,,ii ,cal5d> ,no4 #ecg #aaf? ,,congress 
#b;d ,session  ,s4 #fbi  ,,9 ,,! ,,s5ate
 ,,( ,,! ,,unit$ ,,/ates  ,febru>y #bh1 
#bjai,mr4 ,te/] 7= himself1 ,mrs4       
,murray1 ,mr4 ,blum5?al1 ,mr4 ,br[n1 &  
,ms4 ,duckwor?7 introduc$ ! foll[+ bill2
 :i* 0 read twice & ref]r$ to !         
,committee on ,vet]ans' ,affairs        
,septemb] #ae1 #bjbj,report$ by ,mr4    
,moran1 ) an amendment,strike out all   
aft] ! enact+ clause & ins]t ! "p pr9t$ 
9 italic  ,a ,,bill  ,to require !      
,secret>y ( ,vet]ans ,affairs to review 
! processes & requirem5ts ( ! ,dep>tm5t 
( ,vet]ans ,affairs = s*$ul+ appo9tm5ts 
= heal? c>e & conduct+ consultations "u 
! laws adm9i/]$ by ! ,secret>y1 & = o!r 
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,acc\ntability 9 ,dep>tm5t 
( ,vet]ans ,affairs ,s*$ul+ & ,consult  
,managem5t ,act4  #b4 ,processes &      
requirem5ts = s*$ul+ appo9tm5ts = heal? 
c>e f ,dep>tm5t ( ,vet]ans ,affairs  7a7
 ,processes & requirem5ts  7#a7 ,9 g5]al
 ,n lat] ?an #fj days aft] ! date ( !   

enactm5t ( ?is ,act1 ! ,secret>y (      
,vet]ans ,affairs %all submit to !      
,committee on ,vet]ans' ,affairs ( !    
,s5ate & ! ,committee on ,vet]ans'      
,affairs ( ! ,h\se ( ,repres5tatives a  
description ( ! processes & requirem5ts 
( ! ,dep>tm5t ( ,vet]ans ,affairs =     
s*$ul+ appo9tm5ts = heal? c>e f !       
,dep>tm5t at ! m$ical facility level4   
7#b7 ,p]iodic revision  7,a7 ,9 g5]al ,!
 ,secret>y may revise ! processes &     
requirem5ts requir$ "u p>agraph 7#a7 z !
 ,secret>y consid]s necess>y4  7,b7     
,submittal to ,congress ,n lat] ?an #cj 
days be=e revis+ ! processes &          
requirem5ts "u subp>agraph 7,a71 !      
,secret>y %all submit to ! ,committee on
 ,vet]ans' ,affairs ( ! ,s5ate & !      
,committee on ,vet]ans' ,affairs ( !    
,h\se ( ,repres5tative a description (  
^? revis$ processes & requirem5ts1      
includ+ a description ( any             
modifications to ! c]tification & tra9+ 
"u subsection 7b74  7b7 ,tra9+ on       
processes & requirem5ts  7#a7           

,c]tification ,n lat] ?an "o ye> aft] ! 
date ( ! enactm5t ( ?is ,act1 !         
,secret>y %all require individuals      
involv$ 9 ! s*$ul+ ( appo9tm5ts = heal? 
c>e f ! ,dep>tm5t to c]tify to !        
,secret>y t ! individual und]/&s !      
processes & requirem5ts describ$ 9      
subsection 7a71 includ+ ! maximum numb] 
( days all[$ to complete ea* /ep ( !    
s*$ul+ process4  7#b7 ,new employees ,! 
,secret>y %all require all employees    
hir$ by ! ,dep>tm5t aft] ! date ( !     
enactm5t ( ?is ,act :o are to be involv$
 9 ! s*$ul+ ( appo9tm5ts = heal? c>e f !
 ,dep>tm5t to und]go tra9+ on !         
processes & requirem5ts describ$ 9      
subsection 7a7 z "p ( ! onbo>d+ process4
  7c7 ,me?od ,to monitor compliance     
7#a7 ,9 g5]al ,n lat] ?an #ahj days aft]
 ! date ( ! enactm5t ( ?is ,act1 !      
,secret>y %all e/abli% or ma9ta9 a me?od
 or tool to enable real-"t monitor+ ( & 
ensure t ea* m$ical facility ( !        
,dep>tm5t complies ) ! s*$ul+ processes 
& requirem5ts describ$ 9 subsection 7a71

 includ+ compliance ) policies ( !      
,dep>tm5t relat+ to ! maximum numb] (   
days all[$ to complete ea* /ep ( !      
s*$ul+ process4  7#b7 ,use ?r\gh\t      
,dep>tm5t  7,a7 ,9 g5]al ,! ,secret>y   
%all require ea* m$ical facility ( !    
,dep>tm5t to use ! me?od or tool        
describ$ 9 p>agraph 7#a74  7,b7         
,c]tification ,n lat] ?an "o ye> aft] ! 
date ( ! enactm5t ( ?is ,act1 !         
,secret>y %all require ! director ( ea* 
m$ical facility ( ! ,dep>tm5t to c]tify 
to ! ,secret>y t ! director is us+ !    
me?od or tool describ$ 9 p>agraph 7#a74 
7d7 ,comptroll] ,g5]al report ,n lat]   
?an two ye>s aft] ! date ( ! enactm5t ( 
?is ,act1 ! ,comptroll] ,g5]al ( !      
,unit$ ,/ates %all submit to !          
,committee on ,vet]ans' ,affairs ( !    
,s5ate & ! ,committee on ,vet]ans'      
,affairs ( ! ,h\se ( ,repres5tatives a  
report on ! compliance ( ! ,secret>y ) !
 requirem5ts ( ?is section4  #c4 ,audits
 reg>d+ s*$ul+ ( appo9tm5ts & managem5t 
( consultations = heal? c>e f ,dep>tm5t 

( ,vet]ans ,affairs  7a7 ,9 g5]al ,n    
lat] ?an "o ye> aft] ! date ( ! enactm5t
 ( ?is ,act1 & n less frequ5tly ?an     
annually !reaft]1 ! ,secret>y ( ,vet]ans
 ,affairs %all provide = ! conduct (    
facility-level audits ( ! s*$ul+ (      
appo9tm5ts & ! managem5t ( consultations
 = heal? c>e "u ! laws adm9i/]$ by !    
,secret>y4  7b7 ,elem5ts ,ea* audit     
conduct$ "u subsection 7a7 %all include 
! foll[+3 7#a7 ,) respect to ea* m$ical 
c5t] ( ! ,dep>tm5t ( ,vet]ans ,affairs1 
an assessm5t ( any s*$ul+ or            
consultation managem5t issues at t      
m$ical c5t]1 includ+ ! foll[+3 7,a7 ,an 
assessm5t ( non-compliance ) policies ( 
! ,vet]ans ,heal? ,adm9i/ration relat+  
to s*$ul+ appo9tm5ts & manag+           
consultations4  7,b7 ,an assessm5t ( !  
ext5t to :i* appo9tm5ts or consultations
 are n timely process$4  7,c7 ,a        
description ( any backlogs 9 appo9tm5ts 
or consultations t are await+ action4   
7,d7 ,an assessm5t ( :e!r consultations 
are appropriately process$4  7,e7 ,data 

) respect to consultations z foll[s3 7i7
 ,consultations t 7 s*$ul$ )9 ! reque/  
w9d[4  7ii7 ,duplicate consultation     
reque/s4  7iii7 ,consultations t 7      
discont9u$4  7iv7 ,delays 9             
consultations4  7v7 ,consultations t 7 n
 prop]ly clos$ or discont9u$1 includ+ a 
description ( rem$iation attempts4  7,f7
 ,a review = accuracy ) respect to      
consultation managem5t z foll[s3 7i7 ,a 
review ( ! accuracy ( ! type ( s]vice1  
ei!r adm9i/rative or cl9ical1 t is      
inputt$ 9 ! electronic heal? record4    
7ii7 ,a review ( ! accuracy ( ! type (  
consultation sett+1 ei!r impati5t or    
outpati5t1 t is inputt$ 9 ! electronic  
heal? record4  7iii7 ,a review ( !      
appropriat5ess ( ! level ( urg5cy ( !   
consultation t is inputt$ 9 ! electronic
 heal? record4  7iv7 ,a review ( any    
delay$ or unresolv$ consultations4  7#b7
 ,an id5tification ( su* recomm5dations 
= corrective action z ! ,secret>y       
consid]s necess>y1 includ+ additional   
tra9+1 increas$ p]sonnel1 & o!r         

res\rces4  7#c7 ,a c]tification t !     
director ( ea* m$ical c5t] ( ! ,dep>tm5t
 is 9 compliance ) ! processes &        
requirem5ts describ$ 9 section #b7;a7 & 
su* o!r requirem5ts relat+ to ! s*$ul+ (
 appo9tm5ts & managem5t ( consultations 
z ! ,secret>y consid]s appropriate4     
7#d7 ,) respect to ref]rals = heal? c>e 
betwe5 heal? c>e provid]s or facilities 
( ! ,dep>tm5t1 a measurem5t (1 = ea*    
m$ical facility ( ! ,dep>tm5t1 ! "t x   
takes f ! date t a cl9ician ( !         
,dep>tm5t det]m9es t a vet]an requires  
c>e f ano!r heal? c>e provid] or        
facility to ea* ( ! foll[+3 7,a7 ,! date
 t ! ref]ral = c>e is s5t to ! o!r heal?
 c>e provid] or facility4  7,b7 ,! date 
t ! o!r heal? c>e provid] or facility   
accepts ! ref]ral4  7,c7 ,! date t !    
appo9tm5t ) ! o!r heal? c>e provid] or  
at ! o!r facility is made4  7,d7 ,! date
 ( ! appo9tm5t ) ! o!r heal? c>e provid]
 or at ! o!r facility4  7,e7 ,any o!r   
/ep t ! ,secret>y det]m9es necess>y to  
measure4  7c7 ,conduct ( audit by ?ird  

p>ty ,ea* audit conduct$ "u subsection  
7a7 ) respect to a m$ical facility ( !  
,dep>tm5t %all be conduct$ by an        
individual or entity t is n affiliat$ ) 
! facility4  7d7 ,transmittal to ,,vha  
,ea* audit conduct$ "u subsection 7a7   
%all be transmitt$ to ! ,"u ,secret>y = 
,heal? ( ! ,dep>tm5t s t ! ,"u ,secret>y
 c-- 7#a7 /r5g!n ov]sight ( ! s*$ul+ (  
appo9tm5ts & managem5t ( consultations  
?r\gh\t ! ,dep>tm5t2  7#b7 monitor      
national policy on su* s*$ul+ &         
managem5t2  7#c7 det]m9e if a mobile    
deploym5t team furni%$ "u ! pilot       
program e/abli%$ "u section #djb ( !    
,,va ,,mission ,act ( #bjah 7,public    
,law #aae-ahb7 is w>rant$2 &  7#d7      
develop a rem$iation plan to address    
issues uncov]$ by ^? audits4  7e7       
,annual report  7#a7 ,9 g5]al ,n lat]   
?an ,decemb] #ca ( ea* ye>1 ! ,secret>y 
%all submit to ! ,committee on ,vet]ans'
 ,affairs ( ! ,s5ate & ! ,committee on  
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives a report on ! audits    

conduct$ "u subsection 7a7 dur+ ! ye>   
end+ on t date4  7#b7 ,elem5ts ,!       
,secret>y %all include 9 ea* report     
requir$ by p>agraph 7#a7-- 7,a7 a       
description ( ! audits conduct$ "u      
subsection 7a7 ) respect to ea* facility
 ( ! ,dep>tm5t2  7,b7 an assessm5t ( h[ 
! ,dep>tm5t /r5g!n$ ov]sight ( ! s*$ul+ 
( appo9tm5ts & managem5t ( consultations
 at t facility z a result ( ^? audits2  
7,c7 an assessm5t ( h[ ^? audits in=m$ !
 national policy ( ! ,dep>tm5t ) respect
 to ! s*$ul+ ( appo9tm5ts & managem5t ( 
consultations2 &  7,d7 a description (  
any rem$iation plans to address issues  
rais$ by ^? audits t 7 complet$4  #d4   
,adm9i/ration ( non-,dep>tm5t ( ,vet]ans
 ,affairs heal? c>e  7a7 ,c]tification (
 prop] adm9i/ration  7#a7 ,review  7,a7 
,9 g5]al ,! ,secret>y ( ,vet]ans        
,affairs %all conduct a review ( !      
/aff+1 tra9+1 & o!r requirem5ts necess>y
 to adm9i/] section #aja ( ! ,vet]ans   
,access1 ,*oice1 & ,acc\ntability ,act (
 #bjad 7,public ,law #aac-adf2 #ch      

,u4,s4,c4 #agja note71 section #agjc (  
title #ch1 ,unit$ ,/ates ,code 7z 9     
effect on ! date specifi$ 9 section     
#aja7;b7 ( ! ,c>+ = ,our ,vet]ans ,act (
 #bjah 7title ,i ( ,public ,law         
#aae-ahb771 & any o!r community c>e     
program ( ! ,dep>tm5t ( ,vet]ans        
,affairs4  7,b7 ,elem5ts ,! review      
conduct$ "u p>agraph 7#a7 %all include1 
) respect to ea* m$ical facility ( !    
,dep>tm5t-- 7i7 an assessm5t ( ! type ( 
positions requir$ to be /aff$ at !      
m$ical facility2  7ii7 ! numb] ( su*    
positions au?oriz$2  7iii7 ! numb] ( su*
 positions fill$2 &  7iv7 ! numb] (     
additional su* positions requir$ to be  
au?oriz$4  7#b7 ,c]tification ,n lat]   
?an #ahj days aft] ! date ( ! enactm5t (
 ?is ,act1 & e #ahj days !reaft]1 !     
,secret>y ( ,vet]ans ,affairs %all      
submit to ! ,committee on ,vet]ans'     
,affairs ( ! ,s5ate & ! ,committee on   
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives ! results ( ! review    
conduct$ "u p>agraph 7#a71 includ+ a    

c]tification t all /aff+1 tra9+1 & o!r  
requirem5ts describ$ 9 p>agraph         
7#a77;,a7 are fulfill$4  7b7 ,s*$ul+ (  
appo9tm5ts  7#a7 ,9 g5]al ,! ,secret>y  
%all be responsible = ensur+ t          
appo9tm5ts = heal? c>e f non-,dep>tm5t  
heal? c>e provid]s "u ! laws adm9i/]$ by
 ! ,secret>y are s*$ul$4  7#b7          
,timel9ess goals ,n lat] ?an #cj days   
aft] ! date ( ! enactm5t ( ?is ,act1 !  
,secret>y %all e/abli% timel9ess goals =
 ea* /ep 9 s*$ul+ an appo9tm5t = heal?  
c>e f a non-,dep>tm5t heal? c>e provid] 
set =? "u subp>agraphs 7,a7 ?r\gh 7,f7 (
 p>agraph 7#c74  7#c7 ,measurem5t (     
timel9ess = ea* facility ,n lat] ?an    
#abj days aft] ! date ( ! enactm5t ( ?is
 ,act1 ! ,secret>y %all measure1 = ea*  
m$ical facility ( ! ,dep>tm5t1 ! "t x   
takes f ! date t a cl9ician ( !         
,dep>tm5t det]m9es t a vet]an requires  
c>e f a non-,dep>tm5t heal? c>e provid] 
to ea* ( ! foll[+3 7,a7 ,! date t !     
ref]ral = c>e is s5t to ! non-,dep>tm5t 
heal? c>e provid]4  7,b7 ,! date t !    

non-,dep>tm5t heal? c>e provid] accepts 
! ref]ral4  7,c7 ,! date t ! appo9tm5t )
 ! non-,dep>tm5t heal? c>e provid] is   
made4  7,d7 ,! date t ! appo9tm5t ) !   
non-,dep>tm5t heal? c>e provid] occurs4 
7,e7 ,! date t ! ref]ral to !           
non-,dep>tm5t heal? c>e provid] is      
complet$4  7,f7 ,any o!r /ep t !        
,secret>y det]m9es necess>y to measure4 
7#d7 ,publication ( data  7,a7 ,9 g5]al 
,n lat] ?an "o ye> aft] ! date ( !      
enactm5t ( ?is ,act1 ! ,secret>y %all   
publi% ! data measur$ "u p>agraph 7#c71 
disaggregat$ by m$ical facility1 on a   
publicly available ,int]net website ( ! 
,dep>tm5t4  7,b7 ,update ,n less        
frequ5tly ?an biweekly1 ! ,secret>y %all
 update ! data publi%$ "u subp>agraph   
7,a74  7c7 ,comptroll] ,g5]al report    
7#a7 ,review ,beg9n+ n lat] ?an "o ye>  
aft] ! date ( ! enactm5t ( ?is ,act1 !  
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all review compliance by ! ,secret>y ) 
! requirem5ts ( ?is section1 includ+ a  
review ( ! validity & reliability ( data

 publi%$ by ! ,secret>y "u subsection   
7b77#d74  7#b7 ,completion ,n lat] ?an  
?ree ye>s aft] ! date ( ! enactm5t ( ?is
 ,act1 ! ,comptroll] ,g5]al %all submit 
to ! ,committee on ,vet]ans' ,affairs ( 
! ,s5ate & ! ,committee on ,vet]ans'    
,affairs ( ! ,h\se ( ,repres5tatives !  
results ( ! review conduct$ "u p>agraph 
7#a74  #e4 ,reque/s = mobile deploym5t  
teams by directors ( m$ical c5t]s (     
,dep>tm5t ( ,vet]ans ,affairs  7a7 ,9   
g5]al ,a director ( a m$ical c5t] ( !   
,dep>tm5t ( ,vet]ans ,affairs %all      
reque/ f ! ,secret>y ( ,vet]ans ,affairs
 a mobile deploym5t team "u ! pilot     
program e/abli%$ "u section #djb ( !    
,,va ,,mission ,act ( #bjah 7,public    
,law #aae-ahb7 if requirem5ts ( !       
,dep>tm5t "u sections #b & #d h n be5   
met ) respect to a facility "u !        
jurisdiction ( ! director4  7b7 ,report 
,n less frequ5tly ?an once e #ahj days1 
! ,secret>y %all submit to ! appropriate
 committees ( ,congress a report sett+  
=? ea* reque/ "u subsection 7a7 dur+ !  

p]iod cov]$ by ! report1 includ+ an     
explanation ( :y a mobile deploym5t team
 0 or 0 n provid$1 z ! case may be4  7c7
 ,appropriate committees ( congress     
def9$ ,9 ?is section1 ! t]m appropriate 
committees ( ,congress means-- 7#a7 !   
,committee on ,vet]ans' ,affairs & !    
,committee on ,appropriations ( !       
,s5ate2 &  7#b7 ! ,committee on         
,vet]ans' ,affairs & ! ,committee on    
,appropriations ( ! ,h\se (             
,repres5tatives4  #f4 ,exam9ation (     
heal? c>e consultation & s*$ul+         
positions ( ,dep>tm5t ( ,vet]ans        
,affairs  7a7 ,prop] grad+ (            
consultation & s*$ul+ positions  7#a7 ,9
 g5]al ,! ,secret>y ( ,vet]ans ,affairs 
%all conduct an exam9ation ( heal? c>e  
positions ( ! ,dep>tm5t ( ,vet]ans      
,affairs to det]m9e :e!r heal? c>e      
positions involv$ 9 ! consultation &    
s*$ul+ processes are appropriately      
grad$4  7#b7 ,consultation ,9 conduct+ !
 exam9ation "u p>agraph 7#a71 !         
,secret>y %all consult ) heal? c>e /aff+

 exp]ts 9 ! ,f$]al ,gov]nm5t & ! private
 sector4  7#c7 ,submittal to ,congress  
,n lat] ?an #abj days aft] ! date ( !   
enactm5t ( ?is ,act1 ! ,secret>y %all   
submit to ! appropriate committees (    
,congress ! results ( ! exam9ation      
conduct$ "u p>agraph 7#a74  7b7 ,review 
( onbo>d+ process ,n lat] ?an #ahj days 
aft] ! date ( ! enactm5t ( ?is ,act1 !  
,secret>y %all submit to ! appropriate  
committees ( ,congress-- 7#a7 a review (
 ! onbo>d+ process ( individuals 9 heal?
 c>e positions describ$ 9 subsection    
7a71 includ+ h[ long x takes to hire ^? 
individuals2 &  7#b7 a description ( any
 *anges t ! ,secret>y has made or plans 
to make to improve t process4  7c7      
,appropriate committees ( ,congress     
def9$ ,9 ?is section1 ! t]m appropriate 
committees ( ,congress means-- 7#a7 !   
,committee on ,vet]ans' ,affairs & !    
,committee on ,appropriations ( !       
,s5ate2 &  7#b7 ! ,committee on         
,vet]ans' ,affairs & ! ,committee on    
,appropriations ( ! ,h\se (             

,repres5tatives4  #a4 ,%ort title ,?is  
,act may be cit$ z ! ,acc\ntability 9   
,dep>tm5t ( ,vet]ans ,affairs ,s*$ul+ & 
,consult ,managem5t ,act 4  #b4 ,process
 & requirem5ts = s*$ul+ appo9tm5ts =    
heal? c>e f ,dep>tm5t ( ,vet]ans        
,affairs  7a7 ,process & requirem5ts    
7#a7 ,9 g5]al ,n lat] ?an #fj days aft] 
! date ( ! enactm5t ( ?is ,act1 !       
,secret>y ( ,vet]ans ,affairs %all--    
7,a7 e/abli% a process & requirem5ts =  
s*$ul+ appo9tm5ts = heal? c>e f !       
,dep>tm5t ( ,vet]ans ,affairs2 &  7,b7  
submit to ! ,committee on ,vet]ans'     
,affairs ( ! ,s5ate & ! ,committee on   
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives a description ( su*     
process & requirem5ts4  7#b7 ,elem5ts ( 
description ,! description ( ! process &
 requirem5ts = s*$ul+ appo9tm5ts = heal?
 c>e f ! ,dep>tm5t requir$ to be        
submitt$ "u p>agraph 7#a77;,b7 %all     
include-- 7,a7 in=mation on h[ su*      
process & requirem5ts take into acc\nt !
 access /&>ds e/abli%$ "u section       

#agjc;,b ( title #ch1 ,unit$ ,/ates     
,code2 &  7,b7 ! maximum numb] ( days   
all[$ to complete ea* /ep ( su* process4
  7#c7 ,p]iodic revision  7,a7 ,9 g5]al 
,! ,secret>y may revise ! process &     
requirem5ts requir$ "u p>agraph 7#a7 z !
 ,secret>y consid]s necess>y4  7,b7     
,submittal to ,congress ,n lat] ?an #cj 
days be=e revis+ ! process & requirem5ts
 "u subp>agraph 7,a71 ! ,secret>y %all  
submit to ! ,committee on ,vet]ans'     
,affairs ( ! ,s5ate & ! ,committee on   
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives a description ( su*     
revis$ process & requirem5ts1 includ+ a 
description ( any modifications to !    
c]tification & tra9+ "u subsection 7b74 
7b7 ,c]tification & tra9+ on process &  
requirem5ts  7#a7 ,c]tification ,n lat] 
?an "o ye> aft] ! date ( ! enactm5t (   
?is ,act1 ! ,secret>y %all require      
individuals involv$ 9 ! s*$ul+ (        
appo9tm5ts = heal? c>e f ! ,dep>tm5t1   
includ+ s*$ul]s1 cl9ical coord9ators1 & 
sup]visors1 to c]tify to ! ,secret>y t !

 individual und]/&s ! process &         
requirem5ts e/abli%$ "u subsection 7a71 
includ+ ! maximum numb] ( days all[$ to 
complete ea* /ep ( su* process4  7#b7   
,new employees ,! ,secret>y %all require
 all employees hir$ by ! ,dep>tm5t on or
 aft] ! date ( ! enactm5t ( ?is ,act :o 
are to be involv$ 9 ! s*$ul+ (          
appo9tm5ts = heal? c>e f ! ,dep>tm5t--  
7,a7 to und]go tra9+ on ! process &     
requirem5ts e/abli%$ "u subsection 7a7 z
 "p ( tra9+ = ! position = :i* !y h be5 
hir$2 &  7,b7 to make ! c]tification to 
! ,secret>y requir$ "u p>agraph 7#a74   
7c7 ,me?od to monitor compliance  7#a7  
,9 g5]al ,n lat] ?an #ahj days aft] !   
date ( ! enactm5t ( ?is ,act1 !         
,secret>y %all e/abli% or ma9ta9 a me?od
 or tool-- 7,a7 to enable monitor+ ( !  
compliance ( ! ,dep>tm5t ) ! process &  
requirem5ts e/abli%$ "u subsection 7a71 
includ+ compliance ) policies ( !       
,dep>tm5t relat+ to ! maximum numb] (   
days all[$ to complete ea* /ep ( su*    
process2 &  7,b7 to ensure t ea* m$ical 

facility ( ! ,dep>tm5t complies ) su*   
process & requirem5ts4  7#b7 ,use       
?r\gh\t ,dep>tm5t  7,a7 ,9 g5]al ,!     
,secret>y %all require ea* m$ical       
facility ( ! ,dep>tm5t to use ! me?od or
 tool describ$ 9 p>agraph 7#a74  7,b7   
,report ,n lat] ?an "o ye> aft] ! date (
 ! enactm5t ( ?is ,act1 ! ,secret>y %all
 submit to ! ,committee on ,vet]ans'    
,affairs ( ! ,s5ate & ! ,committee on   
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives a report indicat+ :e!r  
ea* m$ical facility ( ! ,dep>tm5t is us+
 ! me?od or tool describ$ 9 p>agraph    
7#a74  7d7 ,comptroll] ,g5]al report ,n 
lat] ?an two ye>s aft] ! date ( !       
enactm5t ( ?is ,act1 ! ,comptroll]      
,g5]al ( ! ,unit$ ,/ates %all submit to 
! ,committee on ,vet]ans' ,affairs ( !  
,s5ate & ! ,committee on ,vet]ans'      
,affairs ( ! ,h\se ( ,repres5tatives a  
report on ! compliance ( ! ,secret>y ) !
 requirem5ts ( ?is section4  #c4 ,audits
 reg>d+ s*$ul+ ( appo9tm5ts & managem5t 
( consultations = heal? c>e f ,dep>tm5t 

( ,vet]ans ,affairs  7a7 ,9 g5]al ,n    
lat] ?an ea* ( "o ye> & two ye>s aft] ! 
date ( ! enactm5t ( ?is ,act1 !         
,secret>y ( ,vet]ans ,affairs %all      
provide = ! conduct ( a facility-level  
audit ( ! s*$ul+ ( appo9tm5ts & !       
managem5t ( consultations = heal? c>e "u
 ! laws adm9i/]$ by ! ,secret>y4  7b7   
,application  7#a7 ,fir/ audit ,! fir/  
audit requir$ "u subsection 7a7 %all    
apply to ea* m$ical facility ( !        
,dep>tm5t ( ,vet]ans ,affairs4  7#b7    
,second audit ,! second audit requir$ "u
 subsection 7a7 %all apply to only ^?   
m$ical facilities ( ! ,dep>tm5t t did n 
f>e well 9 ! fir/ audit & are 9 ne$ (   
corrective action1 z det]m9$ by !       
,secret>y4  7c7 ,elem5ts ,ea* audit     
conduct$ "u subsection 7a7 %all include 
! foll[+3 7#a7 ,) respect to ea* m$ical 
c5t] ( ! ,dep>tm5t cov]$ by ! audit1 an 
assessm5t ( any s*$ul+ or consultation  
managem5t issues at t m$ical c5t]1      
includ+ ! foll[+3 7,a7 ,an assessm5t (  
noncompliance ) policies ( ! ,vet]ans   

,heal? ,adm9i/ration relat+ to s*$ul+   
appo9tm5ts & manag+ consultations4  7,b7
 ,an assessm5t ( ! ext5t to :i*         
appo9tm5ts or consultations are n timely
 process$4  7,c7 ,a description ( any   
backlogs 9 appo9tm5ts or consultations t
 are await+ action4  7,d7 ,an assessm5t 
( :e!r consultations are appropriately  
process$4  7,e7 ,data ) respect to      
consultations z foll[s3 7i7             
,consultations t 7 s*$ul$ )9 ! reque/   
w9d[4  7ii7 ,duplicate consultation     
reque/s4  7iii7 ,consultations t 7      
discont9u$4  7iv7 ,delays 9             
consultations4  7v7 ,consultations t 7 n
 prop]ly clos$ or discont9u$1 includ+ a 
description ( rem$iation attempts4  7,f7
 ,a review = accuracy ) respect to      
consultation managem5t z foll[s3 7i7 ,a 
review ( ! accuracy ( ! type ( s]vice1  
ei!r adm9i/rative or cl9ical1 t is      
inputt$ 9 ! electronic heal? record4    
7ii7 ,a review ( ! accuracy ( ! type (  
consultation sett+1 ei!r impati5t or    
outpati5t1 t is inputt$ 9 ! electronic  

heal? record4  7iii7 ,a review ( !      
appropriat5ess ( ! level ( urg5cy ( !   
consultation t is inputt$ 9 ! electronic
 heal? record4  7iv7 ,a review ( any    
delay$ or unresolv$ consultations4  7#b7
 ,an id5tification ( su* recomm5dations 
= corrective action z ! ,secret>y       
consid]s necess>y1 includ+ additional   
tra9+1 increas$ p]sonnel1 & o!r         
res\rces4  7#c7 ,a c]tification t !     
director ( ea* m$ical c5t] ( ! ,dep>tm5t
 cov]$ by ! audit is 9 compliance ) !   
process & requirem5ts e/abli%$ "u       
section #b7;a7 & su* o!r requirem5ts    
relat+ to ! s*$ul+ ( appo9tm5ts &       
managem5t ( consultations z ! ,secret>y 
consid]s appropriate4  7#d7 ,) respect  
to ref]rals = heal? c>e betwe5 heal? c>e
 provid]s or facilities ( ! ,dep>tm5t1 a
 measurem5t (1 = ea* m$ical facility ( !
 ,dep>tm5t cov]$ by ! audit1 ! "t x     
takes f ! date t a cl9ician ( !         
,dep>tm5t det]m9es t a vet]an requires  
c>e f ano!r heal? c>e provid] or        
facility to ea* ( ! foll[+3 7,a7 ,! date

 t ! ref]ral = c>e is s5t to ! o!r heal?
 c>e provid] or facility4  7,b7 ,! date 
t ! o!r heal? c>e provid] or facility   
accepts ! ref]ral4  7,c7 ,! date t !    
appo9tm5t ) ! o!r heal? c>e provid] or  
at ! o!r facility is made4  7,d7 ,! date
 ( ! appo9tm5t ) ! o!r heal? c>e provid]
 or at ! o!r facility4  7,e7 ,any o!r   
/ep t ! ,secret>y det]m9es necess>y to  
measure4  7d7 ,conduct ( audit by ?ird  
p>ty ,ea* audit conduct$ "u subsection  
7a7 ) respect to a m$ical facility ( !  
,dep>tm5t %all be conduct$ by an        
individual or entity t is n affiliat$ ) 
! facility4  7e7 ,transmittal to ,,vha  
,ea* audit conduct$ "u subsection 7a7   
%all be transmitt$ to ! ,"u ,secret>y = 
,heal? ( ! ,dep>tm5t s t ! ,"u ,secret>y
 c-- 7#a7 /r5g!n ov]sight ( ! s*$ul+ (  
appo9tm5ts & managem5t ( consultations  
?r\gh\t ! ,dep>tm5t2  7#b7 monitor      
national policy on su* s*$ul+ &         
managem5t2 &  7#c7 develop a rem$iation 
plan to address issues uncov]$ by ^?    
audits4  7f7 ,annual report  7#a7 ,9    

g5]al ,n lat] ?an ,decemb] #ca ( ea* ye>
 9 :i* an audit is conduct$ "u          
subsection 7a71 ! ,secret>y %all submit 
to ! ,committee on ,vet]ans' ,affairs ( 
! ,s5ate & ! ,committee on ,vet]ans'    
,affairs ( ! ,h\se ( ,repres5tatives a  
report on ! audit conduct$ dur+ t ye>4  
7#b7 ,elem5ts ,! ,secret>y %all include 
9 ea* report requir$ by p>agraph 7#a7-- 
7,a7 a description ( ! audits conduct$  
"u subsection 7a7 ) respect to ea*      
facility ( ! ,dep>tm5t cov]$ by su*     
audits2  7,b7 an assessm5t ( h[ !       
,dep>tm5t /r5g!n$ ov]sight ( ! s*$ul+ ( 
appo9tm5ts & managem5t ( consultations  
at t facility z a result ( ^? audits2   
7,c7 an assessm5t ( h[ ^? audits in=m$ !
 national policy ( ! ,dep>tm5t ) respect
 to ! s*$ul+ ( appo9tm5ts & managem5t ( 
consultations2 &  7,d7 a description (  
any rem$iation plans to address issues  
rais$ by ^? audits t 7 complet$4  #d4   
,adm9i/ration ( non-,dep>tm5t ( ,vet]ans
 ,affairs heal? c>e  7a7 ,c]tification (
 prop] adm9i/ration ( non-,dep>tm5t c>e 

7#a7 ,review  7,a7 ,9 g5]al ,! ,secret>y
 ( ,vet]ans ,affairs %all conduct a     
review ( ! /aff+1 tra9+1 & o!r          
requirem5ts necess>y to adm9i/] section 
#agjc ( title #ch1 ,unit$ ,/ates ,code4 
7,b7 ,elem5ts ,! review conduct$ "u     
subp>agraph 7,a7 %all include1 ) respect
 to ea* m$ical facility ( ! ,dep>tm5t-- 
7i7 an assessm5t ( ! type ( positions   
requir$ to be /aff$ at ! m$ical         
facility2  7ii7 ! numb] ( su* positions 
au?oriz$2  7iii7 ! numb] ( su* positions
 fill$2 &  7iv7 ! numb] ( additional su*
 positions requir$ to be au?oriz$4  7#b7
 ,submittal to ,congress ,n lat] ?an    
#ahj days aft] ! date ( ! enactm5t ( ?is
 ,act1 & e #ahj days !reaft]1 !         
,secret>y %all submit to ! ,committee on
 ,vet]ans' ,affairs ( ! ,s5ate & !      
,committee on ,vet]ans' ,affairs ( !    
,h\se ( ,repres5tatives-- 7,a7 ! results
 ( ! review conduct$ "u p>agraph 7#a72 &
  7,b7 a c]tification t ! ,secret>y has 
e/abli%$ all /aff+1 tra9+1 & o!r        
requirem5ts requir$ to be review$ "u su*

 p>agraph4  7b7 ,s*$ul+ ( appo9tm5ts    
7#a7 ,9 g5]al ,! ,secret>y %all be      
responsible = ensur+ t appo9tm5ts =     
heal? c>e f non-,dep>tm5t ( ,vet]ans    
,affairs heal? c>e provid]s "u section  
#agjc ( title #ch1 ,unit$ ,/ates ,code1 
are s*$ul$4  7#b7 ,timel9ess goals ,n   
lat] ?an #cj days aft] ! date ( !       
enactm5t ( ?is ,act1 ! ,secret>y %all   
e/abli% timel9ess goals = ea* /ep 9     
s*$ul+ an appo9tm5t = heal? c>e f a     
non-,dep>tm5t heal? c>e provid] set =?  
"u subp>agraphs 7,a7 ?r\gh 7,f7 (       
p>agraph 7#c74  7#c7 ,measurem5t (      
timel9ess = ea* facility ,n lat] ?an    
#abj days aft] ! date ( ! enactm5t ( ?is
 ,act1 ! ,secret>y %all measure1 = ea*  
m$ical facility ( ! ,dep>tm5t1 ! "t x   
takes f ! date t a cl9ician ( !         
,dep>tm5t det]m9es t a vet]an requires  
c>e1 or a vet]an pres5ts to ! ,dep>tm5t 
reque/+ c>e1 f a non-,dep>tm5t heal? c>e
 provid] to ea* ( ! foll[+3 7,a7 ,! date
 t ! ref]ral = c>e is s5t to a          
non-,dep>tm5t heal? c>e provid]4  7,b7  

,! date t a non-,dep>tm5t heal? c>e     
provid] accepts ! ref]ral4  7,c7 ,! date
 t ! ref]ral to a non-,dep>tm5t heal?   
c>e provid] is complet$4  7,d7 ,! date t
 an appo9tm5t ) a non-,dep>tm5t heal?   
c>e provid] is made4  7,e7 ,! date t an 
appo9tm5t ) a non-,dep>tm5t heal? c>e   
provid] occurs4  7,f7 ,any o!r /ep t !  
,secret>y det]m9es necess>y to measure4 
7#d7 ,publication ( data  7,a7 ,9 g5]al 
,n lat] ?an "o ye> aft] ! date ( !      
enactm5t ( ?is ,act1 ! ,secret>y %all   
publi% ! data measur$ "u p>agraph 7#c71 
disaggregat$ by m$ical facility1 on a   
publicly available website ( !          
,dep>tm5t4  7,b7 ,update ,n less        
frequ5tly ?an biweekly1 ! ,secret>y %all
 update ! data publi%$ "u subp>agraph   
7,a74  7#e7 ,me?od ,to monitor          
compliance ,n lat] ?an #ahj days aft] ! 
date ( ! enactm5t ( ?is ,act1 !         
,secret>y %all e/abli% or ma9ta9 a me?od
 or tool-- 7,a7 to enable monitor+ (    
compliance by ea* m$ical facility ( !   
,dep>tm5t ) ! timel9ess goals e/abli%$  

"u p>agraph 7#b72 &  7,b7 to ensure t   
ea* m$ical facility ( ! ,dep>tm5t       
complies su* timel9ess goals4  7c7      
,comptroll] ,g5]al report  7#a7 ,review 
,beg9n+ n lat] ?an "o ye> aft] ! date ( 
! enactm5t ( ?is ,act1 ! ,comptroll]    
,g5]al ( ! ,unit$ ,/ates %all review    
compliance by ! ,secret>y ) !           
requirem5ts ( ?is section1 includ+ a    
review ( ! validity & reliability ( data
 publi%$ by ! ,secret>y "u subsection   
7b77#d74  7#b7 ,report ,n lat] ?an ?ree 
ye>s aft] ! date ( ! enactm5t ( ?is     
,act1 ! ,comptroll] ,g5]al %all submit  
to ! ,committee on ,vet]ans' ,affairs ( 
! ,s5ate & ! ,committee on ,vet]ans'    
,affairs ( ! ,h\se ( ,repres5tatives !  
results ( ! review conduct$ "u p>agraph 
7#a74  #e4 ,exam9ation ( heal? c>e      
consultation & s*$ul+ positions (       
,dep>tm5t ( ,vet]ans ,affairs  7a7      
,prop] grad+ ( consultation & s*$ul+    
positions  7#a7 ,9 g5]al ,! ,secret>y ( 
,vet]ans ,affairs %all conduct an       
exam9ation ( heal? c>e positions ( !    

,dep>tm5t ( ,vet]ans ,affairs to det]m9e
 :e!r heal? c>e positions involv$ 9 !   
consultation & s*$ul+ processes are     
appropriately grad$4  7#b7 ,consultation
 ,9 conduct+ ! exam9ation "u p>agraph   
7#a71 ! ,secret>y %all consult ) heal?  
c>e /aff+ exp]ts 9 ! ,f$]al ,gov]nm5t & 
! private sector4  7#c7 ,submittal to   
,congress ,n lat] ?an #abj days aft] !  
date ( ! enactm5t ( ?is ,act1 !         
,secret>y %all submit to ! appropriate  
committees ( ,congress ! results ( !    
exam9ation conduct$ "u p>agraph 7#a74   
7b7 ,review ( onbo>d+ process ,n lat]   
?an #ahj days aft] ! date ( ! enactm5t (
 ?is ,act1 ! ,secret>y %all submit to ! 
appropriate committees ( ,congress--    
7#a7 a review ( ! onbo>d+ process (     
individuals 9 heal? c>e positions       
describ$ 9 subsection 7a71 includ+ h[   
long x takes to hire ^? individuals2 &  
7#b7 a description ( any *anges t !     
,secret>y has made or plans to make to  
improve t process4  7c7 ,appropriate    
committees ( ,congress def9$ ,9 ?is     

section1 ! t]m appropriate committees ( 
,congress means-- 7#a7 ! ,committee on  
,vet]ans' ,affairs & ! ,committee on    
,appropriations ( ! ,s5ate2 &  7#b7 !   
,committee on ,vet]ans' ,affairs & !    
,committee on ,appropriations ( ! ,h\se 
( ,repres5tatives4  ,septemb] #ae1      
#bjbj,report$ ) an am5dm5t