d1 as added by section #aaa1 the following new section3 #agjc;,e4 ,center for ,innovation for ,care and ,payment 7a7 ,in general 7#a7 ,there is established within the ,department a ,center for ,innovation for ,care and ,payment 7in this section referred to as the ,center74 7#b7 ,the ,secretary1 acting through the ,center1 may carry out such pilot programs the ,secretary determines to be appropriate to develop innovative approaches to testing payment and service delivery models in order to reduce expenditures while preserving or enhancing the quality of care furnished by the ,department4 7#c7 ,the ,secretary1 acting through the ,center1 shall test payment and service delivery models to determine whether such models-- 7,a7 improve access to1 and quality1 timeliness1 and patient satisfaction of care and services2 and 7,b7 create cost savings for the ,department4 7#d7 7,a7 ,the ,secretary shall test a model in a location where the ,secretary determines that the model will addresses deficits in care 7including poor clinical outcomes or potentially avoidable expenditures7 for a defined population4 7,b7 ,the ,secretary shall focus on models the ,secretary expects to reduce program costs while preserving or enhancing the quality of care received by individuals receiving benefits under this chapter4 7,c7 ,the models selected may include those described in section #aaae;,a7b77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77;,b774 7#e7 ,in selecting a model for testing1 the ,secretary may consider1 in addition to other factors identified in this subsection1 the following factors3 7,a7 ,whether the model includes a regular process for monitoring and updating patient care plans in a manner that is consistent with the needs and preferences of individuals receiving benefits under this chapter4 7,b7 ,whether the model places the individual receiving benefits under this chapter 7including family members and other caregivers of such individual7 at the center of the care team of such individual4 7,c7 ,whether the model uses technology or new systems to coordinate care over time and across settings4 7,d7 ,whether the model demonstrates effective linkage with other public sector payers1 private sector payers1 or statewide payment models4 7#f7 7,a7 ,models tested under this section may not be designed in such a way that would allow the ,united ,states to recover or collect reasonable charges from a ,federal health care program for care or services furnished by the ,secretary to a veteran under pilot programs carried out under this section4 7,b7 ,in this paragraph1 the term ,federal health care program means-- 7i7 an insurance program described in section #ahaa of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c7 or established by section #ahca of such ,act 7#db ,u4,s4,c4 #acie;j72 7ii7 a ,state plan for medical assistance approved under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq472 or 7iii7 a ,,tricare program operated under sections #ajge1 #ajge;a1 #ajgf1 #ajgf;a1 #ajgf;c1 #ajgf;d1 #ajgf;e1 or #ajgf;f of title #aj4 7b7 ,duration ,each pilot program carried out by the ,secretary under this section shall terminate no later than #e years after the date of the commencement of the pilot program4 7c7 ,location ,the ,secretary shall ensure that each pilot program carried out under this section occurs in an area or areas appropriate for the intended purposes of the pilot program4 ,to the extent practicable1 the ,secretary shall ensure that the pilot programs are located in geographically diverse areas of the ,united ,states4 7d7 ,budget ,funding for each pilot program carried out by the ,secretary under this section shall come from appropriations-- 7#a7 provided in advance in appropriations acts for the ,veterans ,health ,administration2 and 7#b7 provided for information technology systems4 7e7 ,notice ,the ,secretary shall-- 7#a7 publish information about each pilot program under this section in the ,federal ,register2 and 7#b7 take reasonable actions to provide direct notice to veterans eligible to participate in such pilot programs4 7f7 ,waiver of authorities 7#a7 ,subject to reporting under paragraph 7#b7 and approval under paragraph 7#c71 in implementing a pilot program under this section1 the ,secretary may waive such requirements in subchapters ,i1 ,,ii1 and ,,iii of this chapter as the ,secretary determines necessary solely for the purposes of carrying out this section with respect to testing models described in subsection 7a74 7#b7 ,before waiving any authority under paragraph 7#a71 the ,secretary shall submit to the ,speaker of the ,house of ,representatives1 the minority leader of the ,house of ,representatives1 the majority leader of the ,senate1 the minority leader of the ,senate1 and each standing committee with jurisdiction under the rules of the ,senate and of the ,house of ,representatives to report a bill to amend the provision or provisions of law that would be waived by the ,department1 a report on a request for waiver that describes in detail the following3 7,a7 ,the specific authorities to be waived under the pilot program4 7,b7 ,the standard or standards to be used in the pilot program in lieu of the waived authorities4 7,c7 ,the reasons for such waiver or waivers4 7,d7 ,a description of the metric or metrics the ,secretary will use to determine the effect of the waiver or waivers upon the access to and quality1 timeliness1 or patient satisfaction of care and services furnished through the pilot program4 7,e7 ,the anticipated cost savings1 if any1 of the pilot program4 7,f7 ,the schedule for interim reports on the pilot program describing the results of the pilot program so far and the feasibility and advisability of continuing the pilot program4 7,g7 ,the schedule for the termination of the pilot program and the submission of a final report on the pilot program describing the result of the pilot program and the feasibility and advisability of making the pilot program permanent4 7,h7 ,the estimated budget of the pilot program4 7#c7 7,a7 ,upon receipt of a report submitted under paragraph 7#b71 each ,house of ,congress shall provide copies of the report to the chairman and ranking member of each standing committee with jurisdiction under the rules of the ,house of ,representatives or the ,senate to report a bill to amend the provision or provisions of law that would be waived by the ,department under this subsection4 7,b7 ,the waiver requested by the ,secretary under paragraph 7#b7 shall be considered approved under this paragraph if there is enacted into law a joint resolution approving such request in its entirety4 7,c7 ,for purposes of this paragraph1 the term joint resolution means only a joint resolution which is introduced within the period of five legislative days beginning on the date on which the ,secretary transmits the report to the ,congress under such paragraph 7#b71 and-- 7i7 which does not have a preamble2 and 7ii7 the matter after the resolving clause of which is as follows3 that ,congress approves the request for a waiver under section #agjc;,e7f7 of title #ch1 ,united ,states ,code1 as submitted by the ,secretary on 1 the blank space being filled with the appropriate date4 7,d7 7i7 ,any committee of the ,house of ,representatives to which a joint resolution is referred shall report it to the ,house without amendment not later than #ae legislative days after the date of introduction thereof4 ,if a committee fails to report the joint resolution within that period1 the committee shall be discharged from further consideration of the joint resolution4 7ii7 ,it shall be in order at any time after the third legislative day after each committee authorized to consider a joint resolution has reported or has been discharged from consideration of a joint resolution1 to move to proceed to consider the joint resolution in the ,house4 ,all points of order against the motion are waived4 ,such a motion shall not be in order after the ,house has disposed of a motion to proceed on a joint resolution addressing a particular submission4 ,the previous question shall be considered as ordered on the motion to its adoption without intervening motion4 ,the motion shall not be debatable4 ,a motion to reconsider the vote by which the motion is disposed of shall not be in order4 7iii7 ,the joint resolution shall be considered as read4 ,all points of order against the joint resolution and against its consideration are waived4 ,the previous question shall be considered as ordered on the joint resolution to its passage without intervening motion except two hours of debate equally divided and controlled by the proponent and an opponent4 ,a motion to reconsider the vote on passage of the joint resolution shall not be in order4 7,e7 7i7 ,a joint resolution introduced in the ,senate shall be referred to the ,committee on ,veterans' ,affairs4 7ii7 ,any committee of the ,senate to which a joint resolution is referred shall report it to the ,senate without amendment not later than #ae session days after the date of introduction of a joint resolution described in paragraph 7,c74 ,if a committee fails to report the joint resolution within that period1 the committee shall be discharged from further consideration of the joint resolution and the joint resolution shall be placed on the calendar4 7iii7 7,i7 ,notwithstanding ,rule ,,xxii of the ,standing ,rules of the ,senate1 it is in order at any time after the third session day on which the ,committee on ,veterans' ,affairs has reported or has been discharged from consideration of a joint resolution described in paragraph 7,c7 7even though a previous motion to the same effect has been disagreed to7 to move to proceed to the consideration of the joint resolution1 and all points of order against the joint resolution 7and against consideration of the joint resolution7 are waived4 ,the motion to proceed is not debatable4 ,the motion is not subject to a motion to postpone4 ,a motion to reconsider the vote by which the motion is agreed to or disagreed to shall not be in order4 ,if a motion to proceed to the consideration of the resolution is agreed to1 the joint resolution shall remain the unfinished business until disposed of4 7,,ii7 ,consideration of the joint resolution1 and on all debatable motions and appeals in connection therewith1 shall be limited to not more than two hours1 which shall be divided equally between the majority and minority leaders or their designees4 ,a motion further to limit debate is in order and not debatable4 ,an amendment to1 or a motion to postpone1 or a motion to proceed to the consideration of other business1 or a motion to recommit the joint resolution is not in order4 7,,iii7 ,if the ,senate has voted to proceed to a joint resolution1 the vote on passage of the joint resolution shall occur immediately following the conclusion of consideration of the joint resolution1 and a single quorum call at the conclusion of the debate if requested in accordance with the rules of the ,senate4 7,,iv7 ,appeals from the decisions of the ,chair relating to the application of the rules of the ,senate1 as the case may be1 to the procedure relating to a joint resolution shall be decided without debate4 7,f7 ,a joint resolution considered pursuant to this paragraph shall not be subject to amendment in either the ,house of ,representatives or the ,senate4 7,g7 7i7 ,if1 before the passage by one ,house of the joint resolution of that ,house1 that ,house receives the joint resolution from the other ,house1 then the following procedures shall apply3 7,i7 ,the joint resolution of the other ,house shall not be referred to a committee4 7,,ii7 ,with respect to the joint resolution of the ,house receiving the joint resolution-- 7aa7 the procedure in that ,house shall be the same as if no joint resolution had been received from the other ,house2 but 7bb7 the vote on passage shall be on the joint resolution of the other ,house4 7ii7 ,if the ,senate fails to introduce or consider a joint resolution under this paragraph1 the joint resolution of the ,house shall be entitled to expedited floor procedures under this subparagraph4 7iii7 ,if1 following passage of the joint resolution in the ,senate1 the ,senate then receives the companion measure from the ,house of ,representatives1 the companion measure shall not be debatable4 7,h7 ,this subparagraph is enacted by ,congress-- 7i7 as an exercise of the rulemaking power of the ,senate and ,house of ,representatives1 respectively1 and as such it is deemed a part of the rules of each ,house1 respectively1 but applicable only with respect to the procedure to be followed in that ,house in the case of a joint resolution1 and it supersedes other rules only to the extent that it is inconsistent with such rules2 and 7ii7 with full recognition of the constitutional right of either ,house to change the rules 7so far as relating to the procedure of that ,house7 at any time1 in the same manner1 and to the same extent as in the case of any other rule of that ,house4 7g7 ,limitations 7#a7 ,the ,secretary may not carry out more than #aj pilot programs concurrently4 7#b7 7,a7 ,subject to subparagraph 7,b71 the ,secretary may not expend more than #ej1jjj1jjj in any fiscal year from amounts under subsection 7d74 7,b7 ,the ,secretary may expend more than the amount in subparagraph 7,a7 if-- 7i7 the ,secretary determines that the additional expenditure is necessary to carry out pilot programs under this section2 7ii7 the ,secretary submits to the ,committees on ,veterans' ,affairs of the ,senate and the ,house of ,representatives a report setting forth the amount of the additional expenditure and a justification for the additional expenditure2 and 7iii7 the ,chairmen of the ,committees on ,veterans' ,affairs of the ,senate and the ,house of ,representatives transmit to the ,secretary a letter approving of the additional expenditure4 7#c7 ,the waiver provisions in subsection 7f7 shall not apply unless the ,secretary1 in accordance with the requirements in subsection 7f71 submits the first proposal for a pilot program not later than #ah months after the date of the enactment of the ,caring for ,our ,veterans ,act of #bjah4 7#d7 ,notwithstanding section #ejb of this title1 decisions by the ,secretary under this section shall1 consistent with section #eaa of this title1 be final and conclusive and may not be reviewed by any other official or by any court1 whether by an action in the nature of mandamus or otherwise4 7#e7 7,a7 ,if the ,secretary determines that a pilot program is not improving the quality of care or producing cost savings1 the ,secretary shall-- 7i7 propose a modification to the pilot program in the interim report that shall also be considered a report under subsection 7f77#b7 and shall be subject to the terms and conditions of subsection 7f77#b72 or 7ii7 terminate such pilot program not later than #cj days after submitting the interim report to ,congress4 7,b7 ,if the ,secretary terminates a pilot program under subparagraph 7,a77ii71 for purposes of subparagraphs 7,f7 and 7,g7 of subsection 7f77#b71 such interim report will also serve as the final report for that pilot program4 7h7 ,evaluation and reporting requirements 7#a7 ,the ,secretary shall conduct an evaluation of each model tested1 which shall include1 at a minimum1 an analysis of-- 7,a7 the quality of care furnished under the model1 including the measurement of patient-level outcomes and patient-centeredness criteria determined appropriate by the ,secretary2 and 7,b7 the changes in spending by reason of that model4 7#b7 ,the ,secretary shall make the results of each evaluation under this subsection available to the public in a timely fashion and may establish requirements for other entities participating in the testing of models under this section to collect and report information that the ,secretary determines is necessary to monitor and evaluate such models4 7i7 ,coordination and advice 7#a7 ,the ,secretary shall obtain advice from the ,under ,secretary for ,health and the ,special ,medical ,advisory ,group established pursuant to section #gcab of this title in the development and implementation of any pilot program operated under this section4 7#b7 ,in carrying out the duties under this section1 the ,secretary shall consult representatives of relevant ,federal agencies1 and clinical and analytical experts with expertise in medicine and health care management4 ,the ,secretary shall use appropriate mechanisms to seek input from interested parties4 7j7 ,expansion of successful pilot programs ,taking into account the evaluation under subsection 7f71 the ,secretary may1 through rulemaking1 expand 7including implementation on a nationwide basis7 the duration and the scope of a model that is being tested under subsection 7a7 to the extent determined appropriate by the ,secretary1 if-- 7#a7 the ,secretary determines that such expansion is expected to-- 7,a7 reduce spending without reducing the quality of care2 or 7,b7 improve the quality of patient care without increasing spending2 and 7#b7 the ,secretary determines that such expansion would not deny or limit the coverage or provision of benefits for individuals receiving benefits under this chapter4 4 7b7 ,conforming amendment ,the table of sections at the beginning of such chapter1 as amended by this title1 is further amended by inserting after the item relating to section #agjc;,d the following new item3 #agjc;,e4 ,center for ,innovation for ,care and ,payment4 4 #aec4 ,authorization to provide for operations on live donors for purposes of conducting transplant procedures for veterans 7a7 ,in general ,subchapter ,,viii of chapter #ag is amended by adding at the end the following new section3 #aghh4 ,transplant procedures with live donors and related services 7a7 ,in general ,subject to subsections 7b7 and 7c71 in a case in which a veteran is eligible for a transplant procedure from the ,department1 the ,secretary may provide for an operation on a live donor to carry out such procedure for such veteran1 notwithstanding that the live donor may not be eligible for health care from the ,department4 7b7 ,other services ,subject to the availability of appropriations for such purpose1 the ,secretary shall furnish to a live donor any care or services before and after conducting the transplant procedure under subsection 7a7 that may be required in connection with such procedure4 7c7 ,use of non-,department facilities ,in carrying out this section1 the ,secretary may provide for the operation described in subsection 7a7 on a live donor and furnish to the live donor the care and services described in subsection 7b7 at a non-,department facility pursuant to an agreement entered into by the ,secretary under this chapter4 ,the live donor shall be deemed to be an individual eligible for hospital care and medical services at a non-,department facility pursuant to such an agreement solely for the purposes of receiving such operation1 care1 and services at the non-,department facility4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag is amended by inserting after the item relating to section #aghg the following new item3 #aghh4 ,transplant procedures with live donors and related services4 4 ,c ,family ,caregivers #afa4 ,expansion of family caregiver program of ,department of ,veterans ,affairs 7a7 ,family caregiver program 7#a7 ,expansion of eligibility 7,a7 ,in general ,subparagraph 7,b7 of subsection 7a77#b7 of section #agbj;,g is amended to read as follows3 7,b7 for assistance provided under this subsection-- 7i7 before the date on which the ,secretary submits to ,congress a certification that the ,department has fully implemented the information technology system required by section #afb7;a7 of the ,caring for ,our ,veterans ,act of #bjah1 has a serious injury 7including traumatic brain injury1 psychological trauma1 or other mental disorder7 incurred or aggravated in the line of duty in the active military1 naval1 or air service on or after ,september #aa1 #bjja2 7ii7 during the #b-year period beginning on the date on which the ,secretary submitted to ,congress the certification described in clause 7i71 has a serious injury 7including traumatic brain injury1 psychological trauma1 or other mental disorder7 incurred or aggravated in the line of duty in the active military1 naval1 or air service-- 7,i7 on or before ,may #g1 #aige2 or 7,,ii7 on or after ,september #aa1 #bjja2 or 7iii7 after the date that is #b years after the date on which the ,secretary submits to ,congress the certification described in clause 7i71 has a serious injury 7including traumatic brain injury1 psychological trauma1 or other mental disorder7 incurred or aggravated in the line of duty in the active military1 naval1 or air service2 and 4 7,b7 ,publication in ,federal ,register ,not later than #cj days after the date on which the ,secretary of ,veterans ,affairs submits to ,congress the certification described in subsection 7a77#b77;,b77i7 of section #agbj;,g of such title1 as amended by subparagraph 7,a7 of this paragraph1 the ,secretary shall publish the date specified in such subsection in the ,federal ,register4 7#b7 ,expansion of needed services in eligibility criteria ,subsection 7a77#b77;,c7 of such section is amended-- 7,a7 in clause 7ii71 by striking 2 or and inserting a semicolon2 7,b7 by redesignating clause 7iii7 as clause 7iv72 and 7,c7 by inserting after clause 7ii7 the following new clause 7iii73 7iii7 a need for regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired2 or 4 7#c7 ,expansion of services provided ,subsection 7a77#c77;,a77ii7 of such section is amended-- 7,a7 in subclause 7,,iv71 by striking 2 and and inserting a semicolon2 7,b7 in subclause 7,v71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following new subclause3 7,,vi7 through the use of contracts with1 or the provision of grants to1 public or private entities-- 7aa7 financial planning services relating to the needs of injured veterans and their caregivers2 and 7bb7 legal services1 including legal advice and consultation1 relating to the needs of injured veterans and their caregivers4 4 7#d7 ,modification of stipend calculation ,subsection 7a77#c77;,c7 of such section is amended-- 7,a7 by redesignating clause 7iii7 as clause 7iv72 and 7,b7 by inserting after clause 7ii7 the following new clause 7iii73 7iii7 ,in determining the amount and degree of personal care services provided under clause 7i7 with respect to an eligible veteran whose need for personal care services is based in whole or in part on a need for supervision or protection under paragraph 7#b77;,c77ii7 or regular instruction or supervision under paragraph 7#b77;,c77iii71 the ,secretary shall take into account the following3 7,i7 ,the assessment by the family caregiver of the needs and limitations of the veteran4 7,,ii7 ,the extent to which the veteran can function safely and independently in the absence of such supervision1 protection1 or instruction4 7,,iii7 ,the amount of time required for the family caregiver to provide such supervision1 protection1 or instruction to the veteran4 4 7#e7 ,periodic evaluation of need for certain services ,subsection 7a77#c7 of such section is amended by adding at the end the following new subparagraph3 7,d7 ,in providing instruction1 preparation1 and training under subparagraph 7,a77i77,i7 and technical support under subparagraph 7,a77i77,,ii7 to each family caregiver who is approved as a provider of personal care services for an eligible veteran under paragraph 7#f71 the ,secretary shall periodically evaluate the needs of the eligible veteran and the skills of the family caregiver of such veteran to determine if additional instruction1 preparation1 training1 or technical support under those subparagraphs is necessary4 4 7#f7 ,use of primary care teams ,subsection 7a77#e7 of such section is amended1 in the matter preceding subparagraph 7,a71 by inserting 7in collaboration with the primary care team for the eligible veteran to the maximum extent practicable7 after evaluate4 7#g7 ,assistance for family caregivers ,subsection 7a7 of such section is amended by adding at the end the following new paragraph3 7#aa7 7,a7 ,in providing assistance under this subsection to family caregivers of eligible veterans1 the ,secretary may enter into contracts1 provider agreements1 and memoranda of understanding with ,federal agencies1 ,states1 and private1 nonprofit1 and other entities to provide such assistance to such family caregivers4 7,b7 ,the ,secretary may provide assistance under this paragraph only if such assistance is reasonably accessible to the family caregiver and is substantially equivalent or better in quality to similar services provided by the ,department4 7,c7 ,the ,secretary may provide fair compensation to ,federal agencies1 ,states1 and other entities that provide assistance under this paragraph4 4 7b7 ,modification of definition of personal care services ,subsection 7d77#d7 of such section is amended-- 7#a7 in subparagraph 7,a71 by striking independent2 7#b7 by redesignating subparagraph 7,b7 as subparagraph 7,d72 and 7#c7 by inserting after subparagraph 7,a7 the following new subparagraphs3 7,b7 ,supervision or protection based on symptoms or residuals of neurological or other impairment or injury4 7,c7 ,regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired4 4 #afb4 ,implementation of information technology system of ,department of ,veterans ,affairs to assess and improve the family caregiver program 7a7 ,implementation of new system 7#a7 ,in general ,not later than ,october #a1 #bjah1 the ,secretary of ,veterans ,affairs shall implement an information technology system that fully supports the ,program and allows for data assessment and comprehensive monitoring of the ,program4 7#b7 ,elements of system ,the information technology system required to be implemented under paragraph 7#a7 shall include the following3 7,a7 ,the ability to easily retrieve data that will allow all aspects of the ,program 7at the medical center and aggregate levels7 and the workload trends for the ,program to be assessed and comprehensively monitored4 7,b7 ,the ability to manage data with respect to a number of caregivers that is more than the number of caregivers that the ,secretary expects to apply for the ,program4 7,c7 ,the ability to integrate the system with other relevant information technology systems of the ,veterans ,health ,administration4 7b7 ,assessment of ,program ,not later than #ahj days after implementing the system described in subsection 7a71 the ,secretary shall1 through the ,under ,secretary for ,health1 use data from the system and other relevant data to conduct an assessment of how key aspects of the ,program are structured and carried out4 7c7 ,ongoing monitoring of and modifications to ,program 7#a7 ,monitoring ,the ,secretary shall use the system implemented under subsection 7a7 to monitor and assess the workload of the ,program1 including monitoring and assessment of data on-- 7,a7 the status of applications1 appeals1 and home visits in connection with the ,program2 and 7,b7 the use by caregivers participating in the ,program of other support services under the ,program such as respite care4 7#b7 ,modifications ,based on the monitoring and assessment conducted under paragraph 7#a71 the ,secretary shall identify and implement such modifications to the ,program as the ,secretary considers necessary to ensure the ,program is functioning as intended and providing veterans and caregivers participating in the ,program with services in a timely manner4 7d7 ,reports 7#a7 ,initial report 7,a7 ,in general ,not later than #ij days after the date of the enactment of this ,act1 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate1 the ,committee on ,veterans' ,affairs of the ,house of ,representatives1 and the ,comptroller ,general of the ,united ,states a report that includes-- 7i7 the status of the planning1 development1 and deployment of the system required to be implemented under subsection 7a71 including any changes in the timeline for the implementation of the system2 and 7ii7 an assessment of the needs of family caregivers of veterans described in subparagraph 7,b71 the resources needed for the inclusion of such family caregivers in the ,program1 and such changes to the ,program as the ,secretary considers necessary to ensure the successful expansion of the ,program to include such family caregivers4 7,b7 ,veterans described ,veterans described in this subparagraph are veterans who are eligible for the ,program under clause 7ii7 or 7iii7 of section #agbj;,g7a77#b77;,b7 of title #ch1 ,united ,states ,code1 as amended by section #afa7;a77#a7 of this title1 solely due to a serious injury 7including traumatic brain injury1 psychological trauma1 or other mental disorder7 incurred or aggravated in the line of duty in the active military1 naval1 or air service before ,september #aa1 #bjja4 7#b7 ,notification by ,comptroller ,general ,the ,comptroller ,general shall review the report submitted under paragraph 7#a7 and notify the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives with respect to the progress of the ,secretary in-- 7,a7 fully implementing the system required under subsection 7a72 and 7,b7 implementing a process for using such system to monitor and assess the ,program under subsection 7c77#a7 and modify the ,program as considered necessary under subsection 7c77#b74 7#c7 ,final report 7,a7 ,in general ,not later than ,october #a1 #bjai1 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate1 the ,committee on ,veterans' ,affairs of the ,house of ,representatives1 and the ,comptroller ,general a report on the implementation of subsections 7a7 through 7c74 7,b7 ,elements ,the report required by subparagraph 7,a7 shall include the following3 7i7 ,a certification by the ,secretary that the information technology system described in subsection 7a7 has been implemented4 7ii7 ,a description of how the ,secretary has implemented such system4 7iii7 ,a description of the modifications to the ,program1 if any1 that were identified and implemented under subsection 7c77#b74 7iv7 ,a description of how the ,secretary is using such system to monitor the workload of the ,program4 7e7 ,definitions ,in this section3 7#a7 ,active military1 naval1 or air service ,the term active military1 naval1 or air service has the meaning given that term in section #aja of title #ch1 ,united ,states ,code4 7#b7 ,program ,the term ,program means the program of comprehensive assistance for family caregivers under section #agbj;,g7a7 of title #ch1 ,united ,states ,code1 as amended by section #afa of this title4 #afc4 ,modifications to annual evaluation report on caregiver program of ,department of ,veterans ,affairs 7a7 ,barriers to care and services ,subparagraph 7,a77iv7 of section #aja7;c77#b7 of the ,caregivers and ,veterans ,omnibus ,health ,services ,act of #bjaj 7,public ,law #aaa-afc2 #ch ,u4,s4,c4 #agbj;,g note7 is amended by inserting 1 including a description of any barriers to accessing and receiving care and services under such programs before the semicolon4 7b7 ,sufficiency of training for family caregiver program ,subparagraph 7,b7 of such section is amended-- 7#a7 in clause 7i71 by striking 2 and and inserting a semicolon2 7#b7 in clause 7ii71 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following new clause3 7iii7 an evaluation of the sufficiency and consistency of the training provided to family caregivers under such program in preparing family caregivers to provide care to veterans under such program4 4 ,,ii ,,va ,asset and ,infrastructure ,review ,a ,asset and ,infrastructure ,review #bja4 ,short title ,this subtitle may be cited as the ,,va ,asset and ,infrastructure ,review ,act of #bjah4 #bjb4 ,the ,commission 7a7 ,establishment ,there is established an independent commission to be known as the ,asset and ,infrastructure ,review ,commission 7in this subtitle referred to as the ,commission74 7b7 ,duties ,the ,commission shall carry out the duties specified for it in this subtitle4 7c7 ,appointment 7#a7 ,in general 7,a7 ,appointment ,the ,commission shall be composed of nine members appointed by the ,president1 by and with the advice and consent of the ,senate4 7,b7 ,transmission of nominations ,the ,president shall transmit to the ,senate the nominations for appointment to the ,commission not later than ,may #ca1 #bjba4 7#b7 ,consultation in selection process ,in selecting individuals for nominations for appointments to the ,commission1 the ,president shall consult with-- 7,a7 the ,speaker of the ,house of ,representatives2 7,b7 the majority leader of the ,senate2 7,c7 the minority leader of the ,house of ,representatives2 7,d7 the minority leader of the ,senate2 and 7,e7 congressionally chartered1 membership based veterans service organizations concerning the appointment of three members4 7#c7 ,designation of ,chair ,at the time the ,president nominates individuals for appointment to the ,commission under paragraph 7#a77;,b71 the ,president shall designate one such individual who shall serve as ,chair of the ,commission and one such individual who shall serve as ,vice ,chair of the ,commission4 7#d7 ,member representation ,in nominating individuals under this subsection1 the ,president shall ensure that-- 7,a7 veterans1 reflecting current demographics of veterans enrolled in the system of annual patient enrollment under section #agje of title #ch1 ,united ,states ,code1 are adequately represented in the membership of the ,commission2 7,b7 at least one member of the ,commission has experience working for a private integrated health care system that has annual gross revenues of more than #ej1jjj1jjj2 7,c7 at least one member has experience as a senior manager for an entity specified in clause 7ii71 7iii71 or 7iv7 of section #aja7;a77#a77;,b7 of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note72 7,d7 at least one member-- 7i7 has experience with capital asset management for the ,federal ,government2 and 7ii7 is familiar with trades related to building and real property1 including construction1 engineering1 architecture1 leasing1 and strategic partnerships2 and 7,e7 at least three members represent congressionally chartered1 membership-based1 veterans service organizations4 7d7 ,meetings 7#a7 ,in general ,the ,commission shall meet only during calendar years #bjbb and #bjbc4 7#b7 ,public nature of meetings and proceedings 7,a7 ,public meetings ,each meeting of the ,commission shall be open to the public4 7,b7 ,open participation ,all the proceedings1 information1 and deliberations of the ,commission shall be available for review by the public4 7e7 ,vacancies ,a vacancy in the ,commission shall be filled in the same manner as the original appointment1 but the individual appointed to fill the vacancy shall serve only for the unexpired portion of the term for which the individual's predecessor was appointed4 7f7 ,pay 7#a7 ,in general ,members of the ,commission shall serve without pay4 7#b7 ,officers or employees of the ,united ,states ,each member of the ,commission who is an officer or employee of the ,united ,states shall serve without compensation in addition to that received for service as an officer or employee of the ,united ,states4 7#c7 ,travel expenses ,members shall receive travel expenses1 including per diem in lieu of subsistence1 in accordance with sections #egjb and #egjc of title #e1 ,united ,states ,code4 7g7 ,director of staff 7#a7 ,appointment ,the ,commission shall appoint a ,director who-- 7,a7 has not served as an employee of the ,department of ,veterans ,affairs during the #a-year period preceding the date of such appointment2 and 7,b7 is not otherwise barred or prohibited from serving as ,director under ,federal ethics laws and regulations1 by reason of post-employment conflict of interest4 7#b7 ,rate of pay ,the ,director shall be paid at the rate of basic pay payable for level ,,iv of the ,executive ,schedule under section #ecae of title #e1 ,united ,states ,code4 7h7 ,staff 7#a7 ,pay of personnel ,subject to paragraphs 7#b7 and 7#c71 the ,director1 with the approval of the ,commission1 may appoint and fix the pay of additional personnel4 7#b7 ,exemption from certain requirements ,the ,director may make such appointments without regard to the provisions of title #e1 ,united ,states ,code1 governing appointments in the competitive service1 and any personnel so appointed may be paid without regard to the provisions of chapter #ea and subchapter ,,iii of chapter #ec of that title relating to classification and ,general ,schedule pay rates1 except that an individual so appointed may not receive pay in excess of the annual rate of basic pay payable for ,,gs-#ae of the ,general ,schedule4 7#c7 ,detailees 7,a7 ,limitation on number ,not more than two-thirds of the personnel employed by or detailed to the ,commission may be on detail from the ,department of ,veterans ,affairs4 7,b7 ,professional analysts ,not more than half of the professional analysts of the ,commission staff may be persons detailed from the ,department of ,veterans ,affairs to the ,commission4 7,c7 ,prohibition on detail of certain personnel ,a person may not be detailed from the ,department of ,veterans ,affairs to the ,commission if1 within #f months before the detail is to begin1 that person participated personally and substantially in any matter within the ,department of ,veterans ,affairs concerning the preparation of recommendations regarding facilities of the ,veterans ,health ,administration4 7#d7 ,authority to request detailed personnel ,subject to paragraph 7#c71 the head of any ,federal department or agency1 upon the request of the ,director1 may detail any of the personnel of that department or agency to the ,commission to assist the ,commission in carrying out its duties under this subtitle4 7#e7 ,information from ,federal agencies ,the ,commission may secure directly from any ,federal agency such information the ,commission considers necessary to carry out this subtitle4 ,upon request of the ,chair1 the head of such agency shall furnish such information to the ,commission4 7i7 ,other authority 7#a7 ,temporary and intermittent services ,the ,commission may procure by contract1 to the extent funds are available1 the temporary or intermittent services of experts or consultants pursuant to section #caji of title #e1 ,united ,states ,code4 7#b7 ,leasing and acquisition of property ,to the extent funds are available1 the ,commission may lease real property and acquire personal property either of its own accord or in consultation with the ,general ,services ,administration4 7j7 ,termination ,the ,commission shall terminate on ,december #ca1 #bjbc4 7k7 ,prohibition against restricting communications 7#a7 ,in general ,except as provided in paragraph 7#b71 no person may restrict an employee of the ,department of ,veterans ,affairs in communicating with the ,commission4 7#b7 ,unlawful communications ,paragraph 7#a7 does not apply to a communication that is unlawful4 #bjc4 ,procedure for making recommendations 7a7 ,selection criteria 7#a7 ,publication ,the ,secretary shall1 not later than ,february #a1 #bjba1 and after consulting with veterans service organizations1 publish in the ,federal ,register and transmit to the ,committees on ,veterans' ,affairs of the ,senate and the ,house of ,representatives the criteria proposed to be used by the ,department of ,veterans ,affairs in assessing and making recommendations regarding the modernization or realignment of facilities of the ,veterans ,health ,administration under this subtitle4 ,such criteria shall include the preferences of veterans regarding health care furnished by the ,department4 7#b7 ,public comment ,the ,secretary shall provide an opportunity for public comment on the proposed criteria under paragraph 7#a7 for a period of at least #ij days and shall include notice of that opportunity in the publication required under such paragraph4 7#c7 ,publication of final criteria ,the ,secretary shall1 not later than ,may #ca1 #bjba1 publish in the ,federal ,register and transmit to the ,committees on ,veterans' ,affairs of the ,senate and the ,house of ,representatives the final criteria to be used in making recommendations regarding the closure1 modernization1 or realignment of facilities of the ,veterans ,health ,administration under this subtitle4 7b7 ,recommendations of the ,secretary 7#a7 ,publication in ,federal ,register ,the ,secretary shall1 not later than ,january #ca1 #bjbb1 and after consulting with veterans service organizations1 publish in the ,federal ,register and transmit to the ,committees on ,veterans' ,affairs of the ,senate and the ,house of ,representatives and to the ,commission a report detailing the recommendations regarding the modernization or realignment of facilities of the ,veterans ,health ,administration on the basis of the final criteria referred to in subsection 7a77#b7 that are applicable4 7#b7 ,factors for consideration ,in making recommendations under this subsection1 the ,secretary shall consider each of the following factors3 7,a7 ,the degree to which any health care delivery or other site for providing services to veterans reflect the metrics of the ,department of ,veterans ,affairs regarding market area health system planning4 7,b7 ,the provision of effective and efficient access to high-quality health care and services for veterans4 7,c7 ,the extent to which the real property that no longer meets the needs of the ,federal ,government could be reconfigured1 repurposed1 consolidated1 realigned1 exchanged1 outleased1 replaced1 sold1 or disposed4 7,d7 ,the need of the ,veterans ,health ,administration to acquire infrastructure or facilities that will be used for the provision of health care and services to veterans4 7,e7 ,the extent to which the operating and maintenance costs are reduced through consolidating1 colocating1 and reconfiguring space1 and through realizing other operational efficiencies4 7,f7 ,the extent and timing of potential costs and savings1 including the number of years such costs or savings will be incurred1 beginning with the date of completion of the proposed recommendation4 7,g7 ,the extent to which the real property aligns with the mission of the ,department of ,veterans ,affairs4 7,h7 ,the extent to which any action would impact other missions of the ,department 7including education1 research1 or emergency preparedness74 7,i7 ,local stakeholder inputs and any factors identified through public field hearings4 7,j7 ,the assessments under paragraph 7#c74 7,k7 ,the extent to which the ,veterans ,health ,administration has appropriately staffed the medical facility1 including determinations whether there has been insufficient resource allocation or deliberate understaffing4 7,l7 ,any other such factors the ,secretary determines appropriate4 7#c7 ,capacity and commercial market assessments 7,a7 ,assessments ,the ,secretary shall assess the capacity of each ,veterans ,integrated ,service ,network and medical facility of the ,department to furnish hospital care or medical services to veterans under chapter #ag of title #ch1 ,united ,states ,code4 ,each such assessment shall-- 7i7 identify gaps in furnishing such care or services at such ,veterans ,integrated ,service ,network or medical facility2 7ii7 identify how such gaps can be filled by-- 7,i7 entering into contracts or agreements with network providers under this section or with entities under other provisions of law2 7,,ii7 making changes in the way such care and services are furnished at such ,veterans ,integrated ,service ,network or medical facility1 including-- 7aa7 extending hours of operation2 7bb7 adding personnel2 or 7cc7 expanding space through the construction1 leasing1 or sharing of health care facilities2 and 7,,iii7 the building or realignment of ,department resources or personnel2 7iii7 forecast1 based on future projections and historical trends1 both the short- and long-term demand in furnishing care or services at such ,veterans ,integrated ,service ,network or medical facility and assess how such demand affects the needs to use such network providers2 7iv7 include a commercial health care market assessment of designated catchment areas in the ,united ,states conducted by a non-governmental entity2 and 7v7 consider the unique ability of the ,federal ,government to retain a presence in an area otherwise devoid of commercial health care providers or from which such providers are at risk of leaving4 7,b7 ,consultation ,in carrying out the assessments under subparagraph 7,a71 the ,secretary shall consult with veterans service organizations and veterans served by each such ,veterans ,integrated ,service ,network and medical facility4 7,c7 ,submittal ,the ,secretary shall submit such assessments to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate with the recommendations of the ,secretary under this subsection and make the assessments publicly available4 7#d7 ,summary of selection process ,the ,secretary shall include1 with the list of recommendations published and transmitted pursuant to paragraph 7#a71 a summary of the selection process that resulted in the recommendation for each facility of the ,veterans ,health ,administration1 including a justification for each recommendation4 ,the ,secretary shall transmit the matters referred to in the preceding sentence not later than #g days after the date of the transmittal to the ,committees on ,veterans' ,affairs of the ,senate and the ,house of ,representatives and the ,commission of the report referred to in paragraph 7#a74 7#e7 ,treatment of facilities ,in assessing facilities of the ,veterans ,health ,administration1 the ,secretary shall consider all such facilities equally without regard to whether the facility has been previously considered or proposed for reuse1 closure1 modernization1 or realignment by the ,department of ,veterans ,affairs4 7#f7 ,availability of information to ,congress ,in addition to making all information used by the ,secretary to prepare the recommendations under this subsection available to ,congress 7including any committee or ,member of ,congress71 the ,secretary shall also make such information available to the ,commission and the ,comptroller ,general of the ,united ,states4 7#g7 ,certification of accuracy 7,a7 ,in general ,each person referred to in subparagraph 7,b71 when submitting information to the ,secretary or the ,commission concerning the modernization or realignment of a facility of the ,veterans ,health ,administration1 shall certify that such information is accurate and complete to the best of that person's knowledge and belief4 7,b7 ,covered persons ,subparagraph 7,a7 applies to the following persons3 7i7 ,each ,under ,secretary of the ,department of ,veterans ,affairs4 7ii7 ,each director of a ,veterans ,integrated ,service ,network4 7iii7 ,each director of a medical center of the ,department of ,veterans ,affairs4 7iv7 ,each director of a program office of the ,department of ,veterans ,affairs4 7v7 ,each person who is in a position the duties of which include personal and substantial involvement in the preparation and submission of information and recommendations concerning the modernization or realignment of facilities of the ,veterans ,health ,administration4 7c7 ,review and recommendations by the ,commission 7#a7 ,public hearings 7,a7 ,in general ,after receiving the recommendations from the ,secretary pursuant to subsection 7b71 the ,commission shall conduct public hearings on the recommendations4 7,b7 ,locations ,the ,commission shall conduct public hearings in regions affected by a recommendation of the ,secretary to close a facility of the ,veterans ,health ,administration4 ,to the greatest extent practicable1 the ,commission shall conduct public hearings in regions affected by a recommendation of the ,secretary to modernize or realign such a facility4 7,c7 ,required witnesses ,witnesses at each public hearing shall include at a minimum-- 7i7 a veteran-- 7,i7 enrolled under section #agje of title #ch1 ,united ,states ,code2 and 7,,ii7 identified by a local veterans service organization2 and 7ii7 a local elected official4 7#b7 ,transmittal to ,president 7,a7 ,in general ,the ,commission shall1 not later than ,january #ca1 #bjbc1 transmit to the ,president a report containing the ,commission's findings and conclusions based on a review and analysis of the recommendations made by the ,secretary1 together with the ,commission's recommendations1 for modernizations and realignments of facilities of the ,veterans ,health ,administration4 7,b7 ,authority to make changes to recommendations ,subject to subparagraph 7,c71 in making its recommendations1 the ,commission may change any recommendation made by the ,secretary if the ,commission-- 7i7 determines that the ,secretary deviated substantially from the final criteria referred to in subsection 7a77#b7 in making such recommendation2 7ii7 determines that the change is consistent with the final criteria referred to in subsection 7a77#b72 7iii7 publishes a notice of the proposed change in the ,federal ,register not less than #de days before transmitting its recommendations to the ,president pursuant to subparagraph 7,a72 and 7iv7 conducts public hearings on the proposed change4 7#c7 ,justification for changes ,the ,commission shall explain and justify in its report submitted to the ,president pursuant to paragraph 7#b7 any recommendation made by the ,commission that is different from the recommendations made by the ,secretary pursuant to subsection 7b74 ,the ,commission shall transmit a copy of such report to the ,committees on ,veterans' ,affairs of the ,senate and the ,house of ,representatives on the same date on which it transmits its recommendations to the ,president under paragraph 7#b74 7#d7 ,provision of information to ,congress ,after the ,commission transmits its report to the ,president1 the ,commission shall promptly provide1 upon request1 to any ,member of ,congress1 information used by the ,commission in making its recommendations4 7d7 ,review by the ,president 7#a7 ,report ,the ,president shall1 not later than ,february #ae1 #bjbc1 transmit to the ,commission and to the ,congress a report containing the ,president's approval or disapproval of the ,commission's recommendations4 7#b7 ,presidential approval ,if the ,president approves all the recommendations of the ,commission1 the ,president shall transmit a copy of such recommendations to the ,congress1 together with a certification of such approval4 7#c7 ,presidential disapproval ,if the ,president disapproves the recommendations of the ,commission1 in whole or in part1 the ,president shall transmit to the ,commission and the ,congress1 not later than ,march #a1 #bjbc1 the reasons for that disapproval4 ,the ,commission1 after consideration of the ,president's reasons for disapproval1 shall then transmit to the ,president1 not later than ,march #ae1 #bjbc1 a report containing-- 7,a7 the ,commission's findings and conclusions based on a review and analysis of those reasons for disapproval provided by the ,president2 and 7,b7 recommendations that the ,commission determines are appropriate for modernizations and realignments of facilities of the ,veterans ,health ,administration4 7#d7 ,transmittal of recommendations to ,congress ,if the ,president approves all recommendations of the ,commission transmitted to the ,president under paragraph 7#c71 the ,president shall transmit a copy of such recommendations to the ,congress1 together with a certification of such approval4 7#e7 ,failure to transmit ,if the ,president does not transmit to the ,congress an approval and certification described in paragraph 7#b7 or 7#d7 by ,march #cj1 #bjbc1 the process by which facilities of the ,veterans ,health ,administration may be selected for modernization or realignment under this subtitle shall be terminated4 #bjd4 ,actions regarding infrastructure and facilities of the ,veterans ,health ,administration 7a7 ,in general ,subject to subsection 7b71 the ,secretary shall begin to implement the recommended modernizations and realignments in the report under section #bjc7;d7 not later than #c years after the date on which the ,president transmits such report to ,congress4 ,in any fiscal year1 such implementation includes-- 7#a7 the planning of modernizations and realignments of facilities of the ,veterans ,health ,administration as recommended in such report2 and 7#b7 providing detailed information on the budget for such modernizations or realignments in documents submitted to ,congress by the ,secretary in support of the ,president's budget for that fiscal year4 7b7 ,congressional disapproval 7#a7 ,in general ,the ,secretary may not carry out any modernization or realignment recommended by the ,commission in a report transmitted from the ,president pursuant to section #bjc7;d7 if a joint resolution is enacted1 in accordance with the provisions of section #bjg1 disapproving such recommendations of the ,commission before the earlier of-- 7,a7 the end of the #de-;day period beginning on the date on which the ,president transmits such report2 or 7,b7 the adjournment of ,congress sine die for the session during which such report is transmitted4 7#b7 ,computation of period ,for purposes of paragraph 7#a7 and subsections 7a7 and 7c7 of section #bjg1 the days on which either ,house of ,congress is not in session because of an adjournment of more than three days to a day certain shall be excluded in the computation of a period4 #bje4 ,implementation 7a7 ,in general 7#a7 ,modernizing and realigning facilities ,in modernizing or realigning any facility of the ,veterans ,health ,administration under this subtitle1 the ,secretary may-- 7,a7 take such actions as may be necessary to modernize or realign any such facility1 including the alteration of such facilities1 the acquisition of such land1 the leasing or construction of such replacement facilities1 the disposition of such land or facilities1 the performance of such activities1 and the conduct of such advance planning and design as may be required to transfer functions from a facility of the ,veterans ,health ,administration to another such facility1 and may use for such purpose funds in the ,account or funds appropriated to the ,department of ,veterans ,affairs for such purposes2 7,b7 carry out activities for the purposes of environmental mitigation1 abatement1 or restoration at any such facility1 and shall use for such purposes funds in the ,account2 7,c7 reimburse other ,federal agencies for actions performed at the request of the ,secretary with respect to any such closure or realignment1 and may use for such purpose funds in the ,account or funds appropriated to the ,department of ,veterans ,affairs and available for such purpose2 and 7,d7 exercise the authority of the ,secretary under subchapter ,v of chapter #ha of title #ch1 ,united ,states ,code4 7#b7 ,environmental restoration2 historic preservation ,in carrying out any closure or realignment under this subtitle1 the ,secretary1 with regards to any property made excess to the needs of the ,department of ,veterans ,affairs as a result of such closure or realignment1 shall carry out1 as soon as possible with funds available for such purpose1 any of the following for which the ,secretary is responsible3 7,a7 ,environmental mitigation4 7,b7 ,environmental abatement4 7,c7 ,environmental restoration4 7,d7 ,compliance with historic preservation requirements4 7b7 ,management and disposal of property 7#a7 ,existing ,disposal ,authorities ,to transfer or dispose of surplus real property or infrastructure located at any facility of the ,veterans ,health ,administration that is modernized or realigned under this title1 the ,secretary may exercise the authorities of the ,secretary under subchapters ,i and ,,ii of chapter #ha of title #ch1 ,united ,states ,code1 or the authorities delegated to the ,secretary by the ,administrator of ,general ,services under subchapter ,,iii of chapter #e of title #dj1 ,united ,states ,code4 7#b7 ,effects on local communities 7,a7 ,consultation with ,state and local government ,before any action may be taken with respect to the disposal of any surplus real property or infrastructure located at any facility of the ,veterans ,health ,administration to be closed or realigned under this subtitle1 the ,secretary of ,veterans ,affairs shall consult with the ,governor of the ,state and the heads of the local governments concerned for the purpose of considering any plan for the use of such property by the local community concerned4 7,b7 ,treatment of roads ,if infrastructure or a facility of the ,veterans ,health ,administration to be closed or realigned under this subtitle includes a road used for public access through1 into1 or around the facility1 the ,secretary-- 7i7 shall consult with the ,government of the ,state and the heads of the local governments concerned for the purpose of considering the continued availability of the road for public use after the recommended action is complete2 and 7ii7 may exercise the authority of the ,secretary under section #hajh of title #ch1 ,united ,states ,code4 7#c7 ,leases2 ,,cercla 7,a7 ,lease authority 7i7 ,transfer to redevelopment authority for lease ,the ,secretary may transfer title to a facility of the ,veterans ,health ,administration approved for closure or realignment under this subtitle 7including property at a facility of the ,veterans ,health ,administration approved for realignment which will be retained by the ,department of ,veterans ,affairs or another ,federal agency after realignment7 to the redevelopment authority for the facility if the redevelopment authority agrees to lease1 directly upon transfer1 one or more portions of the property transferred under this subparagraph to the ,secretary or to the head of another department or agency of the ,federal ,government4 7ii7 ,term of lease ,a lease under clause 7i7 shall be for a term of not to exceed #ej years1 but may provide for options for renewal or extension of the term by the department or agency concerned4 7iii7 ,limitation ,a lease under clause 7i7 may not require rental payments by the ,united ,states4 7iv7 ,treatment of remaindered lease terms ,a lease under clause 7i7 shall include a provision specifying that if the department or agency concerned ceases requiring the use of the leased property before the expiration of the term of the lease1 the remainder of the lease term may be satisfied by the same or another department or agency of the ,federal ,government using the property for a use similar to the use under the lease4 ,exercise of the authority provided by this clause shall be made in consultation with the redevelopment authority concerned4 7v7 ,facility services ,notwithstanding clause 7iii71 if a lease under clause 7i7 involves a substantial portion of the facility1 the department or agency concerned may obtain facility services for the leased property and common area maintenance from the redevelopment authority or the redevelopment authority's assignee as a provision of the lease4 ,the facility services and common area maintenance shall be provided at a rate no higher than the rate charged to non-,federal tenants of the transferred property4 ,facility services and common area maintenance covered by the lease shall not include-- 7,i7 municipal services that a ,state or local government is required by law to provide to all landowners in its jurisdiction without direct charge2 or 7,,ii7 firefighting or security-guard functions4 7,b7 ,application of ,,cercla ,the provisions of section #abj7;h7 of the ,comprehensive ,environmental ,response1 ,compensation1 and ,liability ,act of #aihj 7#db ,u4,s4,c4 #ifbj7;h77 shall apply to any transfer of real property under this paragraph4 7,c7 ,additional terms and conditions ,the ,secretary may require any additional terms and conditions in connection with a transfer under this paragraph as such ,secretary considers appropriate to protect the interests of the ,united ,states4 7#d7 ,application of ,mc,kinney-,vento ,homeless ,assistance ,act ,nothing in this subtitle shall limit or otherwise affect the application of the provisions of the ,mc,kinney-,vento ,homeless ,assistance ,act 7#db ,u4,s4,c4 #aacja et seq47 to facilities of the ,veterans ,health ,administration closed under this subtitle4 7c7 ,applicability of ,national ,environmental ,policy ,act of #aifi 7#a7 ,in general ,the provisions of the ,national ,environmental ,policy ,act of #aifi 7#db ,u4,s4,c4 #dcba et seq47 shall not apply to the actions of the ,president1 the ,commission1 and1 except as provided in paragraph 7#b71 the ,department of ,veterans ,affairs in carrying out this subtitle4 7#b7 ,department of ,veterans ,affairs 7,a7 ,covered activities ,the provisions of the ,national ,environmental ,policy ,act of #aifi shall apply to actions of the ,department of ,veterans ,affairs under this subtitle-- 7i7 during the process of property disposal2 and 7ii7 during the process of relocating functions from a facility of the ,veterans ,health ,administration being closed or realigned to another facility after the receiving facility has been selected but before the functions are relocated4 7,b7 ,other activities ,in applying the provisions of the ,national ,environmental ,policy ,act of #aifi to the processes referred to in subparagraph 7,a71 the ,secretary shall not have to consider-- 7i7 the need for closing or realigning the facility of the ,veterans ,health ,administration as recommended by the ,commission2 7ii7 the need for transferring functions to any facility of the ,veterans ,health ,administration which has been selected as the receiving facility2 or 7iii7 facilities of the ,veterans ,health ,administration alternative to those recommended or selected4 7d7 ,waiver 7#a7 ,restrictions on use of funds ,the ,secretary may close or realign facilities of the ,veterans ,health ,administration under this subtitle without regard to any provision of law restricting the use of funds for closing or realigning facilities of the ,veterans ,health ,administration included in any appropriation or authorization ,act4 7#b7 ,restrictions on authorities ,the ,secretary may close or realign facilities of the ,veterans ,health ,administration under this subtitle without regard to the restrictions of section #haaj of title #ch1 ,united ,states ,code4 7e7 ,transfer authority in connection with payment of environmental remediation costs 7#a7 ,in general 7,a7 ,transfer by deed ,subject to paragraph 7#b7 of this subsection and section #abj7;h7 of the ,comprehensive ,environmental ,response1 ,compensation1 and ,liability ,act of #aihj 7#db ,u4,s4,c4 #ifbj7;h771 the ,secretary may enter into an agreement to transfer by deed a facility of the ,veterans ,health ,administration with any person who agrees to perform all environmental restoration1 waste management1 and environmental compliance activities that are required for the property or facilities under ,federal and ,state laws1 administrative decisions1 agreements 7including schedules and milestones71 and concurrences4 7,b7 ,additional terms or conditions ,the ,secretary may require any additional terms and conditions in connection with an agreement authorized by subparagraph 7,a7 as the ,secretary considers appropriate to protect the interests of the ,united ,states4 7#b7 ,limitation ,a transfer of a facility of the ,veterans ,health ,administration may be made under paragraph 7#a7 only if the ,secretary certifies to ,congress that-- 7,a7 the costs of all environmental restoration1 waste management1 and environmental compliance activities otherwise to be paid by the ,secretary with respect to the facility of the ,veterans ,health ,administration are equal to or greater than the fair market value of the property or facilities to be transferred1 as determined by the ,secretary2 or 7,b7 if such costs are lower than the fair market value of the facility of the ,veterans ,health ,administration1 the recipient of such transfer agrees to pay the difference between the fair market value and such costs4 7#c7 ,payment by the ,secretary for certain transfers ,in the case of a facility of the ,veterans ,health ,administration covered by a certification under paragraph 7#b77;,a71 the ,secretary may pay the recipient of such facility an amount equal to the lesser of-- 7,a7 the amount by which the costs incurred by the recipient of the facility of the ,veterans ,health ,administration for all environmental restoration1 waste1 management1 and environmental compliance activities with respect to such facility exceed the fair market value of such property as specified in such certification2 or 7,b7 the amount by which the costs 7as determined by the ,secretary7 that would otherwise have been incurred by the ,secretary for such restoration1 management1 and activities with respect to such facility of the ,veterans ,health ,administration exceed the fair market value of property as so specified4 7#d7 ,disclosure ,as part of an agreement under paragraph 7#a71 the ,secretary shall disclose to the person to whom the facility of the ,veterans ,health ,administration will be transferred any information of the ,secretary regarding the environmental restoration1 waste management1 and environmental compliance activities described in paragraph 7#a7 that relate to the facility of the ,veterans ,health ,administration4 ,the ,secretary shall provide such information before entering into the agreement4 7#e7 ,applicability of certain environmental laws ,nothing in this subsection shall be construed to modify1 alter1 or amend the ,comprehensive ,environmental ,response1 ,compensation1 and ,liability ,act of #aihj 7#db ,u4,s4,c4 #ifja et seq47 or the ,solid ,waste ,disposal ,act 7#db ,u4,s4,c4 #fija et seq474 #bjf4 ,department of ,veterans ,affairs ,asset and ,infrastructure ,review ,account 7a7 ,establishment ,there is hereby established in the ledgers of the ,treasury an account to be known as the ,department of ,veterans ,affairs ,asset and ,infrastructure ,review ,account which shall be administered by the ,secretary as a single account4 7b7 ,credits to account ,there shall be credited to the ,account the following3 7#a7 ,funds authorized for and appropriated to the ,account4 7#b7 ,proceeds received from the lease1 transfer1 or disposal of any property at a facility of the ,veterans ,health ,administration closed or realigned under this subtitle4 7c7 ,use of account ,the ,secretary may use the funds in the ,account only for the following purposes3 7#a7 ,to carry out this subtitle4 7#b7 ,to cover property management and disposal costs incurred at facilities of the ,veterans ,health ,administration closed1 modernized1 or realigned under this subtitle4 7#c7 ,to cover costs associated with supervision1 inspection1 overhead1 engineering1 and design of construction projects undertaken under this subtitle1 and subsequent claims1 if any1 related to such activities4 7#d7 ,other purposes that the ,secretary determines support the mission and operations of the ,department of ,veterans ,affairs4 7d7 ,consolidated budget justification display for account 7#a7 ,consolidated budget information required ,the ,secretary shall establish a consolidated budget justification display in support of the ,account that for each fiscal year-- 7,a7 details the amount and nature of credits to1 and expenditures from1 the ,account during the preceding fiscal year2 7,b7 separately details the environmental remediation costs associated with facility of the ,veterans ,health ,administration for which a budget request is made2 7,c7 specifies the transfers into the ,account and the purposes for which these transferred funds will be further obligated1 to include caretaker and environment remediation costs associated with each facility of the ,veterans ,health ,administration2 and 7,d7 details any intra-budget activity transfers within the ,account that exceeded #a1jjj1jjj during the preceding fiscal year or that are proposed for the next fiscal year and will exceed #a1jjj1jjj4 7#b7 ,submission ,the ,secretary shall include the information required by paragraph 7#a7 in the materials that the ,secretary submits to ,congress in support of the budget for a fiscal year submitted by the ,president pursuant to section #aaje of title #ca1 ,united ,states ,code4 7e7 ,closure of account2 treatment of remaining funds 7#a7 ,closure ,the ,account shall be closed at the time and in the manner provided for appropriation accounts under section #aeee of title #ca1 ,united ,states ,code1 except that unobligated funds which remain in the ,account upon closure shall be held by the ,secretary of the ,treasury until transferred to the ,secretary of ,veterans ,affairs by law after the ,committees on ,veterans' ,affairs of the ,senate and the ,house of ,representatives receive the final report transmitted under paragraph 7#b74 7#b7 ,final report ,no later than #fj days after the closure of the ,account under paragraph 7#a71 the ,secretary shall transmit to the ,committees on ,veterans' ,affairs of the ,senate and the ,house of ,representatives and the ,committees on ,appropriations of the ,house of ,representatives and the ,senate a report containing an accounting of-- 7,a7 all the funds credited to and expended from the ,account or otherwise expended under this subtitle2 and 7,b7 any funds remaining in the ,account4 #bjg4 ,congressional consideration of ,commission report 7a7 ,disapproval resolution ,for purposes of this subtitle1 the term joint resolution means only a joint resolution which is introduced within the #e-;day period beginning on the date on which the ,president transmits the report to the ,congress under section #bjc7;d71 and-- 7#a7 which does not have a preamble2 7#b7 the matter after the resolving clause of which is as follows3 that ,congress disapproves the recommendations of the ,,vha ,asset and ,infrastructure ,review ,commission as submitted by the ,president on 1 the blank space being filled with the appropriate date2 and 7#c7 the title of which is as follows3 ,joint resolution disapproving the recommendations of the ,,vha ,asset and ,infrastructure ,review ,commission44 7b7 ,consideration in the ,house of ,representatives 7#a7 ,reporting and discharge ,any committee of the ,house of ,representatives to which a joint resolution is referred shall report it to the ,house without amendment not later than #ae legislative days after the date of introduction thereof4 ,if a committee fails to report the joint resolution within that period1 the committee shall be discharged from further consideration of the joint resolution4 7#b7 ,proceeding to consideration ,it shall be in order at any time after the third legislative day after each committee authorized to consider a joint resolution has reported or has been discharged from consideration of a joint resolution1 to move to proceed to consider the joint resolution in the ,house4 ,all points of order against the motion are waived4 ,such a motion shall not be in order after the ,house has disposed of a motion to proceed on a joint resolution addressing a particular submission4 ,the previous question shall be considered as ordered on the motion to its adoption without intervening motion4 ,the motion shall not be debatable4 ,a motion to reconsider the vote by which the motion is disposed of shall not be in order4 7#c7 ,consideration ,the joint resolution shall be considered as read4 ,all points of order against the joint resolution and against its consideration are waived4 ,the previous question shall be considered as ordered on the joint resolution to its passage without intervening motion except #b hours of debate equally divided and controlled by the proponent and an opponent4 ,a motion to reconsider the vote on passage of the joint resolution shall not be in order4 7c7 ,consideration in the ,senate 7#a7 ,referral ,a joint resolution introduced in the ,senate shall be referred to the ,committee on ,veterans' ,affairs4 7#b7 ,reporting and discharge ,any committee of the ,senate to which a joint resolution is referred shall report it to the ,senate without amendment not later than #ae session days after the date of introduction of a joint resolution described in subsection 7a74 ,if a committee fails to report the joint resolution within that period1 the committee shall be discharged from further consideration of the joint resolution and the joint resolution shall be placed on the calendar4 7#c7 ,floor consideration 7,a7 ,in general ,notwithstanding ,rule ,,xxii of the ,standing ,rules of the ,senate1 it is in order at any time after the third session day on which the ,committee on ,veterans' ,affairs has reported or has been discharged from consideration of a joint resolution described in subsection 7a7 7even though a previous motion to the same effect has been disagreed to7 to move to proceed to the consideration of the joint resolution1 and all points of order against the joint resolution 7and against consideration of the joint resolution7 are waived4 ,the motion to proceed is not debatable4 ,the motion is not subject to a motion to postpone4 ,a motion to reconsider the vote by which the motion is agreed to or disagreed to shall not be in order4 ,if a motion to proceed to the consideration of the resolution is agreed to1 the joint resolution shall remain the unfinished business until disposed of4 7,b7 ,consideration ,consideration of the joint resolution1 and on all debatable motions and appeals in connection therewith1 shall be limited to not more than #b hours1 which shall be divided equally between the majority and minority leaders or their designees4 ,a motion further to limit debate is in order and not debatable4 ,an amendment to1 or a motion to postpone1 or a motion to proceed to the consideration of other business1 or a motion to recommit the joint resolution is not in order4 7,c7 ,vote on passage ,if the ,senate has voted to proceed to a joint resolution1 the vote on passage of the joint resolution shall occur immediately following the conclusion of consideration of the joint resolution1 and a single quorum call at the conclusion of the debate if requested in accordance with the rules of the ,senate4 7,d7 ,rulings of the ,chair on procedure ,appeals from the decisions of the ,chair relating to the application of the rules of the ,senate1 as the case may be1 to the procedure relating to a joint resolution shall be decided without debate4 7d7 ,amendment not in order ,a joint resolution of disapproval considered pursuant to this section shall not be subject to amendment in either the ,house of ,representatives or the ,senate4 7e7 ,coordination with action by other ,house 7#a7 ,in general ,if1 before the passage by one ,house of the joint resolution of that ,house1 that ,house receives the joint resolution from the other ,house1 then the following procedures shall apply3 7,a7 ,the joint resolution of the other ,house shall not be referred to a committee4 7,b7 ,with respect to the joint resolution of the ,house receiving the joint resolution-- 7i7 the procedure in that ,house shall be the same as if no joint resolution had been received from the other ,house2 but 7ii7 the vote on passage shall be on the joint resolution of the other ,house4 7#b7 ,treatment of joint resolution of other ,house ,if the ,senate fails to introduce or consider a joint resolution under this section1 the joint resolution of the ,house shall be entitled to expedited floor procedures under this section4 7#c7 ,treatment of companion measures ,if1 following passage of the joint resolution in the ,senate1 the ,senate then receives the companion measure from the ,house of ,representatives1 the companion measure shall not be debatable4 7f7 ,rules of the ,house of ,representatives and ,senate ,this section is enacted by ,congress-- 7#a7 as an exercise of the rulemaking power of the ,senate and ,house of ,representatives1 respectively1 and as such it is deemed a part of the rules of each ,house1 respectively1 but applicable only with respect to the procedure to be followed in that ,house in the case of a joint resolution1 and it supersedes other rules only to the extent that it is inconsistent with such rules2 and 7#b7 with full recognition of the constitutional right of either ,house to change the rules 7so far as relating to the procedure of that ,house7 at any time1 in the same manner1 and to the same extent as in the case of any other rule of that ,house4 #bjh4 ,other matters 7a7 ,online publication of communications 7#a7 ,in general ,not later than #bd hours after the transmission or receipt of any communication under this subtitle that is transmitted or received by a party specified in paragraph 7#b71 the ,secretary of ,veterans ,affairs shall publish such communication online4 7#b7 ,parties specified ,the parties specified under this paragraph are the following3 7,a7 ,the ,secretary of ,veterans ,affairs4 7,b7 ,the ,commission4 7,c7 ,the ,president4 7b7 ,continuation of existing construction projects and planning ,during activities that the ,commission1 ,president1 or ,congress carry out under this subtitle1 the ,secretary of ,veterans ,affairs may not stop1 solely because of such activities-- 7#a7 a construction or leasing project of the ,veterans ,health ,administration2 7#b7 long term planning regarding infrastructure and assets of the ,veterans ,health ,administration2 or 7#c7 budgetary processes for the ,veterans ,health ,administration4 7c7 ,recommendations for future asset reviews ,the ,secretary of ,veterans ,affairs may1 after consulting with veterans service organizations1 include in budget submissions the ,secretary submits after the termination of the ,commission recommendations for future such commissions or other capital asset realignment and management processes4 #bji4 ,definitions ,in this subtitle3 7#a7 ,the term ,account means the ,department of ,veterans ,affairs ,asset and ,infrastructure ,review ,account established by section #bjf7;a74 7#b7 ,the term ,commission means the ,commission established by section #bjb4 7#c7 ,the term date of approval1 with respect to a modernization or realignment of a facility of the ,veterans ,health ,administration1 means the date on which the authority of ,congress to disapprove a recommendation of modernization or realignment1 as the case may be1 of such facility under this subtitle expires4 7#d7 ,the term facility of the ,veterans ,health ,administration-- 7,a7 means any land1 building1 structure1 or infrastructure 7including any medical center1 nursing home1 domiciliary facility1 outpatient clinic1 center that provides readjustment counseling1 or leased facility7 that is-- 7i7 under the jurisdiction of the ,department of ,veterans ,affairs2 7ii7 under the control of the ,veterans ,health ,administration2 and 7iii7 not under the control of the ,general ,services ,administration2 or 7,b7 with respect to a colocated facility of the ,department of ,veterans ,affairs1 includes any land1 building1 or structure-- 7i7 under the jurisdiction of the ,department of ,veterans ,affairs2 7ii7 under the control of another administration of the ,department of ,veterans ,affairs2 and 7iii7 not under the control of the ,general ,services ,administration4 7#e7 ,the term infrastructure means improvements to land other than buildings or structures4 7#f7 ,the term modernization includes-- 7,a7 any action1 including closure1 required to align the form and function of a facility of the ,veterans ,health ,administration to the provision of modern day health care1 including utilities and environmental control systems2 7,b7 the construction1 purchase1 lease1 or sharing of a facility of the ,veterans ,health ,administration2 and 7,c7 realignments1 disposals1 exchanges1 collaborations between the ,department of ,veterans ,affairs and other ,federal entities1 and strategic collaborations between the ,department and non-,federal entities1 including tribal organizations4 7#g7 ,the term realignment1 with respect to a facility of the ,veterans ,health ,administration1 includes-- 7,a7 any action that changes the numbers of or relocates services1 functions1 and personnel positions2 7,b7 disposals or exchanges between the ,department of ,veterans ,affairs and other ,federal entities1 including the ,department of ,defense2 and 7,c7 strategic collaborations between the ,department of ,veterans ,affairs and non-,federal entities1 including tribal organizations4 7#h7 ,the term redevelopment authority1 in the case of a facility of the ,veterans ,health ,administration closed or modernized under this subtitle1 means any entity 7including an entity established by a ,state or local government7 recognized by the ,secretary of ,veterans ,affairs as the entity responsible for developing the redevelopment plan with respect to the facility or for directing the implementation of such plan4 7#i7 ,the term redevelopment plan in the case of a facility of the ,veterans ,health ,administration to be closed or realigned under this subtitle1 means a plan that-- 7,a7 is agreed to by the local redevelopment authority with respect to the facility2 and 7,b7 provides for the reuse or redevelopment of the real property and personal property of the facility that is available for such reuse and redevelopment as a result of the closure or realignment of the facility4 7#aj7 ,the term ,secretary means the ,secretary of ,veterans ,affairs4 7#aa7 ,the term tribal organization has the meaning given such term in section #cgfe of title #ch1 ,united ,states ,code4 ,b ,other ,infrastructure ,matters #baa4 ,improvement to training of construction personnel ,subsection 7g7 of section #hajc of title #ch1 ,united ,states ,code1 is amended to read as follows3 7g7 7#a7 7,a7 ,not later than ,september #cj of the fiscal year following the fiscal year during which the ,,va ,asset and ,infrastructure ,review ,act of #bjah is enacted1 the ,secretary shall implement the covered training curriculum and the covered certification program4 7,b7 ,in designing and implementing the covered training curriculum and the covered certification program under paragraph 7#a71 the ,secretary shall use as models existing training curricula and certification programs that have been established under chapter #hg of title #aj1 ,united ,states ,code1 as determined relevant by the ,secretary4 7#b7 ,the ,secretary may develop the training curriculum under paragraph 7#a77;,a7 in a manner that provides such training in any combination of-- 7,a7 training provided in person2 7,b7 training provided over an internet website2 or 7,c7 training provided by another department or agency of the ,federal ,government4 7#c7 ,the ,secretary may develop the certification program under paragraph 7#a77;,a7 in a manner that uses-- 7,a7 one level of certification2 or 7,b7 more than one level of certification1 as determined appropriate by the ,secretary with respect to the level of certification for different grades of the ,general ,schedule4 7#d7 ,the ,secretary may enter into a contract with an appropriate entity to provide the covered training curriculum and the covered certification program under paragraph 7#a77;,a74 7#e7 7,a7 ,not later than ,september #cj of the second fiscal year following the fiscal year during which the ,,va ,asset and ,infrastructure ,review ,act of #bjah is enacted1 the ,secretary shall ensure that the majority of employees subject to the covered certification program achieve the certification or the appropriate level of certification pursuant to paragraph 7#c71 as the case may be4 7,b7 ,after carrying out subparagraph 7,a71 the ,secretary shall ensure that each employee subject to the covered certification program achieves the certification or the appropriate level of certification pursuant to paragraph 7#c71 as the case may be1 as quickly as practicable4 7#f7 ,in this subsection3 7,a7 ,the term covered certification program means1 with respect to employees of the ,department of ,veterans ,affairs who are members of occupational series relating to construction or facilities management1 or employees of the ,department who award or administer contracts for major construction1 minor construction1 or nonrecurring maintenance1 including as contract specialists or contracting officers' representatives1 a program to certify knowledge and skills relating to construction or facilities management and to ensure that such employees maintain adequate expertise relating to industry standards and best practices for the acquisition of design and construction services4 7,b7 ,the term covered training curriculum means1 with respect to employees specified in subparagraph 7,a71 a training curriculum relating to construction or facilities management4 4 #bab4 ,review of enhanced use leases ,section #hafb7;b77#f7 is amended to read as follows3 7#f7 ,the ,office of ,management and ,budget shall review each enhanced-use lease before the lease goes into effect to determine whether the lease is in compliance with paragraph 7#e74 4 #bac4 ,assessment of health care furnished by the ,department to veterans who live in the ,pacific territories 7a7 ,in general ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall submit to the ,committees on ,veterans' ,affairs of the ,senate and the ,house of ,representatives a report regarding health care furnished by the ,department of ,veterans ,affairs to veterans who live in the ,pacific territories4 7b7 ,elements ,the report under subsection 7a7 shall include assessments of the following3 7#a7 ,the ability of the ,department to furnish to veterans who live in the ,pacific territories the following3 7,a7 ,hospital care4 7,b7 ,medical services4 7,c7 ,mental health services4 7,d7 ,geriatric services4 7#b7 ,the feasibility of establishing a community-based outpatient clinic of the ,department in any ,pacific territory that does not contain such a facility4 7c7 ,definition ,in this section1 the term ,pacific territories means ,american ,samoa1 ,guam1 and the ,northern ,mariana ,islands4 ,,iii ,improvements to ,recruitment of ,health ,care ,professionals #cja4 ,designated scholarships for physicians and dentists under ,department of ,veterans ,affairs ,health ,professional ,scholarship ,program 7a7 ,scholarships for physicians and dentists ,section #gfab7;b7 of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new paragraph3 7#f7 7,a7 ,of the scholarships awarded under this subchapter1 the ,secretary shall ensure that not less than #ej scholarships are awarded each year to individuals who are accepted for enrollment or enrolled 7as described in section #gfjb of this title7 in a program of education or training leading to employment as a physician or dentist until such date as the ,secretary determines that the staffing shortage of physicians and dentists in the ,department is less than #ejj4 7,b7 ,after such date1 the ,secretary shall ensure that of the scholarships awarded under this subchapter1 a number of scholarships is awarded each year to individuals referred to in subparagraph 7,a7 in an amount equal to not less than ten percent of the staffing shortage of physicians and dentists in the ,department1 as determined by the ,secretary4 7,c7 ,notwithstanding subsection 7c77#a71 the agreement between the ,secretary and a participant in the ,scholarship ,program who receives a scholarship pursuant to this paragraph shall provide the following3 7i7 ,the ,secretary's agreement to provide the participant with a scholarship under this subchapter for a specified number 7from two to four7 of school years during which the participant is pursuing a course of education or training leading to employment as a physician or dentist4 7ii7 ,the participant's agreement to serve as a full-time employee in the ,veterans ,health ,administration for a period of time 7hereinafter in this subchapter referred to as the period of obligated service7 of #ah months for each school year or part thereof for which the participant was provided a scholarship under the ,scholarship ,program4 7,d7 ,in providing scholarships pursuant to this paragraph1 the ,secretary may provide a preference for applicants who are veterans4 7,e7 ,on an annual basis1 the ,secretary shall provide to appropriate educational institutions informational material about the availability of scholarships under this paragraph4 4 7b7 ,breach of agreement ,section #gfag of such title is amended-- 7#a7 by redesignating paragraphs 7#d7 and 7#e7 as paragraphs 7#e7 and 7#f71 respectively2 and 7#b7 by inserting after paragraph 7#c7 the following new paragraph 7#d73 7#d7 ,in the case of a participant who is enrolled in a program or education or training leading to employment as a physician1 the participant fails to successfully complete post-graduate training leading to eligibility for board certification in a specialty4 4 7c7 ,extension of program ,section #gfai of such title is amended by striking ,december #ca1 #bjai and inserting ,december #ca1 #bjcc4 #cjb4 ,increase in maximum amount of debt that may be reduced under ,education ,debt ,reduction ,program of ,department of ,veterans ,affairs 7a7 ,increase in amount ,section #gfhc7;d77#a7 is amended-- 7#a7 by striking #abj1jjj and inserting #bjj1jjj2 and 7#b7 by striking #bd1jjj and inserting #dj1jjj4 7b7 ,study 7#a7 ,in general ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall-- 7,a7 conduct a study on the demand for education debt reduction under subchapter ,,vii of chapter #gf of title #ch1 ,united ,states ,code2 and 7,b7 submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on the findings of the ,secretary with respect to the study carried out under subparagraph 7,a74 7#b7 ,considerations ,in carrying out the study required by paragraph 7#a77;,a71 the ,secretary shall consider the following3 7,a7 ,the total number of vacancies within the ,veterans ,health ,administration whose applicants are eligible to participate in the ,education ,debt ,reduction ,program pursuant to section #gfhb7;a7 of such title4 7,b7 ,the types of medical professionals in greatest demand in the ,united ,states4 7,c7 ,projections by the ,secretary of the numbers and types of medical professions that meet the needs of veterans4 #cjc4 ,establishing the ,department of ,veterans ,affairs ,specialty ,education ,loan ,repayment ,program 7a7 ,in general ,chapter #gf of title #ch1 ,united ,states ,code1 is amended by inserting after subchapter ,,vii the following new subchapter3 ,,viii ,specialty ,education ,loan ,repayment ,program #gfia4 ,establishment ,as part of the ,educational ,assistance ,program1 the ,secretary may carry out a student loan repayment program under section #ecgi of title #e4 ,the program shall be known as the ,department of ,veterans ,affairs ,specialty ,education ,loan ,repayment ,program 7in this chapter referred to as the ,specialty ,education ,loan ,repayment ,program74 #gfib4 ,purpose ,the purpose of the ,specialty ,education ,loan ,repayment ,program is to assist1 through the establishment of an incentive program for certain individuals employed in the ,veterans ,health ,administration1 in meeting the staffing needs of the ,veterans ,health ,administration for physicians in medical specialties for which the ,secretary determines recruitment or retention of qualified personnel is difficult4 #gfic4 ,eligibility2 preferences2 covered costs 7a7 ,eligibility ,an individual is eligible to participate in the ,specialty ,education ,loan ,repayment ,program if the individual-- 7#a7 is hired under section #gdja of this title to work in an occupation described in section #gfib of this title2 7#b7 owes any amount of principal or interest under a loan1 the proceeds of which were used by or on behalf of that individual to pay costs relating to a course of education or training which led to a degree that qualified the individual for the position referred to in paragraph 7#a72 and 7#c7 is-- 7,a7 recently graduated from an accredited medical or osteopathic school and matched to an accredited residency program in a medical specialty described in section #gfib of this title2 or 7,b7 a physician in training in a medical specialty described in section #gfib of this title with more than #b years remaining in such training4 7b7 ,preferences ,in selecting individuals for participation in the ,specialty ,education ,loan ,repayment ,program under this subchapter1 the ,secretary may give preference to the following3 7#a7 ,individuals who are1 or will be1 participating in residency programs in health care facilities-- 7,a7 located in rural areas2 7,b7 operated by ,indian tribes1 tribal organizations1 or the ,indian ,health ,service2 or 7,c7 affiliated with underserved health care facilities of the ,department4 7#b7 ,veterans4 7c7 ,covered costs ,for purposes of subsection 7a77#b71 costs relating to a course of education or training include-- 7#a7 tuition expenses2 7#b7 all other reasonable educational expenses1 including expenses for fees1 books1 equipment1 and laboratory expenses2 and 7#c7 reasonable living expenses4 #gfid4 ,specialty education loan repayment 7a7 ,in general ,payments under the ,specialty ,education ,loan ,repayment ,program shall consist of payments for the principal and interest on loans described in section #gfhb7;a77#b7 of this title for individuals selected to participate in the ,program to the holders of such loans4 7b7 ,frequency of payment ,the ,secretary shall make payments for any given participant in the ,specialty ,education ,loan ,repayment ,program on a schedule determined appropriate by the ,secretary4 7c7 ,maximum amount2 waiver 7#a7 ,the amount of payments made for a participant under the ,specialty ,education ,loan ,repayment ,program may not exceed #afj1jjj over a total of #d years of participation in the ,program1 of which not more than #dj1jjj of such payments may be made in each year of participation in the ,program4 7#b7 7,a7 ,the ,secretary may waive the limitations under paragraph 7#a7 in the case of a participant described in subparagraph 7,b74 ,in the case of such a waiver1 the total amount of payments payable to or for that participant is the total amount of the principal and the interest on the participant's loans referred to in subsection 7a74 7,b7 ,a participant described in this subparagraph is a participant in the ,program who the ,secretary determines serves in a position for which there is a shortage of qualified employees by reason of either the location or the requirements of the position4 #gfie4 ,choice of location ,each participant in the ,specialty ,education ,loan ,repayment ,program who completes residency may select1 from a list of medical facilities of the ,veterans ,health ,administration provided by the ,secretary1 at which such facility the participant will work in a medical specialty described in section #gfib of this title4 #gfif4 ,term of obligated service 7a7 ,in general ,in addition to any requirements under section #ecgi7;c7 of title #e1 a participant in the ,specialty ,education ,loan ,repayment ,program must agree1 in writing and before the ,secretary may make any payment to or for the participant1 to-- 7#a7 obtain a license to practice medicine in a ,state2 7#b7 successfully complete post-graduate training leading to eligibility for board certification in a specialty2 7#c7 serve as a full-time clinical practice employee of the ,veterans ,health ,administration for #ab months for every #dj1jjj in such benefits that the employee receives1 but in no case for fewer than #bd months2 and 7#d7 except as provided in subsection 7b71 to begin such service as a full-time practice employee by not later than #fj days after completing a residency4 7b7 ,fellowship ,in the case of a participant who receives an accredited fellowship in a medical specialty other than a medical specialty described in section #gfib of this title1 the ,secretary1 on written request of the participant1 may delay the term of obligated service under subsection 7a7 for the participant until after the participant completes the fellowship1 but in no case later than #fj days after completion of such fellowship4 7c7 ,penalty 7#a7 ,an employee who does not complete a period of obligated service under this section shall owe the ,federal ,government an amount determined in accordance with the following formula3 ,a ,b 77,t ,s7 ,t774 7#b7 ,in the formula in paragraph 7#a73 7,a7 ,a is the amount the employee owes the ,federal ,government4 7,b7 ,b is the sum of all payments to or for the participant under the ,specialty ,education ,loan ,repayment ,program4 7,c7 ,t is the number of months in the period of obligated service of the employee4 7,d7 ,s is the number of whole months of such period of obligated service served by the employee4 #gfig4 ,relationship to ,educational ,assistance ,program ,assistance under the ,specialty ,education ,loan ,repayment ,program may be in addition to other assistance available to individuals under the ,educational ,assistance ,program4 4 7b7 ,conforming and technical amendments 7#a7 ,conforming amendments 7,a7 ,section #gfja7;a7 of title #ch1 ,united ,states ,code1 is amended-- 7i7 in paragraph 7#d71 by striking and2 7ii7 in paragraph 7#e71 by striking the period and inserting 2 and2 and 7iii7 by adding at the end the following new paragraph3 7#f7 the specialty education loan repayment program provided for in subchapter ,,viii of this chapter4 4 7,b7 ,section #gfjc7;a77#a7 of title #ch1 ,united ,states ,code1 is amended by striking or ,,vi and inserting ,,vi1 or ,,viii4 7,c7 ,section #gfjd of title #ch1 ,united ,states ,code1 is amended by striking or ,,vi each place it appears and inserting ,,vi1 or ,,viii4 7,d7 ,section #gfca of title #ch1 ,united ,states ,code1 is amended-- 7i7 in subsection 7a77#a7-- 7,i7 by striking and after scholarship amount12 and 7,,ii7 by inserting 1 and the maximum specialty education loan repayment amount after reduction payments amount2 and 7ii7 in subsection 7b7 by adding at the end the following new paragraph3 7#g7 ,the term specialty education loan repayment amount means the maximum amount of specialty education loan repayment payments payable to or for a participant in the ,department of ,veterans ,affairs ,specialty ,education ,loan ,repayment ,program under subchapter ,,viii of this chapter1 as specified in section #gfid7;c77#a7 of this title and as previously adjusted 7if at all7 in accordance with this section4 4 7,e7 ,section #gfcb of title #ch1 ,united ,states ,code1 is amended-- 7i7 in paragraph 7#a71 by striking and the ,education ,debt ,reduction ,program and inserting the ,education ,debt ,reduction ,program1 and the ,specialty ,education ,loan ,repayment ,program2 and 7ii7 in paragraph 7#d71 by striking and per participant in the ,education ,debt ,reduction ,program and inserting per participant in the ,education ,debt ,reduction ,program1 and per participant in the ,specialty ,education ,loan ,repayment ,program4 7#b7 ,table of sections ,the table of sections at the beginning of chapter #gf of such title is amended by inserting after the items relating to subchapter ,,vii the following3 ,subchapter ,,viii--,specialty ,education ,loan ,repayment ,program #gfia4 ,establishment4 #gfib4 ,purpose4 #gfic4 ,eligibility2 preferences2 covered costs4 #gfid4 ,specialty education loan repayment4 #gfie4 ,choice of location4 #gfif4 ,term of obligated service4 #gfig4 ,relationship to ,educational ,assistance ,program4 4 7c7 ,needs of the ,,vha ,in making determinations each year under section #gfib of title #ch1 ,united ,states ,code1 as enacted by subsection 7a71 the ,secretary of ,veterans ,affairs shall consider the anticipated needs of the ,veterans ,health ,administration during the period #b to #f years in the future4 7d7 ,preference ,in granting preference under section #gfic of title #ch1 ,united ,states ,code1 as enacted by subsection 7a71 the ,secretary of ,veterans ,affairs shall determine whether a facility of the ,department is underserved based on the criteria developed under section #dja of this ,act4 7e7 ,offer deadline ,in the case of an applicant who applies before receiving a residency match and whom the ,secretary of ,veterans ,affairs selects for participation in the ,specialty ,education ,loan ,repayment ,program established by subsection 7a71 the ,secretary shall offer participation to the applicant not later than #bh days after-- 7#a7 the applicant matches with a residency in a medical specialty described in section #gfib of title #ch1 ,united ,states ,code1 as enacted by subsection 7a72 and 7#b7 such match is published4 7f7 ,publicity ,the ,secretary of ,veterans ,affairs shall take such steps as the ,secretary determines are appropriate to publicize the ,specialty ,education ,loan ,repayment ,program established under subchapter ,,viii of chapter #gf of title #ch1 ,united ,states ,code1 as enacted by subsection 7a74 #cjd4 ,veterans healing veterans medical access and scholarship program 7a7 ,establishment ,the ,secretary of ,veterans ,affairs1 acting through the ,office of ,academic ,affiliations of the ,department of ,veterans ,affairs1 shall carry out a pilot program under which the ,secretary shall provide funding for the medical education of a total of #ah eligible veterans4 ,such funding shall be provided for two veterans enrolled in each covered medical schools in accordance with this section4 7b7 ,eligible veterans ,to be eligible to receive funding for medical education under this section1 a veteran shall-- 7#a7 have been discharged from the ,armed ,forces not more than #aj years before the date of application for admission to a covered medical school2 7#b7 not be entitled to educational assistance under chapter #cj1 #ca1 #cb1 #cc1 #cd1 or #ce of title #ch1 ,united ,states ,code1 or chapter #afjf or #afjg of title #aj1 ,united ,states ,code2 7#c7 apply for admission to a covered medical school for the entering class of #bjai2 7#d7 indicate on such application for admission that the veteran would like to be considered for an award of funding under this section2 7#e7 meet the minimum admissions criteria for the covered medical school to which the veteran applies2 and 7#f7 enter into an agreement described in subsection 7e74 7c7 ,award of funding 7#a7 ,in general ,each covered medical school that opts to participate in the program under this section shall reserve two seats in the entering class of #bjai for eligible veterans who receive funding under such program4 ,such funding shall be awarded to the two eligible veterans with the highest admissions rankings for such class at such school4 7#b7 ,amount of funding ,each eligible veteran who receives funding under this section shall receive an amount equal to the actual cost of-- 7,a7 tuition at the covered medical school at which the veteran enrolls for #d years2 7,b7 books1 fees1 and technical equipment2 7,c7 fees associated with the ,national ,residency ,match ,program2 7,d7 two away rotations performed during the fourth year at a ,department of ,veterans ,affairs medical facility2 and 7,e7 a monthly stipend for the #d-year period during which the veteran is enrolled in medical school in an amount to be determined by the ,secretary4 7#c7 ,distribution of funding ,in the event that two or more eligible veterans do not apply for admission at one of the covered medical schools for the entering class of #bjai1 the ,secretary shall distribute the available funding to eligible veterans who applied for admission at other covered medical schools4 7d7 ,agreement 7#a7 ,terms of agreement ,each eligible veteran who accepts funding for medical education under this section shall enter into an agreement with the ,secretary that provides that the veteran agrees-- 7,a7 to maintain enrollment and attendance in the medical school2 7,b7 while enrolled in such medical school1 to maintain an acceptable level of academic standing 7as determined by the medical school under regulations prescribed by the ,secretary72 7,c7 to complete post-graduate training leading to eligibility for board certification in a speciality applicable to the ,department of ,veterans ,affairs1 as determined by the ,secretary2 7,d7 after completion of medical school1 to obtain a license to practice medicine in a ,state2 and 7,e7 after completion of medical school and post-graduate training1 to serve as a full-time clinical practice employee in the ,veterans ,health ,administration for a period of #d years4 7#b7 ,breach of agreement ,if an eligible veteran who accepts funding under this section breaches the terms of the agreement described in paragraph 7#a71 the ,united ,states shall be entitled to recover damages in an amount equal to the total amount of such funding received by the veteran4 7e7 ,rule of construction ,nothing in this section shall be construed to prevent any covered medical school from accepting more than two eligible veterans for the entering class of #bjai4 7f7 ,report to ,congress ,not later than ,december #ca1 #bjbj1 and annually thereafter for the subsequent #c years1 the ,secretary shall submit to ,congress a report on the pilot program under this section4 ,such report shall include the evaluation of the ,secretary of the success of the pilot program1 including the number of veterans who received funding under the program who matriculated and an evaluation of the academic progress of such veterans4 7g7 ,covered medical schools ,in this section1 the term covered medical school means any of the following3 7#a7 ,the ,teague-,cranston medical schools1 consisting of-- 7,a7 ,texas ,a,m ,college of ,medicine2 7,b7 ,quillen ,college of ,medicine at ,east ,tennessee ,state ,university2 7,c7 ,boonshoft ,school of ,medicine at ,wright ,state ,university2 7,d7 ,joan ,c4 ,edwards ,school of ,medicine at ,marshall ,university2 and 7,e7 ,university of ,south ,carolina ,school of ,medicine4 7#b7 ,charles ,r ,drew ,university of ,medicine and ,science4 7#c7 ,howard ,university ,college of ,medicine4 7#d7 ,meharry ,medical ,college4 7#e7 ,morehouse ,school of ,medicine4 #cje4 ,bonuses for recruitment1 relocation1 and retention ,section #gje7;a7 of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #gjc note7 is amended-- 7#a7 in paragraph 7#a71 by striking #bcj1jjj1jjj and inserting #bej1jjj1jjj1 of which not less than #bj1jjj1jjj shall be for recruitment1 relocation1 and retention bonuses2 and 7#b7 in paragraph 7#b71 by striking #bbe1jjj1jjj and inserting #bij1jjj1jjj1 of which not less than #bj1jjj1jjj shall be for recruitment1 relocation1 and retention bonuses4 #cjf4 ,inclusion of ,vet ,center employees in ,education ,debt ,reduction ,program of ,department of ,veterans ,affairs 7a7 ,in general ,the ,secretary of ,veterans ,affairs shall ensure that clinical staff working at ,vet ,centers are eligible to participate in the ,education ,debt ,reduction ,program of the ,department of ,veterans ,affairs under subchapter ,,vii of chapter #gf of title #ch1 ,united ,states ,code4 7b7 ,report ,not later than #a year after the date of the enactment of this ,act1 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on the number of participants in the ,education ,debt ,reduction ,program of the ,department under such subchapter who work at ,vet ,centers4 7c7 ,vet ,center defined ,in this section1 the term ,vet ,center has the meaning given that term in section #agab;,a7h7 of title #ch1 ,united ,states ,code4 ,,iv ,health ,care in ,underserved ,areas #dja4 ,development of criteria for designation of certain medical facilities of the ,department of ,veterans ,affairs as underserved facilities and plan to address problem of underserved facilities 7a7 ,in general ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall develop criteria to designate medical centers1 ambulatory care facilities1 and community based outpatient clinics of the ,department of ,veterans ,affairs as underserved facilities4 7b7 ,consideration ,criteria developed under subsection 7a7 shall include consideration of the following with respect to a facility3 7#a7 ,the ratio of veterans to health care providers of the ,department of ,veterans ,affairs for a standardized geographic area surrounding the facility1 including a separate ratio for general practitioners and specialists4 7#b7 ,the range of clinical specialties covered by such providers in such area4 7#c7 ,whether the local community is medically underserved4 7#d7 ,the type1 number1 and age of open consults4 7#e7 ,whether the facility is meeting the wait-time goals of the ,department4 7#f7 ,such other criteria as the ,secretary considers important in determining which facilities are not adequately serving area veterans4 7c7 ,analysis of facilities ,not less frequently than annually1 directors of ,veterans ,integrated ,service ,networks of the ,department shall perform an analysis to determine which facilities within that ,veterans ,integrated ,service ,network qualify as underserved facilities pursuant to criteria developed under subsection 7a74 7d7 ,annual plan ,to address underserved facilities 7#a7 ,plan required ,not later than #a year after the date of the enactment of this ,act and not less frequently than once each year1 the ,secretary shall submit to ,congress a plan to address the problem of underserved facilities of the ,department1 as designated pursuant to criteria developed under subsection 7a74 7#b7 ,contents ,each plan submitted under paragraph 7#a7 shall address the following3 7,a7 ,increasing personnel or temporary personnel assistance1 including mobile deployment teams furnished under section #djg of this ,act4 7,b7 ,providing special hiring incentives1 including under the ,education ,debt ,reduction ,program under subchapter ,,vii of chapter #gf of title #ch1 ,united ,states ,code1 and recruitment1 relocation1 and retention incentives4 7,c7 ,using direct hiring authority4 7,d7 ,improving training opportunities for staff4 7,e7 ,such other actions as the ,secretary considers appropriate4 #djb4 ,pilot program to furnish mobile deployment teams to underserved facilities 7a7 ,in general ,the ,secretary of ,veterans ,affairs shall carry out a pilot program to furnish mobile deployment teams of medical personnel to underserved facilities4 7b7 ,elements ,in furnishing mobile deployment teams under subsection 7a71 the ,secretary shall consider the following elements3 7#a7 ,the medical positions of greatest need at underserved facilities4 7#b7 ,the size and composition of teams to be deployed4 7#c7 ,such other elements as the ,secretary considers necessary for effective oversight of the program established under subsection 7a74 7c7 ,use of annual analysis ,the ,secretary shall use the results of the annual analysis conducted under section #dja7;c7 of this ,act to form mobile deployment teams under subsection 7a7 that are composed of the most needed medical personnel for underserved facilities4 7d7 ,reporting 7#a7 ,progress report ,not later than #a year after the date of the enactment of this ,act1 the ,secretary shall submit a report to ,congress on the implementation of the pilot program under this section4 7#b7 ,final report ,not later than the termination of the pilot program under this section1 the ,secretary shall submit a final report to ,congress that contains the recommendations of the ,secretary regarding the feasibility and advisability of-- 7,a7 extending or expanding the pilot program2 and 7,b7 making the pilot program 7or any aspect thereof7 permanent4 7e7 ,duration ,the pilot program under this section shall terminate #c years after the date of the enactment of this ,act4 7f7 ,underserved facility defined ,in this section1 the term underserved facility means a medical center1 ambulatory care facility1 or community based outpatient clinic of the ,department of ,veterans ,affairs designated by the ,secretary of ,veterans ,affairs as underserved pursuant to criteria developed under section #dja of this ,act4 #djc4 ,pilot program on graduate medical education and residency 7a7 ,establishment 7#a7 ,in general ,subject to paragraph 7#e71 the ,secretary of ,veterans ,affairs shall establish a pilot program to establish medical residency positions authorized under section #cja7;b77#b7 of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #gcjb note7 at covered facilities4 7#b7 ,covered facilities ,for purposes of this section1 a covered facility is any of the following3 7,a7 ,a health care facility of the ,department of ,veterans ,affairs4 7,b7 ,a health care facility operated by an ,indian tribe or a tribal organization1 as those terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd74 7,c7 ,a health care facility operated by the ,indian ,health ,service4 7,d7 ,a ,federally-qualified health center1 as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b774 7,e7 ,a health care facility operated by the ,department of ,defense4 7,f7 ,such other health care facility as the ,secretary considers appropriate for purposes of this section4 7#c7 ,agreements ,to carry out the pilot program under this section1 the ,secretary may enter into agreements with entities that operate covered facilities in which the ,secretary places residents under paragraph 7#a74 7#d7 ,parameters for location1 affiliate sponsor1 and duration ,when determining in which covered facilities to place residents under paragraph 7#a71 the ,secretary shall consider the extent to which there is a clinical need for providers in an area1 as determined by the following3 7,a7 ,the ratio of veterans to health care providers of the ,department for a standardized geographic area surrounding a facility1 including a separate ratio for general practitioners and specialists4 7,b7 ,the range of clinical specialties of providers in standardized geographic areas surrounding a facility4 7,c7 ,whether the specialty of a provider is included in the most recent staffing shortage determination of the ,department under section #gdab of title #ch1 ,united ,states ,code4 7,d7 ,whether the local community is designated by the ,secretary of ,veterans ,affairs as underserved pursuant to criteria developed under section #dja of this ,act4 7,e7 ,whether the facility is located in a community that is designated by the ,secretary of ,health and ,human ,services as a health professional shortage area under section #ccb of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e74 7,f7 ,whether the facility is located in a rural or remote area4 7,g7 ,such other criteria as the ,secretary considers important in determining which facilities are not adequately serving area veterans4 7#e7 ,priority in placements ,during the pilot program under this section1 the ,secretary shall place no fewer than #ajj residents in covered facilities-- 7,a7 operated by the ,indian ,health ,service2 7,b7 operated by an ,indian tribe2 7,c7 operated by a tribal organization2 or 7,d7 located in communities designated by the ,secretary as underserved pursuant to criteria developed under section #dja of this ,act4 7#f7 ,stipends and benefits ,the ,secretary may pay stipends and provide benefits for residents in positions under paragraph 7#a71 regardless of whether they have been assigned in a ,department facility4 7b7 ,reimbursement ,if a covered facility establishes a new residency program in which the ,secretary places a resident under the pilot program1 the ,secretary shall reimburse that covered facility for costs of the following3 7#a7 ,curriculum development4 7#b7 ,recruitment and retention of faculty4 7#c7 ,accreditation of the program by the ,accreditation ,council for ,graduate ,medical ,education4 7#d7 ,the portion of faculty salaries attributable to duties under an agreement subsection 7a77#c74 7#e7 ,expenses relating to educating a resident under the pilot program4 7c7 ,reporting 7#a7 ,in general ,not later than #a year after the date of the enactment of this ,act and not less frequently than once each year thereafter until the termination of the pilot program1 the ,secretary shall submit to ,congress a report on the implementation of the pilot program4 7#b7 ,elements ,each report submitted under paragraph 7#a7 shall include the following with regard to the immediately preceding year1 and in comparison to the year immediately preceding that year3 7,a7 ,the number of veterans who received care from residents under the pilot program4 7,b7 ,the number of veterans who received care from each resident per position described in subsection 7a77#a7 under the pilot program4 7,c7 ,the number of veterans who received care from residents under the pilot program expressed as a percentage of all individuals who received care from such residents4 7,d7 ,the number of clinical appointments for veterans conducted by each resident under the pilot program4 7,e7 ,the number of clinical appointments for veterans conducted by residents per position described in subsection 7a77#a7 under the pilot program4 7,f7 ,the number of clinical appointments for veterans expressed as a percentage of all clinical appointments conducted by residents under the pilot program4 7,g7 ,the number of positions described in subsection 7a77#a7 at each covered facility under the pilot program4 7,h7 ,for each position described in subsection 7a77#a7 in a residency program affiliated with a health care facility of the ,department1 the time a resident under the pilot program spent training at that facility of the ,department1 expressed as a percentage of the total training time for that resident position4 7,i7 ,for each residency program affiliated with a health care facility of the ,department1 the time all residents under the pilot program spent training at that facility of the ,department1 expressed as a percentage of the total training time for those residents4 7,j7 ,the time that all residents under the pilot program who are assigned to programs affiliated with health care facilities of the ,department spent training at facilities of the ,department1 expressed as a percentage of the total training time for those residents4 7,k7 ,the cost to the ,department of ,veterans ,affairs under the pilot program in the year immediately preceding the report and since the beginning of the pilot program4 7,l7 ,the cost to the ,department of ,veterans ,affairs per resident placed under the pilot program at each covered facility4 7,m7 ,the number of residents under the pilot program hired by the ,secretary to work in the ,veterans ,health ,administration after completion of residency in the year immediately preceding the report and since the beginning of the pilot program4 7,n7 ,the medical specialties pursued by residents under the pilot program4 7d7 ,duration ,the pilot program under this section shall terminate on ,august #g1 #bjbd4 ,v ,other ,matters #eja4 ,annual report on performance awards and bonuses awarded to certain high-level employees of the department 7a7 ,in general ,chapter #g of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new section3 #gbf4 ,annual report on performance awards and bonuses awarded to certain high-level employees 7a7 ,in general ,not later than #ajj days after the end of each fiscal year1 the ,secretary shall submit to the appropriate committees of ,congress a report that contains1 for the most recent fiscal year ending before the submittal of the report1 a description of all performance awards or bonuses awarded to each of the following3 7#a7 ,regional ,office ,director of the ,department4 7#b7 ,director of a ,medical ,center of the ,department4 7#c7 ,director of a ,veterans ,integrated ,service ,network4 7#d7 ,senior executive of the ,department4 7b7 ,elements ,each report submitted under subsection 7a7 shall include the following with respect to each performance award or bonus awarded to an individual described in such subsection3 7#a7 ,the amount of each award or bonus4 7#b7 ,the job title of the individual awarded the award or bonus4 7#c7 ,the location where the individual awarded the award or bonus works4 7c7 ,definitions ,in this section3 7#a7 ,the term appropriate committees of ,congress means the ,committees on ,veterans' ,affairs and ,appropriations of the ,senate and ,house of ,representatives4 7#b7 ,the term senior executive means-- 7,a7 a career appointee2 or 7,b7 an individual-- 7i7 in an administrative or executive position2 and 7ii7 appointed under section #gcjf7;a7 or section #gdja7a7 of this title4 7#c7 ,the term career appointee has the meaning given that term in section #cacb7;a7 of title #e1 ,united ,states ,code4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item relating to section #gbe the following new item3 #gbf4 ,annual report on performance awards and bonuses awarded to certain high-level employees4 4 #ejb4 ,role of podiatrists in ,department of ,veterans ,affairs 7a7 ,inclusion as physician 7#a7 ,in general ,subchapter ,i of chapter #gd is amended by adding at the end the following new section3 #gdac4 ,treatment of podiatrists2 clinical oversight standards 7a7 ,podiatrists ,except as provided by subsection 7b71 a doctor of podiatric medicine who is appointed as a podiatrist under section #gdja7a7 of this title is eligible for any supervisory position in the ,veterans ,health ,administration to the same degree that a physician appointed under such section is eligible for the position4 7b7 ,establishment of clinical oversight standards ,the ,secretary1 in consultation with appropriate stakeholders1 shall establish standards to ensure that specialists appointed in the ,veterans ,health ,administration to supervisory positions do not provide direct clinical oversight for purposes of peer review or practice evaluation for providers of other clinical specialties4 4 7#b7 ,clerical amendment ,the table of sections at the beginning of chapter #gd is amended by inserting after the item relating to section #gdab the following new item3 #gdac4 ,treatment of podiatrists2 clinical oversight standards4 4 7b7 ,modification and clarification of pay grade 7#a7 ,grade ,the list in section #gdjd7;b7 of such title is amended-- 7,a7 by striking ,,physician ,,and ,,dentist ,,schedule and inserting ,,physician ,,and ,,surgeon 7,,md_/,,do71 ,,podiatric ,,surgeon 7,,dpm71 ,,and ,,dentist ,,and ,,oral ,,surgeon 7,,dds1 ,,dmd7 ,,schedule2 7,b7 by striking ,physician grade and inserting ,physician and surgeon grade2 and 7,c7 by striking ,,podiatrist1 ,,chiropractor1 ,,and and inserting ,,chiropractor ,,and4 7#b7 ,application ,the amendments made by paragraph 7#a7 shall apply with respect to a pay period of the ,department of ,veterans ,affairs beginning on or after the date that is #cj days after the date of the enactment of this ,act4 #ejc4 ,definition of major medical facility project 7a7 ,modification of definition of medical facility ,section #haja7c7 is amended by striking ,secretary and all that follows through nursing home1 and inserting ,secretary1 or as otherwise authorized by law1 for the provision of health-care services 7including hospital1 outpatient clinic1 nursing home14 7b7 ,modification of definition of major medical facility project ,paragraph 7#c7 of section #hajd7;a7 is amended to read as follows3 7#c7 ,for purposes of this subsection1 the term major medical facility project means a project for the construction1 alteration1 or acquisition of a medical facility involving a total expenditure of more than #bj1jjj1jjj1 but such term does not include an acquisition by exchange1 nonrecurring maintenance projects of the ,department1 or the construction1 alteration1 or acquisition of a shared ,federal medical facility for which the ,department's estimated share of the project costs does not exceed #bj1jjj1jjj4 4 #ejd4 ,authorization of certain major medical facility projects of the ,department of ,veterans ,affairs 7a7 ,authorization ,the ,secretary of ,veterans ,affairs may carry out the following major medical facility project1 to be carried out in an amount not to exceed the amount specified for that project3 ,construction of the new ,east ,bay ,community ,based ,outpatient ,clinic and all associated site work1 utilities1 parking1 and landscaping1 construction of the ,central ,valley ,engineering and ,logistics support facility1 and enhanced flood plain mitigation at the ,central ,valley and ,east ,bay ,community ,based ,outpatient ,clinics as part of the realignment of medical facilities in ,livermore1 ,california1 in an amount not to exceed #aag1cjj1jjj4 7b7 ,authorization of appropriations for construction ,there is authorized to be appropriated to the ,secretary of ,veterans ,affairs for fiscal year #bjah or the year in which funds are appropriated for the ,construction1 ,major ,projects account1 #aag1cjj1jjj for the project authorized in subsection 7a74 7c7 ,submittal of information ,not later than #ij days after the date of the enactment of this ,act1 for the project authorized in subsection 7a71 the ,secretary of ,veterans ,affairs shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives the following information3 7#a7 ,a line item accounting of expenditures relating to construction management carried out by the ,department of ,veterans ,affairs for such project4 7#b7 ,the future amounts that are budgeted to be obligated for construction management carried out by the ,department for such project4 7#c7 ,a justification for the expenditures described in paragraph 7#a7 and the future amounts described in paragraph 7#b74 7#d7 ,any agreement entered into by the ,secretary regarding a non-,department of ,veterans ,affairs ,federal entity providing management services relating to such project1 including reimbursement agreements and the costs to the ,department for such services4 #eje4 ,department of ,veterans ,affairs personnel transparency 7a7 ,publication of staffing and vacancies 7#a7 ,website required ,subject to paragraph 7#b7 and not later than #ij days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall make publicly available on an ,internet website of the ,department of ,veterans ,affairs the following information1 which shall1 subject to subparagraph 7,d71 be displayed by departmental component or1 in the case of information relating to ,veterans ,health ,administration positions1 by medical facility3 7,a7 ,the number of personnel encumbering positions4 7,b7 ,the number of accessions and separation actions processed during the quarter preceding the date of the publication of the information4 7,c7 ,the number of vacancies1 by occupation4 7,d7 ,the percentage of new hires for the ,department who were hired within the time-to-hire target of the ,office of ,personnel ,management1 disaggregated by administration4 7#b7 ,exceptions ,the ,secretary may withhold from publication under paragraph 7#a7 information relating to law enforcement1 information security1 or such positions in the ,department that the ,secretary determines to be sensitive4 7#c7 ,update of information ,the ,secretary shall update the information on the website required under paragraph 7#a7 on a quarterly basis4 7#d7 ,treatment of contractor positions ,any ,department of ,veterans ,affairs position that is filled with a contractor may not be treated as a ,department position for purposes of the information required to be published under paragraph 7#a74 7#e7 ,inspector ,general review ,on a semi-annual basis1 the ,inspector ,general of the ,department shall review the administration of the website required under paragraph 7#a7 and make recommendations relating to the improvement of such administration4 7b7 ,report to ,congress ,the ,secretary of ,veterans ,affairs shall submit to ,congress an annual report on the steps the ,department is taking to achieve full staffing capacity4 ,each such report shall include the amount of additional funds necessary to enable the ,department to reach full staffing capacity4 #ejf4 ,program on establishment of peer specialists in patient aligned care team settings within medical centers of ,department of ,veterans ,affairs 7a7 ,program required ,the ,secretary of ,veterans ,affairs shall carry out a program to establish not fewer than two peer specialists in patient aligned care teams at medical centers of the ,department of ,veterans ,affairs to promote the use and integration of services for mental health1 substance use disorder1 and behavioral health in a primary care setting4 7b7 ,timeframe for establishment of program ,the ,secretary shall carry out the program at medical centers of the ,department as follows3 7#a7 ,not later than ,may #ca1 #bjai1 at not fewer than #ae medical centers of the ,department4 7#b7 ,not later than ,may #ca1 #bjbj1 at not fewer than #cj medical centers of the ,department4 7c7 ,selection of locations 7#a7 ,in general ,the ,secretary shall select medical centers for the program as follows3 7,a7 ,not fewer than five shall be medical centers of the ,department that are designated by the ,secretary as polytrauma centers4 7,b7 ,not fewer than #aj shall be medical centers of the ,department that are not designated by the ,secretary as polytrauma centers4 7#b7 ,considerations ,in selecting medical centers for the program under paragraph 7#a71 the ,secretary shall consider the feasibility and advisability of selecting medical centers in the following areas3 7,a7 ,rural areas and other areas that are underserved by the ,department4 7,b7 ,areas that are not in close proximity to an active duty military installation4 7,c7 ,areas representing different geographic locations1 such as census tracts established by the ,bureau of the ,census4 7d7 ,gender-,specific services ,in carrying out the program at each location selected under subsection 7c71 the ,secretary shall ensure that-- 7#a7 the needs of female veterans are specifically considered and addressed2 and 7#b7 female peer specialists are made available to female veterans who are treated at each location4 7e7 ,engagement with community providers ,at each location selected under subsection 7c71 the ,secretary shall consider ways in which peer specialists can conduct outreach to health care providers in the community who are known to be serving veterans to engage with those providers and veterans served by those providers4 7f7 ,reports 7#a7 ,periodic reports 7,a7 ,in general ,not later than #ahj days after the date of the enactment of this ,act1 and not less frequently than once every #ahj days thereafter until the ,secretary determines that the program is being carried out at the last location to be selected under subsection 7c71 the ,secretary shall submit to ,congress a report on the program4 7,b7 ,elements ,each report required by subparagraph 7,a7 shall1 with respect to the #ahj-;day period preceding the submittal of the report1 include the following3 7i7 ,the findings and conclusions of the ,secretary with respect to the program4 7ii7 ,an assessment of the benefits of the program to veterans and family members of veterans4 7iii7 ,an assessment of the effectiveness of peer specialists in engaging under subsection 7e7 with health care providers in the community and veterans served by those providers4 7#b7 ,final report ,not later than #ahj days after the ,secretary determines that the program is being carried out at the last location to be selected under subsection 7c71 the ,secretary shall submit to ,congress a report detailing the recommendations of the ,secretary as to the feasibility and advisability of expanding the program to additional locations4 #ejg4 ,department of ,veterans ,affairs medical scribe pilot program 7a7 ,in general ,the ,secretary of ,veterans ,affairs shall carry out a #b-year pilot program under which the ,secretary shall increase the use of medical scribes at ,department of ,veterans ,affairs medical centers4 7b7 ,locations ,the ,secretary shall carry out the pilot program at the #aj medical centers of the ,department as follows3 7#a7 ,at least four such medical centers located in rural areas4 7#b7 ,at least four such medical centers located in urban areas4 7#c7 ,two such medical centers located in areas with need for increased access or increased efficiency1 as determine by the ,secretary4 7c7 ,medical scribes 7#a7 ,hiring ,under the pilot program the ,secretary shall-- 7,a7 hire #bj new ,department of ,veterans ,affairs term employees as medical scribes2 and 7,b7 seek to enter into contracts with appropriate entities for the employment of #bj additional medical scribes4 7#b7 ,distribution ,the ,secretary shall assign four medical scribes to each of the #aj medical centers of the ,department where the ,secretary carries out the pilot program as follows3 7,a7 ,two scribes shall be assigned to each of two physicians4 7,b7 ,thirty percent of the scribes shall be employed in the provision of emergency care4 7,c7 ,seventy percent of the scribes shall be employed in the provision of speciality care in specialties with the longest patient wait times or lowest efficiency ratings1 as determined by the ,secretary4 7d7 ,reports 7#a7 ,reports to ,congress ,not later than #ahj days after the commencement of the pilot program required under this section1 and every #ahj days thereafter for the duration of the pilot program1 the ,secretary of ,veterans ,affairs shall submit to ,congress a report on the pilot program4 ,each such report shall include each of the following3 7,a7 ,a separate analysis of each the following with respect to medical scribes employed by the ,department of ,veterans ,affairs and medical scribes performing ,department of ,veterans ,affairs functions under a contract3 7i7 ,provider efficiency4 7ii7 ,patient satisfaction4 7iii7 ,average wait time4 7iv7 ,the number of patients seen per day by each physician or practitioner4 7v7 ,the amount of time required to hire and train an employee to perform medical scribe functions under the pilot program4 7,b7 ,metrics and data for analyzing the effects of the pilot program1 including an evaluation of the each of the elements under clauses 7i7 through 7iv7 of subparagraph 7,a7 at medical centers who employed scribes under the pilot program for an appropriate period preceding the hiring of such scribes4 7#b7 ,comptroller ,general report ,not later than #ij days after the termination of the pilot program under this section1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report on the pilot program4 ,such report shall include a comparison of the pilot program with similar programs carried out in the private sector4 7e7 ,definitions ,in this section3 7#a7 ,the term medical scribe means an unlicensed individual hired to enter information into the electronic health record or chart at the direction of a physician or licensed independent practitioner whose responsibilities include the following3 7,a7 ,assisting the physician or practitioner in navigating the electronic health record4 7,b7 ,responding to various messages as directed by the physician or practitioner4 7,c7 ,entering information into the electronic health record1 as directed by the physician or practitioner4 7#b7 ,the terms urban and rural have the meanings given such terms under the rural-urban commuting codes developed by the ,secretary of ,agriculture and the ,secretary of ,health and ,human ,services4 7f7 ,funding ,the pilot program under this section shall be carried out using amounts otherwise authorized to be appropriated for the ,department of ,veterans ,affairs4 ,no additional amounts are authorized to be appropriated to carry out such program4 #ejh4 ,extension of requirement to collect fees for housing loans guaranteed by ,secretary of ,veterans ,affairs ,section #cgbi7;b77#b7 of title #ch1 ,united ,states ,code1 is amended by striking #bjbg each place it appears and inserting #bjbh4 #eji4 ,extension of reduction in amount of pension furnished by ,department of ,veterans ,affairs for certain veterans covered by ,medicaid plans for services furnished by nursing facilities ,section #eejc7;d77#g7 of title #ch1 ,united ,states ,code1 is amended by striking ,september #cj1 #bjbg and inserting ,september #cj1 #bjbh4 #eaj4 ,appropriation of amounts 7a7 ,veterans ,choice ,program ,there is authorized to be appropriated1 and is appropriated1 to the ,secretary of ,veterans ,affairs1 out of any funds in the ,treasury not otherwise appropriated1 #e1bjj1jjj1jjj to be deposited in the ,veterans ,choice ,fund under section #hjb of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note74 7b7 ,availability of amounts ,the amounts appropriated under subsection 7a7 shall be available for obligation or expenditure without fiscal year limitation4 #eaa4 ,technical correction ,section #agab;,i of title #ch1 ,united ,states ,code1 is redesignated as section #agbj;,i of such title4 #eab4 ,budgetary effects 7a7 ,statutory ,pay-,as-,you-,go scorecards ,the budgetary effects of this ,act shall not be entered on either ,,paygo scorecard maintained pursuant to section #d7;d7 of the ,statutory ,pay-,as-,you-,go ,act of #bjaj4 7b7 ,senate ,,paygo scorecards ,the budgetary effects of this ,act shall not be entered on any ,,paygo scorecard maintained for purposes of section #dajf of ,h4 ,con4 ,res4 #ga 7#aaeth ,congress74 ,clerk4