#aaf? ,,congress  #a/ ,session  ,h4 ,r4 
#cecj  ,,an ,,act  ,to am5d title #ch1  
,unit$ ,/ates ,code1 to direct !        
,secret>y ( ,vet]ans ,affairs to en=ce !
 lic5sure requirem5t = m$ical provid]s (
 ! ,dep>tm5t ( ,vet]ans ,affairs4  #a4  
,%ort title ,?is ,act may be cit$ z !   
,improv+ ,confid5ce 9 ,vet]ans' ,c>e    
,act4  #b4 ,compliance ) requirem5ts =  
exam9+ qualifications & cl9ical         
abilities ( ,dep>tm5t ( ,vet]ans        
,affairs heal? c>e pr(essionals  7a7 ,9 
g5]al ,sub*apt] ,i ( *apt] #gd ( title  
#ch1 ,unit$ ,/ates ,code1 is am5d$ by   
add+ at ! end ! foll[+ new section3     
#gdad4 ,compliance ) requirem5ts =      
exam9+ qualifications & cl9ical         
abilities ( heal? c>e pr(essionals  7a7 
,compliance ) cr$5tial+ requirem5ts ,!  
,secret>y %all ensure t ea* m$ical c5t] 
( ! ,dep>tm5t1 9 a consi/5t mann]-- 7#a7
 compiles1 v]ifies1 & reviews           
docum5tation = ea* heal? c>e pr(essional
 ( ! ,dep>tm5t at su* m$ical c5t]       
reg>d+1 at a m9imum--  7,a7 !           

pr(essional lic5sure1 c]tification1 or  
regi/ration ( ! heal? c>e pr(essional2  
7,b7 :e!r ! heal? c>e pr(essional holds 
a ,drug ,en=cem5t ,adm9i/ration         
regi/ration2 &  7,c7 ! education1 tra9+1
 exp]i5ce1 malpractice hi/ory1 & cl9ical
 compet5ce ( ! heal? c>e pr(essional2 & 
7#b7 cont9u\sly monitors any *anges to !
 matt]s "u p>agraph 7#a71 includ+ )     
respect to susp5sions1 re/rictions1     
limitations1 probations1 d5ials1        
revocations1 & o!r *anges1 relat+ to !  
failure ( a heal? c>e pr(essional to    
meet g5]ally accept$ /&>ds ( cl9ical    
practice 9 a mann] t pres5ts reasonable 
conc]n = ! safety ( pati5ts4  7b7       
,regi/ration reg>d+ controll$ sub/ances 
7#a7 ,except z provid$ by p>agraph 7#b71
 ! ,secret>y %all ensure t ea* cov]$    
heal? c>e pr(essional holds an active   
,drug ,en=cem5t ,adm9i/ration           
regi/ration4  7#b7 ,! ,secret>y %all--  
7,a7 det]m9e ! circum/ances 9 :i* a     
m$ical c5t] ( ! ,dep>tm5t mu/ obta9 a   
waiv] "u section #cjc ( ! ,controll$    

,sub/ances ,act 7#ba ,u4,s4,c4 #hbc7 )  
respect to cov]$ heal? c>e pr(essionals2
 &  7,b7 e/abli% a process = m$ical     
c5t]s to reque/ su* waiv]s4  7#c7 ,9    
c>ry+ out p>agraph 7#a71 ! ,secret>y    
%all ensure t ea* m$ical c5t] ( !       
,dep>tm5t monitors ! ,drug ,en=cem5t    
,adm9i/ration regi/rations ( cov]$ heal?
 c>e pr(essionals at su* m$ical c5t] 9 a
 mann] t ensures ! m$ical c5t] is made  
aw>e ( any *ange 9 /atus 9 ! regi/ration
 by n lat] ?an #g days aft] su* *ange 9 
/atus4  7#d7 ,if a cov]$ heal? c>e      
pr(essional does n hold an active ,drug 
,en=cem5t ,adm9i/ration regi/ration1 !  
,secret>y %all c>ry out any ( ! foll[+  
actions1 z ! ,secret>y det]m9es         
appropriate3  7,a7 ,obta9 a waiv]       
pursuant to p>agraph 7#b74  7,b7        
,transf] ! heal? c>e pr(essional to a   
position t does n require prescrib+1    
disp5s+1 adm9i/]+1 or conduct+ rese>* ) 
controll$ sub/ances4  7,c7 ,take adv]se 
actions "u sub*apt] ,v ( ?is *apt]1 )   
respect to an employee ( ! ,dep>tm5t1 or

 t]m9ate ! s]vices ( a contractor1 )    
respect to a contractor ( ! ,dep>tm5t4  
7c7 ,reviews ( conc]ns relat+ to quality
 ( cl9ical c>e  7#a7 ,! ,secret>y %all  
ensure t ea* m$ical c5t] ( ! ,dep>tm5t1 
9 a consi/5t mann]1 c>ries out--  7,a7  
ongo+1 retrospective1 & compreh5sive    
monitor+ ( ! p]=mance & quality ( !     
heal? c>e deliv]$ by ea* heal? c>e      
pr(essional ( ! ,dep>tm5t locat$ at !   
m$ical c5t]1 includ+ ) respect to !     
safety ( su* c>e2 &  7,b7 timely &      
docum5t$ reviews ( su* c>e if an        
individual notifies ! ,secret>y ( any   
pot5tial conc]ns relat+ to a failure ( !
 heal? c>e pr(essional to meet g5]ally  
accept$ /&>ds ( cl9ical practice 9 a    
mann] t pres5ts reasonable conc]n = !   
safety ( pati5ts4  7#b7 ,! ,secret>y    
%all e/abli% a policy to c>ry out       
p>agraph 7#a71 includ+ ) respect to--   
7,a7 det]m9+ ! p]iod by :i* a m$ical    
c5t] ( ! ,dep>tm5t mu/ initiate ! review
 ( a conc]n describ$ 9 subp>agraph 7,b7 
( su* p>agraph foll[+ ! date on :i* !   

conc]n is receiv$2 &  7,b7 ensur+ !     
compliance ( ea* m$ical c5t] ) su*      
policy4  7d7 ,compliance ) requirem5ts =
 report+ quality ( c>e conc]ns ,:5 !    
,secret>y sub/antiates a conc]n relat+  
to ! cl9ical compet5cy (1 or quality (  
c>e deliv]$ by1 a heal? c>e pr(essional 
( ! ,dep>tm5t 7includ+ a =m] su* heal?  
c>e pr(essional71 ! ,secret>y %all      
ensure t ! appropriate m$ical c5t] ( !  
,dep>tm5t timely notifies ! foll[+      
entities ( su* conc]n1 z appropriate3   
7#a7 ,! appropriate lic5s+1 regi/ration1
 or c]tification body 9 ea* ,/ate 9 :i* 
! heal? c>e pr(essional is lic5s$1      
regi/]$1 or c]tifi$4  7#b7 ,! ,drug     
,en=cem5t ,adm9i/ration4  7#c7 ,!       
,national ,practition] ,data ,bank      
e/abli%$ pursuant to ! ,heal? ,c>e      
,quality ,improvem5t ,act ( #aihf 7#db  
,u4,s4,c4 #aaaja et seq474  7#d7 ,any   
o!r relevant entity4  7e7 ,prohibition  
on c]ta9 settlem5t agreem5t t]ms  7#a7  
,except z provid$ by p>agraph 7#b71 !   
,secret>y may n ent] into a settlem5t   

agreem5t relat+ to an adv]se action     
aga9/ a heal? c>e pr(essional ( !       
,dep>tm5t if su* agreem5t includes t]ms 
t require ! ,secret>y to conceal f !    
p]sonnel file ( ! employee a s]i\s      
m$ical error or lapse 9 cl9ical practice
 t con/itutes a sub/antial failure to   
meet g5]ally accept$ /&>ds ( cl9ical    
practice z to raise reasonable conc]n = 
! safety ( pati5ts4  7#b7 ,p>agraph 7#a7
 does n apply to adv]se actions t !     
,special ,c\nsel "u section #abaa (     
title #e det]m9es con/itutes a prohibit$
 p]sonnel practice4  7f7 ,tra9+ ,n less 
frequ5tly ?an biannually1 ! ,secret>y   
%all provide m&atory tra9+ to employees 
( ea* m$ical c5t] ( ! ,dep>tm5t :o are  
responsible = any ( ! foll[+ activities3
 7#a7 ,compil+1 validat+1 or review+ !  
cr$5tials ( heal? c>e pr(essionals ( !  
,dep>tm5t4  7#b7 ,review+ ! quality (   
cl9ical c>e deliv]$ by heal? c>e        
pr(essionals ( ! ,dep>tm5t4  7#c7 ,tak+ 
adv]se privileg+ actions or mak+        
det]m9ations relat+ to o!r discipl9>y   

actions or employm5t actions aga9/ heal?
 c>e pr(essionals ( ! ,dep>tm5t =       
reasons relat+ to ! failure ( a heal?   
c>e pr(essional to meet g5]ally accept$ 
/&>ds ( cl9ical practice 9 a mann] t    
pres5ts reasonable conc]n = ! safety (  
pati5ts4  7#d7 ,mak+ notifications "u   
subsection 7d74  7g7 ,def9itions ,9 ?is 
section3  7#a7 ,! t]m controll$ sub/ance
 has ! mean+ giv5 t t]m 9 section #ajb (
 ! ,controll$ ,sub/ances ,act 7#ba      
,u4,s4,c4 #hjb74  7#b7 ,! t]m cov]$     
heal? c>e pr(essional means a p]son     
employ$ 9 a position z a heal? c>e      
pr(essional ( ! ,dep>tm5t1 or a         
contractor ( ! ,dep>tm5t1 t requires !  
p]son to be au?oriz$ to prescribe1      
disp5se1 adm9i/]1 or conduct rese>* )1  
controll$ sub/ances4  7#c7 ,! t]m ,drug 
,en=cem5t ,adm9i/ration regi/ration     
means regi/ration ) ! ,drug ,en=cem5t   
,adm9i/ration "u section #cjc ( !       
,controll$ ,sub/ances ,act 7#ba         
,u4,s4,c4 #hbc7 by heal? c>e            
practition]s au?oriz$ to disp5se1       

prescribe1 adm9i/]1 or conduct rese>* )1
 controll$ sub/ances4  7#d7 ,! t]m heal?
 c>e pr(essional ( ! ,dep>tm5t means !  
pr(essionals describ$ 9 section         
#agcj;,c7b7 ( ?is title1 & includes a   
contractor ( ! ,dep>tm5t s]v+ z su* a   
pr(essional4  4  7b7 ,cl]ical am5dm5t ,!
 table ( sections at ! beg9n+ ( su*     
*apt] is am5d$ by ins]t+ aft] ! item    
relat+ to section #gdac ! foll[+ new    
item3  #gdad4 ,compliance ) requirem5ts 
= exam9+ qualifications & cl9ical       
abilities ( heal? c>e pr(essionals4  4  
7c7 ,deadl9e = implem5tation ,!         
,secret>y ( ,vet]ans ,affairs %all      
comm5ce ! implem5tation ( section #gdad 
( title #ch1 ,unit$ ,/ates ,code1 z add$
 by subsection 7a71 by ! foll[+ dates3  
7#a7 ,) respect to subsections 7a71     
7c77#b71 7d71 & 7f71 n lat] ?an #ahj    
days aft] ! date ( ! enactm5t ( ?is     
,act4  7#b7 ,) respect to subsection    
7c77#a71 n lat] ?an #a ye> aft] ! date (
 ! enactm5t ( ?is ,act4  7#c7 ,) respect
 to subsection 7b77#b71 n lat] ?an #ah  

mon?s aft] ! date ( ! enactm5t ( ?is    
,act4  7d7 ,audits & reports  7#a7      
,audits ,! ,secret>y ( ,vet]ans ,affairs
 %all c>ry out annual audits ( !        
compliance ( m$ical c5t]s ( ! ,dep>tm5t 
( ,vet]ans ,affairs ) ! matt]s requir$  
by section #gdad ( title #ch1 ,unit$    
,/ates ,code1 z add$ by subsection 7a74 
,9 c>ry+ out su* audits1 ! ,secret>y--  
7,a7 may n au?orize ! m$ical c5t] be+   
audit$ to conduct ! audit2 &  7,b7 may  
ent] into an agreem5t ) ano!r dep>tm5t  
or ag5cy ( ! ,f$]al ,gov]nm5t or a      
nongov]nm5tal entity to conduct su*     
audits4  7#b7 ,reports ,n lat] ?an #a   
ye> aft] ! date ( ! enactm5t ( ?is ,act1
 & annually !reaft] = #e ye>s1 !        
,secret>y ( ,vet]ans ,affairs %all      
submit to ! ,committees on ,vet]ans'    
,affairs ( ! ,h\se ( ,repres5tatives & !
 ,s5ate a report on ! audits conduct$ "u
 p>agraph 7#a74 ,ea* su* report %all    
include a summ>y ( ! compliance by ea*  
m$ical c5t] ) ! matt]s requir$ by su*   
section #gdad4  7#c7 ,initial report ,! 

,secret>y %all include 9 ! fir/ report  
submitt$ "u p>agraph 7#b7 ! foll[+3     
7,a7 ,a description ( ! progress made by
 ! ,secret>y 9 implem5t+ su* section    
#gdad1 includ+ any matt]s "u su* section
 t ! ,secret>y has n fully implem5t$4   
7,b7 ,an analysis ( ! feasibility1      
advisability1 & co/ ( requir+ cr$5tial+ 
employees ( ! ,dep>tm5t to be tra9$ by  
an outside entity & to ma9ta9 a         
cr$5tial+ c]tification4  ,pass$ ! ,h\se 
( ,repres5tatives ,decemb] #ag1         
#bjai4;,cl]k4