[House Report 113-564]
[From the U.S. Government Publishing Office]
113th Congress } { Report
2d Session } HOUSE OF REPRESENTATIVES { 113-564
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VETERANS ACCESS, CHOICE, AND ACCOUNTABILITY ACT OF 2014
_______
July 28, 2014.--Ordered to be printed
_______
Mr. Miller of Florida, from the committee of conference, submitted the
following
CONFERENCE REPORT
[To accompany H.R. 3230]
The committee of conference on the disagreeing votes of
the two Houses on the amendment of the House to the amendment
of the Senate to the bill (H.R. 3230), making continuing
appropriations during a Government shutdown to provide pay and
allowances to members of the reserve components of the Armed
Forces who perform inactive-duty training during such period,
having met, after full and free conference, have agreed to
recommend and do recommend to their respective Houses as
follows:
That the Senate recede from its disagreement to the
amendment of the House and agree to the same with an amendment
as follows:
In lieu of the matter proposed to be inserted by the
House amendment, insert the following:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Veterans
Access, Choice, and Accountability Act of 2014''.
(b) Table of Contents.--The table of contents for this Act
is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
TITLE I--IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT OF VETERANS
AFFAIRS PROVIDERS
Sec. 101. Expanded availability of hospital care and medical services
for veterans through the use of agreements with non-Department
of Veterans Affairs entities.
Sec. 102. Enhancement of collaboration between Department of Veterans
Affairs and Indian Health Service.
Sec. 103. Enhancement of collaboration between Department of Veterans
Affairs and Native Hawaiian health care systems.
Sec. 104. Reauthorization and modification of pilot program of enhanced
contract care authority for health care needs of veterans.
Sec. 105. Prompt payment by Department of Veterans Affairs.
Sec. 106. Transfer of authority for payments for hospital care, medical
services, and other health care from non-Department of
Veterans Affairs providers to the chief business office of the
Veterans Health Administration.
TITLE II--HEALTH CARE ADMINISTRATIVE MATTERS
Sec. 201. Independent assessment of the health care delivery systems and
management processes of the Department of Veterans Affairs.
Sec. 202. Commission on Care.
Sec. 203. Technology task force on review of scheduling system and
software of the Department of Veterans Affairs.
Sec. 204. Improvement of access of veterans to mobile vet centers and
mobile medical centers of the Department of Veterans Affairs.
Sec. 205. Improved performance metrics for health care provided by
Department of Veterans Affairs.
Sec. 206. Improved transparency concerning health care provided by
Department of Veterans Affairs.
Sec. 207. Information for veterans on the credentials of Department of
Veterans Affairs physicians.
Sec. 208. Information in annual budget of the President on hospital care
and medical services furnished through expanded use of
contracts for such care.
Sec. 209. Prohibition on falsification of data concerning wait times and
quality measures at Department of Veterans Affairs.
TITLE III--HEALTH CARE STAFFING, RECRUITMENT, AND TRAINING MATTERS
Sec. 301. Treatment of staffing shortage and biennial report on staffing
of medical facilities of the Department of Veterans Affairs.
Sec. 302. Extension and modification of certain programs within the
Department of Veterans Affairs Health Professionals
Educational Assistance Program.
Sec. 303. Clinic management training for employees at medical facilities
of the Department of Veterans Affairs.
TITLE IV--HEALTH CARE RELATED TO SEXUAL TRAUMA
Sec. 401. Expansion of eligibility for sexual trauma counseling and
treatment to veterans on inactive duty training.
Sec. 402. Provision of counseling and treatment for sexual trauma by the
Department of Veterans Affairs to members of the Armed Forces.
Sec. 403. Reports on military sexual trauma.
TITLE V--OTHER HEALTH CARE MATTERS
Sec. 501. Extension of pilot program on assisted living services for
veterans with traumatic brain injury.
TITLE VI--MAJOR MEDICAL FACILITY LEASES
Sec. 601. Authorization of major medical facility leases.
Sec. 602. Budgetary treatment of Department of Veterans Affairs major
medical facilities leases.
TITLE VII--OTHER VETERANS MATTERS
Sec. 701. Expansion of Marine Gunnery Sergeant John David Fry
Scholarship.
Sec. 702. Approval of courses of education provided by public
institutions of higher learning for purposes of All-Volunteer
Force Educational Assistance Program and Post-9/11 Educational
Assistance conditional on in-State tuition rate for veterans.
Sec. 703. 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.
Sec. 704. Extension of requirement for collection of fees for housing
loans guaranteed by Secretary of Veterans Affairs.
Sec. 705. Limitation on awards and bonuses paid to employees of
Department of Veterans Affairs.
Sec. 706. Extension of authority to use income information.
Sec. 707. Removal of senior executives of the Department of Veterans
Affairs for performance or misconduct.
TITLE VIII--OTHER MATTERS
Sec. 801. Appropriation of amounts.
Sec. 802. Veterans Choice Fund.
Sec. 803. Emergency designations.
SEC. 2. DEFINITIONS.
In this Act:
(1) The term ``facility of the Department'' has the
meaning given the term ``facilities of the Department''
in section 1701 of title 38, United States Code.
(2) The terms ``hospital care'' and ``medical
services'' have the meanings given such terms in
section 1701 of title 38, United States Code.
TITLE I--IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT OF VETERANS
AFFAIRS PROVIDERS
SEC. 101. EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL SERVICES
FOR VETERANS THROUGH THE USE OF AGREEMENTS WITH
NON-DEPARTMENT OF VETERANS AFFAIRS ENTITIES.
(a) Expansion of Available Care and Services.--
(1) Furnishing of care.--
(A) In general.--Hospital care and medical
services under chapter 17 of title 38, United
States Code, shall be furnished to an eligible
veteran described in subsection (b), at the
election of such veteran, through agreements
authorized under subsection (d), or any other
law administered by the Secretary of Veterans
Affairs, with entities specified in
subparagraph (B) for the furnishing of such
care and services to veterans.
(B) Entities specified.--The entities
specified in this subparagraph are the
following:
(i) Any health care provider that
is participating in the Medicare
program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.).
(ii) Any Federally-qualified health
center (as defined in section
1905(l)(2)(B) of the Social Security
Act (42 U.S.C. 1396d(l)(2)(B))).
(iii) The Department of Defense.
(iv) The Indian Health Service.
(2) Choice of provider.--An eligible veteran who
makes an election under subsection (c) to receive
hospital care or medical services under this section
may select a provider of such care or services from
among the entities specified in paragraph (1)(B) that
are accessible to the veteran.
(3) Coordination of care and services.--The
Secretary shall coordinate, through the Non-VA Care
Coordination Program of the Department of Veterans
Affairs, the furnishing of care and services under this
section to eligible veterans, including by ensuring
that an eligible veteran receives an appointment for
such care and services within the wait-time goals of
the Veterans Health Administration for the furnishing
of hospital care and medical services.
(b) Eligible Veterans.--A veteran is an eligible veteran
for purposes of this section if--
(1)(A) as of August 1, 2014, the veteran is
enrolled in the patient enrollment system of the
Department of Veterans Affairs established and operated
under section 1705 of title 38, United States Code,
including any such veteran who has not received
hospital care or medical services from the Department
and has contacted the Department seeking an initial
appointment from the Department for the receipt of such
care or services; or
(B) the veteran is eligible for hospital care and
medical services under section 1710(e)(1)(D) of such
title and is a veteran described in section 1710(e)(3)
of such title; and
(2) the veteran--
(A) attempts, or has attempted, to schedule
an appointment for the receipt of hospital care
or medical services under chapter 17 of title
38, United States Code, but is unable to
schedule an appointment within the wait-time
goals of the Veterans Health Administration for
the furnishing of such care or services;
(B) resides more than 40 miles from the
medical facility of the Department, including a
community-based outpatient clinic, that is
closest to the residence of the veteran;
(C) resides--
(i) in a State without a medical
facility of the Department that
provides--
(I) hospital care;
(II) emergency medical
services; and
(III) surgical care rated
by the Secretary as having a
surgical complexity of
standard; and
(ii) more than 20 miles from a
medical facility of the Department
described in clause (i); or
(D)(i) resides in a location, other than a
location in Guam, American Samoa, or the
Republic of the Philippines, that is 40 miles
or less from a medical facility of the
Department, including a community-based
outpatient clinic; and
(ii)(I) is required to travel by air, boat,
or ferry to reach each medical facility
described in clause (i) that is 40 miles or
less from the residence of the veteran; or
(II) faces an unusual or excessive burden
in accessing each medical facility described in
clause (i) that is 40 miles or less from the
residence of the veteran due to geographical
challenges, as determined by the Secretary.
(c) Election and Authorization.--
(1) In general.--In the case of an eligible veteran
described in subsection (b)(2)(A), the Secretary shall,
at the election of the eligible veteran--
(A) place such eligible veteran on an
electronic waiting list described in paragraph
(2) for an appointment for hospital care or
medical services the veteran has elected to
receive under this section; or
(B)(i) authorize that such care or services
be furnished to the eligible veteran under this
section for a period of time specified by the
Secretary; and
(ii) notify the eligible veteran by the
most effective means available, including
electronic communication or notification in
writing, describing the care or services the
eligible veteran is eligible to receive under
this section.
(2) Electronic waiting list.--The electronic
waiting list described in this paragraph shall be
maintained by the Department and allow access by each
eligible veteran via www.myhealth.va.gov or any
successor website for the following purposes:
(A) To determine the place of such eligible
veteran on the waiting list.
(B) To determine the average length of time
an individual spends on the waiting list,
disaggregated by medical facility of the
Department and type of care or service needed,
for purposes of allowing such eligible veteran
to make an informed election under paragraph
(1).
(d) Care and Services Through Agreements.--
(1) Agreements.--
(A) In general.--The Secretary shall enter
into agreements for furnishing care and
services to eligible veterans under this
section with entities specified in subsection
(a)(1)(B).
(B) Agreement defined.--In this paragraph,
the term ``agreement'' includes contracts,
intergovernmental agreements, and provider
agreements, as appropriate.
(2) Rates and reimbursement.--
(A) In general.--In entering into an
agreement under paragraph (1) with an entity
specified in subsection (a)(1)(B), the
Secretary shall--
(i) negotiate rates for the
furnishing of care and services under
this section; and
(ii) reimburse the entity for such
care and services at the rates
negotiated pursuant to clause (i) as
provided in such agreement.
(B) Limit on rates.--
(i) In general.--Except as provided
in clause (ii), rates negotiated under
subparagraph (A)(i) shall not be more
than the rates paid by the United
States to a provider of services (as
defined in section 1861(u) of the
Social Security Act (42 U.S.C.
1395x(u))) or a supplier (as defined in
section 1861(d) of such Act (42 U.S.C.
1395x(d))) under the Medicare program
under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.)
for the same care or services.
(ii) Exception.--
(I) In general.--The
Secretary may negotiate a rate
that is more than the rate paid
by the United States as
described in clause (i) with
respect to the furnishing of
care or services under this
section to an eligible veteran
who resides in a highly rural
area.
(II) Highly rural area
defined.--In this clause, the
term ``highly rural area''
means an area located in a
county that has fewer than
seven individuals residing in
that county per square mile.
(C) Limit on collection.--For the
furnishing of care or services pursuant to an
agreement under paragraph (1), an entity
specified in subsection (a)(1)(B) may not
collect any amount that is greater than the
rate negotiated pursuant to subparagraph
(A)(i).
(3) Certain procedures.--
(A) In general.--In entering into an
agreement under paragraph (1) with an entity
described in subparagraph (B), the Secretary
may use the procedures, including those
procedures relating to reimbursement, available
for entering into provider agreements under
section 1866(a) of the Social Security Act (42
U.S.C. 1395cc(a)). During the period in which
such entity furnishes care or services pursuant
to this section, such entity may not be treated
as a Federal contractor or subcontractor by the
Office of Federal Contract Compliance Programs
of the Department of Labor by virtue of
furnishing such care or services.
(B) Entities described.--The entities
described in this subparagraph are the
following:
(i) In the case of the Medicare
program, any provider of service that
has entered into a provider agreement
under section 1866(a) of the Social
Security Act (42 U.S.C. 1395cc(a)); and
(ii) In the case of the Medicaid
program, any provider participating
under a State plan under title XIX of
such Act (42 U.S.C. 1396 et seq.).
(4) Information on policies and procedures.--The
Secretary shall provide to any entity with which the
Secretary has entered into an agreement under paragraph
(1) the following:
(A) Information on applicable policies and
procedures for submitting bills or claims for
authorized care or services furnished to
eligible veterans under this section.
(B) Access to a telephone hotline
maintained by the Department that such entity
may call for information on the following:
(i) Procedures for furnishing care
and services under this section.
(ii) Procedures for submitting
bills or claims for authorized care and
services furnished to eligible veterans
under this section and being reimbursed
for furnishing such care and services.
(iii) Whether particular care or
services under this section are
authorized, and the procedures for
authorization of such care or services.
(e) Other Health-care Plan.--
(1) Submittal of information to secretary.--Before
receiving hospital care or medical services under this
section, an eligible veteran shall provide to the
Secretary information on any health-care plan described
in paragraph (4) under which the eligible veteran is
covered.
(2) Disclosure of information to non-department
entity.--Notwithstanding section 5701 of title 38,
United States Code, for purposes of furnishing hospital
care or medical services to an eligible veteran under
this section, the Secretary shall disclose to the
entity specified in paragraph (1)(B) of subsection (a)
with which the Secretary has entered into an agreement
described in such subsection--
(A) whether the eligible veteran is covered
under a health-care plan described in paragraph
(4); and
(B) whether the hospital care or medical
services sought by the eligible veteran is for
a medical condition that is related to a non-
service-connected disability described in
paragraph (3)(C).
(3) Care for which the department is secondarily
responsible.--
(A) In general.--If an eligible veteran is
covered under a health-care plan described in
paragraph (4) and receives hospital care or
medical services for a non-service-connected
disability described in subparagraph (C), such
health-care plan shall be primarily responsible
for paying for such care or services, to the
extent such care or services is covered by such
health-care plan, and the Secretary shall be
secondarily responsible for paying for such
care or services in accordance with
subparagraph (B)(ii).
(B) Responsibility for costs of care.--In a
case in which the Secretary is secondarily
responsible for paying for hospital care or
medical services as described in subparagraph
(A)--
(i) the health care provider that
furnishes such care or services
pursuant to an agreement described in
subsection (a) shall be responsible for
seeking reimbursement for the cost of
such care or services from the health-
care plan described in paragraph (4)
under which the eligible veteran is
covered; and
(ii) the Secretary shall be
responsible for promptly paying only
the amount that is not covered by such
health-care plan, except that such
responsibility for payment may not
exceed the rate determined for such
care or services pursuant to subsection
(d)(2).
(C) Non-service-connected disability
described.--A non-service-connected disability
described in this subsection is a non-service-
connected disability (as defined in section 101
of title 38, United States Code)--
(i) that is incurred incident to a
veteran's employment and that is
covered under a workers' compensation
law or plan that provides for payment
for the cost of health care and
services provided to the veteran by
reason of the disability;
(ii) that is incurred as the result
of a motor vehicle accident to which
applies a State law that requires the
owners or operators of motor vehicles
registered in that State to have in
force automobile accident reparations
insurance;
(iii) that is incurred as the
result of a crime of personal violence
that occurred in a State, or a
political subdivision of a State, in
which a person injured as the result of
such a crime is entitled to receive
health care and services at such
State's or subdivision's expense for
personal injuries suffered as the
result of such crime;
(iv) that is incurred by a
veteran--
(I) who does not have a
service-connected disability;
and
(II) who is entitled to
care (or payment of the
expenses of care) under a
health-care plan; or
(v) for which care and services are
furnished under this section to a
veteran who--
(I) has a service-connected
disability; and
(II) is entitled to care
(or payment of the expenses of
care) under a health-care plan.
(4) Health-care plan.--A health-care plan described
in this paragraph--
(A) is an insurance policy or contract,
medical or hospital service agreement,
membership or subscription contract, or similar
arrangement not administered by the Secretary
of Veterans Affairs, under which health
services for individuals are provided or the
expenses of such services are paid; and
(B) does not include any such policy,
contract, agreement, or similar arrangement
pursuant to title XVIII or XIX of the Social
Security Act (42 U.S.C. 1395 et seq.) or
chapter 55 of title 10, United States Code.
(f) Veterans Choice Card.--
(1) In general.--For purposes of receiving care and
services under this section, the Secretary shall, not
later than 90 days after the date of the enactment of
this Act, issue to each veteran described in subsection
(b)(1) a card that may be presented to a health care
provider to facilitate the receipt of care or services
under this section.
(2) Name of card.--Each card issued under paragraph
(1) shall be known as a ``Veterans Choice Card''.
(3) Details of card.--Each Veterans Choice Card
issued to a veteran under paragraph (1) shall include
the following:
(A) The name of the veteran.
(B) An identification number for the
veteran that is not the social security number
of the veteran.
(C) The contact information of an
appropriate office of the Department for health
care providers to confirm that care or services
under this section are authorized for the
veteran.
(D) Contact information and other relevant
information for the submittal of claims or
bills for the furnishing of care or services
under this section.
(E) The following statement: ``This card is
for qualifying medical care outside the
Department of Veterans Affairs. Please call the
Department of Veterans Affairs phone number
specified on this card to ensure that treatment
has been authorized.''.
(4) Information on use of card.--Upon issuing a
Veterans Choice Card to a veteran, the Secretary shall
provide the veteran with information clearly stating
the circumstances under which the veteran may be
eligible for care or services under this section.
(g) Information on Availability of Care.--The Secretary
shall provide information to a veteran about the availability
of care and services under this section in the following
circumstances:
(1) In the case of a veteran described in
subsection (b)(1)(B), when the veteran enrolls in the
patient enrollment system of the Department under
section 1705 of title 38, United States Code.
(2) When the veteran attempts to schedule an
appointment for the receipt of hospital care or medical
services from the Department but is unable to schedule
an appointment within the wait-time goals of the
Veterans Health Administration for the furnishing of
such care or services.
(3) When the veteran becomes eligible for hospital
care or medical services under this section under
subparagraph (B), (C), or (D) of subsection (b)(2).
(h) Follow-Up Care.--In carrying out this section, the
Secretary shall ensure that, at the election of an eligible
veteran who receives hospital care or medical services from a
health care provider in an episode of care under this section,
the veteran receives such hospital care and medical services
from such health care provider through the completion of the
episode of care (but for a period not exceeding 60 days),
including all specialty and ancillary services deemed necessary
as part of the treatment recommended in the course of such
hospital care or medical services.
(i) Providers.--To be eligible to furnish care or services
under this section, a health care provider must--
(1) maintain at least the same or similar
credentials and licenses as those credentials and
licenses that are required of health care providers of
the Department, as determined by the Secretary for
purposes of this section; and
(2) submit, not less frequently than once each year
during the period in which the Secretary is authorized
to carry out this section pursuant to subsection (p),
verification of such licenses and credentials
maintained by such health care provider.
(j) Cost-sharing.--
(1) In general.--The Secretary shall require an
eligible veteran to pay a copayment for the receipt of
care or services under this section only if such
eligible veteran would be required to pay a copayment
for the receipt of such care or services at a medical
facility of the Department or from a health care
provider of the Department pursuant to chapter 17 of
title 38, United States Code.
(2) Limitation.--The amount of a copayment charged
under paragraph (1) may not exceed the amount of the
copayment that would be payable by such eligible
veteran for the receipt of such care or services at a
medical facility of the Department or from a health
care provider of the Department pursuant to chapter 17
of title 38, United States Code.
(3) Collection of copayment.--A health care
provider that furnishes care or services to an eligible
veteran under this section shall collect the copayment
required under paragraph (1) from such eligible veteran
at the time of furnishing such care or services.
(k) Claims Processing System.--
(1) In general.--The Secretary shall provide for an
efficient nationwide system for processing and paying
bills or claims for authorized care and services
furnished to eligible veterans under this section.
(2) Regulations.--Not later than 90 days after the
date of the enactment of this Act, the Secretary of
Veterans Affairs shall prescribe regulations for the
implementation of such system.
(3) Oversight.--The Chief Business Office of the
Veterans Health Administration shall oversee the
implementation and maintenance of such system.
(4) Accuracy of payment.--
(A) In general.--The Secretary shall ensure
that such system meets such goals for accuracy
of payment as the Secretary shall specify for
purposes of this section.
(B) Quarterly report.--
(i) In general.--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 quarterly
report on the accuracy of such system.
(ii) Elements.--Each report
required by clause (i) shall include
the following:
(I) A description of the
goals for accuracy for such
system specified by the
Secretary under subparagraph
(A).
(II) An assessment of the
success of the Department in
meeting such goals during the
quarter covered by the report.
(iii) Deadline.--The Secretary
shall submit each report required by
clause (i) not later than 20 days after
the end of the quarter covered by the
report.
(l) Medical Records.--
(1) In general.--The Secretary shall ensure that
any health care provider that furnishes care or
services under this section to an eligible veteran
submits to the Department any medical record related to
the care or services provided to such eligible veteran
by such health care provider for inclusion in the
electronic medical record of such eligible veteran
maintained by the Department upon the completion of the
provision of such care or services to such eligible
veteran.
(2) Electronic format.--Any medical record
submitted to the Department under paragraph (1) shall,
to the extent possible, be in an electronic format.
(m) Tracking of Missed Appointments.--The Secretary shall
implement a mechanism to track any missed appointments for care
or services under this section by eligible veterans to ensure
that the Department does not pay for such care or services that
were not furnished to an eligible veteran.
(n) Implementation.--Not later than 90 days after the date
of the enactment of this Act, the Secretary shall prescribe
interim final regulations on the implementation of this section
and publish such regulations in the Federal Register.
(o) Inspector General Report.--Not later than 30 days after
the date on which the Secretary determines that 75 percent of
the amounts deposited in the Veterans Choice Fund established
by section 802 have been exhausted, the Inspector General of
the Department shall submit to the Secretary a report on the
results of an audit of the care and services furnished under
this section to ensure the accuracy and timeliness of payments
by the Department for the cost of such care and services,
including any findings and recommendations of the Inspector
General.
(p) Authority to Furnish Care and Services.--
(1) In general.--The Secretary may not use the
authority under this section to furnish care and
services after the date specified in paragraph (2).
(2) Date specified.--The date specified in this
paragraph is the date on which the Secretary has
exhausted all amounts deposited in the Veterans Choice
Fund established by section 802, or the date that is
three years after the date of the enactment of this
Act, whichever occurs first.
(3) Publication.--The Secretary shall publish such
date in the Federal Register and on an Internet website
of the Department available to the public not later
than 30 days before such date.
(q) Reports.--
(1) Initial report.--Not later than 90 days after
the publication of the interim final regulations under
subsection (n), 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 furnishing of care and
services under this section that includes the
following:
(A) The number of eligible veterans who
have received care or services under this
section.
(B) A description of the types of care and
services furnished to eligible veterans under
this section.
(2) Final report.--Not later than 30 days after the
date on which the Secretary determines that 75 percent
of the amounts deposited in the Veterans Choice Fund
established by section 802 have been exhausted, 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
furnishing of care and services under this section that
includes the following:
(A) The total number of eligible veterans
who have received care or services under this
section, disaggregated by--
(i) eligible veterans described in
subsection (b)(2)(A);
(ii) eligible veterans described in
subsection (b)(2)(B);
(iii) eligible veterans described
in subsection (b)(2)(C); and
(iv) eligible veterans described in
subsection (b)(2)(D).
(B) A description of the types of care and
services furnished to eligible veterans under
this section.
(C) An accounting of the total cost of
furnishing care and services to eligible
veterans under this section.
(D) The results of a survey of eligible
veterans who have received care or services
under this section on the satisfaction of such
eligible veterans with the care or services
received by such eligible veterans under this
section.
(E) An assessment of the effect of
furnishing care and services under this section
on wait times for appointments for the receipt
of hospital care and medical services from the
Department.
(F) An assessment of the feasibility and
advisability of continuing furnishing care and
services under this section after the
termination date specified in subsection (p).
(r) Rule of Construction.--Nothing in this section shall be
construed to alter the process of the Department for filling
and paying for prescription medications.
(s) Wait-time Goals of the Veterans Health
Administration.--
(1) In general.--Except as provided in paragraph
(2), in this section, the term ``wait-time goals of the
Veterans Health Administration'' means not more than 30
days from the date on which a veteran requests an
appointment for hospital care or medical services from
the Department.
(2) Alternate goals.--If the Secretary submits to
Congress, not later than 60 days after the date of the
enactment of this Act, a report stating that the actual
wait-time goals of the Veterans Health Administration
are different from the wait-time goals specified in
paragraph (1)--
(A) for purposes of this section, the wait-
time goals of the Veterans Health
Administration shall be the wait-time goals
submitted by the Secretary under this
paragraph; and
(B) the Secretary shall publish such wait-
time goals in the Federal Register and on an
Internet website of the Department available to
the public.
SEC. 102. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF VETERANS
AFFAIRS AND INDIAN HEALTH SERVICE.
(a) Outreach to Tribal-Run Medical Facilities.--The
Secretary of Veterans Affairs shall, in consultation with the
Director of the Indian Health Service, conduct outreach to each
medical facility operated by an Indian tribe or tribal
organization through a contract or compact with the Indian
Health Service under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.) to raise
awareness of the ability of such facilities, Indian tribes, and
tribal organizations to enter into agreements with the
Department of Veterans Affairs under which the Secretary
reimburses such facilities, Indian tribes, or tribal
organizations, as the case may be, for health care provided to
veterans who are--
(1) eligible for health care at such facilities;
and
(2)(A) enrolled in the patient enrollment system of
the Department established and operated under section
1705 of title 38, United States Code; or
(B) eligible for hospital care and medical services
pursuant to subsection (c)(2) of such section.
(b) Performance Metrics for Memorandum of Understanding.--
The Secretary of Veterans Affairs shall establish performance
metrics for assessing the performance by the Department of
Veterans Affairs and the Indian Health Service under the
memorandum of understanding entitled ``Memorandum of
Understanding between the Department of Veterans Affairs (VA)
and the Indian Health Service (IHS)'' in increasing access to
health care, improving quality and coordination of health care,
promoting effective patient-centered collaboration and
partnerships between the Department and the Service, and
ensuring health-promotion and disease-prevention services are
appropriately funded and available for beneficiaries under both
health care systems.
(c) Report.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs and
the Director of the Indian Health Service shall jointly submit
to Congress a report on the feasibility and advisability of the
following:
(1) Entering into agreements for the reimbursement
by the Secretary of the costs of direct care services
provided through organizations receiving amounts
pursuant to grants made or contracts entered into under
section 503 of the Indian Health Care Improvement Act
(25 U.S.C. 1653) to veterans who are otherwise eligible
to receive health care from such organizations.
(2) Including the reimbursement of the costs of
direct care services provided to veterans who are not
Indians in agreements between the Department and the
following:
(A) The Indian Health Service.
(B) An Indian tribe or tribal organization
operating a medical facility through a contract
or compact with the Indian Health Service under
the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.).
(C) A medical facility of the Indian Health
Service.
(d) Definitions.--In this section:
(1) Indian.--The terms ``Indian'' and ``Indian
tribe'' have the meanings given those terms in section
4 of the Indian Health Care Improvement Act (25 U.S.C.
1603).
(2) Medical facility of the indian health
service.--The term ``medical facility of the Indian
Health Service'' includes a facility operated by an
Indian tribe or tribal organization through a contract
or compact with the Indian Health Service under the
Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.).
(3) Tribal organization.--The term ``tribal
organization'' has the meaning given the term in
section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450b).
SEC. 103. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF VETERANS
AFFAIRS AND NATIVE HAWAIIAN HEALTH CARE SYSTEMS.
(a) In General.--The Secretary of Veterans Affairs shall,
in consultation with Papa Ola Lokahi and such other
organizations involved in the delivery of health care to Native
Hawaiians as the Secretary considers appropriate, enter into
contracts or agreements with Native Hawaiian health care
systems that are in receipt of funds from the Secretary of
Health and Human Services pursuant to grants awarded or
contracts entered into under section 6(a) of the Native
Hawaiian Health Care Improvement Act (42 U.S.C. 11705(a)) for
the reimbursement of direct care services provided to eligible
veterans as specified in such contracts or agreements.
(b) Definitions.--In this section, the terms ``Native
Hawaiian'', ``Native Hawaiian health care system'', and ``Papa
Ola Lokahi'' have the meanings given those terms in section 12
of the Native Hawaiian Health Care Improvement Act (42 U.S.C.
11711).
SEC. 104. REAUTHORIZATION AND MODIFICATION OF PILOT PROGRAM OF ENHANCED
CONTRACT CARE AUTHORITY FOR HEALTH CARE NEEDS OF
VETERANS.
Section 403 of the Veterans' Mental Health and Other Care
Improvements Act of 2008 (Public Law 110-387; 38 U.S.C. 1703
note) is amended--
(1) in subsection (a)--
(A) in paragraph (3), by striking ``only
during the'' and all that follows through the
period at the end and inserting ``only during
the period beginning on the date of the
commencement of the pilot program under
paragraph (2) and ending on the date that is
two years after the date of the enactment of
the Veterans Access, Choice, and Accountability
Act of 2014.''; and
(B) by amending paragraph (4) to read as
follows:
``(4) Program locations.--The Secretary shall carry
out the pilot program at locations in the following
Veterans Integrated Service Networks (and such other
locations as the Secretary considers appropriate):
``(A) Veterans Integrated Service Network
1.
``(B) Veterans Integrated Service Network
6.
``(C) Veterans Integrated Service Network
15.
``(D) Veterans Integrated Service Network
18.
``(E) Veterans Integrated Service Network
19.'';
(2) in subsection (b)(1)(A), by striking ``as of
the date of the commencement of the pilot program under
subsection (a)(2)'' and inserting ``as of August 1,
2014'';
(3) by redesignating subsection (h) as subsection
(k);
(4) by inserting after subsection (g) the following
new subsections:
``(h) Appointments.--In carrying out the pilot program
under this section, the Secretary shall ensure that medical
appointments for covered veterans--
``(1) are scheduled not later than 5 days after the
date on which the appointment is requested; and
``(2) occur not later than 30 days after such date.
``(i) Outreach.--The Secretary shall ensure that covered
veterans are informed about the pilot program under this
section.
``(j) Use of Existing Contracts.--In carrying out the pilot
program under this section after the date of the enactment of
the Veterans Access, Choice, and Accountability Act of 2014,
the Secretary shall make use of contracts entered into before
such date or may enter into new contracts.''; and
(5) in paragraph (2)(B) of subsection (k), as
redesignated by paragraph (3) of this section, by
striking the semicolon at the end and inserting ``;
and''.
SEC. 105. PROMPT PAYMENT BY DEPARTMENT OF VETERANS AFFAIRS.
(a) Sense of Congress on Prompt Payment by Department.--It
is the sense of Congress that the Secretary of Veterans Affairs
shall comply with section 1315 of title 5, Code of Federal
Regulations (commonly known as the ``prompt payment rule''), or
any corresponding similar regulation or ruling, in paying for
health care pursuant to contracts entered into with non-
Department of Veterans Affairs providers to provide health care
under the laws administered by the Secretary.
(b) Establishment of Claims Processing System.--
(1) Claims processing system.--The Secretary of
Veterans Affairs shall establish and implement a system
to process and pay claims for payment for hospital
care, medical services, and other health care furnished
by non-Department of Veterans Affairs health care
providers under the laws administered by the Secretary.
(2) Compliance with prompt payment act.--The system
established and implemented under paragraph (1) shall
comply with all requirements of chapter 39, United
States Code (commonly referred to as the ``Prompt
Payment Act'').
(c) Report.--Not later than one year after the date of the
enactment of this Act, the Comptroller General of the United
States shall submit to Congress a report on the timeliness of
payments by the Secretary for hospital care, medical services,
and other health care furnished by non-Department of Veterans
Affairs health care providers under the laws administered by
the Secretary.
(d) Elements.--The report required by subsection (b) shall
include the following:
(1) The results of a survey of non-Department
health care providers who have submitted claims to the
Department for hospital care, medical services, or
other health care furnished to veterans for which
payment is authorized under the laws administered by
the Secretary during the one-year period preceding the
submittal of the report, which survey shall include the
following:
(A) The amount of time it took for such
health care providers, after submitting such
claims, to receive payment from the Department
for such care or services.
(B) A comparison of the amount of time
under subparagraph (A) and the amount of time
it takes such health care providers to receive
payments from the United States for similar
care or services provided to the following, if
applicable:
(i) Beneficiaries under the
Medicare program under title XVIII of
the Social Security Act (42 U.S.C. 1395
et seq.).
(ii) Covered beneficiaries under
the TRICARE program under chapter 55 of
title 10, United States Code.
(2) Such recommendations for legislative or
administrative action as the Comptroller General
considers appropriate.
(e) Survey Elements.--In carrying out the survey, the
Comptroller General shall seek responses from non-Department
health care providers in a manner that ensures that the survey
reflects the responses of such providers that--
(1) are located in different geographic areas;
(2) furnish a variety of different hospital care,
medical services, and other health care; and
(3) furnish such care and services in a variety of
different types of medical facilities.
SEC. 106. TRANSFER OF AUTHORITY FOR PAYMENTS FOR HOSPITAL CARE, MEDICAL
SERVICES, AND OTHER HEALTH CARE FROM NON-DEPARTMENT
OF VETERANS AFFAIRS PROVIDERS TO THE CHIEF BUSINESS
OFFICE OF THE VETERANS HEALTH ADMINISTRATION.
(a) Transfer of Authority.--
(1) In general.--Effective as of October 1, 2014,
the Secretary of Veterans Affairs shall transfer the
authority to pay for hospital care, medical services,
and other health care furnished through non-Department
of Veterans Affairs providers from--
(A) the Veterans Integrated Service
Networks and medical centers of the Department
of Veterans Affairs, to
(B) the Chief Business Office of the
Veterans Health Administration of the
Department of Veterans Affairs.
(2) Manner of care.--The Chief Business Office
shall work in consultation with the Office of Clinical
Operations and Management of the Department to ensure
that care and services described in paragraph (1) are
provided in a manner that is clinically appropriate and
in the best interest of the veterans receiving such
care and services.
(3) No delay in payment.--The transfer of authority
under paragraph (1) shall be carried out in a manner
that does not delay or impede any payment by the
Department for hospital care, medical services, or
other health care furnished through a non-Department
provider under the laws administered by the Secretary.
(b) Budget Matters.--The budget of the Department of
Veterans Affairs for any fiscal year beginning after the date
of the enactment of this Act (as submitted to Congress pursuant
to section 1105(a) of title 31, United States Code) shall
specify funds for the payment for hospital care, medical
services, and other health care furnished through non-
Department of Veterans Affairs providers, including any
administrative costs associated with such payment, as funds for
the Chief Business Office of the Veterans Health Administration
rather than as funds for the Veterans Integrated Service
Networks or medical centers of the Department.
TITLE II--HEALTH CARE ADMINISTRATIVE MATTERS
SEC. 201. INDEPENDENT ASSESSMENT OF THE HEALTH CARE DELIVERY SYSTEMS
AND MANAGEMENT PROCESSES OF THE DEPARTMENT OF
VETERANS AFFAIRS.
(a) Independent Assessment.--
(1) Assessment.--Not later than 90 days after the
date of the enactment of this Act, the Secretary of
Veterans Affairs shall enter into one or more contracts
with a private sector entity or entities described in
subsection (b) to conduct an independent assessment of
the hospital care, medical services, and other health
care furnished in medical facilities of the Department.
Such assessment shall address each of the following:
(A) Current and projected demographics and
unique health care needs of the patient
population served by the Department.
(B) Current and projected health care
capabilities and resources of the Department,
including hospital care, medical services, and
other health care furnished by non-Department
facilities under contract with the Department,
to provide timely and accessible care to
veterans.
(C) The authorities and mechanisms under
which the Secretary may furnish hospital care,
medical services, and other health care at non-
Department facilities, including whether the
Secretary should have the authority to furnish
such care and services at such facilities
through the completion of episodes of care.
(D) The appropriate system-wide access
standard applicable to hospital care, medical
services, and other health care furnished by
and through the Department, including an
identification of appropriate access standards
for each individual specialty and post-care
rehabilitation.
(E) The workflow process at each medical
facility of the Department for scheduling
appointments for veterans to receive hospital
care, medical services, or other health care
from the Department.
(F) The organization, workflow processes,
and tools used by the Department to support
clinical staffing, access to care, effective
length-of-stay management and care transitions,
positive patient experience, accurate
documentation, and subsequent coding of
inpatient services.
(G) The staffing level at each medical
facility of the Department and the productivity
of each health care provider at such medical
facility, compared with health care industry
performance metrics, which may include an
assessment of any of the following:
(i) The case load of, and number of
patients treated by, each health care
provider at such medical facility
during an average week.
(ii) The time spent by such health
care provider on matters other than the
case load of such health care provider,
including time spent by such health
care provider as follows:
(I) At a medical facility
that is affiliated with the
Department.
(II) Conducting research.
(III) Training or
supervising other health care
professionals of the
Department.
(H) The information technology strategies
of the Department with respect to furnishing
and managing health care, including an
identification of any weaknesses and
opportunities with respect to the technology
used by the Department, especially those
strategies with respect to clinical
documentation of episodes of hospital care,
medical services, and other health care,
including any clinical images and associated
textual reports, furnished by the Department in
Department or non-Department facilities.
(I) Business processes of the Veterans
Health Administration, including processes
relating to furnishing non-Department health
care, insurance identification, third-party
revenue collection, and vendor reimbursement,
including an identification of mechanisms as
follows:
(i) To avoid the payment of
penalties to vendors.
(ii) To increase the collection of
amounts owed to the Department for
hospital care, medical services, or
other health care provided by the
Department for which reimbursement from
a third party is authorized and to
ensure that such amounts collected are
accurate.
(iii) To increase the collection of
any other amounts owed to the
Department with respect to hospital
care, medical services, and other
health care and to ensure that such
amounts collected are accurate.
(iv) To increase the accuracy and
timeliness of Department payments to
vendors and providers.
(J) The purchasing, distribution, and use
of pharmaceuticals, medical and surgical
supplies, medical devices, and health care
related services by the Department, including
the following:
(i) The prices paid for,
standardization of, and use by the
Department of the following:
(I) Pharmaceuticals.
(II) Medical and surgical
supplies.
(III) Medical devices.
(ii) The use by the Department of
group purchasing arrangements to
purchase pharmaceuticals, medical and
surgical supplies, medical devices, and
health care related services.
(iii) The strategy and systems used
by the Department to distribute
pharmaceuticals, medical and surgical
supplies, medical devices, and health
care related services to Veterans
Integrated Service Networks and medical
facilities of the Department.
(K) The process of the Department for
carrying out construction and maintenance
projects at medical facilities of the
Department and the medical facility leasing
program of the Department.
(L) The competency of leadership with
respect to culture, accountability, reform
readiness, leadership development, physician
alignment, employee engagement, succession
planning, and performance management.
(2) Particular elements of certain assessments.--
(A) Scheduling assessment.--In carrying out
the assessment required by paragraph (1)(E),
the private sector entity or entities shall do
the following:
(i) Review all training materials
pertaining to scheduling of
appointments at each medical facility
of the Department.
(ii) Assess whether all employees
of the Department conducting tasks
related to scheduling are properly
trained for conducting such tasks.
(iii) Assess whether changes in the
technology or system used in scheduling
appointments are necessary to limit
access to the system to only those
employees that have been properly
trained in conducting such tasks.
(iv) Assess whether health care
providers of the Department are making
changes to their schedules that hinder
the ability of employees conducting
such tasks to perform such tasks.
(v) Assess whether the
establishment of a centralized call
center throughout the Department for
scheduling appointments at medical
facilities of the Department would
improve the process of scheduling such
appointments.
(vi) Assess whether booking
templates for each medical facility or
clinic of the Department would improve
the process of scheduling such
appointments.
(vii) Assess any interim technology
changes or attempts by Department to
internally develop a long-term
scheduling solutions with respect to
the feasibility and cost effectiveness
of such internally developed solutions
compared to commercially available
solutions.
(viii) Recommend actions, if any,
to be taken by the Department to
improve the process for scheduling such
appointments, including the following:
(I) Changes in training
materials provided to employees
of the Department with respect
to conducting tasks related to
scheduling such appointments.
(II) Changes in monitoring
and assessment conducted by the
Department of wait times of
veterans for such appointments.
(III) Changes in the system
used to schedule such
appointments, including changes
to improve how the Department--
(aa) measures wait
times of veterans for
such appointments;
(bb) monitors the
availability of health
care providers of the
Department; and
(cc) provides
veterans the ability to
schedule such
appointments.
(IV) Such other actions as
the private sector entity or
entities considers appropriate.
(B) Medical construction and maintenance
project and leasing program assessment.--In
carrying out the assessment required by
paragraph (1)(K), the private sector entity or
entities shall do the following:
(i) Review the process of the
Department for identifying and
designing proposals for construction
and maintenance projects at medical
facilities of the Department and leases
for medical facilities of the
Department.
(ii) Assess the process through
which the Department determines the
following:
(I) That a construction or
maintenance project or lease is
necessary with respect to a
medical facility or proposed
medical facility of the
Department.
(II) The proper size of
such medical facility or
proposed medical facility with
respect to treating veterans in
the catchment area of such
medical facility or proposed
medical facility.
(iii) Assess the management
processes of the Department with
respect to the capital management
programs of the Department, including
processes relating to the methodology
for construction and design of medical
facilities of the Department, the
management of projects relating to the
construction and design of such
facilities, and the activation of such
facilities.
(iv) Assess the medical facility
leasing program of the Department.
(3) Timing.--The private sector entity or entities
carrying out the assessment required by paragraph (1)
shall complete such assessment not later than 240 days
after entering into the contract described in such
paragraph.
(b) Private Sector Entities Described.--A private entity
described in this subsection is a private entity that--
(1) has experience and proven outcomes in
optimizing the performance of the health care delivery
systems of the Veterans Health Administration and the
private sector and in health care management; and
(2) specializes in implementing large-scale
organizational and cultural transformations, especially
with respect to health care delivery systems.
(c) Program Integrator.--
(1) In general.--If the Secretary enters into
contracts with more than one private sector entity
under subsection (a), the Secretary shall designate one
such entity that is predominately a health care
organization as the program integrator.
(2) Responsibilities.--The program integrator
designated pursuant to paragraph (1) shall be
responsible for coordinating the outcomes of the
assessments conducted by the private entities pursuant
to such contracts.
(d) Report on Assessment.--
(1) In general.--Not later than 60 days after
completing the assessment required by subsection (a),
the private sector entity or entities carrying out such
assessment shall submit to the Secretary of Veterans
Affairs, the Committee on Veterans' Affairs of the
Senate, the Committee on Veterans' Affairs of the House
of Representatives, and the Commission on Care
established under section 202 a report on the findings
and recommendations of the private sector entity or
entities with respect to such assessment.
(2) Publication.--Not later than 30 days after
receiving the report under paragraph (1), the Secretary
shall publish such report in the Federal Register and
on an Internet website of the Department of Veterans
Affairs that is accessible to the public.
(e) Non-department Facilities Defined.--In this section,
the term ``non-Department facilities'' has the meaning given
that term in section 1701 of title 38, United States Code.
SEC. 202. COMMISSION ON CARE.
(a) Establishment of Commission.--
(1) In general.--There is established a commission,
to be known as the ``Commission on Care'' (in this
section referred to as the ``Commission''), to examine
the access of veterans to health care from the
Department of Veterans Affairs and strategically
examine how best to organize the Veterans Health
Administration, locate health care resources, and
deliver health care to veterans during the 20-year
period beginning on the date of the enactment of this
Act.
(2) Membership.--
(A) Voting members.--The Commission shall
be composed of 15 voting members who are
appointed as follows:
(i) Three members appointed by the
Speaker of the House of
Representatives, at least one of whom
shall be a veteran.
(ii) Three members appointed by the
Minority Leader of the House of
Representatives, at least one of whom
shall be a veteran.
(iii) Three members appointed by
the Majority Leader of the Senate, at
least one of whom shall be a veteran.
(iv) Three members appointed by the
Minority Leader of the Senate, at least
one of whom shall be a veteran.
(v) Three members appointed by the
President, at least two of whom shall
be veterans.
(B) Qualifications.--Of the members
appointed under subparagraph (A)--
(i) at least one member shall
represent an organization recognized by
the Secretary of Veterans Affairs for
the representation of veterans under
section 5902 of title 38, United States
Code;
(ii) at least one member shall have
experience as senior management for a
private integrated health care system
with an annual gross revenue of more
than $50,000,000;
(iii) at least one member shall be
familiar with government health care
systems, including those systems of the
Department of Defense, the Indian
Health Service, and Federally-qualified
health centers (as defined in section
1905(l)(2)(B) of the Social Security
Act (42 U.S.C. 1396d(l)(2)(B)));
(iv) at least one member shall be
familiar with the Veterans Health
Administration but shall not be
currently employed by the Veterans
Health Administration; and
(v) at least one member shall be
familiar with medical facility
construction and leasing projects
carried out by government entities and
have experience in the building trades,
including construction, engineering,
and architecture.
(C) Date.--The appointments of members of
the Commission shall be made not later than one
year after the date of the enactment of this
Act.
(3) Period of appointment.--
(A) In general.--Members shall be appointed
for the life of the Commission.
(B) Vacancies.--Any vacancy in the
Commission shall not affect its powers, but
shall be filled in the same manner as the
original appointment.
(4) Initial meeting.--Not later than 15 days after
the date on which eight voting members of the
Commission have been appointed, the Commission shall
hold its first meeting.
(5) Meetings.--The Commission shall meet at the
call of the Chairperson.
(6) Quorum.--A majority of the members of the
Commission shall constitute a quorum, but a lesser
number of members may hold hearings.
(7) Chairperson and vice chairperson.--The
President shall designate a member of the commission to
serve as Chairperson of the Commission. The Commission
shall select a Vice Chairperson from among its members.
(b) Duties of Commission.--
(1) Evaluation and assessment.--The Commission
shall undertake a comprehensive evaluation and
assessment of access to health care at the Department
of Veterans Affairs.
(2) Matters evaluated and assessed.--In undertaking
the comprehensive evaluation and assessment required by
paragraph (1), the Commission shall evaluate and assess
the results of the assessment conducted by the private
sector entity or entities under section 201, including
any findings, data, or recommendations included in such
assessment.
(3) Reports.--The Commission shall submit to the
President, through the Secretary of Veterans Affairs,
reports as follows:
(A) Not later than 90 days after the date
of the initial meeting of the Commission, an
interim report on--
(i) the findings of the Commission
with respect to the evaluation and
assessment required by this subsection;
and
(ii) such recommendations as the
Commission may have for legislative or
administrative action to improve access
to health care through the Veterans
Health Administration.
(B) Not later than 180 days after the date
of the initial meeting of the Commission, a
final report on--
(i) the findings of the Commission
with respect to the evaluation and
assessment required by this subsection;
and
(ii) such recommendations as the
Commission may have for legislative or
administrative action to improve access
to health care through the Veterans
Health Administration.
(c) Powers of the Commission.--
(1) Hearings.--The Commission may hold such
hearings, sit and act at such times and places, take
such testimony, and receive such evidence as the
Commission considers advisable to carry out this
section.
(2) Information from federal agencies.--The
Commission may secure directly from any Federal agency
such information as the Commission considers necessary
to carry out this section. Upon request of the
Chairperson of the Commission, the head of such agency
shall furnish such information to the Commission.
(d) Commission Personnel Matters.--
(1) Compensation of members.--
(A) In general.--Each member of the
Commission who is not an officer or employee of
the Federal Government shall be compensated at
a rate equal to the daily equivalent of the
annual rate of basic pay prescribed for level
IV of the Executive Schedule under section 5315
of title 5, United States Code, for each day
(including travel time) during which such
member is engaged in the performance of the
duties of the Commission.
(B) Officers or employees of the united
states.--All members of the Commission who are
officers or employees of the United States
shall serve without compensation in addition to
that received for their services as officers or
employees of the United States.
(2) Travel expenses.--The members of the Commission
shall be allowed travel expenses, including per diem in
lieu of subsistence, at rates authorized for employees
of agencies under subchapter I of chapter 57 of title
5, United States Code, while away from their homes or
regular places of business in the performance of
services for the Commission.
(3) Staff.--
(A) In general.--The Chairperson of the
Commission may, without regard to the civil
service laws and regulations, appoint and
terminate an executive director and such other
additional personnel as may be necessary to
enable the Commission to perform its duties.
The employment of an executive director shall
be subject to confirmation by the Commission.
(B) Compensation.--The Chairperson of the
Commission may fix the compensation of the
executive director and other personnel without
regard to chapter 51 and subchapter III of
chapter 53 of title 5, United States Code,
relating to classification of positions and
General Schedule pay rates, except that the
rate of pay for the executive director and
other personnel may not exceed the rate payable
for level V of the Executive Schedule under
section 5316 of such title.
(4) Detail of government employees.--Any Federal
Government employee may be detailed to the Commission
without reimbursement, and such detail shall be without
interruption or loss of civil service status or
privilege.
(5) Procurement of temporary and intermittent
services.--The Chairperson of the Commission may
procure temporary and intermittent services under
section 3109(b) of title 5, United States Code, at
rates for individuals that do not exceed the daily
equivalent of the annual rate of basic pay prescribed
for level V of the Executive Schedule under section
5316 of such title.
(e) Termination of the Commission.--The Commission shall
terminate 30 days after the date on which the Commission
submits the report under subsection (b)(3)(B).
(f) Funding.--The Secretary of Veterans Affairs shall make
available to the Commission from amounts appropriated or
otherwise made available to the Secretary such amounts as the
Secretary and the Chairperson of the Commission jointly
consider appropriate for the Commission to perform its duties
under this section.
(g) Executive Action.--
(1) Action on recommendations.--The President shall
require the Secretary of Veterans Affairs and such
other heads of relevant Federal departments and
agencies to implement each recommendation set forth in
a report submitted under subsection (b)(3) that the
President--
(A) considers feasible and advisable; and
(B) determines can be implemented without
further legislative action.
(2) Reports.--Not later than 60 days after the date
on which the President receives a report under
subsection (b)(3), the President shall submit to the
Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives and such other committees of Congress
as the President considers appropriate a report setting
forth the following:
(A) An assessment of the feasibility and
advisability of each recommendation contained
in the report received by the President.
(B) For each recommendation assessed as
feasible and advisable under subparagraph (A)
the following:
(i) Whether such recommendation
requires legislative action.
(ii) If such recommendation
requires legislative action, a
recommendation concerning such
legislative action.
(iii) A description of any
administrative action already taken to
carry out such recommendation.
(iv) A description of any
administrative action the President
intends to be taken to carry out such
recommendation and by whom.
SEC. 203. TECHNOLOGY TASK FORCE ON REVIEW OF SCHEDULING SYSTEM AND
SOFTWARE OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Task Force Review.--
(1) In general.--The Secretary of Veterans Affairs
shall, through the use of a technology task force,
conduct a review of the needs of the Department of
Veterans Affairs with respect to the scheduling system
and scheduling software of the Department of Veterans
Affairs that is used by the Department to schedule
appointments for veterans for hospital care, medical
services, and other health care from the Department.
(2) Agreement.--
(A) In general.--The Secretary shall seek
to enter into an agreement with a technology
organization or technology organizations to
carry out the review required by paragraph (1).
(B) Prohibition on use of funds.--
Notwithstanding any other provision of law, no
Federal funds may be used to assist the
technology organization or technology
organizations under subparagraph (A) in
carrying out the review required by paragraph
(1).
(b) Report.--
(1) In general.--Not later than 45 days after the
date of the enactment of this Act, the technology task
force required under subsection (a)(1) shall submit to
the Secretary, the Committee on Veterans' Affairs of
the Senate, and the Committee on Veterans' Affairs of
the House of Representatives a report setting forth the
findings and recommendations of the technology task
force regarding the needs of the Department with
respect to the scheduling system and scheduling
software of the Department described in such
subsection.
(2) Elements.--The report required by paragraph (1)
shall include the following:
(A) Proposals for specific actions to be
taken by the Department to improve the
scheduling system and scheduling software of
the Department described in subsection (a)(1).
(B) A determination as to whether one or
more existing off-the-shelf systems would--
(i) meet the needs of the
Department to schedule appointments for
veterans for hospital care, medical
services, and other health care from
the Department; and
(ii) improve the access of veterans
to such care and services.
(3) Publication.--Not later than 30 days after the
receipt of the report required by paragraph (1), the
Secretary shall publish such report in the Federal
Register and on an Internet website of the Department
accessible to the public.
(c) Implementation of Task Force Recommendations.--Not
later than one year after the receipt of the report required by
subsection (b)(1), the Secretary shall implement the
recommendations set forth in such report that the Secretary
considers are feasible, advisable, and cost effective.
SEC. 204. IMPROVEMENT OF ACCESS OF VETERANS TO MOBILE VET CENTERS AND
MOBILE MEDICAL CENTERS OF THE DEPARTMENT OF
VETERANS AFFAIRS.
(a) Improvement of Access.--
(1) In general.--The Secretary of Veterans Affairs
shall improve the access of veterans to telemedicine
and other health care through the use of mobile vet
centers and mobile medical centers of the Department of
Veterans Affairs by providing standardized requirements
for the operation of such centers.
(2) Requirements.--The standardized requirements
required by paragraph (1) shall include the following:
(A) The number of days each mobile vet
center and mobile medical center of the
Department is expected to travel per year.
(B) The number of locations each center is
expected to visit per year.
(C) The number of appointments each center
is expected to conduct per year.
(D) The method and timing of notifications
given by each center to individuals in the area
to which the center is traveling, including
notifications informing veterans of the
availability to schedule appointments at the
center.
(3) Use of telemedicine.--The Secretary shall
ensure that each mobile vet center and mobile medical
center of the Department has the capability to provide
telemedicine services.
(b) Reports.--
(1) In general.--Not later than one year after the
date of the enactment of this Act, and not later than
September 30 each year thereafter, 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 access to health care through the use of
mobile vet centers and mobile medical centers of the
Department that includes statistics on each of the
requirements set forth in subsection (a)(2) for the
year covered by the report.
(2) Elements.--Each report required by paragraph
(1) shall include the following:
(A) A description of the use of mobile vet
centers and mobile medical centers to provide
telemedicine services to veterans during the
year preceding the submittal of the report,
including the following:
(i) The number of days each mobile
vet center and mobile medical center
was open to provide such services.
(ii) The number of days each center
traveled to a location other than the
headquarters of the center to provide
such services.
(iii) The number of appointments
each center conducted to provide such
services on average per month and in
total during such year.
(B) An analysis of the effectiveness of
using mobile vet centers and mobile medical
centers to provide health care services to
veterans through the use of telemedicine.
(C) Any recommendations for an increase in
the number of mobile vet centers and mobile
medical centers of the Department.
(D) Any recommendations for an increase in
the telemedicine capabilities of each mobile
vet center and mobile medical center.
(E) The feasibility and advisability of
using temporary health care providers,
including locum tenens, to provide direct
health care services to veterans at mobile vet
centers and mobile medical centers.
(F) Such other recommendations on
improvement of the use of mobile vet centers
and mobile medical centers by the Department as
the Secretary considers appropriate.
SEC. 205. IMPROVED PERFORMANCE METRICS FOR HEALTH CARE PROVIDED BY
DEPARTMENT OF VETERANS AFFAIRS.
(a) Prohibition on Use of Scheduling and Wait-time Metrics
in Determination of Performance Awards.--The Secretary of
Veterans Affairs shall ensure that scheduling and wait-time
metrics or goals are not used as factors in determining the
performance of the following employees for purposes of
determining whether to pay performance awards to such
employees:
(1) Directors, associate directors, assistant
directors, deputy directors, chiefs of staff, and
clinical leads of medical centers of the Department of
Veterans Affairs.
(2) Directors, assistant directors, and quality
management officers of Veterans Integrated Service
Networks of the Department of Veterans Affairs.
(b) Modification of Performance Plans.--
(1) In general.--Not later than 30 days after the
date of the enactment of this Act, the Secretary shall
modify the performance plans of the directors of the
medical centers of the Department and the directors of
the Veterans Integrated Service Networks to ensure that
such plans are based on the quality of care received by
veterans at the health care facilities under the
jurisdictions of such directors.
(2) Factors.--In modifying performance plans under
paragraph (1), the Secretary shall ensure that
assessment of the quality of care provided at health
care facilities under the jurisdiction of a director
described in paragraph (1) includes consideration of
the following:
(A) Recent reviews by the Joint Commission
(formerly known as the ``Joint Commission on
Accreditation of Healthcare Organizations'') of
such facilities.
(B) The number and nature of
recommendations concerning such facilities by
the Inspector General of the Department in
reviews conducted through the Combined
Assessment Program, in the reviews by the
Inspector General of community-based outpatient
clinics and primary care clinics, and in
reviews conducted through the Office of
Healthcare Inspections during the two most
recently completed fiscal years.
(C) The number of recommendations described
in subparagraph (B) that the Inspector General
of the Department determines have not been
carried out satisfactorily with respect to such
facilities.
(D) Reviews of such facilities by the
Commission on Accreditation of Rehabilitation
Facilities.
(E) The number and outcomes of
administrative investigation boards, root cause
analyses, and peer reviews conducted at such
facilities during the fiscal year for which the
assessment is being conducted.
(F) The effectiveness of any remedial
actions or plans resulting from any Inspector
General recommendations in the reviews and
analyses described in subparagraphs (A) through
(E).
(3) Additional leadership positions.--To the degree
practicable, the Secretary shall assess the performance
of other employees of the Department in leadership
positions at Department medical centers, including
associate directors, assistant directors, deputy
directors, chiefs of staff, and clinical leads, and in
Veterans Integrated Service Networks, including
assistant directors and quality management officers,
using factors and criteria similar to those used in the
performance plans modified under paragraph (1).
(c) Removal of Certain Performance Goals.--For each fiscal
year that begins after the date of the enactment of this Act,
the Secretary shall not include in the performance goals of any
employee of a Veterans Integrated Service Network or medical
center of the Department any performance goal that might
disincentivize the payment of Department amounts to provide
hospital care, medical services, or other health care through a
non-Department provider.
SEC. 206. IMPROVED TRANSPARENCY CONCERNING HEALTH CARE PROVIDED BY
DEPARTMENT OF VETERANS AFFAIRS.
(a) Publication of Wait Times.--Not later than 90 days
after the date of the enactment of this Act, the Secretary of
Veterans Affairs shall publish in the Federal Register, and on
a publicly accessible Internet website of each medical center
of the Department of Veterans Affairs, the wait-times for the
scheduling of an appointment in each Department facility by a
veteran for the receipt of primary care, specialty care, and
hospital care and medical services based on the general
severity of the condition of the veteran. Whenever the wait-
times for the scheduling of such an appointment changes, the
Secretary shall publish the revised wait-times--
(1) on a publicly accessible Internet website of
each medical center of the Department by not later than
30 days after such change; and
(2) in the Federal Register by not later than 90
days after such change.
(b) Publicly Available Database of Patient Safety, Quality
of Care, and Outcome Measures.--
(1) In general.--Not later than 180 days after the
date of the enactment of this Act, the Secretary shall
develop and make available to the public a
comprehensive database containing all applicable
patient safety, quality of care, and outcome measures
for health care provided by the Department that are
tracked by the Secretary.
(2) Update frequency.--The Secretary shall update
the database required by paragraph (1) not less
frequently than once each year.
(3) Unavailable measures.--For all measures that
the Secretary would otherwise publish in the database
required by paragraph (1) but has not done so because
such measures are not available, the Secretary shall
publish notice in the database of the reason for such
unavailability and a timeline for making such measures
available in the database.
(4) Accessibility.--The Secretary shall ensure that
the database required by paragraph (1) is accessible to
the public through the primary Internet website of the
Department and through each primary Internet website of
a Department medical center.
(c) Hospital Compare Website of Department of Health and
Human Services.--
(1) Agreement required.--Not later than 180 days
after the date of the enactment of this Act, the
Secretary of Veterans Affairs shall enter into an
agreement with the Secretary of Health and Human
Services for the provision by the Secretary of Veterans
Affairs of such information as the Secretary of Health
and Human Services may require to report and make
publicly available patient quality and outcome
information concerning Department of Veterans Affairs
medical centers through the Hospital Compare Internet
website of the Department of Health and Human Services
or any successor Internet website.
(2) Information provided.--The information provided
by the Secretary of Veterans Affairs to the Secretary
of Health and Human Services under paragraph (1) shall
include the following:
(A) Measures of timely and effective health
care.
(B) Measures of readmissions, complications
of death, including with respect to 30-day
mortality rates and 30-day readmission rates,
surgical complication measures, and health care
related infection measures.
(C) Survey data of patient experiences,
including the Hospital Consumer Assessment of
Healthcare Providers and Systems or any similar
successor survey developed by the Department of
Health and Human Services.
(D) Any other measures required of or
reported with respect to hospitals
participating in the Medicare program under
title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.).
(3) Unavailable information.--For any applicable
metric collected by the Department of Veterans Affairs
or required to be provided under paragraph (2) and
withheld from or unavailable in the Hospital Compare
Internet website or any successor Internet website, the
Secretary of Veterans Affairs shall publish a notice on
such Internet website stating the reason why such
metric was withheld from public disclosure and a
timeline for making such metric available, if
applicable.
(d) Comptroller General Review of Publicly Available Safety
and Quality Metrics.--Not later than three years after the date
of the enactment of this Act, the Comptroller General of the
United States shall conduct a review of the safety and quality
metrics made publicly available by the Secretary of Veterans
Affairs under this section to assess the degree to which the
Secretary is complying with the provisions of this section.
SEC. 207. INFORMATION FOR VETERANS ON THE CREDENTIALS OF DEPARTMENT OF
VETERANS AFFAIRS PHYSICIANS.
(a) Improvement of ``Our Doctors'' Internet Website
Links.--
(1) Availability through department of veterans
affairs homepage.--A link to the ``Our Doctors'' health
care providers database of the Department of Veterans
Affairs, or any successor database, shall be available
on and through the homepage of the Internet website of
the Department that is accessible to the public.
(2) Information on location of residency
training.--The Internet website of the Department that
is accessible to the public shall include under the
link to the ``Our Doctors'' health care providers
database of the Department, or any successor database,
the name of the facility at which each licensed
physician of the Department underwent residency
training.
(3) Information on physicians at particular
facilities.--The ``Our Doctors'' health care providers
database of the Department, or any successor database,
shall identify whether each licensed physician of the
Department is a physician in residency.
(b) Information on Credentials of Physicians for Veterans
Undergoing Surgical Procedures.--
(1) In general.--Each veteran who is undergoing a
surgical procedure by or through the Department shall
be provided information described in paragraph (2) with
respect to the surgeon to be performing such procedure
at such time in advance of the procedure as is
appropriate to permit such veteran to evaluate such
information.
(2) Information described.--The information
described in this paragraph with respect to a surgeon
described in paragraph (1) is as follows:
(A) The education and training of the
surgeon.
(B) The licensure, registration, and
certification of the surgeon by the State or
national entity responsible for such licensure,
registration, or certification.
(3) Other individuals.--If a veteran is unable to
evaluate the information provided under paragraph (1)
due to the health or mental competence of the veteran,
such information shall be provided to an individual
acting on behalf of the veteran.
(c) Comptroller General Report and Plan.--
(1) Report.--Not later than two years after the
date of the enactment of this Act, the Comptroller
General of the United States shall submit to the
Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report setting forth an assessment by
the Comptroller General of the following:
(A) The manner in which contractors under
the Patient-Centered Community Care initiative
of the Department perform oversight of the
credentials of physicians within the networks
of such contractors under the initiative.
(B) The oversight by the Department of the
contracts under the Patient-Centered Community
Care initiative.
(C) The verification by the Department of
the credentials and licenses of health care
providers furnishing hospital care and medical
services under section 101.
(2) Plan.--
(A) In general.--Not later than 30 days
after the submittal of the report under
paragraph (1), the Secretary shall submit to
the Comptroller General, the Committee on
Veterans' Affairs of the Senate, and the
Committee on Veterans' Affairs of the House of
Representatives a plan to address any findings
and recommendations of the Comptroller General
included in such report.
(B) Implementation.--Not later than 90 days
after the submittal of the report under
paragraph (1), the Secretary shall carry out
such plan.
SEC. 208. INFORMATION IN ANNUAL BUDGET OF THE PRESIDENT ON HOSPITAL
CARE AND MEDICAL SERVICES FURNISHED THROUGH
EXPANDED USE OF CONTRACTS FOR SUCH CARE.
The materials on the Department of Veterans Affairs in the
budget of the President for a fiscal year, as submitted to
Congress pursuant to section 1105(a) of title 31, United States
Code, shall set forth the following:
(1) The number of veterans who received hospital
care and medical services under section 101 during the
fiscal year preceding the fiscal year in which such
budget is submitted.
(2) The amount expended by the Department on
furnishing care and services under such section during
the fiscal year preceding the fiscal year in which such
budget is submitted.
(3) The amount requested in such budget for the
costs of furnishing care and services under such
section during the fiscal year covered by such budget,
set forth in aggregate and by amounts for each account
for which amounts are so requested.
(4) The number of veterans that the Department
estimates will receive hospital care and medical
services under such section during the fiscal years
covered by the budget submission.
(5) The number of employees of the Department on
paid administrative leave at any point during the
fiscal year preceding the fiscal year in which such
budget is submitted.
SEC. 209. PROHIBITION ON FALSIFICATION OF DATA CONCERNING WAIT TIMES
AND QUALITY MEASURES AT DEPARTMENT OF VETERANS
AFFAIRS.
Not later than 60 days after the date of the enactment of
this Act, and in accordance with title 5, United States Code,
the Secretary of Veterans Affairs shall establish policies
whereby any employee of the Department of Veterans Affairs who
knowingly submits false data concerning wait times for health
care or quality measures with respect to health care to another
employee of the Department or knowingly requires another
employee of the Department to submit false data concerning such
wait times or quality measures to another employee of the
Department is subject to a penalty the Secretary considers
appropriate after notice and an opportunity for a hearing,
including civil penalties, unpaid suspensions, or termination.
TITLE III--HEALTH CARE STAFFING, RECRUITMENT, AND TRAINING MATTERS
SEC. 301. TREATMENT OF STAFFING SHORTAGE AND BIENNIAL REPORT ON
STAFFING OF MEDICAL FACILITIES OF THE DEPARTMENT OF
VETERANS AFFAIRS.
(a) Staffing Shortages.--
(1) In general.--Subchapter I of chapter 74 of
title 38, United States Code, is amended by adding at
the end the following new section:
``Sec. 7412. Annual determination of staffing shortages; recruitment
and appointment for needed occupations
``(a) In General.--Not later than September 30 of each
year, the Inspector General of the Department shall determine,
and the Secretary shall publish in the Federal Register, the
five occupations of personnel of this title of the Department
covered under section 7401 of this title for which there are
the largest staffing shortages throughout the Department as
calculated over the five-year period preceding the
determination.
``(b) Recruitment and Appointment.--Notwithstanding
sections 3304 and 3309 through 3318 of title 5, the Secretary
may, upon a determination by the Inspector General under
paragraph (1) that there is a staffing shortage throughout the
Department with respect to a particular occupation, recruit and
directly appoint, during the fiscal year after the fiscal year
during which such determination is made, qualified personnel to
serve in that particular occupation for the Department.''.
(2) Clerical amendment.--The table of sections at
the beginning of such chapter is amended by inserting
after the item relating to section 7411 the following
new item:
``7412. Annual determination of staffing shortages; recruitment and
appointment for needed occupations.''.
(3) Deadline for first determination.--
Notwithstanding the deadline under section 7412 of
title 38, United States Code, as added by paragraph
(1), for the annual determination of staffing shortages
in the Veterans Health Administration, the Inspector
General of the Department of Veterans Affairs shall
make the first determination required under such
section, and the Secretary of Veterans Affairs shall
publish in the Federal Register such determination, by
not later than the date that is 180 days after the date
of the enactment of this Act.
(b) Increase of Graduate Medical Education Residency
Positions.--
(1) In general.--Section 7302 of title 38, United
States Code, is amended by adding at the end the
following new subsection:
``(e)(1) In carrying out this section, the Secretary shall
establish medical residency programs, or ensure that already
established medical residency programs have a sufficient number
of residency positions, at any medical facility of the
Department that the Secretary determines--
``(A) is experiencing a shortage of physicians; and
``(B) is located in a community that is designated
as a health professional shortage area (as defined in
section 332 of the Public Health Service Act (42 U.S.C.
254e)).
``(2) In carrying out paragraph (1), the Secretary shall--
``(A) allocate the residency positions under such
paragraph among occupations included in the most
current determination published in the Federal Register
pursuant to section 7412(a) of this title; and
``(B) give priority to residency positions and
programs in primary care, mental health, and any other
specialty the Secretary determines appropriate.''.
(2) Five-year increase.--
(A) In general.--In carrying out section
7302(e) of title 38, United States Code, as
added by paragraph (1), during the five-year
period beginning on the day that is one year
after the date of the enactment of this Act,
the Secretary of Veterans Affairs shall
increase the number of graduate medical
education residency positions at medical
facilities of the Department by up to 1,500
positions.
(B) Priority.--In increasing the number of
graduate medical education residency positions
at medical facilities of the Department under
subparagraph (A), the Secretary shall give
priority to medical facilities that--
(i) as of the date of the enactment
of this Act, do not have a medical
residency program; and
(ii) are located in a community
that has a high concentration of
veterans.
(3) Report.--
(A) In general.--Not later than 60 days
after the date of the enactment of this Act,
and not later than October 1 each year
thereafter until 2019, 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 graduate medical education residency
positions at medical facilities of the
Department.
(B) Elements.--Each report required by
subparagraph (A) shall include the following:
(i) For the year preceding the
submittal of the report, the number of
graduate medical education residency
positions at medical facilities of the
Department as follows:
(I) That were filled.
(II) That were not filled.
(III) That the Department
anticipated filling.
(ii) With respect to each graduate
medical education residency position
specified in clause (i)--
(I) the geographic location
of each such position; and
(II) if such position was
filled, the academic
affiliation of the medical
resident that filled such
position.
(iii) The policy at each medical
facility of the Department with respect
to the ratio of medical residents to
staff supervising medical residents.
(iv) During the one-year period
preceding the submittal of the report,
the number of individuals who declined
an offer from the Department to serve
as a medical resident at a medical
facility of the Department and the
reason why each such individual
declined such offer.
(v) During the one-year period
preceding the submittal of the report,
a description of--
(I) challenges, if any,
faced by the Department in
filling graduate medical
education residency positions
at medical facilities of the
Department; and
(II) actions, if any, taken
by the Department to address
such challenges.
(vi) A description of efforts of
the Department, as of the date of the
submittal of the report, to recruit and
retain medical residents to work for
the Veterans Health Administration as
full-time employees.
(c) Priority in Scholarship Program of Health Professionals
Educational Assistance Program to Certain Providers.--Section
7612(b)(5) of title 38, United States Code, is amended--
(1) in subparagraph (A), by striking ``and'' at the
end;
(2) by redesignating subparagraph (B) as
subparagraph (C); and
(3) by inserting after subparagraph (A) the
following new subparagraph (B):
``(B) shall give priority to applicants pursuing a
course of education or training toward a career in an
occupation for which the Inspector General of the
Department has, in the most current determination
published in the Federal Register pursuant to section
7412(a) of this title, determined that there is one of
the largest staffing shortages throughout the
Department with respect to such occupation; and''.
(d) Reports.--
(1) In general.--Not later than 180 days after the
date of the enactment of this Act, and not later than
December 31 of each even-numbered year thereafter until
2024, the Secretary of Veterans Affairs shall submit to
the Committees on Veterans' Affairs of the Senate and
House of Representatives a report assessing the
staffing of each medical facility of the Department.
(2) Elements.--Each report submitted under
paragraph (1) shall include the following:
(A) The results of a system-wide assessment
of all medical facilities of the Department to
ensure the following:
(i) Appropriate staffing levels for
health care professionals to meet the
goals of the Secretary for timely
access to care for veterans.
(ii) Appropriate staffing levels
for support personnel, including
clerks.
(iii) Appropriate sizes for
clinical panels.
(iv) Appropriate numbers of full-
time staff, or full-time equivalents,
dedicated to direct care of patients.
(v) Appropriate physical plant
space to meet the capacity needs of the
Department in that area.
(vi) Such other factors as the
Secretary considers necessary.
(B) A plan for addressing any issues
identified in the assessment described in
subparagraph (A), including a timeline for
addressing such issues.
(C) A list of the current wait times and
workload levels for the following clinics in
each medical facility:
(i) Mental health.
(ii) Primary care.
(iii) Gastroenterology.
(iv) Women's health.
(v) Such other clinics as the
Secretary considers appropriate.
(D) A description of the results of the
most current determination of the Inspector
General under subsection (a) of section 7412 of
title 38, United States Code, as added by
subsection (a)(1) of this section, and a plan
to use direct appointment authority under
subsection (b) of such section 7412 to fill
staffing shortages, including recommendations
for improving the speed at which the
credentialing and privileging process can be
conducted.
(E) The current staffing models of the
Department for the following clinics, including
recommendations for changes to such models:
(i) Mental health.
(ii) Primary care.
(iii) Gastroenterology.
(iv) Women's health.
(v) Such other clinics as the
Secretary considers appropriate.
(F) A detailed analysis of succession
planning at medical facilities of the
Department, including the following:
(i) The number of positions in
medical facilities throughout the
Department that are not filled by a
permanent employee.
(ii) The length of time each
position described in clause (i)
remained vacant or filled by a
temporary or acting employee.
(iii) A description of any barriers
to filling the positions described in
clause (i).
(iv) A plan for filling any
positions that are vacant or filled by
a temporary or acting employee for more
than 180 days.
(v) A plan for handling emergency
circumstances, such as administrative
leave or sudden medical leave for
senior officials.
(G) The number of health care providers of
the Department who have been removed from their
positions, have retired, or have left their
positions for another reason, disaggregated by
provider type, during the two-year period
preceding the submittal of the report.
(H) Of the health care providers specified
in subparagraph (G) who have been removed from
their positions, the following:
(i) The number of such health care
providers who were reassigned to other
positions in the Department.
(ii) The number of such health care
providers who left the Department.
(iii) The number of such health
care providers who left the Department
and were subsequently rehired by the
Department.
SEC. 302. EXTENSION AND MODIFICATION OF CERTAIN PROGRAMS WITHIN THE
DEPARTMENT OF VETERANS AFFAIRS HEALTH PROFESSIONALS
EDUCATIONAL ASSISTANCE PROGRAM.
(a) Extension of Scholarship Program.--Section 7619 of
title 38, United States Code, is amended by striking ``December
31, 2014'' and inserting ``December 31, 2019''.
(b) Modification of Education Debt Reduction Program.--
(1) Modification of amount and duration of
eligibility.--Paragraph (1) of section 7683(d) of such
title is amended--
(A) by striking ``$60,000'' and inserting
``$120,000''; and
(B) by striking ``$12,000 of such
payments'' and all that follows through the
period at the end and inserting ``$24,000 of
such payments may be made in each year of
participation in the Program''.
(2) Elimination of limitation.--
(A) In general.--Such section is further
amended--
(i) by striking paragraph (2);
(ii) by redesignating paragraph (3)
as paragraph (2); and
(iii) in paragraph (2), as
redesignated by clause (ii), by
striking ``paragraphs (1) and (2)'' and
inserting ``paragraph (1)''.
(B) Conforming amendment.--Paragraph (1) of
such section, as amended by paragraph (1), is
further amended by striking ``Subject to
paragraph (2), the amount'' and inserting ``The
amount''.
SEC. 303. CLINIC MANAGEMENT TRAINING FOR EMPLOYEES AT MEDICAL
FACILITIES OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Clinic Management Training Program.--
(1) In general.--Not later than 180 days after the
date of the enactment of this Act, the Secretary of
Veterans Affairs shall commence a role-specific clinic
management training program to provide in-person,
standardized education on systems and processes for
health care practice management and scheduling to all
appropriate employees, as determined by the Secretary,
at medical facilities of the Department.
(2) Elements.--
(A) In general.--The clinic management
training program required by paragraph (1)
shall include the following:
(i) Training on how to manage the
schedules of health care providers of
the Department, including the
following:
(I) Maintaining such
schedules in a manner that
allows appointments to be
booked at least eight weeks in
advance.
(II) Proper planning
procedures for vacation, leave,
and graduate medical education
training schedules.
(ii) Training on the appropriate
number of appointments that a health
care provider should conduct on a daily
basis, based on specialty.
(iii) Training on how to determine
whether there are enough available
appointment slots to manage demand for
different appointment types and
mechanisms for alerting management of
insufficient slots.
(iv) Training on how to properly
use the appointment scheduling system
of the Department, including any new
scheduling system implemented by the
Department.
(v) Training on how to optimize the
use of technology, including the
following:
(I) Telemedicine.
(II) Electronic mail.
(III) Text messaging.
(IV) Such other
technologies as specified by
the Secretary.
(vi) Training on how to properly
use physical plant space at medical
facilities of the Department to ensure
efficient flow and privacy for patients
and staff.
(B) Role-specific.--The Secretary shall
ensure that each employee of the Department
included in the clinic management training
program required by paragraph (1) receives
education under such program that is relevant
to the responsibilities of such employee.
(3) Sunset.--The clinic management training program
required by paragraph (1) shall terminate on the date
that is two years after the date on which the Secretary
commences such program.
(b) Training Materials.--
(1) In general.--After the termination of the
clinic management training program required by
subsection (a), the Secretary shall provide training
materials on health care management to each of the
following employees of the Department that are relevant
to the position and responsibilities of such employee
upon the commencement of employment of such employee:
(A) Any manager of a medical facility of
the Department.
(B) Any health care provider at a medical
facility of the Department.
(C) Such other employees of the Department
as the Secretary considers appropriate.
(2) Update.--The Secretary shall regularly update
the training materials required under paragraph (1).
TITLE IV--HEALTH CARE RELATED TO SEXUAL TRAUMA
SEC. 401. EXPANSION OF ELIGIBILITY FOR SEXUAL TRAUMA COUNSELING AND
TREATMENT TO VETERANS ON INACTIVE DUTY TRAINING.
Section 1720D(a)(1) of title 38, United States Code, is
amended by striking ``or active duty for training'' and
inserting ``, active duty for training, or inactive duty
training''.
SEC. 402. PROVISION OF COUNSELING AND TREATMENT FOR SEXUAL TRAUMA BY
THE DEPARTMENT OF VETERANS AFFAIRS TO MEMBERS OF
THE ARMED FORCES.
(a) Expansion of Coverage to Members of the Armed Forces.--
Subsection (a) of section 1720D of title 38, United States
Code, is amended--
(1) by redesignating paragraph (2) as paragraph
(3);
(2) by inserting after paragraph (1) the following
new paragraph (2):
``(2)(A) In operating the program required by paragraph
(1), the Secretary may, in consultation with the Secretary of
Defense, provide counseling and care and services to members of
the Armed Forces (including members of the National Guard and
Reserves) on active duty to overcome psychological trauma
described in that paragraph.
``(B) A member described in subparagraph (A) shall not be
required to obtain a referral before receiving counseling and
care and services under this paragraph.''; and
(3) in paragraph (3), as redesignated by paragraph
(1)--
(A) by striking ``a veteran'' and inserting
``an individual''; and
(B) by striking ``that veteran'' each place
it appears and inserting ``that individual''.
(b) Information to Members on Availability of Counseling
and Services.--Subsection (c) of such section is amended--
(1) by striking ``to veterans'' each place it
appears; and
(2) in paragraph (3), by inserting ``members of the
Armed Forces and'' before ``individuals''.
(c) Inclusion of Members in Reports on Counseling and
Services.--Subsection (e) of such section is amended--
(1) in the matter preceding paragraph (1), by
striking ``to veterans'';
(2) in paragraph (2)--
(A) by striking ``women veterans'' and
inserting ``individuals''; and
(B) by striking ``training under subsection
(d).'' and inserting ``training under
subsection (d), disaggregated by--
``(A) veterans;
``(B) members of the Armed Forces
(including members of the National Guard and
Reserves) on active duty; and
``(C) for each of subparagraphs (A) and
(B)--
``(i) men; and
``(ii) women.'';
(3) in paragraph (4), by striking ``veterans'' and
inserting ``individuals''; and
(4) in paragraph (5)--
(A) by striking ``women veterans'' and
inserting ``individuals''; and
(B) by inserting ``, including specific
recommendations for individuals specified in
subparagraphs (A), (B), and (C) of paragraph
(2)'' before the period at the end.
(d) Effective Date.--The amendments made by this section
shall take effect on the date that is one year after the date
of the enactment of this Act.
SEC. 403. REPORTS ON MILITARY SEXUAL TRAUMA.
(a) Report on Services Available for Military Sexual Trauma
in the Department of Veterans Affairs.--Not later than 630 days
after the date of the enactment of this Act, 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 treatment and
services available from the Department of Veterans Affairs for
male veterans who experience military sexual trauma compared to
such treatment and services available to female veterans who
experience military sexual trauma.
(b) Reports on Transition of Military Sexual Trauma
Treatment From Department of Defense to Department of Veterans
Affairs.--Not later than 630 days after the date of the
enactment of this Act, and annually thereafter for five years,
the Department of Veterans Affairs-Department of Defense Joint
Executive Committee established by section 320(a) of title 38,
United States Code, shall submit to the appropriate committees
of Congress a report on military sexual trauma that includes
the following:
(1) The processes and procedures utilized by the
Department of Veterans Affairs and the Department of
Defense to facilitate transition of treatment of
individuals who have experienced military sexual trauma
from treatment provided by the Department of Defense to
treatment provided by the Department of Veterans
Affairs.
(2) A description and assessment of the
collaboration between the Department of Veterans
Affairs and the Department of Defense in assisting
veterans in filing claims for disabilities related to
military sexual trauma, including permitting veterans
access to information and evidence necessary to develop
or support such claims.
(c) Definitions.--In this section:
(1) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Veterans' Affairs and
the Committee on Armed Services of the Senate;
and
(B) the Committee on Veterans' Affairs and
the Committee on Armed Services of the House of
Representatives.
(2) Military sexual trauma.--The term ``military
sexual trauma'' means psychological trauma, which in
the judgment of a mental health professional employed
by the Department, resulted from a physical assault of
a sexual nature, battery of a sexual nature, or sexual
harassment which occurred while the veteran was serving
on active duty, active duty for training, or inactive
duty training.
(3) Sexual harassment.--The term ``sexual
harassment'' means repeated, unsolicited verbal or
physical contact of a sexual nature which is
threatening in character.
(4) Sexual trauma.--The term ``sexual trauma''
shall have the meaning given that term by the Secretary
of Veterans Affairs for purposes of this section.
(d) Effective Date.--This section shall take effect on the
date that is 270 days after the date of the enactment of this
Act.
TITLE V--OTHER HEALTH CARE MATTERS
SEC. 501. EXTENSION OF PILOT PROGRAM ON ASSISTED LIVING SERVICES FOR
VETERANS WITH TRAUMATIC BRAIN INJURY.
(a) In General.--Section 1705 of the National Defense
Authorization Act for Fiscal Year 2008 (Public Law 110-181; 38
U.S.C. 1710C note) is amended by adding at the end the
following:
``(g) Termination.--The pilot program shall terminate on
October 6, 2017.''.
(b) Conforming Amendment.--Subsection (a) of such section
is amended by striking ``five-year''.
TITLE VI--MAJOR MEDICAL FACILITY LEASES
SEC. 601. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.
(a) In General.--The Secretary of Veterans Affairs may
carry out the following major medical facility leases at the
locations specified, and in an amount for each lease not to
exceed the amount shown for such location (not including any
estimated cancellation costs):
(1) For a clinical research and pharmacy
coordinating center, Albuquerque, New Mexico, an amount
not to exceed $9,560,000.
(2) For a community-based outpatient clinic, Brick,
New Jersey, an amount not to exceed $7,280,000.
(3) For a new primary care and dental clinic annex,
Charleston, South Carolina, an amount not to exceed
$7,070,250.
(4) For a community-based outpatient clinic, Cobb
County, Georgia, an amount not to exceed $6,409,000.
(5) For the Leeward Outpatient Healthcare Access
Center, Honolulu, Hawaii, including a co-located clinic
with the Department of Defense and the co-location of
the Honolulu Regional Office of the Veterans Benefits
Administration and the Kapolei Vet Center of the
Department of Veterans Affairs, an amount not to exceed
$15,887,370.
(6) For a community-based outpatient clinic,
Johnson County, Kansas, an amount not to exceed
$2,263,000.
(7) For a replacement community-based outpatient
clinic, Lafayette, Louisiana, an amount not to exceed
$2,996,000.
(8) For a community-based outpatient clinic, Lake
Charles, Louisiana, an amount not to exceed $2,626,000.
(9) For outpatient clinic consolidation, New Port
Richey, Florida, an amount not to exceed $11,927,000.
(10) For an outpatient clinic, Ponce, Puerto Rico,
an amount not to exceed $11,535,000.
(11) For lease consolidation, San Antonio, Texas,
an amount not to exceed $19,426,000.
(12) For a community-based outpatient clinic, San
Diego, California, an amount not to exceed $11,946,100.
(13) For an outpatient clinic, Tyler, Texas, an
amount not to exceed $4,327,000.
(14) For the Errera Community Care Center, West
Haven, Connecticut, an amount not to exceed $4,883,000.
(15) For the Worcester Community-Based Outpatient
Clinic, Worcester, Massachusetts, an amount not to
exceed $4,855,000.
(16) For the expansion of a community-based
outpatient clinic, Cape Girardeau, Missouri, an amount
not to exceed $4,232,060.
(17) For a multispecialty clinic, Chattanooga,
Tennessee, an amount not to exceed $7,069,000.
(18) For the expansion of a community-based
outpatient clinic, Chico, California, an amount not to
exceed $4,534,000.
(19) For a community-based outpatient clinic, Chula
Vista, California, an amount not to exceed $3,714,000.
(20) For a new research lease, Hines, Illinois, an
amount not to exceed $22,032,000.
(21) For a replacement research lease, Houston,
Texas, an amount not to exceed $6,142,000.
(22) For a community-based outpatient clinic,
Lincoln, Nebraska, an amount not to exceed $7,178,400.
(23) For a community-based outpatient clinic,
Lubbock, Texas, an amount not to exceed $8,554,000.
(24) For a community-based outpatient clinic
consolidation, Myrtle Beach, South Carolina, an amount
not to exceed $8,022,000.
(25) For a community-based outpatient clinic,
Phoenix, Arizona, an amount not to exceed $20,757,000.
(26) For the expansion of a community-based
outpatient clinic, Redding, California, an amount not
to exceed $8,154,000.
(27) For the expansion of a community-based
outpatient clinic, Tulsa, Oklahoma, an amount not to
exceed $13,269,200.
(b) Requirements for Clinic in Tulsa.--
(1) In general.--In carrying out the expansion of
the community-based outpatient clinic in Tulsa,
Oklahoma, authorized by subsection (a)(27), the
Secretary of Veterans Affairs shall ensure that such
clinic satisfies the following requirements:
(A) Consist of not more than 140,000 gross
square feet.
(B) Have an annual cost per square foot of
not more than the average market rate in Tulsa,
Oklahoma, for an equivalent medical facility
plus 20 percent.
(C) Satisfy the mandate of the Department
of Veterans Affairs to provide veterans in
Oklahoma with access to quality and efficient
care.
(D) Expand clinical capacity in the region
in which the clinic is located in a cost
efficient manner based upon regional cost
comparisons, taking into account the needs of
current veterans and the potential demand by
veterans for care in the future.
(E) Be the most cost effective option for
the Department as predicted over a 30-year life
cycle for such clinic.
(2) Cost effective determination.--
(A) In general.--If the Secretary
determines that the most cost effective option
over a 30-year life cycle would be to purchase
or construct a facility in Tulsa, Oklahoma,
instead of entering into a major medical
facility lease in such location as authorized
by subsection (a)(27), the Secretary shall not
enter into such lease.
(B) Major medical facility project.--If the
Secretary makes the determination described in
subparagraph (A), the Secretary may request
authority for a major medical facility project
in Tulsa, Oklahoma, from Congress pursuant to
section 8104(b) of title 38, United States
Code.
(C) Cost-benefit analysis.--If the
Secretary requests authority for the major
medical facility project described in
subparagraph (B), not later than 90 days after
making the determination described in
subparagraph (A), the Secretary shall submit to
Congress a detailed cost-benefit analysis of
such major medical facility project.
SEC. 602. BUDGETARY TREATMENT OF DEPARTMENT OF VETERANS AFFAIRS MAJOR
MEDICAL FACILITIES LEASES.
(a) Findings.--Congress finds the following:
(1) Title 31, United States Code, requires the
Department of Veterans Affairs to record the full cost
of its contractual obligation against funds available
at the time a contract is executed.
(2) Office of Management and Budget Circular A-11
provides guidance to agencies in meeting the statutory
requirements under title 31, United States Code, with
respect to leases.
(3) For operating leases, Office of Management and
Budget Circular A-11 requires the Department of
Veterans Affairs to record up-front budget authority in
an ``amount equal to total payments under the full term
of the lease or [an] amount sufficient to cover first
year lease payments plus cancellation costs''.
(b) Requirement for Obligation of Full Cost.--
(1) In general.--Subject to the availability of
appropriations provided in advance, in exercising the
authority of the Secretary of Veterans Affairs to enter
into leases provided in this Act, the Secretary shall
record, pursuant to section 1501 of title 31, United
States Code, as the full cost of the contractual
obligation at the time a contract is executed either--
(A) an amount equal to total payments under
the full term of the lease; or
(B) if the lease specifies payments to be
made in the event the lease is terminated
before its full term, an amount sufficient to
cover the first year lease payments plus the
specified cancellation costs.
(2) Self-insuring authority.--The requirements of
paragraph (1) may be satisfied through the use of the
self-insuring authority identified in title 40, United
States Code, consistent with Office of Management and
Budget Circular A-11.
(c) Transparency.--
(1) Compliance.--Subsection (b) of section 8104 of
title 38, United States Code, is amended by adding at
the end the following new paragraph:
``(7) In the case of a prospectus proposing funding
for a major medical facility lease, a detailed analysis
of how the lease is expected to comply with Office of
Management and Budget Circular A-11 and section 1341 of
title 31 (commonly referred to as the `Anti-Deficiency
Act'). Any such analysis shall include--
``(A) an analysis of the classification of
the lease as a `lease-purchase', `capital
lease', or `operating lease' as those terms are
defined in Office of Management and Budget
Circular A-11;
``(B) an analysis of the obligation of
budgetary resources associated with the lease;
and
``(C) an analysis of the methodology used
in determining the asset cost, fair market
value, and cancellation costs of the lease.''.
(2) Submittal to congress.--Such section 8104 is
further amended by adding at the end the following new
subsection:
``(h)(1) Not less than 30 days before entering into a major
medical facility lease, the Secretary shall submit to the
Committees on Veterans' Affairs of the Senate and the House of
Representatives--
``(A) notice of the Secretary's intention to enter
into the lease;
``(B) a detailed summary of the proposed lease;
``(C) a description and analysis of any differences
between the prospectus submitted pursuant to subsection
(b) and the proposed lease; and
``(D) a scoring analysis demonstrating that the
proposed lease fully complies with Office of Management
and Budget Circular A-11.
``(2) Each committee described in paragraph (1) shall
ensure that any information submitted to the committee under
such paragraph is treated by the committee with the same level
of confidentiality as is required by law of the Secretary and
subject to the same statutory penalties for unauthorized
disclosure or use as the Secretary.
``(3) Not more than 30 days after entering into a major
medical facility lease, the Secretary shall submit to each
committee described in paragraph (1) a report on any material
differences between the lease that was entered into and the
proposed lease described under such paragraph, including how
the lease that was entered into changes the previously
submitted scoring analysis described in subparagraph (D) of
such paragraph.''.
(d) Rule of Construction.--Nothing in this section, or the
amendments made by this section, shall be construed to in any
way relieve the Department of Veterans Affairs from any
statutory or regulatory obligations or requirements existing
prior to the enactment of this section and such amendments.
TITLE VII--OTHER VETERANS MATTERS
SEC. 701. EXPANSION OF MARINE GUNNERY SERGEANT JOHN DAVID FRY
SCHOLARSHIP.
(a) Expansion of Entitlement.--Subsection (b)(9) of section
3311 of title 38, United States Code, is amended by inserting
``or spouse'' after ``child''.
(b) Limitation and Election on Certain Benefits.--
Subsection (f) of such section is amended--
(1) by redesignating paragraph (2) as paragraph
(4); and
(2) by inserting after paragraph (1) the following
new paragraphs:
``(2) Limitation.--The entitlement of an individual
to assistance under subsection (a) pursuant to
paragraph (9) of subsection (b) because the individual
was a spouse of a person described in such paragraph
shall expire on the earlier of--
``(A) the date that is 15 years after the
date on which the person died; or
``(B) the date on which the individual
remarries.
``(3) Election on receipt of certain benefits.--A
surviving spouse entitled to assistance under
subsection (a) pursuant to paragraph (9) of subsection
(b) who is also entitled to educational assistance
under chapter 35 of this title may not receive
assistance under both this section and such chapter,
but shall make an irrevocable election (in such form
and manner as the Secretary may prescribe) under which
section or chapter to receive educational
assistance.''.
(c) Conforming Amendment.--Section 3321(b)(4) of such title
is amended--
(1) by striking ``an individual'' and inserting ``a
child''; and
(2) by striking ``such individual's'' each time it
appears and inserting ``such child's''.
(d) Effective Date.--The amendments made by this section
shall apply with respect to a quarter, semester, or term, as
applicable, commencing on or after January 1, 2015.
SEC. 702. APPROVAL OF COURSES OF EDUCATION PROVIDED BY PUBLIC
INSTITUTIONS OF HIGHER LEARNING FOR PURPOSES OF
ALL-VOLUNTEER FORCE EDUCATIONAL ASSISTANCE PROGRAM
AND POST-9/11 EDUCATIONAL ASSISTANCE CONDITIONAL ON
IN-STATE TUITION RATE FOR VETERANS.
(a) In General.--Section 3679 of title 38, United States
Code, is amended by adding at the end the following new
subsection:
``(c)(1) Notwithstanding any other provision of this
chapter and subject to paragraphs (3) through (6), the
Secretary shall disapprove a course of education provided by a
public institution of higher learning to a covered individual
pursuing a course of education with educational assistance
under chapter 30 or 33 of this title while living in the State
in which the public institution of higher learning is located
if the institution charges tuition and fees for that course for
the covered individual at a rate that is higher than the rate
the institution charges for tuition and fees for that course
for residents of the State in which the institution is located,
regardless of the covered individual's State of residence.
``(2) For purposes of this subsection, a covered individual
is any individual as follows:
``(A) A veteran who was discharged or released from
a period of not fewer than 90 days of service in the
active military, naval, or air service less than three
years before the date of enrollment in the course
concerned.
``(B) An individual who is entitled to assistance
under section 3311(b)(9) or 3319 of this title by
virtue of such individual's relationship to a veteran
described in subparagraph (A).
``(3) If after enrollment in a course of education that is
subject to disapproval under paragraph (1) by reason of
paragraph (2)(A) or (2)(B) a covered individual pursues one or
more courses of education at the same public institution of
higher learning while remaining continuously enrolled (other
than during regularly scheduled breaks between courses,
semesters or terms) at that institution of higher learning, any
course so pursued by the covered individual at that institution
of higher learning while so continuously enrolled shall also be
subject to disapproval under paragraph (1).
``(4) It shall not be grounds to disapprove a course of
education under paragraph (1) if a public institution of higher
learning requires a covered individual pursuing a course of
education at the institution to demonstrate an intent, by means
other than satisfying a physical presence requirement, to
establish residency in the State in which the institution is
located, or to satisfy other requirements not relating to the
establishment of residency, in order to be charged tuition and
fees for that course at a rate that is equal to or less than
the rate the institution charges for tuition and fees for that
course for residents of the State.
``(5) The Secretary may waive such requirements of
paragraph (1) as the Secretary considers appropriate.
``(6) Disapproval under paragraph (1) shall apply only with
respect to educational assistance under chapters 30 and 33 of
this title.''.
(b) Effective Date.--Subsection (c) of section 3679 of
title 38, United States Code (as added by subsection (a) of
this section), shall apply with respect to educational
assistance provided for pursuit of a program of education
during a quarter, semester, or term, as applicable, that begins
after July 1, 2015.
SEC. 703. 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 5503(d)(7) of title 38, United States Code, is
amended by striking ``November 30, 2016'' and inserting
``September 30, 2024''.
SEC. 704. EXTENSION OF REQUIREMENT FOR COLLECTION OF FEES FOR HOUSING
LOANS GUARANTEED BY SECRETARY OF VETERANS AFFAIRS.
Section 3729(b)(2) of title 38, United States Code, is
amended--
(1) in subparagraph (A)--
(A) in clause (iii), by striking ``October
1, 2017'' and inserting ``September 30, 2024'';
and
(B) in clause (iv), by striking ``October
1, 2017'' and inserting ``September 30, 2024'';
(2) in subparagraph (B)--
(A) in clause (i), by striking ``October 1,
2017'' and inserting ``September 30, 2024'';
and
(B) in clause (ii), by striking ``October
1, 2017'' and inserting ``September 30, 2024'';
(3) in subparagraph (C)--
(A) in clause (i), by striking ``October 1,
2017'' and inserting ``September 30, 2024'';
and
(B) in clause (ii), by striking ``October
1, 2017'' and inserting ``September 30, 2024'';
and
(4) in subparagraph (D)--
(A) in clause (i), by striking ``October 1,
2017'' and inserting ``September 30, 2024'';
and
(B) in clause (ii), by striking ``October
1, 2017'' and inserting ``September 30, 2024''.
SEC. 705. LIMITATION ON AWARDS AND BONUSES PAID TO EMPLOYEES OF
DEPARTMENT OF VETERANS AFFAIRS.
In each of fiscal years 2015 through 2024, the Secretary of
Veterans Affairs shall ensure that the aggregate amount of
awards and bonuses paid by the Secretary in a fiscal year under
chapter 45 or 53 of title 5, United States Code, or any other
awards or bonuses authorized under such title does not exceed
$360,000,000.
SEC. 706. EXTENSION OF AUTHORITY TO USE INCOME INFORMATION.
Section 5317(g) of title 38, United States Code, is amended
by striking ``September 30, 2016'' and inserting ``September
30, 2024''.
SEC. 707. REMOVAL OF SENIOR EXECUTIVES OF THE DEPARTMENT OF VETERANS
AFFAIRS FOR PERFORMANCE OR MISCONDUCT.
(a) Removal or Transfer.--
(1) In general.--Chapter 7 of title 38, United
States Code, is amended by adding at the end the
following new section:
``Sec. 713. Senior executives: removal based on performance or
misconduct
``(a) In General.--(1) The Secretary may remove an
individual employed in a senior executive position at the
Department of Veterans Affairs from the senior executive
position if the Secretary determines the performance or
misconduct of the individual warrants such removal. If the
Secretary so removes such an individual, the Secretary may--
``(A) remove the individual from the civil service
(as defined in section 2101 of title 5); or
``(B) in the case of an individual described in
paragraph (2), transfer the individual from the senior
executive position to a General Schedule position at
any grade of the General Schedule for which the
individual is qualified and that the Secretary
determines is appropriate.
``(2) An individual described in this paragraph is an
individual who--
``(A) previously occupied a permanent position
within the competitive service (as that term is defined
in section 2102 of title 5);
``(B) previously occupied a permanent position
within the excepted service (as that term is defined in
section 2103 of title 5); or
``(C) prior to employment in a senior executive
position at the Department of Veterans Affairs, did not
occupy any position within the Federal Government.
``(b) Pay of Transferred Individual.--(1) Notwithstanding
any other provision of law, including the requirements of
section 3594 of title 5, any individual transferred to a
General Schedule position under subsection (a)(2) shall,
beginning on the date of such transfer, receive the annual rate
of pay applicable to such position.
``(2) An individual so transferred may not be placed on
administrative leave or any other category of paid leave during
the period during which an appeal (if any) under this section
is ongoing, and may only receive pay if the individual reports
for duty. If an individual so transferred does not report for
duty, such individual shall not receive pay or other benefits
pursuant to subsection (e)(5).
``(c) Notice to Congress.--Not later than 30 days after
removing or transferring an individual from a senior executive
position under subsection (a), the Secretary shall submit to
the Committees on Veterans' Affairs of the Senate and House of
Representatives notice in writing of such removal or transfer
and the reason for such removal or transfer.
``(d) Procedure.--(1) The procedures under section 7543(b)
of title 5 shall not apply to a removal or transfer under this
section.
``(2)(A) Subject to subparagraph (B) and subsection (e),
any removal or transfer under subsection (a) may be appealed to
the Merit Systems Protection Board under section 7701 of title
5.
``(B) An appeal under subparagraph (A) of a removal or
transfer may only be made if such appeal is made not later than
seven days after the date of such removal or transfer.
``(e) Expedited Review by Administrative Judge.--(1) Upon
receipt of an appeal under subsection (d)(2)(A), the Merit
Systems Protection Board shall refer such appeal to an
administrative judge pursuant to section 7701(b)(1) of title 5.
The administrative judge shall expedite any such appeal under
such section and, in any such case, shall issue a decision not
later than 21 days after the date of the appeal.
``(2) Notwithstanding any other provision of law, including
section 7703 of title 5, the decision of an administrative
judge under paragraph (1) shall be final and shall not be
subject to any further appeal.
``(3) In any case in which the administrative judge cannot
issue a decision in accordance with the 21-day requirement
under paragraph (1), the removal or transfer is final. In such
a case, the Merit Systems Protection Board shall, within 14
days after the date that such removal or transfer is final,
submit to Congress and the Committees on Veterans' Affairs of
the Senate and House of Representatives a report that explains
the reasons why a decision was not issued in accordance with
such requirement.
``(4) The Merit Systems Protection Board or administrative
judge may not stay any removal or transfer under this section.
``(5) During the period beginning on the date on which an
individual appeals a removal from the civil service under
subsection (d) and ending on the date that the administrative
judge issues a final decision on such appeal, such individual
may not receive any pay, awards, bonuses, incentives,
allowances, differentials, student loan repayments, special
payments, or benefits.
``(6) To the maximum extent practicable, the Secretary
shall provide to the Merit Systems Protection Board, and to any
administrative judge to whom an appeal under this section is
referred, such information and assistance as may be necessary
to ensure an appeal under this subsection is expedited.
``(f) Relation to Title 5.--(1) The authority provided by
this section is in addition to the authority provided by
section 3592 or subchapter V of chapter 75 of title 5.
``(2) Section 3592(b)(1) of title 5 does not apply to an
action to remove or transfer an individual under this section.
``(g) Definitions.--In this section:
``(1) The term `individual' means--
``(A) a career appointee (as that term is
defined in section 3132(a)(4) of title 5); or
``(B) any individual who occupies an
administrative or executive position and who
was appointed under section 7306(a) or section
7401(1) of this title.
``(2) The term `misconduct' includes neglect of
duty, malfeasance, or failure to accept a directed
reassignment or to accompany a position in a transfer
of function.
``(3) The term `senior executive position' means--
``(A) with respect to a career appointee
(as that term is defined in section 3132(a)(4)
of title 5), a Senior Executive Service
position (as such term is defined in section
3132(a)(2) of title 5); and
``(B) with respect to an individual
appointed under section 7306(a) or section
7401(1) of this title, an administrative or
executive position.''.
(2) Clerical amendment.--The table of sections at
the beginning of such chapter is amended by adding at
the end the following new item:
``713. Senior executives: removal based on performance or misconduct.''.
(b) Establishment of Expedited Review Process.--
(1) In general.--Not later than 14 days after the
date of the enactment of this Act, the Merit Systems
Protection Board shall establish and put into effect a
process to conduct expedited reviews in accordance with
section 713(d) of title 38, United States Code.
(2) Inapplicability of certain regulations.--
Section 1201.22 of title 5, Code of Federal
Regulations, as in effect on the day before the date of
the enactment of this Act, shall not apply to expedited
reviews carried out under section 713(d) of title 38,
United States Code.
(3) Waiver.--The Merit Systems Protection Board may
waive any other regulation in order to provide for the
expedited review required under section 713(d) of title
38, United States Code.
(4) Report by merit systems protection board.--Not
later than 14 days after the date of the enactment of
this Act, the Merit Systems Protection Board shall
submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a report on the
actions the Board plans to take to conduct expedited
reviews under section 713(d) of title 38, United States
Code, as added by subsection (a). Such report shall
include a description of the resources the Board
determines will be necessary to conduct such reviews
and a description of whether any resources will be
necessary to conduct such reviews that were not
available to the Board on the day before the date of
the enactment of this Act.
(c) Temporary Exemption From Certain Limitation on
Initiation of Removal From Senior Executive Service.--During
the 120-day period beginning on the date of the enactment of
this Act, an action to remove an individual from the Senior
Executive Service at the Department of Veterans Affairs
pursuant to section 7543 of title 5, United States Code, may be
initiated, notwithstanding section 3592(b) of such title, or
any other provision of law.
(d) Construction.--
(1) In general.--Nothing in this section or section
713 of title 38, United States Code, as added by
subsection (a), shall be construed to apply to an
appeal of a removal, transfer, or other personnel
action that was pending before the date of the
enactment of this Act.
(2) Relation to title 5.--With respect to the
removal or transfer of an individual (as that term is
defined in such section 713) employed at the Department
of Veterans Affairs, the authority provided by such
section 713 is in addition to the authority provided by
section 3592 or subchapter V of chapter 75 of title 5,
United States Code.
TITLE VIII--OTHER MATTERS
SEC. 801. APPROPRIATION OF AMOUNTS.
(a) In General.--There is authorized to be appropriated,
and is appropriated, to the Secretary of Veterans Affairs, out
of any funds in the Treasury not otherwise appropriated
$5,000,000,000 to carry out subsection (b). Such funds shall be
available for obligation or expenditure without fiscal year
limitation.
(b) Use of Amounts.--The amount appropriated under
subsection (a) shall be used by the Secretary as follows:
(1) To increase the access of veterans to care as
follows:
(A) To hire primary care and specialty care
physicians for employment in the Department of
Veterans Affairs.
(B) To hire other medical staff, including
the following:
(i) Physicians.
(ii) Nurses.
(iii) Social workers.
(iv) Mental health professionals.
(v) Other health care professionals
as the Secretary considers appropriate.
(C) To carry out sections 301 and 302,
including the amendments made by such sections.
(D) To pay for expenses, equipment, and
other costs associated with the hiring of
primary care, specialty care physicians, and
other medical staff under subparagraphs (A),
(B), and (C).
(2) To improve the physical infrastructure of the
Department as follows:
(A) To maintain and operate hospitals,
nursing homes, domiciliary facilities, and
other facilities of the Veterans Health
Administration.
(B) To enter into contracts or hire
temporary employees to repair, alter, or
improve facilities under the jurisdiction of
the Department that are not otherwise provided
for under this paragraph.
(C) To carry out leases for facilities of
the Department.
(D) To carry out minor construction
projects of the Department.
(c) Availability.--The amount appropriated under subsection
(a) shall remain available until expended.
(d) Report.--
(1) In general.--Not later than one year after the
date of the enactment of this Act, the Secretary of
Veterans Affairs shall submit to the appropriate
committees of Congress a report on how the Secretary
has obligated the amounts appropriated under subsection
(a) as of the date of the submittal of the report.
(2) Appropriate committees of congress defined.--In
this subsection, the term ``appropriate committees of
Congress'' means--
(A) the Committee on Veterans' Affairs and
the Committee on Appropriations of the Senate;
and
(B) the Committee on Veterans' Affairs and
the Committee on Appropriations of the House of
Representatives.
(e) Funding Plan.--The Secretary shall submit to Congress a
funding plan describing how the Secretary intends to use the
amounts provided under subsection (a).
SEC. 802. VETERANS CHOICE FUND.
(a) In General.--There is established in the Treasury of
the United States a fund to be known as the Veterans Choice
Fund.
(b) Administration of Fund.--The Secretary of Veterans
Affairs shall administer the Veterans Choice Fund established
by subsection (a).
(c) Use of Amounts.--
(1) In general.--Any amounts deposited in the
Veteran Choice Fund shall be used by the Secretary of
Veterans Affairs to carry out section 101, including,
subject to paragraph (2), any administrative
requirements of such section.
(2) Amount for administrative requirements.--
(A) Limitation.--Except as provided by
subparagraph (B), of the amounts deposited in
the Veterans Choice Fund, not more than
$300,000,000 may be used for administrative
requirements to carry out section 101.
(B) Increase.--The Secretary may increase
the amount set forth in subparagraph (A) with
respect to the amounts used for administrative
requirements if--
(i) the Secretary determines that
the amount of such increase is
necessary to carry out section 101;
(ii) the Secretary submits to the
Committees on Veterans' Affairs and
Appropriations of the House of
Representatives and the Committees on
Veterans' Affairs and Appropriations of
the Senate a report described in
subparagraph (C); and
(iii) a period of 60 days has
elapsed following the date on which the
Secretary submits the report under
clause (ii).
(C) Report.--A report described in this
subparagraph is a report that contains the
following:
(i) A notification of the amount of
the increase that the Secretary
determines necessary under subparagraph
(B)(i).
(ii) The justifications for such
increased amount.
(iii) The administrative
requirements that the Secretary will
carry out using such increased amount.
(d) Appropriation and Deposit of Amounts.--
(1) In general.--There is authorized to be
appropriated, and is appropriated, to the Secretary of
Veterans Affairs, out of any funds in the Treasury not
otherwise appropriated $10,000,000,000 to be deposited
in the Veterans Choice Fund established by subsection
(a). Such funds shall be available for obligation or
expenditure without fiscal year limitation, and only
for the program created under section 101.
(2) Availability.--The amount appropriated under
paragraph (1) shall remain available until expended.
(e) Sense of Congress.--It is the sense of Congress that
the Veterans Choice Fund is a supplement to but distinct from
the Department of Veterans Affairs' current and expected level
of non-Department care currently part of Department's medical
care budget. Congress expects that the Department will maintain
at least its existing obligations of non-Department care
programs in addition to but distinct from the Veterans Choice
Fund for each of fiscal years 2015 through 2017.
SEC. 803. EMERGENCY DESIGNATIONS.
(a) In General.--This Act is designated as an emergency
requirement pursuant to section 4(g) of the Statutory Pay-As-
You-Go Act of 2010 (2 U.S.C. 933(g)).
(b) Designation in Senate.--In the Senate, this Act is
designated as an emergency requirement pursuant to section
403(a) of S. Con. Res. 13 (111th Congress), the concurrent
resolution on the budget for fiscal year 2010.
And the House agree to the same.
For consideration of the House amendment and
the Senate amendment, and modifications
committed to conference:
Jeff Miller of Florida,
Doug Lamborn,
David P. Roe of Tennessee,
Bill Flores,
Dan Benishek,
Mike Coffman,
Brad R. Wenstrup,
Jackie Walorski,
Michael H. Michaud,
Corrine Brown of Florida,
Mark Takano,
Julia Brownley of California,
Ann Kirkpatrick,
Timothy J. Walz,
Managers on the part of the House.
Bernard Sanders,
John D. Rockefeller IV,
Patty Murray,
Sherrod Brown,
Jon Tester,
Mark Begich,
Richard Blumenthal,
Mazie K. Hirono,
Richard Burr,
Johnny Isakson,
Mike Johanns,
Managers on the part of the Senate.
JOINT EXPLANATORY STATEMENT OF THE COMMITTEE OF CONFERENCE
The managers on the part of the House and the Senate at
the conference on the disagreeing votes of the two Houses on
the amendment of the House to the amendment of the Senate to
the bill (H.R. 3230), making continuing appropriations during a
Government shutdown to provide pay and allowances to members of
the reserve components of the Armed Forces who perform
inactive-duty training during such period, submit the following
joint statement to the House and the Senate in explanation of
the effect of the action agreed upon by the managers and
recommended in the accompanying conference report:
The House amendment to the Senate amendment struck all of
the House bill after the enacting clause and inserted a
substitute text.
The Senate recedes from its disagreement to the amendment
of the House with an amendment that is a substitute for the
House bill and the House amendment to the Senate amendment. The
differences between the House amendment, the Senate amendment,
and the substitute agreed to in conference are noted below,
except for clerical corrections, conforming changes made
necessary by agreements reached by the conferees, and minor
drafting and clarifying changes.
OVERVIEW
The House amendment to the Senate amendment to the
Conference bill consists of provisions from the following House
bills: H.R. 4810, the Veteran Access to Care Act of 2014, which
passed the House on June 10, 2014, and H.R. 4031, the
Department of Veterans Affairs Management Accountability Act of
2014, which passed the House on May 21, 2014.
The Senate amendment consists of provisions from the
following Senate bill: S. 2450, the Veterans' Access to Care
through Choice, Accountability, and Transparency Act of 2014,
which was incorporated as a substitute amendment to H.R. 3230
and passed the Senate on June 11, 2014.
Title I--Improvement of Access to Care From Non-Department of Veterans
Affairs Providers
EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL SERVICES FOR
VETERANS THROUGH THE USE OF AGREEMENTS WITH NON-DEPARTMENT OF VETERANS
AFFAIRS ENTITIES
Current Law
Section 1710 of title 38, United States Code
(hereinafter, ``U.S.C.''), requires the Department of Veterans
Affairs (hereinafter, ``VA'') to provide hospital care and
medical services to eligible veterans. Section 1703 of title
38, U.S.C., authorizes VA to contract with non-Department
facilities and providers to furnish hospital or medical
services to eligible veterans when VA is not capable of
providing economical care because of geographical
inaccessibility or due to an inability to furnish such care or
services required. Sections 1725 and 1728 of title 38, U.S.C.,
authorize VA to reimburse for certain types of care, such as
emergency treatment, at non-Department facilities. Section 1786
of title 38, U.S.C., authorizes VA to provide needed post-
delivery care and services. Section 8111 of title 38, U.S.C.,
authorizes VA to enter into sharing agreements at other
government facilities. Section 8153 of title 38, U.S.C.,
authorizes a VA facility to enter into a contract or agreement
with non-VA health care entities to secure healthcare services
that are either unavailable or not cost-effective to provide at
a VA facility.
Senate Amendment
The Senate amendment would require VA to provide hospital
and medical services to an eligible veteran, at the election of
such veteran, through non-VA health care providers, who
participate in the Medicare program, or at Federally Qualified
Health Centers (hereinafter, ``FQHCs''), facilities funded by
the Indian Health Service (hereinafter, ``IHS''), or Department
of Defense (hereinafter, ``DOD''). It would also require the
Secretary of Veterans Affairs (hereinafter, ``the Secretary'')
to coordinate the delivery of such non-VA care and services
through the Non-VA Care Coordination Program.
For purposes of receiving non-VA care and services as a
veteran enrolled in the VA health care system, the Senate
amendment would define an eligible veteran as someone who is
unable to schedule an appointment at a VA medical facility
within VA's stated wait-time goals; resides more than 40 miles
from the nearest VA medical facility; or, in the case of a
veteran who resides in a State without a VA medical facility
that provides hospital care, emergency medical services, and
surgical care, resides 20 miles from such VA medical facility.
It would also authorize VA to enter into negotiated
contracts with eligible non-VA providers for the provision of
care and services to an eligible veteran. Furthermore, it would
authorize VA to establish contracts with non-VA providers at
the Medicare rate or to negotiate a rate that is higher than
the Medicare rate, only if VA is unable to find a health care
provider that is able to provide such care and services at the
Medicare rate.
House Amendment
The House amendment would require VA, for two years after
enactment, to offer non-VA care at the Department's expense to
any enrolled veteran who resides more than 40 miles from a VA
medical facility or has waited longer than the VA's wait-time
goals--as of June 1, 2014--for a medical appointment or has
been notified by VA that an appointment is not available within
VA's wait-time goals--as of June 1, 2014--and who elects to
receive care at a non-VA facility. In furnishing such care, the
House amendment would require VA to utilize existing contracts
to the greatest extent possible; to reimburse any non-VA care
providers with which VA has not entered into an existing
contract, at the greater of the rate set by VA, TRICARE, or
Medicare, for care received by an eligible veteran; and, ensure
that a non-VA care authorization encompasses the complete
episode of care but does not exceed sixty days.
It would also require VA to submit to Congress a
quarterly report, which includes how many eligible veterans
have received non-VA care or services.
Conference Agreement
The Conference agreement adopts the Senate provision with
amendments to eligibility, payment rates and VA's obligation
for payments for non-service-connected care or services. The
conference substitute defines an eligible veteran as a veteran
who is enrolled in the patient enrollment system as of August
1, 2014, or any veteran who enrolls after such date and who, at
any time during the five-year period preceding such enrollment,
served on active duty in a theater of combat operation. It also
includes those veterans who live within 40 miles of a medical
facility and are required to travel by air, boat, or ferry to
access a VA medical facility or who face geographical
challenges in accessing that medical facility. In calculating
the distance from a nearest VA medical facility, it is the
Conferees' expectation that VA will use geodesic distance, or
the shortest distance between two points. The Conferees do not
intend the 40-mile eligibility criteria included in this
section to preclude veterans who reside closer than 40-miles
from a VA facility from accessing care through non-VA
providers, particularly if the VA facility the veteran resides
near provides limited services.
Should an appointment not be available for a veteran
within the established wait time goals and the veteran chooses
to be seen by non-VA entities, the veteran will be informed by
electronic means, or by a letter if the veteran so chooses, as
to the care or services they are authorized to receive.
The rates for contracts established under this section
shall be no more than the rates paid to a provider of services
under Medicare with the exception VA may negotiate a higher
rate for care provided to veterans residing in highly rural
areas.
A ``Veterans Choice Card'' will be issued to each
enrolled veteran for presentation to health care providers for
the delivery of authorized medical care and services. This card
will contain identifying information as well as contact and
relevant information for authorization and claims procedures.
The Secretary will provide information to veterans about the
availability of care and services through the use of this card.
The Conferees do not intend for any delays that may occur in
the production of the ``Veterans Choice Card'' to delay the
implementation of the choice program.
This election to receive care through a health care
provider also includes what would be considered an episode of
care up to a period of 60 days. The Conferees recognize that
chronic conditions or illnesses may require episodes of care
that extend beyond the 60 day limit. In such cases, the
Conferees expect the Secretary to authorize additional episodes
of care sufficient to complete the needed treatment or in the
case of treatment needed to maintain a quality of life during a
terminal illness.
For those veterans receiving hospital care or medical
services for non-service-connected conditions, the Department
is secondarily responsible. The health care provider that
furnishes care or services shall be responsible for seeking
reimbursement from the health care plan contract under which
the eligible veteran is covered. Eligible veterans will pay a
copayment for the receipt of hospital care or medical services
under this section only if such eligible veteran would be
required to pay a copayment for the receipt of care and
services at a VA medical facility. Nothing in this section
amends health plans not administered by the Department,
including with respect to the terms and conditions of such
coverage, reimbursement, and cost-sharing.
Numerous reports are required to document program
implementation, establishment and success in meeting goals,
utilization of and satisfaction in care and services delivered
under this section, and Department expenditures.
The Conferees expect VA will provide care and services
under this section at the choice of an eligible veteran if the
veteran experiences the time or distance delays described in
this section. When coordinating care for eligible veterans
through the Non-VA Care Coordination program, the Department
should attempt to ensure when an appointment is authorized, the
eligible veteran receives care within an appropriate time
period, as defined by medical necessity as determined by the
referring physician, or a mandatory time period established by
the Secretary when the request for care is not initiated by a
physician, that all medical fees are appropriately paid and
health care records are returned to the Department within the
prescribed time. The Conferees also expect that VA will utilize
providers who have demonstrated success providing a variety of
care, to veterans under an integrated model of care and a
proven ability to partner with the Federal government.
Congress has authorized a new program to provide care and
choice to veterans, the funds made available for this program
through section 802(d)(1) are available only to carry out this
new program.
ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF VETERANS AFFAIRS AND
INDIAN HEALTH SERVICE
Current Law
Subsection 1645(c) of title 25, U.S.C., requires VA and
DOD to reimburse IHS, an Indian tribe, or a tribal organization
for providing eligible beneficiaries with health care services.
In 2010, VA and IHS signed an updated Memorandum of
Understanding (hereinafter, ``MOU'') in order to establish
``mutual goals and objectives for ongoing collaboration between
VA and IHS in support of their respective missions and to
establish a common mission of serving our nation's American
Indian and Alaska Native Veteran.'' This MOU set forth five
goals, to be achieved through 12 areas of collaboration between
VA and IHS. One of the areas of collaboration focused on
increasing the availability of health care services through
development of payment and reimbursement policies to support
interagency care delivery.
As a result, in December 2012, VA and IHS signed a
national reimbursement agreement to create a mechanism by which
VA can reimburse IHS for health services provided to eligible
veterans. This MOU only covers direct care services provided by
IHS. In addition to providing direct care, IHS also contracts
with Urban Indian Health Centers and Tribal Health Programs
(hereinafter, ``THP'') to provide additional points of care to
eligible Native Americans. VA has worked with individual THPs
to negotiate separate reimbursement agreements to care for
veterans. While VA's agreement with IHS only covers dual
eligible veterans, the Department's agreements with health
providers through the Alaska Native Tribal Health Consortium
include coverage for all veterans. VA has not yet entered into
reimbursement agreements with any Urban IHS Centers to treat
veterans.
In April 2013 and June 2014, the Government
Accountability Office (hereinafter, ``GAO'') issued two reports
on the VA-IHS MOU. GAO's recommendations indicated that better
definition of metrics and improved oversight and guidance would
improve implementation of the MOU and its impact on access to
care for veterans.
Senate Amendment
The Senate amendment would require VA, in consultation
with IHS, to conduct more outreach to IHS tribal health
programs to ensure they are aware of the opportunity to
negotiate a reimbursement agreement.
It would require VA, in collaboration with IHS, to define
metrics for implementing and overseeing existing partnership
efforts under the current VA-IHS MOU.
Finally, it would require VA and IHS to jointly report to
Congress, within 180 days of enactment, on the feasibility and
advisability of entering into reimbursement agreements with
Urban IHS Centers and including treatment of non-Native
veterans as a reimbursable expense under existing reimbursement
structures.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute adopts the Senate provision.
ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF VETERANS AFFAIRS AND
NATIVE HAWAIIAN HEALTH CARE SYSTEMS
Current Law
In October 2013, the VA Pacific Islands Health Care
System (hereinafter, ``VAPIHCS'') entered into an MOU with Papa
Ola Lokahi, the statutorily designated statewide coordinating
body for the five Native Hawaiian Health Care Systems, in order
to improve communication, collaboration, and cooperation
regarding health care for Native Hawaiian veterans. The purpose
statement of the MOU notes that both parties, ``hope to seek
and develop greater means of achieving efficiency of care
provided and to create future processes for VAPIHCS
reimbursement for services provided to Native Hawaiian veterans
referred to Papa Ola Lokahi by VAPIHCS.'' VA estimated the
average waiting time for a new patient requesting a primary
care appointment at VAPIHCS was nearly 130 days, the highest in
the nation. Due to the rural nature of the state, VAPIHCS has
received funding above and beyond its Veterans Equitable
Resource Allocation in Fiscal Year (hereinafter, ``FY'') 2012
and FY 2013, in order to account for the costs of beneficiary
travel for eligible veterans to receive services on other
islands. These numbers were $4.94 million and $4.65 million,
respectively.
Senate Amendment
The Senate amendment would require VA to enter into
contracts or agreements with the Native Hawaiian health care
systems for reimbursement of direct care services provided to
eligible veterans.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute adopts the Senate provision.
REAUTHORIZATION AND MODIFICATION OF PILOT PROGRAM OF ENHANCED CONTRACT
CARE AUTHORITY FOR HEALTH CARE NEEDS OF VETERANS
Current Law
Section 403 of the Veterans' Mental Health and Other Care
Improvements Act of 2008, Public Law 110-387, provided VA with
authority to conduct a pilot program commonly known as Project
ARCH (Access Received Closer to Home) in five Veterans
Integrated Service Networks (hereinafter, ``VISNs''). The pilot
program was to be carried out in at least five VISNs,
restricted by various geographic and demographic factors.
Locations included: Northern Maine; Farmville, Virginia; Pratt,
Kansas; Flagstaff, Arizona; and, Billings, Montana. The aim of
the pilot was to provide health care access to eligible
veterans closer to home through a non-Department health care
provider.
Senate Amendment
The Senate amendment contained no similar provision.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Committee substitute would extend Project ARCH within
specified VISNs for veterans in highly rural areas who are
enrolled in VA health care for an additional 2 years. It would
also require appointments to be scheduled within 5 days from
the date the provider accepts a referral from VA and requires
these veterans receive care within 30 days from the date the
appointment was made.
PROMPT PAYMENT BY THE DEPARTMENT OF VETERANS AFFAIRS
Current Law
In general, the Prompt Payment Act, as amended, requires
executive branch agencies, including VA, to pay late-payment
penalties when the Department does not pay commercial payments
on time.
In March 2014, GAO reported that billing officials at one
non-VA provider experienced ``lengthy delays'' in the
processing of their claims, which in some cases took years.
Additionally, GAO testified at a House Committee on Veterans'
Affairs hearing on June 18, 2014, on claim processing
discrepancies that delayed or denied payments for healthcare
provided by non-VA providers.
According to GAO, these delays or denials create an
environment where non-VA entities are hesitant to provide care
due to fears they will not be paid for services provided. This
hinders access to care for veterans who need non-VA services.
Senate Amendment
The Senate amendment would provide a Sense of Congress
that VA comply with section 1315 of title 5, Code of Federal
Regulations (hereinafter, ``CFR''), (commonly known as the
``prompt payment rule'') in paying for health care pursuant to
contracts with non-VA providers.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute adopts the Senate provision
with an amendment that adds a GAO report on the timeliness of
payments by VA for non-VA care and services. The Committee is
concerned that the Department is not paying claims for services
provided to veterans by non-Department providers in a timely
manner. The Committee urges the Secretary to establish and
implement a system for the processing and paying of those
claims.
TRANSFER OF AUTHORITY FOR PAYMENTS FOR HOSPITAL CARE, MEDICAL SERVICES,
AND OTHER HEALTH CARE FROM NON-DEPARTMENT OF VETERANS AFFAIRS PROVIDERS
TO THE CHIEF BUSINESS OFFICE OF THE VETERANS HEALTH ADMINISTRATION
Current Law
Under current law, section 1703 of title 38, U.S.C., VA
may contract with non-Department facilities and providers to
furnish hospital care or medical services to eligible veterans
when VA is not capable of furnishing the care or services
required or VA is not capable of providing economical care
because of geographical inaccessibility. Further, VA has
authority, under sections 1725 and 1728 of title 38, U.S.C., to
reimburse for certain types of care, such as emergency
treatment, at non-Department facilities.
The criteria for determining whether a veteran is
eligible for non-VA care is established by each VISN or VA
medical center. Committee oversight has determined that a
decentralized eligibility determination process ensures
eligibility is appropriate for each medical center's capacity
and the needs of the veterans it serves. However, such
decentralization has caused disparity in eligibility criteria
throughout the VA health care system and in some cases has led
to the determination of eligibility as subject to facility
budget considerations rather than to the determination of what
is best for the veteran.
The use of non-VA care has increased. In fact, non-VA
care has been the subject of two recent reports by the GAO.
Both reports highlighted vulnerabilities in VA's ability to
manage and oversee utilization of and spending on non-VA care.
In its May 2013 report, GAO noted VA's fee basis care spending
had increased nearly $1.5 billion from FY 2008 through FY 2012
and had witnessed an increase in utilization of 19% during that
same time period.
Without central oversight of non-VA care, VA has limited
ability to collect and analyze data that could help to improve
the program's management.
Senate Amendment
The Senate amendment would require the Secretary to
transfer the authority to pay for hospital care, medical
services, and other health care through non-VA providers to the
Chief Business Office from VA's VISNs and medical centers by
October 1, 2014. It would also require the Chief Business
Office to work with the Office of Clinical Operations and
Management to ensure care and services are provided in a manner
that is clinically appropriate and in the best interest of the
veterans receiving such care and services.
Finally, in each FY after the date of enactment, the
Secretary would be required to include in the Chief Business
Office budget funds to pay for hospital care, medical services,
and other health care provided through non-VA providers.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute adopts the Senate provision.
Title II--Health Care Administrative Matters
INDEPENDENT ASSESSMENT OF THE HEALTH CARE DELIVERY SYSTEMS AND
MANAGEMENT PROCESSES OF THE DEPARTMENT OF VETERANS AFFAIRS
Current Law
VA operates the largest integrated health care system in
the nation, comprised of 150 VA medical centers (hereinafter,
``VAMCs''), 820 community-based outpatient clinics, 135
community-living centers, 300 Vet Centers, 140 domiciliary
treatment programs, and 70 mobile Vet Centers. These sites of
care are divided amongst 21 VISNs. The VA health care system is
overseen by the Veterans Health Administration (hereinafter,
``VHA''), which operates under the leadership of the VA Under
Secretary for Health. VHA employs a staff of approximately
288,000 employees and oversees a medical care budget of
approximately $55 billion. In addition to providing direct
health care services to eligible veterans, caregivers, and
dependents, VHA also conducts education and training programs
for health care professionals and medical residents; operates
an extensive medical research program; and, serves as the
contingency back-up to the Department of Defense during
national emergencies.
VHA directive 2010-027, ``VHA Outpatient Scheduling
Processes and Procedures'' (hereinafter, ``the directive''),
established on June 9, 2010, outlines the policy for
implementing processes and procedures for scheduling outpatient
appointments using the Veterans Health Information Systems and
Technology Architecture (hereinafter, ``VistA''). The directive
also provides detail regarding how to ensure staff is competent
in the scheduling process. This directive is set to expire on
June 30, 2015.
VA's Office of Inspector General (hereinafter,
``VAOIG''), GAO and a recent VA audit have identified
significant problems with VA's ability to provide timely access
to health care.
Senate Amendment
The Senate amendment would require VA to enter into a
contract with an independent third party for a 180-day
assessment of: the process for scheduling appointments at each
VA medical facility; the staffing level at and productivity of
each VA medical facility; the organization, processes, and
tools used to support clinical documentation and coding of
inpatient services; the purchasing, distribution, and use of
pharmaceuticals; and the performance of the Department in
paying amounts owed to third parties and collecting amounts
owed to the Department. The independent third party conducting
the assessment would be required to conduct a comprehensive
review of the Department's scheduling process and recommend any
actions to be taken by the Department to improve its process
for scheduling medical appointments.
The Senate amendment would also require VA to submit a
report to the Committees on Veterans' Affairs of the Senate and
the House of Representatives (hereinafter, ``the Committees''),
no later than 90 days after the date on which the independent
third party completes the assessment, on the results of such
assessment.
House Amendment
The House amendment would require an independent
assessment of hospital care and medical services furnished in
VA medical facilities. The independent assessment would
address: the current and projected demographics and unique
needs of the patient population served by VA; the Department's
current and projected health care capabilities and resources;
the authorities and mechanisms under which the Secretary may
furnish hospital care and medical services at non-VA
facilities; the appropriate system-wide access standard
applicable to hospital care and medical services furnished by
VA; the current organization, processes, and tools used to
support clinical staffing; VA's staffing levels and
productivity standards; information technology strategies; and,
VHA' s business processes. Further, the independent assessment
would include: an identification of improvement areas;
recommendations for how to address such improvement areas; the
business case associated with making such improvements; and
findings and supporting analysis on how credible conclusions
were established.
It would also require the Secretary to designate a
program integrator if VA enters into contracts with more than
one private sector entity to conduct the independent
assessment. The program integrator would be required to be
responsible for coordinating the outcomes of the assessments
conducted by the private entities.
Finally, the House amendment would require VA to submit
to the Committees a report, no later than 10 months after
entering into a contract with a private entity, on the findings
of the independent assessment and a subsequent report, no later
than 120 days after the date of the submission of the first
report, which would be required to include VA's action plan for
fully implementing the recommendations of the independent
assessment.
Conference Agreement
The Conference substitute adopts the House provision with
amendments to broaden the breadth of the assessment to include:
VA leadership; access to care; length of stay management;
patient experience; workflow; care transitions; mechanisms by
which VA ensures timely payments to nonVA care providers;
pharmaceutical; supply and device purchasing; distribution and
use; scheduling; and medical construction, maintenance and
leasing.
The Conferees expect that the assessment will produce
outcomes that identify improvement areas outlined both
qualitatively and quantitatively, taking into consideration
Department of Veterans Affairs' directives and industry
benchmarks from outside the Federal Government. The assessment
is also expected to provide supporting analysis on how credible
conclusions were established. The business cases associated
with and the recommendations for how to address these
identified improvement areas relating to structure,
accountability, process changes, technology, capabilities and
usage, staff compliance, training effectiveness, and other
relevant drivers of performance are expected to better inform
the Commission on Care in its work.
COMMISSION ON CARE
Current Law
Precedent exists for establishing an independent
commission in response to concerns regarding the care provided
to our nation's servicemembers and veterans. In 2007, ``the
President's Commission on Care for America's Returning Wounded
Warriors,'' known as the Dole-Shalala Commission, was
established in response to reports of substandard conditions
and mismanagement at Walter Reed Army Hospital. The subsequent
report and recommendations issued by the Dole-Shalala
Commission have been critical to improving the health care,
benefits, and services available to our nation's veterans in
recent years.
Another independent, high-level commission, the Capital
Asset Realignment for Enhanced Services (``CARES'') Commission
has been utilized in recent history to examine and recommend
improvements for addressing a host of challenges facing VHA,
such as how best to align VA's health care system to deliver
care to veterans.
Physical infrastructure plays a significant role in VA's
ability to provide high quality care to veterans. With more
than 2 million new veterans enrolling into the VA health care
system since 2009, and veterans experiencing extended wait
times for appointments, it is essential that VA facility
leasing programs and maintenance projects are completed on time
and within budget.
Senate Amendment
The Senate amendment would establish a Commission on
Access to Care to examine the access of veterans to health care
and strategically examine how best to organize VHA, locate
health care resources, and deliver health care to veterans. The
Commission would be required to report initial findings and
recommendations within 90 days of its first meeting, and would
be required to provide a final report within 180 days of such
meeting.
The Senate amendment would also establish an Independent
Commission on Department of Veterans Affairs Construction
Projects to review current construction and maintenance
projects and the medical facility leasing program in order to
identify any issues the Department may be experiencing as it
carries out these projects. The Commission would be required to
report to the Secretary and Congress not later than 120 days
after enactment any recommendations for improving how VA
carries out its construction and maintenance projects.
Following submission of the Commission's report, the Secretary
would have 60 days to submit to Congress a report on the
feasibility and advisability of implementing the
recommendations of the Commission, including a timeline for the
implementation of such recommendations.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute adopts the Senate provision on
the Commission on Care with an amendment to include a
representative with familiarity with medical facility
construction and leasing projects. This amendment would allow
the Commission on Care to examine how VA's physical
infrastructure impacts VA's ability to provide high quality
care to veterans and eliminate the need for a separate
Independent Commission on Department of Veterans Affairs
Construction Projects. Further, the Conference substitute
increases the number of voting members to 15, eliminates non-
voting members, and allows for appointment by the Speaker and
Minority Leader of the House of Representatives and Majority
and Minority Leaders of the Senate. It is the expectation of
the Conferees that the membership of the Commission on Care
will represent and reflect a bipartisan, cross-section of VHA
users.
The Commission on Care may also consider looking at the
relationship and communication structure between the VHA and
the Veterans Benefits Administration. The Conferees are
concerned the two administrations do not communicate and lack
synergy to ensure that veterans' benefits and services are
rendered in a timely, safe, and veteran focused manner.
TECHNOLOGY TASK FORCE ON REVIEW OF SCHEDULING SYSTEM AND SOFTWARE OF
THE DEPARTMENT OF VETERANS AFFAIRS
Current Law
VHA presently relies on an outpatient scheduling system
that is more than 25 years-old. In October 2001, due to an
aging system with various limitations that hindered its
effectiveness, VHA launched a scheduling replacement
initiative. This process was wrought with setbacks, including
failed information technology (hereinafter, ``IT'') management
and acquisition practices. After expending $127 million on that
effort, VA was only able to obtain defective software that
could not be fixed and did not achieve the intended goal.
Further, reports by GAO and VAOIG have repeatedly highlighted
challenges with the use of the Electronic Wait List
(hereinafter, ``EWL''), an inability to connect with the
consult management system, and other change management
challenges regarding training for medical appointment
schedulers.
Utilizing the America Competes Reauthorization Act of
2011, VA started the 21st Century Medical Scheduling contest in
order to encourage commercial vendors to develop solutions VA
can use and to mitigate risks VA identified in previous
attempts to replace the existing Medical Scheduling Package.
The contest ended on September 30, 2013, and three winners were
identified and awarded slightly over $3 million for their
efforts. VA is currently pursuing modernization of VistA; thus,
there has been renewed focus within the Department on how to
improve its functionality and user experiences across the
board. VA recently held Industry Days and one-on-one
demonstrations with potential vendors in order to choose an
off-the-shelf product as part of a long-term scheduling package
replacement strategy.
Senate Amendment
The Senate amendment would require VA to review, through
the use of a technology task force, the needs of the Department
with respect to the scheduling system and scheduling software.
The task force would be required to issue a report to propose
specific actions that VA can take to improve its scheduling
software and determine whether an existing off-the-shelf system
would meet the Department's needs within 45 days of enactment.
VA would be required to publish the report in the Federal
Register and on a publicly accessible website. VA would also be
required to implement any feasible, advisable, and cost-
effective recommendations set forth in the report within one
year of its receipt.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute adopts the Senate provision.
The Conferees expect VA to utilize the Northern Virginia
Technology Task Force to implement this section. The Task Force
previously provided a pro-bono review for Arlington National
Cemetery.
IMPROVEMENT OF ACCESS OF VETERANS TO MOBILE VET CENTERS AND MOBILE
MEDICAL CENTERS OF THE DEPARTMENT OF VETERANS AFFAIRS
Current Law
In May 2014, VHA's Office of Rural Health published a
fact sheet reporting that, of the Nation's 22 million veterans,
5.3 million live in rural areas. Currently, there are 70 mobile
vet centers operating around the country providing readjustment
counseling and information resources to veterans in rural
areas. Mobile vet centers in some areas also provide limited
telemedicine services. VA, however, has not issued any standard
procedures for the operation of mobile vet centers. Currently,
regional managers determine how a mobile vet center is employed
and utilized. As a result, mobile vet centers are vulnerable to
inconsistencies.
In addition to mobile vet centers, VA uses mobile medical
units (hereinafter, ``MMUs'') to increase access to care for
rural veterans. As of March 2013, VA operated eight MMUs. In
May 2014, VAOIG issued an audit of VA MMUs, which found that VA
lacked critical information regarding the number, locations,
purpose, patient workloads, operation costs, and operations of
MMUs. VAOIG recommended that VA improve oversight of MMUs.
Senate Amendment
The Senate amendment would require VA to improve access
to health care services, including telemedicine, by
standardizing requirements for the operation of mobile vet
centers. It would also require the Secretary to submit an
annual report to Congress on the use of mobile vet centers as
well as recommended improvements for access to telemedicine and
health care via mobile vet centers.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute adopts the Senate provision
with an amendment to require VA to use MMUs as well as mobile
vet centers to improve access to care for veterans,
particularly those residing in rural areas.
IMPROVED PERFORMANCE METRICS FOR HEALTH CARE PROVIDED BY DEPARTMENT OF
VETERANS AFFAIRS
Current Law
Under current law, chapter 45, chapter 53, and other
provisions of title 5, U.S.C., VA has the authority to provide
awards to certain employees. For example, chapter 45 of title
5, U.S.C., provides VA with authority to grant cash awards to
employees in recognition of performance.
Senate Amendment
The Senate amendment would require the Secretary to
ensure that scheduling and wait-time metrics are not used as
factors in determining the performance of certain employees for
purposes of determining whether to pay performance awards to
such employees. It would also require the Secretary to remove
from the performance goals of any VISN or VA medical center
employee, any performance goal that might disincentivize the
payment of Department amounts to provide health care through
non-VA providers.
The Senate amendment would also require the Secretary to
modify the performance plans of the directors of VISNs and VA
medical centers to ensure that such plans are based on the
quality of care received by veterans at VA medical facilities,
including reviews and recommendations concerning such
facilities by the VAOIG and the Joint Commission.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute adopts the Senate provision.
IMPROVED TRANSPARENCY CONCERNING HEALTH CARE PROVIDED BY DEPARTMENT OF
VETERANS AFFAIRS
Current Law
VHA operates the largest integrated health care system in
the nation, providing care to nearly 6.5 million veterans,
survivors, and their dependents every year. According to GAO,
between FY 2005 and FY 2012, the number of outpatient medical
appointments at VA has increased by roughly 45 percent. VA' s
own data on wait times for FY 2010 suggested it was seeing
virtually all its primary and specialty care appointments
within the 30 days of desired date requirement that had been
established in 1995. As a result, in FY 2011, VHA shortened its
goal of scheduling both primary and specialty care appointments
to 14 days. While VA did not publicly publish data related to
wait times, it did attempt to encourage accountability by
incorporating the wait-time goal metric into the performance
contracts of VISN and VAMC directors.
Senate Amendment
The Senate amendment would require the Secretary to
publish wait-times for scheduling an appointment at VA
facilities in the Federal Register and on a public website of
each medical center within 90 days of the date of enactment of
this Act. It would also require VA to publish, on the Internet,
current wait times for appointments in primary and specialty
care at each VA medical center.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute adopts the Senate provision.
INFORMATION FOR VETERANS ON THE CREDENTIALS OF DEPARTMENT OF VETERANS
AFFAIRS PHYSICIANS
Current Law
In FY 2013, 18,342 physicians; 991 dentists; 50,862
registered nurses; 23,729 licensed practical nurses, licensed
vocational nurses, and nurse assistants; and 12,102 non-
physician providers delivered care to nearly 6.5 million
veterans, survivors, and their dependents. VA makes information
regarding its health care providers available to its patients
and the public through the ``Our Doctors'' section on the
website for each of VA's medical centers. Congressional
oversight has determined that these websites contain limited
information regarding the credentials for VA's physicians.
Senate Amendment
The Senate amendment would require VA to improve the
information available to veterans regarding residency training
in the ``Our Doctors'' database located on each VA medical
facility's website. It would also require VA to provide
information regarding a physician's credentials to a veteran,
or an individual acting on behalf of a veteran, prior to
undergoing a surgical procedure by or through VA.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute adopts the Senate provision.
INFORMATION IN ANNUAL BUDGET OF THE PRESIDENT ON HOSPITAL CARE AND
MEDICAL SERVICES FURNISHED THROUGH EXPANDED USE OF CONTRACTS FOR SUCH
CARE
Current Law
Under current law, section 1105 of title 31, U.S.C., the
President submits a budget for the U.S. Government that
includes a message, summary and supporting information.
Senate Amendment
The Senate amendment would require the Secretary to
include information in the Department's budget submission
regarding hospital care and medical services furnished through
expanded use of contracts.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute adopts the Senate provision.
PROHIBITION ON FALSIFICATION OF DATA CONCERNING WAIT TIMES AND QUALITY
MEASURES AT DEPARTMENT OF VETERANS AFFAIRS
Current Law
In May 2014, concerns about VA's scheduling practices,
including excessive wait times, were identified in the VAOIG's
interim report regarding the alleged patient deaths at the
Phoenix Health Care System. The results indicated that 1,700
veterans were waiting for a primary care appointment but had
not been placed on the EWL. In its report, the VAOIG noted
that, as a direct result of not properly placing veterans on
the EWL, the leadership at the Phoenix Health Care System had
radically understated the amount of time new patients waited
for their primary care appointments.
Senate Amendment
The Senate amendment would require VA to establish
disciplinary procedures within 60 days of enactment of this Act
for employees who knowingly submit false data pertaining to
wait times and quality measures or knowingly require another
employee of the Department to submit false data concerning such
wait times or quality measures to another employee of the
Department.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute adopts the Senate provision.
Title III--Health Care Staffing, Recruitment, and Training Matters
TREATMENT OF STAFFING SHORTAGE AND BIENNIAL REPORT ON STAFFING OF
MEDICAL FACILITIES OF THE DEPARTMENT OF VETERANS AFFAIRS
Current Law
Subsection 3304(a) of title 5, U.S.C., authorizes federal
agencies to appoint, without regard to certain hiring
preferences and competitive service selection requirements,
candidates directly to positions for which a severe shortage of
candidates or a critical hiring need has been identified.
VA's own nation-wide access audit determined that VA
faces staffing challenges and needs additional health care
professionals, such as primary care physicians, specialty care
physicians, and administrative and support staff, to improve
access to high quality health care for veterans. These reviews
and Congressional oversight have identified the federal
government's long hiring process as a barrier to recruiting
qualified health care professionals to the VA health care
system.
Furthermore, GAO and VAOIG have reported that inadequate
staffing and gaps in hiring health care professionals at VA
medical facilities throughout the country have adverse effects
on patient care. These adverse effects include increased wait
times and delays in scheduling appointments. Current law,
however, is silent on requiring periodic assessments of VA's
staffing and succession planning process.
Senate Amendment
The Senate amendment would require VAOIG to annually
identify the five occupations of health care providers with the
largest staffing shortages and would authorize VA to utilize
direct appointment authority to fill such openings in an
expedited manner. It would also give priority for VA' s Health
Professionals Educational Assistance Program to individuals
pursuing a medical degree with the intent to specialize in
occupations identified by the VAOIG.
It would also require VA to submit a report to the
Committees, not later than 180 days after the date of enactment
of and not later than December 31, biennially, thereafter
through 2024, on staffing at each VA medical facility. Such
report would be required to include: the results of a system-
wide assessment of all VA medical facilities, including a plan
for addressing any issues identified in such assessment; a list
of the current wait times, workload levels, and staffing models
for certain clinics; the results of the most current VAOIG
findings regarding staffing shortages and VA's plan to use
direct appointment authority to fill such staffing shortages;
an analysis of succession planning at VA medical facilities;
and the number of VA health care providers who have been
removed, retired, or left their positions for other reasons.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute adopts the Senate provision
with an amendment that would require the Secretary to establish
medical residency programs or ensure sufficient numbers of
medical residency positions at facilities with existing
programs in areas experiencing a shortage of physicians or
located in a community that is designated as a health
professional shortage area. It would also increase the number
of graduate medical education residency positions by up to
1,500 over five years with a priority for primary care, mental
health, and other specialties as VA determines appropriate.
Finally, it would require an annual report to Congress.
The Conference encourages VA to explore options of
partnering with private sector and affiliate hospitals who
could potentially provide vacant space to VA for care.
EXTENSION AND MODIFICATION OF CERTAIN PROGRAMS WITHIN THE DEPARTMENT OF
VETERANS AFFAIRS HEALTH PROFESSIONALS EDUCATIONAL ASSISTANCE PROGRAM
Current Law
Section 7601, et seq. of title 38, U.S.C., provides VA
with authority to carry out the VA Health Professionals
Education Assistance Program (hereinafter, ``HPEAP'') to
provide scholarships, tuition assistance, debt reduction
assistance, and other educational programs to VA health care
professionals. HPEAP serves as a recruitment and retention tool
for the Department. For example, the Education Debt Reduction
Program (hereinafter, ``EDRP''), which provides educational
assistance to VHA employees in an effort to maintain staffing
levels, has assisted 10,055 individuals from FY 2002 through FY
2013. However, VA has acknowledged EDRP has experienced lower
than expected utilization rates because it requires
participants to pay student loan expenses upfront which are
reimbursed later by the Department. As a result, the number of
participants defaulting on their loans and subsequently being
removed from the program is higher than anticipated.
Senate Amendment
The Senate amendment contained no similar provision.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute would extend VA's authority to
operate HPEAP through December 31, 2019. It would also increase
the cap on debt reduction payments to an individual participant
from $60,000 to $120,000. These amendments would bring VA's
Health Professionals Educational Assistance Program in line
with other similar federal programs and ensure VA has the
authority to provide appropriate incentives to attract health
care professionals.
CLINIC MANAGEMENT TRAINING FOR EMPLOYEES AT MEDICAL FACILITIES OF THE
DEPARTMENT OF VETERANS AFFAIRS
Current Law
Timely access to health care requires efficient clinic
management. As early as 2005, GAO noted that VHA lacked
standardized training programs for scheduling. Further, VHA has
no leadership or management training in access to care
management. GAO, VAOIG and VA's Office of Medical Inspector
have identified standardization of clinic management training
regarding availability of providers' schedules as a VA
management challenge. Specific VA medical centers that have
experienced difficulty with standardized scheduling processes
are the VA San Diego Health Care System, the Cheyenne, Wyoming,
VA Medical Center, and the Phoenix VA Healthcare System.
Moreover, the tone of VHA's directive entitled Outpatient
Scheduling Processes and Procedures is written in a manner that
offers guidance rather than specific policy, seemingly allowing
for discretion regarding its implementation.
Senate Amendment
The Senate amendment would require VA to implement a
clinic management training program to provide in-person,
standardized education on health care management to all VA
managers and health care providers. Such training program would
be required to include training on: managing the schedules of
VA health care providers; the appropriate number of
appointments that a VA health care provider should conduct on a
daily basis; managing appointments; the proper use of VA' s
appointment scheduling system; optimizing the use of
technology; and the proper use of physical plant space at VA
medical facilities.
It would also require VA to carry out the clinic
management training program for two years and would require VA
to update training materials on an ongoing basis and provide
such training materials to relevant officials, as appropriate.
Updating of training materials will need to account for new IT
such as a new scheduling system or electronic access to care
dash board.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute adopts the Senate provision.
Title IV--Health Care Related to Sexual Trauma
EXPANSION OF ELIGIBILITY FOR SEXUAL TRAUMA COUNSELING AND TREATMENT TO
VETERANS ON INACTIVE DUTY TRAINING
Current Law
Section 1720D of title 38, U.S.C., requires VA to provide
counseling and appropriate care and services to veterans to
overcome psychological trauma, which in the judgment of a VA
mental health professional, resulted from a physical assault of
a sexual nature, battery of a sexual nature, or sexual
harassment which occurred while the veteran was serving on
active duty or active duty for training (otherwise known as
military sexual trauma) (hereinafter, ``MST''). Veterans who
experienced MST while serving on active duty or active duty for
training are included under this authority. However, veterans
who experienced MST while on inactive duty for training--for
example, those who were assaulted during weekend drill training
for the National Guard and Reserve--are not included.
Senate Amendment
The Senate amendment would amend section 1720D of title
38, U.S.C., to provide VA with the authority to provide
counseling, care and services to veterans, and certain other
servicemembers who may not have veteran status, who experienced
sexual trauma while serving on inactive duty for training.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute adopts the Senate provision.
PROVISION OF COUNSELING AND TREATMENT FOR SEXUAL TRAUMA BY THE
DEPARTMENT OF VETERANS AFFAIRS TO MEMBERS OF THE ARMED FORCES
Current Law
Under current law, section 1720D of title 38, U.S.C., VA
has the authority to provide counseling, care and services to
veterans who experienced sexual trauma while serving on active
duty or active duty for training.
Senate Amendment
The Senate amendment would expand eligibility for care
and services for MST at a VA facility to active duty
servicemembers. Active duty servicemembers would not be
required to initially be seen by DOD and receive a referral
before seeking treatment at a VA facility for MST. It would
take effect on the date that is one year after the date of
enactment.
House Amendment
The House amendment contains no similar provision.
Conference Agreement
The Conference substitute adopts the Senate position.
REPORTS ON MILITARY SEXUAL TRAUMA
Current Law
Section 1720D of title 38, U.S.C., states that ``each
year, the Secretary shall submit to Congress an annual report
on the counseling, care, and services provided to veterans
pursuant to this section.'' However, there is no language
requiring an assessment.
Senate Amendment
The Senate amendment would require the VA-DOD Joint
Executive Committee to conduct an annual assessment for the
next five years of the processes and procedures regarding the
transition and continuum of care from the DOD to VA for
individuals who have experienced MST. The assessment would also
include the processes and collaboration by the agencies to
assist individuals filing a claim for MST related disability.
Additionally, VA would be required to submit a report to
Congress no later than 630 days from the date of enactment of
the Act on the treatment and services available for male
veterans who experience MST compared to such treatment and
services available to female veterans. It would take effect on
the date that is 270 days after the date of enactment of the
Act.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute adopts the Senate provision.
Title V--Other Health Care Matters
EXTENSION OF PILOT PROGRAM ON ASSISTED LIVING SERVICES FOR VETERANS
WITH TRAUMATIC BRAIN INJURY
Current Law
Section 1705 of Public Law 110-181, the ``National
Defense Authorization Act for Fiscal Year 2008,'' requires: (1)
VA, in collaboration with the Defense and Veterans Brain Injury
Center, to carry out a five-year pilot program to assess the
effectiveness of providing assisted living services to veterans
with traumatic brain injury (hereinafter, ``TBI'') to enhance
their rehabilitation, quality of life, and community
integration; (2) at least one part of the pilot program to be
carried out in a VISN that contains a VA polytrauma center; (3)
special consideration to be given to veterans in rural areas;
and, (4) VA to report to the Committees on the pilot program.
To comply with this requirement, VA awarded a national contract
to 20 contractors at more than 150 sites of care across the
U.S. However, statutory authority for this pilot program
expires on September 30, 2014.
Senate Amendment
The Senate amendment contains no similar provision.
House Amendment
The House amendment contains no similar provision.
Conference Agreement
The Conference agreement extends the statutory authority
for VA to operate the pilot program from September 30, 2014, to
October 6, 2017.
Title VI--Major Medical Facility Leases
AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES
Current Law
Under current law, section 8104 of title 38, U.S.C.,
Congressional authorization is required prior to entering into
any VA major medical facility lease that has an average annual
rent of $1,000,000 or above.
Senate Amendment
The Senate amendment would authorize VA to enter into 26
major medical facility leases in 17 states and Puerto Rico.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute adopts the Senate provision
with an amendment to include a lease authorization for a VA
community-based outpatient clinic in Tulsa, Oklahoma, in an
amount not to exceed $13.27 million. In enacting such leases,
the Conferees would like the Secretary to consider any
potential cost, energy and schedule savings that might be
offered by standardized design elements and off-site
construction methods, including prefabricated components and
panelized structures.
BUDGETARY TREATMENT OF DEPARTMENT OF VETERANS AFFAIRS MAJOR MEDICAL
FACILITIES LEASES
Current Law
Section 8104 of title 38, U.S.C., requires authorization
of any major medical facility construction project or lease.
Subsections (a)(1)(A) and (a)(1)(B) of section 1341 of title
31, U.S.C., prohibit any government employee from entering into
contracts, or making or authorizing expenditures and
obligations that exceed the amount of appropriated funds for
such expenditures.
Appendix B of the Office of Management and Budget's
(hereinafter, ``OMB'') Circular A-11 (hereinafter,
``Circular'') describes the processes through which budgetary
treatment of lease-purchase and leases of capital assets will
be consistent with scorekeeping rules originally promulgated in
connection with the Budget Enforcement Act of 1990 and the
Anti-Deficiency Act. According to the Circular, at the time an
Agency enters into a binding commitment, the Agency must
obligate sufficient budget authority to cover associated legal
obligations to the government, consistent with the requirements
of the Anti-Deficiency Act. For lease-purchases or capital
leases, this consists of the net present value of the total
estimated legal obligations over the entire life of the
contract. For operating leases, this can consist of either an
amount sufficient to cover the lease payments for the first
year plus a sufficient amount to cover any costs associated
with cancellation of the contract, if the contract includes a
cancellation clause, or an amount sufficient to cover the
annual lease payment, if the lease is funded through a self-
insuring fund such as the General Services Administration's
Federal Building Fund.
After receiving information about how VA has exercised
the authority provided in prior VA major medical facilities
leasing authorizations, the Congressional Budget Office
(hereinafter, ``CBO'') concluded in 2012 that VA has been
entering into binding obligations for the full period of the
lease, without regard to the scorekeeping rules contained in
the Circular.
Senate Amendment
The Senate amendment would require the funding prospectus
of a proposed lease to include a detailed analysis of how the
lease is expected to comply with OMB's Circular and the Anti-
Deficiency Act. It also directs VA, at least 30 days before
entering into a lease, to submit to the Committees: (1) notice
of the intention to enter into, and a detailed summary of, such
lease; (2) a description and analysis of any differences
between the lease prospectus submitted and the proposed lease;
and (3) a scoring analysis demonstrating that the proposed
lease fully complies with OMB's Circular. VA must also report
any material differences between the proposed lease and the
lease entered, no later than 30 days after entering into a
lease.
House Amendment
The House amendment contains no similar provision.
Conference Agreement
The Conference substitute adopts the Senate provision.
Title VII--Other Veterans Matters
EXPANSION OF MARINE GUNNERY SERGEANT JOHN DAVID FRY SCHOLARSHIP
Current Law
Public Law 111-32, the ``Supplemental Appropriations Act
of 2009,'' amended the Post-9/11 GI Bill to establish the
Marine Gunnery Sergeant John David Fry Scholarship for the
children of servicemembers who died in the line of duty after
September 10, 2001. Eligible children are entitled to 36 months
of benefits at the 100 percent level and may use the benefit
until their 33rd birthday.
Currently, surviving spouses of servicemembers who died
in the line of duty are only eligible to receive survivors' and
dependents' educational assistance (hereinafter, ``Chapter
35''). Chapter 35 benefits provide a spouse up to $1,003 per
month as a full-time college student, which may require the
spouse to find other sources of income or funding to offset the
high cost of education. Additionally, recipients of Chapter 35
do not receive a separate living allowance.
Senate Amendment
The Senate amendment would expand the Marine Gunnery
Sergeant John David Fry Scholarship to include surviving
spouses of members of the Armed Forces who died or die in the
line of duty after September 10, 2001. It would amend
subsection (b)(9) of section 3311 of title 38, U.S.C., to
expand the ability to receive the Marine Gunnery Sergeant John
David Fry Scholarship to surviving spouses. It would limit the
entitlement of the surviving spouse to the date that is 15
years after the date of the servicemember's death or the date
the surviving spouse remarries, whichever is earlier. Further,
a surviving spouse, who is entitled both under amended section
3311 and under Chapter 35, would be required to make an
irrevocable election to receive educational assistance under
either amended section 3311 or Chapter 35. Finally, this
provision would make a necessary conforming amendment to
subsection (b)(4) of section 3321 of title 38, U.S.C.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute adopts the Senate position with
an effective date of January 1, 2015.
APPROVAL OF COURSES OF EDUCATION PROVIDED BY PUBLIC INSTITUTIONS OF
HIGHER LEARNING FOR PURPOSES OF ALL-VOLUNTEER FORCE EDUCATIONAL
ASSISTANCE PROGRAM AND POST-9/11 EDUCATIONAL ASSISTANCE CONDITIONAL ON
IN-STATE TUITION RATE FOR VETERANS
Current Law
Section 3313 of title 38, U.S.C., authorizes VA to pay
in-state tuition and fees for veterans attending a public
educational institution using their Post-9/11 GI Bill
educational benefits. However, a veteran may not always qualify
for in-state tuition rates.
Several states currently assist all or certain veterans
by recognizing them as in-state students for purposes of
attending a public educational institution, regardless of
length of residency in the state where the veteran is attending
college. Yet, many states require transitioning veterans to
meet stringent residency requirements before they can be
considered in-state residents. Federal law is silent on this
matter.
Recently-separated veterans may not be able to meet state
residency requirements where they choose to attend school
because they were stationed elsewhere during their military
service, and once enrolled, they may not be able to legally
establish residency because of their status as full-time
students. The federal educational assistance provided to
veterans by VA was designed, in part, to help them develop the
skills and background necessary to make a successful transition
from military service to a civilian life and career.
Senate Amendment
The Senate amendment would amend section 3679 of title
38, U.S.C., by adding a new subsection (c) to require VA to
disapprove courses of education provided by public institutions
of higher learning that charge tuition and fees at more than
the in-state resident rate for veterans within three years from
discharge from a period of at least 90 days service in the
military, irrespective of the veteran's current state of
residence, if the veteran is living in the state in which the
institution is located while pursuing that course of education.
Pursuant to subsection (c), this provision would apply to
veterans using the educational assistance programs administered
by VA under chapters 30 and 33 of title 38, U.S.C., and to
dependent beneficiaries using Post-9/11 GI Bill benefits during
the three years after the veteran's discharge. If the veteran
or dependent enrolls within three years after the veteran's
discharge, the requirement to charge no more than the in-state
tuition rate would apply for the duration the individual
remains continuously enrolled at the institution.
Subsection (c)(4) would permit a public educational
institution to require a covered individual to demonstrate an
intent, by means other than satisfying a physical presence
requirement, to eventually establish residency in that state or
to meet requirements unrelated to residency in order to be
eligible for the in-state tuition rate. This section would also
provide VA discretion to waive the established requirements in
a circumstance where it is deemed appropriate in regards to
approval of a specific course of education. Any disapproval of
courses pursuant to these new requirements would apply only
with respect to benefits provided under chapters 30 and 33 of
title 38. This provision would apply to programs of education
that begin during academic terms after July 1, 2015.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute adopts the Senate provision.
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
Current Law
Section 5503 of title 38, U.S.C., sets forth the criteria
under which eligibility for income-based pension payments and
aid and attendance allowances are affected by domiciliary or
nursing home residence. In instances where a veteran, or
surviving spouse, has neither a spouse nor a child, and is
receiving Medicaid-covered nursing home care, the veteran or
surviving spouse is eligible to receive no more than $90 per
month in VA pension or death pension payments. Under current
law, this authority shall expire on November 30, 2016. This
authority has been extended several times, most recently
pursuant to Public Law 112-260, the ``Dignified Burial and
Other Veterans' Benefits Improvement Act of 2012.''
Senate Amendment
The Senate amendment contains no similar provision.
House Amendment
The House amendment contains no similar provision.
Conference Agreement
The Committee substitute would amend section 5503( d)(7)
to extend, through September 30, 2024, current eligibility
restrictions for recipients of a VA pension who receive
Medicaid-covered nursing home care. The VA pension program
should not be used to subsidize other federal benefit programs.
Further, pension recipients should have available funds for
incidentals and personal expenses.
EXTENSION OF REQUIREMENT FOR COLLECTION OF FEES FOR HOUSING LOANS
GUARANTEED BY SECRETARY OF VETERANS AFFAIRS
Current Law
Under VA's home loan guaranty program, VA may guarantee a
loan made to eligible servicemembers, veterans, reservists, and
certain un-remarried surviving spouses for the purchase (or
refinancing) of houses, condominiums, and manufactured homes.
Section 3729(b)(2) of title 38, U.S.C., sets forth a loan fee
table that lists funding fees, expressed as a percentage of the
loan amount, for different types of loans.
Senate Amendment
The Senate amendment contains no similar provision.
House Amendment
The House amendment contains no similar provision.
Conference Agreement
The Committee substitute would extend VA's authority to
collect certain funding fees through September 30, 2024, by
amending the fee schedule set forth in section 3729(b)(2) of
title 38, U.S.C.
LIMITATION ON AWARDS AND BONUSES PAID TO EMPLOYEES OF DEPARTMENT OF
VETERANS AFFAIRS
Current Law
Under current law, chapter 45, chapter 53, and other
provisions of title 5, U.S.C., VA has the authority to provide
awards to certain employees. For example, chapter 45 of title 5
provides VA with authority to grant cash awards to employees in
recognition of performance.
Senate Amendment
The Senate amendment contained no similar provision.
House Amendment
The House amendment would, for each of FYs 2014 through
2016, prohibit the Secretary from paying awards or bonuses
under chapters 45 or 53 of title 5, U.S.C., or any other awards
or bonuses authorized under such title.
Conference Agreement
The Conference substitute adopts the House provision with
an amendment that would, for each of FYs 2014 through 2024, cap
the amount of awards or bonuses payable under chapter 45 or 53
of title 5, U.S.C., or any other awards or bonuses authorized
under such title, at $360 million. It is the Conferees'
expectation that this cap not disproportionately impact lower-
wage employees.
EXTENSION OF AUTHORITY TO USE INCOME INFORMATION
Current Law
Certain benefit programs administered by VA, including
pension for wartime veterans and compensation for Individual
Unemployability are available only to beneficiaries whose
annual income is below a certain level. VA must have access to
verifiable income information in order to ensure that those
receiving benefits under its income-based programs are not
earning a greater annual income than the law permits.
Section 6103(1)(7)(D) of title 26, U.S.C., authorizes the
release of certain income information by the Internal Revenue
Service (hereinafter, ``IRS'') or the Social Security
Administration (hereinafter, ``SSA'') to VA for the purposes of
verifying income of applicants for VA needs-based benefits.
Section 5317(g) of title 38, U.S.C., provides VA with temporary
authority to obtain and use this information. Under current
law, this authority expires on September 30, 2016.
Senate Amendment
The Senate amendment contains no similar provision.
House Amendment
The House amendment contains no similar provision.
Conference Agreement
The Committee substitute would extend for eight years,
until September 30, 2024, VA's authority to obtain information
from the IRS or the SSA for income verification purposes for
needs-based benefits.
REMOVAL OF SENIOR EXECUTIVE OF THE DEPARTMENT OF VETERANS AFFAIRS FOR
PERFORMANCE OR MISCONDUCT.
Current Law
Under current law, section 7543 of title 5, U.S.C.,
career appointees in the Senior Executive Service (hereinafter,
``SES'') may be removed from government service for misconduct,
neglect of duty, malfeasance, or failure to accept a directed
reassignment or to accompany a position in a transfer of
function. Senior executives removed as a result of these
conduct-related issues are entitled to certain rights,
including at least 30 days advance written notice; a reasonable
time but not less than seven days to reply; representation by
an attorney or other representative; a written decision from
the agency involved; and appeal rights to the Merit Systems
Protection Board (hereinafter, ``MSPB'').
Under current law, section 3592 of title 5, U.S.C.,
career appointees in the SES may be removed from the SES and
placed into a non-SES position for performance-related issues.
This removal may occur at any time during a one-year
probationary period or at any time for less than fully
successful executive performance. Generally, senior executives
removed from the SES and placed into a civil service position
are entitled to an informal hearing before the MSPB.
Also under current law, section 3592(b) of title 5,
U.S.C., there is a 120-day moratorium from removing a career
appointee in the SES following the appointment of the head of
the agency or the SES employee's immediate supervisor.
Senate Amendment
The Senate amendment would provide the Secretary with the
authority to remove or demote any individual from the SES if
the Secretary determines the performance of the individual
warrants such removal and requires the Secretary to notify
Congress within 30 days of removing or demoting a senior
executive under this authority. The senior executive would be
allowed an opportunity for an expedited review by the MSPB.
Under such expedited appeal, the senior executive would have
seven days to appeal a removal or demotion and the MSPB would
be required to adjudicate the appeal within 21 days.
The MSPB would be required to establish and implement a
process to conduct expedited reviews and submit to Congress a
report on their established process within 30 days of
enactment.
The Senate amendment would also provide authority for the
Secretary to immediately remove senior executives
notwithstanding the 120-day moratorium in current law.
House Amendment
The House amendment would provide the Secretary with the
authority to remove or demote any individual from the SES if
the Secretary determines the performance of the individual
warrants such removal and requires the Secretary to notify
Congress within 30 days of removing or demoting a senior
executive under this authority.
Conference Agreement
The Conference substitute generally adopts the Senate
provision with an amendment to change the level of review at
the MSPB. The substitute requires that the expedited review by
the MSPB be conducted by an Administrative Judge at the MSPB,
and if the MSPB Administrative Judge does not conclude their
review within 21 days then the removal or demotion is final.
The substitute does not allow for any further appeal beyond the
Administrative Judge, and does not allow for a second level
review by the three-person board at the MSPB. The substitute
also requires that if the senior executive is removed, and then
appeals VA's decision, the senior executive is not entitled to
any type of pay, bonus, or benefit while appealing the decision
of removal. Furthermore, the substitute requires that if a
senior executive is demoted, and then appeals VA's decision,
the employee may only receive any type of pay, bonus, or
benefit at the rate appropriate for the position they were
demoted to, and only if the individual shows up for duty, while
appealing the decision of demotion. The substitute requires
that the MSPB submit to Congress a plan within 14 days of
enactment of how the expedited review would be implemented. The
substitute also adds language to include title 38 SES
equivalents under this new authority and includes
``misconduct'' along with ``poor performance'' as a reason to
remove or demote a senior executive.
Title VIII--Other Matters
APPROPRIATION OF AMOUNTS
Current Law
Congress uses an appropriation to provide funding for
discretionary spending programs of the Federal government.
Senate Amendment
The Senate amendment would authorize and appropriate for
FYs 2014, 2015, and 2016, the emergency funds necessary to
carry out this Act.
In addition, the Senate amendment would make available,
at the end of FYs 2014 and 2015, unobligated balances in VA's
medical care accounts (medical services, medical support and
compliance, and medical facilities) for the hiring of
additional health care professionals.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute authorizes and appropriates $5
billion to increase veterans access to care through the hiring
of physicians and other medical staff and by improving VA's
physical infrastructure.
VETERANS CHOICE FUND
Current Law
There is no provision of law establishing a Veterans
Choice Fund.
Senate Amendment
The Senate amendment contained no similar provision.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute establishes in the Treasury a
fund to be known as the Veterans Choice Fund to carry out the
expanded availability of hospital care and medical services for
veterans created by section 101 of the Conference substitute.
The Conference substitute also authorizes and appropriates $10
billion for deposit in the Veterans Choice Fund.
EMERGENCY DESIGNATIONS
Current Law
Congress may exempt the budgetary effects of a provision
from certain enforcement procedures by designating it as an
emergency requirement. An emergency designation causes the
spending and revenue effects estimated to result from such
bills as exempt for purposes of enforcing budget procedures.
Senate Amendment
The Senate amendment would designate this Act as an
emergency requirement under the Statutory Pay-As-You-Go Act of
2010 and the Concurrent Resolution on the budget for FY 2010.
House Amendment
The House amendment contained no similar provision.
Conference Agreement
The Conference substitute adopts the Senate provision.
Jeff Miller,
Doug Lamborn,
David P. Roe,
Bill Flores,
Dan Benishek,
Mike Coffman,
Brad R. Wenstrup,
Jackie Walorski,
Michael H. Michaud,
Corrine Brown,
Mark Takano,
Julia Brownley,
Ann Kirkpatrick,
Timothy J. Walz,
Managers on the part of the House.
Bernard Sanders,
John D. Rockefeller IV,
Patty Murray,
Sherrod Brown,
Jon Tester,
Mark Begich,
Richard Blumenthal,
Mazie K. Hirono,
Richard Burr,
Johnny Isakson,
Mike Johanns,
John McCain,
Tom Coburn,
Marco Rubio,
Managers on the part of the Senate.
COMPLIANCE WITH RULES OF THE HOUSE OF REPRESENTATIVES AND SENATE
REGARDING EARMARKS AND CONGRESSIONALLY DIRECTED SPENDING ITEMS
Pursuant to clause 9 of rule XXI of the Rules of the
House of Representatives and rule XLIV of the Standing Rules of
the Senate, neither this Conference report nor the accompanying
joint statement of Conferees contains any congressional
earmarks, congressionally directed spending items, limited tax
benefits, or limited tariff benefits, as defined in such rules.
For consideration of the House amendment and
the Senate amendment, and modifications
committed to conference:
Jeff Miller of Florida,
Doug Lamborn,
David P. Roe of Tennessee,
Bill Flores,
Dan Benishek,
Mike Coffman,
Brad R. Wenstrup,
Jackie Walorski,
Michael H. Michaud,
Corrine Brown of Florida,
Mark Takano,
Julia Brownley of California,
Ann Kirkpatrick,
Timothy J. Walz,
Managers on the part of the House.
Bernard Sanders,
John D. Rockefeller IV,
Patty Murray,
Sherrod Brown,
Jon Tester,
Mark Begich,
Richard Blumenthal,
Mazie K. Hirono,
Richard Burr,
Johnny Isakson,
Mike Johanns,
Managers on the part of the Senate.