,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #ajja  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,april #c1 #bjai,mr4   
,?une 7= himself & ,mr4 ,r\nds7         
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,indian ,affairs  ,a ,,bill  ,to am5d ! 
,indian ,heal? ,c>e ,improvem5t ,act to 
all[ ! ,indian ,heal? ,s]vice to cov] ! 
co/ ( a copaym5t ( an ,indian or ,alaska
 ,native vet]an receiv+ m$ical c>e or   
s]vices f ! ,dep>tm5t ( ,vet]ans        
,affairs1 & = o!r purposes4  #a4 ,%ort  
title ,?is ,act may be cit$ z ! ,tribal 
,vet]ans ,heal? ,c>e ,enhancem5t ,act4  
#b4 ,liability = paym5t ,section #bbb ( 
! ,indian ,heal? ,c>e ,improvem5t ,act  
7#be ,u4,s4,c4 #afbau7 is am5d$ by add+ 
at ! end ! foll[+3  7d7 ,vet]ans        
,affairs copaym5ts ,! ,s]vice may pay1 9
 accordance ) section #dab1 ! co/ ( a   
copaym5t assess$ by ! ,dep>tm5t (       
,vet]ans ,affairs to an eligible ,indian
 vet]an 7z def9$ 9 section #dab7 = cov]$
 m$ical c>e 7z def9$ 9 su* section74  4 

#c4 ,copaym5ts = tribal vet]ans receiv+ 
c]ta9 m$ical s]vices ,title ,,iv ( !    
,indian ,heal? ,c>e ,improvem5t ,act    
7#be ,u4,s4,c4 #afda et seq47 is am5d$  
by add+ at ! end ! foll[+3  #dab4       
,paym5ts = eligible ,indian vet]ans     
receiv+ cov]$ m$ical c>e at ,,va        
facilities  7a7 ,def9itions ,9 ?is      
section3 7#a7 ,appropriate committees ( 
,congress ,! t]m appropriate committees 
( ,congress means-- 7,a7 9 ! ,s5ate--   
7i7 ! ,committee on ,vet]ans' ,affairs2 
&  7ii7 ! ,committee on ,indian         
,affairs2 &  7,b7 9 ! ,h\se (           
,repres5tatives-- 7i7 ! ,committee on   
,vet]ans' ,affairs2 &  7ii7 ! ,committee
 on ,natural ,res\rces4  7#b7 ,cov]$    
m$ical c>e ,! t]m cov]$ m$ical c>e means
 any m$ical c>e or s]vice t is-- 7,a7   
au?oriz$ = an eligible ,indian vet]an "u
 ! contract heal? s]vice & ref]r$ by !  
,s]vice2 &  7,b7 adm9i/]$ at a facility 
( ! ,dep>tm5t ( ,vet]ans ,affairs1      
includ+ any s]vices r5d]$ "u a contract 
) a non-,dep>tm5t ( ,vet]ans ,affairs   

heal? c>e provid]4  7#c7 ,eligible      
,indian vet]an ,! t]m eligible ,indian  
vet]an means an ,indian or ,alaska      
,native vet]an :o is eligible =         
assi/ance f ! ,s]vice4  7b7 ,memor&um ( 
und]/&+  7#a7 ,9 g5]al ,not)/&+ any o!r 
provision ( law1 except z provid$ 9     
p>agraph 7#c71 ! ,secret>y 7or a        
designee1 includ+ ! director ( any area 
(fice ( ! ,s]vice71 ! ,secret>y (       
,vet]ans ,affairs 7or a designee71 & any
 tribal heal? program1 z applicable1    
%all ent] into a memor&um ( und]/&+1 9  
consultation ) ,indian tribes to be     
impact$ by ! memor&um ( und]/&+ 7on a   
national or regional basis71 t au?orizes
 ! ,secret>y or tribal heal? program1 z 
applicable1 to pay to ! ,secret>y (     
,vet]ans ,affairs any copaym5ts ow$ to !
 ,dep>tm5t ( ,vet]ans ,affairs by       
eligible ,indian vet]ans = cov]$ m$ical 
c>e4  7#b7 ,factors = consid]ation ,9   
ent]+ into a memor&um ( und]/&+ "u      
p>agraph 7#a71 ! ,secret>y1 ! ,secret>y 
( ,vet]ans ,affairs1 & any tribal heal? 

program1 z applicable1 %all take into   
consid]ation any f9d+s conta9$ 9 !      
report "u subsection 7e74  7#c7         
,exception ,! ,secret>y1 ! ,secret>y (  
,vet]ans ,affairs1 & any tribal heal?   
program1 z applicable1 %all n be requir$
 to ent] into a memor&um ( und]/&+ "u   
p>agraph 7#a7 if ! ,secret>y1 !         
,secret>y ( ,vet]ans ,affairs1 & any    
tribal heal? program1 z applicable1     
jo9tly c]tify to ! appropriate          
committees ( ,congress t su* a memor&um 
( und]/&+ w\ld-- 7,a7 decrease ! quality
 ( heal? c>e provid$ to eligible ,indian
 vet]ans2  7,b7 imp$e ! access ( ^?     
vet]ans to heal? c>e2 or  7,c7          
sub/antially decrease ! quality (1 or   
access to1 heal? c>e by individuals     
receiv+ heal? c>e f ! ,dep>tm5t (       
,vet]ans ,affairs or b5efici>ies ( !    
,s]vice4  7c7 ,paym5t by ,s]vice        
,not)/&+ any o!r provision ( law & 9    
accordance ) ! relevant memor&um (      
und]/&+ describ$ 9 subsection 7b71 !    
,s]vice may cov] ! co/ ( any copaym5t   

assess$ by ! ,dep>tm5t ( ,vet]ans       
,affairs to an eligible ,indian vet]an  
receiv+ cov]$ m$ical c>e4  7d7          
,au?orization ,to accept funds ,not)/&+ 
section #djg7;c71 section #bija7;b7 ( ! 
,pati5t ,protection & ,af=dable ,c>e    
,act 7#be ,u4,s4,c4 #afbc7;b771 or any  
o!r provision ( law1 & 9 accordance ) ! 
relevant memor&um ( und]/&+ describ$ 9  
subsection 7b71 ! ,secret>y ( ,vet]ans  
,affairs may accept a paym5t f ! ,s]vice
 "u subsection 7c74  7e7 ,report ,n lat]
 ?an #ij days aft] ! date ( enactm5t (  
?is section1 ! ,secret>y & ! ,secret>y (
 ,vet]ans ,affairs %all submit to !     
appropriate committees ( ,congress a    
report t describes-- 7#a7 ! numb] (     
vet]ans1 disaggregat$ by ,/ate1 :o--    
7,a7 are eligible = assi/ance f !       
,s]vice2 &  7,b7 h receiv$ heal? c>e at 
a m$ical facility ( ! ,dep>tm5t (       
,vet]ans ,affairs2  7#b7 ! numb] (      
vet]ans1 disaggregat$ by ,/ate & cal5d> 
ye>1 :o-- 7,a7 are eligible = assi/ance 
f ! ,s]vice2 &  7,b7 7 ref]r$ to a      

m$ical facility ( ! ,dep>tm5t ( ,vet]ans
 ,affairs f a facility ( ! ,s]vice dur+ 
! p]iod-- 7i7 beg9n+ on ,janu>y #a1     
#bjac2 &  7ii7 end+ on ,decemb] #ca1    
#bjah2 &  7#c7 an update reg>d+ ef=ts ( 
! ,secret>y & ! ,secret>y ( ,vet]ans    
,affairs to /reaml9e heal? c>e = vet]ans
 :o are eligible = assi/ance f ! ,s]vice
 & h receiv$ heal? c>e at a m$ical      
facility ( ! ,dep>tm5t ( ,vet]ans       
,affairs & at a facility ( ! ,s]vice1   
includ+ a description (-- 7,a7 any      
*anges to ! provision ( heal? c>e       
requir$ "u ?is ,act2 &  7,b7 any b>ri]s 
to effici5tly /reaml9e ! provision (    
heal? c>e to vet]ans :o are eligible =  
assi/ance f ! ,s]vice4  4