Title III — Health Care Matters

S. 1950 · 113th Congress · Jan 16, 2014 · Lineage

III Health Care Matters

A Expansion and Improvements of Benefits Generally

Sec. 301 Enhancement of nature of eligibility for care of certain veterans

(a)

Nursing home care for category 2 through 6 veterans— Paragraph (2) of section 1710(a) is amended by striking “and medical services, and may furnish nursing home care” and inserting “, medical services, and nursing home care”.

(b)

Care for category 8 veterans— Paragraph (3) of such section is amended by striking “may, to the extent resources and facilities are available and” and inserting “shall,”.

Sec. 302 Requirement for enrollment in patient enrollment system of the Department of Veterans Affairs of certain veterans eligible for enrollment by law but not currently permitted to enroll

(a)

Requirement for enrollment— Section 1705 is amended by adding at the end the following new subsection:

“(d)

“(1) The Secretary shall provide for the enrollment in the patient enrollment system of veterans specified in paragraph (2) by not later than December 31, 2014.

“(2) Veterans specified in this paragraph are as follows:

“(A) Veterans with noncompensable service-connected disabilities rated as zero percent disabling who—

“(i) are not otherwise permitted to enroll in the system as of the date of the enactment of the Comprehensive Veterans Health and Benefits and Military Retirement Pay Restoration Act of 2014; and

“(ii) as of the date of enrollment under this section, do not have access to health insurance except through a health exchange established pursuant to section 1311 of the Patient Protection and Affordable Care Act (42 U.S.C. 18031).

“(B) Veterans without service-connected disability who—

“(i) are not otherwise permitted to enroll in the system as of the date of the enactment of the Comprehensive Veterans Health and Benefits and Military Retirement Pay Restoration Act of 2014; and

“(3) A veteran who, after enrolling in the patient enrollment system pursuant to this subsection, obtains access to health insurance other than through a health exchange shall remain enrolled in the patient enrollment system notwithstanding obtaining access to such health insurance.

“(4) A veteran enrolled in the patient enrollment system pursuant to this subsection shall maintain the priority for care of the veteran at the time of enrollment unless and until a change in circumstances of the veteran results in a higher priority for care of the veteran under subsection (a).”

(b)

Verification of eligibility for enrollment—

(1)

Use of information on health insurance coverage—

(A)

In general— Chapter 53 is amended by inserting after section 5318 the following new section:

“5319. Review of reporting of health insurance coverage

“The Secretary shall notify each veteran who enrolls under subsection (d) of section 1705 of this title in the patient enrollment system of veterans under such section that information on the veteran's access to health insurance that is furnished to the Secretary for purposes of such enrollment may be compared with information obtained by the Secretary of the Treasury under section 6103(l)(23) of the Internal Revenue Code of 1986.”

(B)

Clerical amendment— The table of sections at the beginning of chapter 53 is amended by adding at the end the following new item:

(2)

Disclosure of return information by Internal Revenue Service— Section 6103(l) of the Internal Revenue Code of 1986 is amended by adding at the end the following new paragraph:

“(23) Disclosure of certain return information for verification of eligibility of veterans for enrollment in Department of Veterans Affairs patient enrollment system

“(A) Return information from Internal Revenue Service—The Secretary shall, upon written request, disclose current return information from returns under section 6055 with respect to minimum essential coverage of individuals to the Secretary of Veterans Affairs for the purposes of verifying the eligibility of veterans for enrollment in the patient enrollment system of the Department of Veterans Affairs under section 1705(d) of title 38.

“(B) Restriction on disclosure—The Secretary shall disclose return information under subparagraph (A) only for purposes of, and to the extent necessary in, verifying the eligibility of veterans to enroll in the patient enrollment system described in that subparagraph.

“(C) Restriction on use of disclosed information—Return information disclosed under subparagraph (A) may be used by the Secretary of Veterans Affairs only for the purposes of, and to the extent necessary in, verifying the eligibility of veterans to enroll in the patient enrollment system described in that subparagraph.”

(c)

Public notice of commencement of enrollment— The Secretary of Veterans Affairs shall publish in the Federal Register, and shall make available to the public on an Internet website of the Department of Veterans Affairs, a notice regarding the date on which veterans covered by subsection (d) of section 1705 of title 38, United States Code (as added by subsection (a) of this section), may commence enrollment in the patient enrollment system required by that section.

Sec. 303 Further extension of period of eligibility for health care for veterans of combat service during certain periods of hostilities and war

Section 1710(e)(3) is amended—

(1)

in subparagraph (A), by striking “the date that is five years before the date of the enactment of the National Defense Authorization Act for Fiscal Year 2008, after a period of five years” and inserting “January 27, 2003, after a period of 10 years”; and

(2)

in subparagraph (B), by striking “more than five years” and all that follows and inserting “before January 28, 2003, and who did not enroll in the patient enrollment system under section 1705 of this title before January 28, 2008, after January 27, 2018.”.

Sec. 304 Extension to all veterans with a serious service-connected disability of eligibility for participation in family caregiver program

Section 1720G(a)(2)(B) is amended by striking “on or after September 11, 2001”.

Sec. 305 Improved access to appropriate immunizations for veterans

(a)

Inclusion of recommended adult immunizations as medical services—

(1)

Covered benefit— Subparagraph (F) of section 1701(9) is amended to read as follows:

“(F) immunizations against infectious diseases, including each immunization on the recommended adult immunization schedule at the time such immunization is indicated on that schedule;”

(2)

Recommended adult immunization schedule defined— Section 1701 is amended by adding after paragraph (9) the following new paragraph:

“(10) The term recommended adult immunization schedule means the schedule established (and periodically reviewed and, as appropriate, revised) by the Advisory Committee on Immunization Practices established by the Secretary of Health and Human Services and delegated to the Centers for Disease Control and Prevention.”

(b)

Inclusion of recommended adult immunizations in annual report— Section 1704(1)(A) is amended—

(1)

in clause (i), by striking “and” at the end;

(2)

in clause (ii), by striking the period at the end and inserting “; and”; and

(3)

by inserting after clause (ii) the following new clause:

“(iii) to provide veterans each immunization on the recommended adult immunization schedule at the time such immunization is indicated on that schedule.”

(c)

Report to Congress—

(1)

In general— Not later than two years 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 development and implementation by the Department of Veterans Affairs of quality measures and metrics, including targets for compliance, to ensure that veterans receiving medical services under chapter 17 of title 38, United States Code, receive each immunization on the recommended adult immunization schedule at the time such immunization is indicated on that schedule.

(2)

Recommended adult immunization schedule defined— In this subsection, the term recommended adult immunization schedule has the meaning given that term in section 1701(10) of title 38, United States Code, as added by subsection (a)(2).

(3)

Effective date— This subsection shall take effect on the date that is one year after the date of the enactment of this Act.

Sec. 306 Expansion of provision of chiropractic care and services to veterans

(a)

Program for provision of chiropractic care and services to veterans— Section 204(c) of the Department of Veterans Affairs Health Care Programs Enhancement Act of 2001 (Public Law 107–135; 115 Stat. 2459; 38 U.S.C. 1710 note) is amended—

(1)

by inserting “(1)” before “The program”; and

(2)

by adding at the end the following new paragraph:

“(2) The program shall be carried out at not fewer than two medical centers or clinics in each Veterans Integrated Service Network by not later than one year after the effective date specified in section 306(c) of the Comprehensive Veterans Health and Benefits and Military Retirement Pay Restoration Act of 2014, and at not fewer than 50 percent of all medical centers in each Veterans Integrated Service Network by not later than two years after such effective date.”

(b)

Expanded chiropractor services available to veterans—

(1)

Medical services— Paragraph (6) of section 1701 is amended by adding at the end the following new subparagraph:

“(H) Chiropractic services.”

(2)

Rehabilitative services— Paragraph (8) of such section is amended by inserting “chiropractic,” after “counseling,”.

(3)

Preventive health services— Paragraph (9) of such section is amended—

(A)

by redesignating subparagraphs (F) through (K) as subparagraphs (G) through (L), respectively; and

(B)

by inserting after subparagraph (E) the following new subparagraph (F):

“(F) periodic and preventive chiropractic examinations and services;”

(c)

Effective date— This section and 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. 307 Modification of commencement date of period of service at Camp Lejeune, North Carolina, for eligibility for hospital care and medical services in connection with exposure to contaminated water

(a)

Modification— Section 1710(e)(1)(F) is amended by striking “January 1, 1957,” and inserting “August 1, 1953 (or such earlier date for the commencement of exposure to contaminated water at Camp Lejeune as the Secretary, in consultation with the Agency for Toxic Substances and Disease Registry, shall specify),”.

(b)

Publication— The Secretary of Veterans Affairs shall publish in the Federal Register a notice of any earlier date for the commencement of exposure to contaminated water at Camp Lejeune, North Carolina, for purposes of section 1710(e)(1)(F) of title 38, United States Code, as amended by subsection (a).

Sec. 308 Expansion of emergency treatment reimbursement for certain veterans

(a)

In general— Section 1725(b)(2)(B) is amended—

(1)

by inserting “(i)” after “(B)”;

(2)

by striking the period at the end and inserting “; or”; and

(3)

by adding at the end the following:

“(ii) the veteran was unable to receive care under this chapter within such 24-month period because of a waiting period imposed by the Department with respect to a new patient examination of such veteran.”

(b)

Effective date— The amendments made by subsection (a) shall take effect on the date that is one year after the date of the enactment of this Act.

Sec. 309 Relocation and restatement of limitation on requirements to furnish certain care and services contingent on the availability of appropriations

(a)

Relocation and restatement— Section 1707 is amended by adding at the end the following new subsection:

“(c)

“(1) The requirements specified in paragraph (2) shall be effective in any fiscal year only to the extent and in the amount provided in advance in appropriations Acts for such purposes.

“(2) The requirements specified in this paragraph are as follows:

“(A) The requirement in paragraphs (1), (2), and (3) of section 1710(a) of this title that the Secretary provide hospital care and medical services.

“(B) The requirement in section 1710A(a) of this title that the Secretary provide nursing home care.

“(C) The requirement in section 1710B of this title that the Secretary provide a program of extended care services.

“(D) The requirement in section 1745 of this title that the Secretary provide nursing home care and prescription medicines to veterans with service-connected disabilities in State homes.”

(b)

Conforming repeal of superseded limitation— Section 1710(a) is amended—

(1)

by striking paragraph (4); and

(2)

by redesignating paragraph (5) as paragraph (4).

Sec. 310 Modification of determination of eligibility of veterans for treatment as a low-income family for purposes of enrollment in the patient enrollment system of the Department of Veterans Affairs

(a)

Areas of residence— The Secretary of Veterans Affairs shall modify the areas in which veterans reside as specified for purposes of determining whether veterans qualify for treatment as low-income families for enrollment in the patient enrollment system of the Department of Veterans Affairs under section 1705(a)(7) of title 38, United States Code, to meet the requirements as follows:

(1)

Any area so specified shall be within only one State.

(2)

Any area so specified shall be co-extensive with one or more counties (or similar political subdivisions) in the State concerned.

(b)

Variable income thresholds— The Secretary shall modify the thresholds for income as specified for purposes of determining whether veterans qualify for treatment as low-income families for enrollment in the patient enrollment system referred to in subsection (a) to meet the requirements as follows:

(1)

There shall be one income threshold for each State, equal to the highest income threshold among the counties within such State.

(2)

The calculation of the highest income threshold of a county shall be consistent with the calculation used for purposes of section 3(b) of the United States Housing Act of 1937 (42 U.S.C. 1437a(b)).

(3)

The timing and methodology for implementing any modifications in geographic income thresholds pursuant to paragraph (1) shall be determined by the Secretary in such a manner as to permit the Department to build capacity for enrolling such additional veterans in the patient enrollment system of the Department as become eligible for enrollment as a result of such modifications, except that all required modifications shall be completed not later than five years after date of the enactment of this Act.

Sec. 311 Extension of sunset date regarding transportation of individuals to and from facilities of Department of Veterans Affairs and requirement of report

(a)

Extension of sunset date— Subsection (a)(2) of section 111A is amended by striking “December 31, 2014” and inserting “September 30, 2015”.

(b)

Funding available— Such section is further amended by adding at the end the following new subsection:

“(c) Funding—There is hereby authorized to be appropriated for each of fiscal years 2014 and 2015 for the Department, $4,000,000 to carry out this section.”

(c)

(1)

the efforts of the Secretary to carry out the transportation services required by section 111A(a) of title 38, United States Code;

(2)

the utilization of those services by covered veterans; and

(3)

the feasibility and advisability of the continuation of the provision of such services after September 30, 2015.

Sec. 312 Coverage of costs of care for veterans at medical foster homes

(a)

In general— In conducting the medical foster home program pursuant to section 17.73 of title 38, Code of Federal Regulations, the Secretary of Veterans Affairs may cover the costs associated with the care of veterans at medical foster homes.

(b)

Effective date— Subsection (a) shall take effect on the date that is one year after the date of the enactment of this Act.

Sec. 313 Extension and modification of pilot program on assisted living services for veterans with traumatic brain injury

(a)

Extension of program— Subsection (a) of 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 striking “a five-year” and inserting “an eight-year”.

(b)

Modification of locations— Subsection (b) of such section is amended—

(1)

by redesignating paragraph (2) as paragraph (3); and

(2)

by striking paragraph (1) and inserting the following new paragraphs:

“(1) In general—The pilot program shall be carried out at locations selected by the Secretary for purposes of the pilot program.

“(2) Located in same region as polytrauma centers—Of the locations selected under paragraph (1), at least one location shall be in each health care region of the Veterans Health Administration of the Department of Veterans Affairs that contains a polytrauma center of the Department of Veterans Affairs.”

(c)

Modification of report requirements— Subsection (e) of such section is amended to read as follows:

“(e) Reports

“(1) Annual report

“(A) In general—Not later than two years after the date of the enactment of the Comprehensive Veterans Health and Benefits and Military Retirement Pay Restoration Act of 2014, and not later than September 30 each year thereafter until 2018, 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 pilot program.

“(B) Elements—Each report submitted under subparagraph (A) shall include the following:

“(i) The number of individuals that participated in the pilot program during the year preceding the submission of the report.

“(ii) The number of individuals that successfully completed the pilot program during the year preceding the submission of the report.

“(iii) The degree to which pilot program participants and family members of pilot program participants were satisfied with the pilot program.

“(iv) The interim findings and conclusions of the Secretary with respect to the success of the pilot program and recommendations for improvement.

“(2) Final report

“(A) In general—Not later than 60 days after the completion of the pilot program, 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 final report on the pilot program.

“(B) Elements—The final report required by subparagraph (A) shall include the following:

“(i) A description of the pilot program.

“(ii) An assessment of the utility of the activities under the pilot program in enhancing the rehabilitation, quality of life, and community reintegration of veterans with traumatic brain injury, including complex mild traumatic brain injury.

“(iii) Such recommendations as the Secretary considers appropriate regarding improving the pilot program.”

(d)

Modification of definitions—

(1)

Community-based brain injury residential rehabilitative care services— Such section is further amended—

(A)

in the section heading, by striking “assisted living”and inserting “community-based brain injury residential rehabilitative care”;

(B)

in subsection (c), in the subsection heading, by striking “assisted living” and inserting “community-based brain injury residential rehabilitative care”;

(C)

by striking “assisted living” each place it appears, and inserting “community-based brain injury rehabilitative care”; and

(D)

in subsection (f)(1), by striking “and personal care” and inserting “rehabilitation, and personal care”.

(2)

Eligible veteran— Subsection (f)(3) of such section is amended—

(A)

in subparagraph (C), by striking “; and” and inserting a semicolon;

(B)

in subparagraph (D), by striking the period at the end and inserting “; and”; and

(C)

by adding at the end the following new subparagraph:

“(E) has a traumatic brain injury that is classified as complex-mild to severe.”

(e)

Authorization of appropriations— There is authorized to be appropriated for the Department of Veterans Affairs for fiscal year 2015 $46,000,000 to carry out the pilot program under section 1705 of the National Defense Authorization Act for Fiscal Year 2008 (Public Law 110–181; 38 U.S.C. 1710C note), as amended by this section. The amount so authorized to be appropriated shall be available for obligation for the three-year period beginning on the date that is one year after the date of the enactment of this Act.

(f)

Effective date— The amendments made by this section shall take effect on October 1, 2014.

Sec. 314 Program on health promotion for overweight and obese veterans through support of fitness center memberships

(a)

Program required— Commencing not later than 180 days after the date on which this section takes effect, the Secretary of Veterans Affairs shall, through the National Center for Preventive Health, carry out a program to assess the feasibility and advisability of promoting health in covered veterans, including achieving a healthy weight and reducing risks of chronic disease, through support for fitness center membership.

(b)

Covered veterans— For purposes of this section, a covered veteran is any veteran who—

(1)

is enrolled in the system of annual patient enrollment established and operated by the Secretary under section 1705 of title 38, United States Code;

(2)

is determined by a clinician of the Department of Veterans Affairs to be overweight or obese as of the date of the commencement of the program; and

(3)

resides in a location that is more than 15 minutes driving distance from a fitness center at a facility of the Department that would otherwise be available to the veteran for at least eight hours per day during five or more days per week.

(c)

Duration of program— The program shall be carried out during the two-year period beginning on the date of the commencement of the program.

(d)

Locations—

(1)

In general— In carrying out the program, the Secretary shall select—

(A)

not less than five medical centers of the Department at which the Secretary shall cover the full reasonable cost of a fitness center membership for covered veterans within the catchment area of such centers; and

(B)

not less than five medical centers of the Department at which the Secretary shall cover half the reasonable cost of a fitness center membership for covered veterans within the catchment area of such centers.

(2)

Considerations— In selecting locations for the program, the Secretary shall consider the feasibility and advisability of selecting locations in the following areas:

(A)

Rural areas.

(B)

Areas that are not in close proximity to an active duty military installation.

(C)

Areas in different geographic locations.

(e)

Participation—

(1)

Maximum number of participants— The number of covered veterans who may participate in the program at each location selected under subsection (d) may not exceed 100.

(2)

Voluntary participation— The participation of a covered veteran in the program shall be at the election of the covered veteran in consultation with a clinician of the Department.

(f)

Membership payment—

(1)

In general— Except as provided in paragraph (2), in carrying out the program, the Secretary shall pay the following:

(A)

The full reasonable cost of a fitness center membership for covered veterans within the catchment area of centers selected under subsection (d)(1)(A) who are participating in the program.

(B)

Half the reasonable cost of a fitness center membership for covered veterans within the catchment area of centers selected under subsection (d)(1)(B) who are participating in the program.

(2)

Limitation— Payment for a fitness center membership of a covered veteran may not exceed $50 per month of membership.

(g)

Reports—

(1)

Periodic reports— Not later than 90 days after the date of the commencement of the program and not less frequently than once every 90 days thereafter, 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 activities carried out to implement the program, including outreach activities to veterans and community organizations.

(2)

Final report— Not later than 180 days after the date of the completion of the program, 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 program detailing—

(A)

the findings and conclusions of the Secretary as a result of the program; and

(B)

recommendations for the continuation or expansion of the program.

(h)

Effective date— This section shall take effect on the date that is one year after the date of the enactment of this Act.

Sec. 315 Program on health promotion for veterans through establishment of Department of Veterans Affairs fitness facilities

(a)

Program required— Commencing not later than 180 days after the date on which this section takes effect, the Secretary of Veterans Affairs shall carry out a program to assess the feasibility and advisability of promoting health in covered veterans, including achieving a healthy weight, through establishment of Department of Veterans Affairs fitness facilities.

(b)

Covered veterans— For purposes of this section, a covered veteran is any veteran who is enrolled in the system of annual patient enrollment established and operated by the Secretary under section 1705 of title 38, United States Code.

(c)

Duration of program— The program shall be carried out during the three-year period beginning on the date of the commencement of the program.

(d)

Locations—

(1)

In general— The Secretary shall carry out the program by establishing fitness facilities in Department facilities as follows:

(A)

In not fewer than five Department of Veterans Affairs medical centers selected by the Secretary for purposes of the program.

(B)

In not fewer than five outpatient clinics of the Department selected by the Secretary for purposes of the program.

(2)

Considerations— In selecting locations for the program, the Secretary shall consider the feasibility and advisability of selecting locations in the following areas:

(A)

Rural areas.

(B)

Areas that are not in close proximity to an active duty military installation.

(C)

Areas in different geographic locations.

(e)

Limitation on expenses— In establishing and supporting a fitness facility in a facility of the Department under the program, the Secretary may expend amounts as follows:

(1)

For establishment and support of a fitness facility in a Department of Veterans Affairs medical center, not more than $60,000.

(2)

For establishment and support of a fitness facility in an outpatient clinic of the Department, not more than $40,000.

(f)

Repurposing of physical space and purchases of equipment—

(1)

In general— Subject to subsection (e), the Secretary may, in carrying out the program, repurpose existing physical space of the Department and purchase such fitness equipment and supplies as the Secretary considers appropriate for purposes of the program.

(2)

Repurposing exception— Existing physical space used for the direct delivery of health care to patients may not be repurposed under paragraph (1).

(g)

Prohibition on assessment of user fees— The Secretary may not assess a fee upon a covered veteran for use of a fitness facility established under the program.

(h)

Voluntary participation— The participation of a covered veteran in the program shall be at the election of the covered veteran.

(i)

Reports—

(1)

Periodic reports— Not later than 90 days after the date of the commencement of the program and not less frequently than once every 90 days thereafter, 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 activities carried out to implement the program, including outreach activities to veterans and community organizations.

(2)

Final report— Not later than 180 days after the date of the completion of the program, 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 program detailing—

(A)

the findings and conclusions of the Secretary as a result of the program; and

(B)

recommendations for the continuation or expansion of the program.

(j)

Effective date— This section shall take effect on the date that is one year after the date of the enactment of this Act.

B Health Care Administration

Sec. 321 Extension of Department of Veterans Affairs Health Professional Scholarship Program

Section 7619 is amended by striking “December 31, 2014” and inserting “December 31, 2019”.

Sec. 322 Expansion of availability of prosthetic and orthotic care for veterans

(a)

Establishment or expansion of advanced degree programs To expand availability of provision of care— The Secretary of Veterans Affairs shall work with institutions of higher education to develop partnerships for the establishment or expansion of programs of advanced degrees in prosthetics and orthotics in order to improve and enhance the availability of high quality prosthetic and orthotic care for veterans.

(b)

Report— Not later than one year after the date of the enactment of this Act, 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 setting forth a plan for carrying out subsection (a). The Secretary shall develop the plan in consultation with veterans service organizations, institutions of higher education with accredited degree programs in prosthetics and orthotics, and representatives of the prosthetics and orthotics field.

(c)

Funding—

(1)

Authorization of appropriations— There is hereby authorized to be appropriated for fiscal year 2015 for the Department of Veterans Affairs, $10,000,000 to carry out this section.

(2)

Availability— The amount authorized to be appropriated by paragraph (1) shall remain available for expenditure until September 30, 2017.

Sec. 323 Contracting for health care

(a)

Use of capitation-based resource allocation in entry into contracts— In entering into contracts for the furnishing of health care services under the laws administered by the Secretary of Veterans Affairs (including under this title and the amendments made by this title), the Secretary shall use the capitation-based resource allocation model of the Department of Veterans Affairs.

(b)

Priority for contracts with certain entities— In entering into contracts for the furnishing of health care services under the laws administered by the Secretary, the Secretary shall afford a priority for entry into contracts for Federally Qualified Health Centers (FQHCs) and Community Health Centers (CHCs), whenever appropriate.

(c)

Best practices— The Secretary shall modify the guidance of the Department of Veterans Affairs on contracts for health care services in order to provide for the incorporation into such contracts of standardized requirements for such best practices under such contracts, including the following:

(1)

Requirements that contracts provide the Department on a regular basis information on scheduling and appearance for appointments for health care on per-patient basis.

(2)

Such other best practices requirements as the Secretary considers appropriate.

(d)

Federally Qualified Health Center defined— In this section the term Federally Qualified Health Center means a 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)).

Sec. 324 Limitation on expansion of dialysis pilot program

(a)

Limitation— The Secretary of Veterans Affairs shall not expand the dialysis pilot program to, or expand the capacity to provide additional dialysis care at, any facility owned or leased by the Department that is not an initial facility until after the date that—

(1)

the Secretary has implemented the dialysis pilot program at each initial facility for a period of not less than two years;

(2)

an independent analysis of the dialysis pilot program has been conducted at each initial facility, including a consideration and comparison of factors including—

(A)

the ability of veterans to access care under the dialysis pilot program;

(B)

the quality of care provided under the dialysis pilot program; and

(C)

the satisfaction of veterans who have received treatment under the dialysis pilot program; and

(3)

the report required by subsection (b) has been submitted.

(b)

Report— Not later than 60 days after the date of the completion of the independent analysis required by subsection (a)(2), the Secretary shall submit to Congress a report that—

(1)

includes the results of that independent analysis; and

(2)

addresses any recommendations with respect to the dialysis pilot program provided in a report prepared by the Government Accountability Office.

(c)

Utilization of existing dialysis resources— In order to increase the access of veterans to dialysis care and decrease the travel time of such veterans to receive such care, the Secretary shall fully utilize existing dialysis resources of the Department, including any community dialysis provider with which the Department has entered into a contract or agreement for the provision of such care.

(d)

Definitions— In this section:

(1)

Dialysis pilot program— The term dialysis pilot program means the pilot demonstration program established by the Secretary in 2009 to provide dialysis care to patients at certain outpatient facilities operated by the Department of Veterans Affairs.

(2)

Initial facility— The term initial facility means one of the four outpatient facilities identified by the Secretary to participate in the dialysis pilot program prior to the date of the enactment of this Act.

(e)

Effective date— This section shall take effect on the date that is one year after the date of the enactment of this Act.

Sec. 325 Requirement for Department of Veterans Affairs policy on reporting cases of infectious diseases at facilities of the Department

(a)

In general— Subchapter II of chapter 73 is amended by adding at the end the following new section:

“7330B. Reporting of infectious diseases

“(a) Reporting—The Secretary shall ensure that the Department has in effect an up-to-date policy on reporting a notifiable infectious disease diagnosed at a facility under the jurisdiction of the Secretary in accordance with the provisions of State and local law in effect where such facility is located.

“(b) Notifiable infectious disease—For purposes of this section, a notifiable infectious disease is any infectious disease that is—

“(1) on the list of nationally notifiable diseases published by the Council of State and Territorial Epidemiologists and the Centers for Disease Control and Prevention; or

“(2) covered by a provision of law of a State that requires the reporting of infectious diseases.

“(c) Performance measures—The Secretary shall develop performance measures to assess whether and to what degree the directors of Veterans Integrated Service Networks and Department medical centers are complying with the policy required by subsection (a).”

(b)

Clerical amendment— The table of sections at the beginning of chapter 73 is amended by inserting after the item relating to section 7330A the following new item:

(c)

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. 326 Independent assessment of the Veterans Integrated Service Networks and medical centers of Department of Veterans Affairs

(a)

Contract—

(1)

In general— The Secretary of Veterans Affairs shall seek to enter into a contract with an independent third-party to perform the services covered by this section.

(2)

Timing— The Secretary shall seek to enter into the contract described in paragraph (1) not later than 540 days after the date of the enactment of this Act.

(b)

Independent study—

(1)

In general— Under a contract between the Secretary and an independent third-party under this section, the third party shall carry out a study—

(A)

to assess the organizational structures of medical centers of the Department of Veterans Affairs; and

(B)

to improve succession planning among key leadership roles at Veterans Integrated Service Networks and medical centers of the Department.

(2)

Matters studied and proposed— In carrying out the study, the third party shall—

(A)

assess whether the organizational structure of the medical centers of the Department is effective for the furnishing of medical services, addressing issues that arise regarding the furnishing of medical services, and addressing standard business operations;

(B)

propose one organizational chart for Department medical centers with a common set of base position descriptions;

(C)

propose a base set of medical positions that should be filled to ensure that the health care provided to veterans by the Department is of good quality; and

(D)

identify which key leadership positions at Veterans Integrated Service Networks and Department medical centers should have succession plans and propose how to implement such plans.

(3)

Timing— The third party shall complete the study under this section not later than 270 days after entering into the contract described in subsection (a).

(c)

Report— Not later than 90 days after the date on which the third party completes the study under this section, 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 results of such study.

(d)

Effective date— This section shall take effect on the date that is one year after the date of the enactment of this Act.

Sec. 327 Requirements in connection with next update of current strategic plan for Office of Rural Health of the Department of Veterans Affairs

(a)

Requirements—

(1)

In general— The first update of the Strategic Plan Refresh for Fiscal Years 2012 through 2014 of the Office of Rural Health of the Department of Veterans Affairs after the date of the enactment of this Act, whether an update or refresh of such Strategic Plan Refresh or a strategic plan to supersede such Strategic Plan Refresh, shall be prepared in accordance with this section.

(2)

Consultation— The Director of the Office of Rural Health shall prepare the update in consultation with the following:

(A)

The Director of the Health Care Retention and Recruitment Office of the Department.

(B)

The Director of the Office of Quality and Performance of the Department.

(C)

The Director of the Office of Care Coordination Services of the Department.

(b)

Elements— The update described in subsection (a) shall include, for the period covered by the update, the following:

(1)

Goals and objectives for the recruitment and retention by the Veterans Health Administration of health care personnel in rural areas.

(2)

Goals and objectives for ensuring timeliness and improving quality in the delivery of health care services by the Veterans Health Administration in rural areas through contract and fee-basis providers.

(3)

Goals and objectives for the implementation, expansion, and enhanced use of telemedicine services by the Veterans Health Administration in rural areas, including through coordination with other appropriate offices of the Department.

(4)

Goals and objectives for ensuring the full and effective use of mobile outpatient clinics by the Veterans Health Administration for the provision of health care services in rural areas, including goals and objectives for the use of such clinics on a fully mobile basis and for encouraging health care providers who provide services through such clinics to do so in rural areas.

(5)

Procedures for soliciting from each Veterans Health Administration facility that serves a rural area the following:

(A)

A statement of the clinical capacity of such facility.

(B)

The procedures of such facility in the event of a medical, surgical, or mental health emergency outside the scope of the clinical capacity of such facility.

(C)

The procedures and mechanisms of such facility for the provision and coordination of health care for women veterans, including procedures and mechanisms for coordination with local hospitals and health care facilities, oversight of primary care and fee-basis care, and management of specialty care.

(6)

Goals and objectives for the modification of the funding allocation mechanisms of the Office of Rural Health in order to ensure that the Office distributes funds to components of the Department to best achieve the goals and objectives of the Office and in a timely manner.

(7)

Goals and objectives for the coordination of, and sharing of resources with respect to, the provision of health care services to veterans in rural areas between the Department of Veterans Affairs, the Department of Defense, the Indian Health Service of the Department of Health and Human Services, and other Federal agencies, as appropriate and prudent.

(8)

Specific milestones for the achievement of the goals and objectives developed for the update.

(9)

Procedures for ensuring the effective implementation of the update.

(c)

Transmittal to Congress— Not later than 90 days after the date of the issuance of the update described in subsection (a), the Secretary of Veterans Affairs shall transmit the update to Congress, together with such comments and recommendations in connection with the update as the Secretary considers appropriate.

Sec. 328 Report on provision of telemedicine services

(a)

(1)

Issues that may be impeding the provision by the Department of Veterans Affairs of telemedicine services for veterans, including the following:

(A)

Statutory or regulatory restrictions.

(B)

Licensure or credentialing issues for any provider practicing telemedicine with veterans who live in a different State than the provider.

(C)

Limited broadband access in rural areas.

(D)

Limited information technology resources or capabilities.

(E)

Long distances veterans must travel to access a facility or clinic with telemedicine capabilities.

(F)

Insufficient liability protection for providers.

(G)

Reimbursement issues faced by providers.

(H)

Travel limitations for providers that are unaffiliated with the Department and are participating or seeking to participate in a telemedicine program of the Department.

(2)

Actions taken to address the issues identified in paragraph (1).

(3)

An update on efforts by the Department to carry out the initiative of teleconsultation for the provision of remote mental health and traumatic brain injury assessments required by section 1709A of title 38, United States Code.

(4)

An update on efforts by the Department to offer training opportunities in telemedicine to medical residents, as required by section 108(b) of the Janey Ensminger Act (Public Law 112–154; 38 U.S.C. 7406 note).

(5)

An update on efforts by the Department to, in partnership with primary care providers, install video cameras and instruments to monitor weight, blood pressure, and other vital statistics in the homes of patients.

(b)

Telemedicine defined— In this section, the term telemedicine means the use by a health care provider of telecommunications to assist in the diagnosis or treatment of a patient’s medical condition.

(c)

Effective date— This section shall take effect on the date that is one year after the date of the enactment of this Act.

Sec. 329 Designation of Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center

(a)

Designation— The medical center of the Department of Veterans Affairs located at 3900 Woodland Avenue in Philadelphia, Pennsylvania, shall after the date of the enactment of this Act be known and designated as the “Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center”.

(b)

References— Any reference in any law, regulation, map, document, paper, or other record of the United States to the medical center referred to in subsection (a) shall be considered to be a reference to the Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center.

C Complementary and Alternative Medicine

Sec. 331 Expansion of research and education on and delivery of complementary and alternative medicine to veterans

(a)

Development of plan To expand research, education, and delivery— Not later than six months after the effective date specified in subsection (f), the Secretary of Veterans Affairs shall develop a plan to expand materially and substantially the scope of research and education on, and delivery and integration of, complementary and alternative medicine services into the health care services provided to veterans.

(b)

Elements— The plan required by subsection (a) shall provide for the following:

(1)

Research on the following:

(A)

The comparative effectiveness of various complementary and alternative medicine therapies.

(B)

Approaches to integrating complementary and alternative medicine services into other health care services provided by the Department.

(2)

Education and training for health care professionals of the Department on the following:

(A)

Complementary and alternative medicine services selected by the Secretary for purposes of the plan.

(B)

Appropriate uses of such services.

(C)

Integration of such services into the delivery of health care to veterans.

(3)

Research, education, and clinical activities on complementary and alternative medicine at centers of innovation at Department medical centers.

(4)

Identification or development of metrics and outcome measures to evaluate the provision and integration of complementary and alternative medicine services into the delivery of health care to veterans.

(5)

Integration and delivery of complementary and alternative medicine services with other health care services provided by the Department.

(c)

Consultation—

(1)

In general— In carrying out subsection (a), the Secretary shall consult with the following:

(A)

The Director of the National Center on Complementary and Alternative Medicine of the National Institutes of Health.

(B)

The Commissioner of Food and Drugs.

(C)

Institutions of higher education, private research institutes, and individual researchers with extensive experience in complementary and alternative medicine and the integration of complementary and alternative medicine practices into the delivery of health care.

(D)

Nationally recognized providers of complementary and alternative medicine.

(E)

Such other officials, entities, and individuals with expertise on complementary and alternative medicine as the Secretary considers appropriate.

(2)

Scope of consultation— The Secretary shall undertake consultation under paragraph (1) in carrying out subsection (a) with respect to the following:

(A)

To develop the plan.

(B)

To identify specific complementary and alternative medicine practices that, on the basis of research findings or promising clinical interventions, are appropriate to include as services to veterans.

(C)

To identify barriers to the effective provision and integration of complementary and alternative medicine services into the delivery of health care to veterans, and to identify mechanisms for overcoming such barriers.

(d)

Funding— There is authorized to be appropriated to the Secretary such sums as may be necessary to carry out this section.

(e)

Complementary and alternative medicine defined— In this section, the term complementary and alternative medicine shall have the meaning given that term in regulations the Secretary shall prescribe for purposes of this section, which shall, to the degree practicable, be consistent with the meaning given such term by the Secretary of Health and Human Services.

(f)

Effective date— This section shall take effect on the date that is one year after the date of the enactment of this Act.

Sec. 332 Program on integration of complementary and alternative medicine within Department of Veterans Affairs medical centers

(a)

Program required— The Secretary of Veterans Affairs shall—

(1)

carry out, through the Office of Patient Centered Care and Cultural Transformation of the Department of Veterans Affairs, a program to assess the feasibility and advisability of integrating the delivery of complementary and alternative medicine services selected by the Secretary with other health care services provided by the Department for veterans with mental health conditions, chronic pain conditions, other chronic conditions, and such other conditions as the Secretary determines appropriate; and

(2)

in developing the program, identify and resolve barriers to the provision of complementary and alternative medicine services selected by the Secretary and the integration of those services with other health care services provided by the Department.

(b)

Duration of program— The program shall be carried out during the three-year period beginning on the effective date specified in subsection (j).

(c)

Locations—

(1)

In general— The Secretary shall carry out the program at not fewer than 15 separate Department medical centers.

(2)

Polytrauma centers— Not less than two of the medical centers designated under paragraph (1) shall be located at polytrauma rehabilitation centers of the Department.

(3)

Selection of locations— In carrying out the program, the Secretary shall select locations that include the following areas:

(A)

Rural areas.

(B)

Areas that are not in close proximity to an active duty military installation.

(C)

Areas representing different geographic locations, such as census tracts established by the Bureau of the Census.

(d)

Provision of services— Under the program, the Secretary shall provide covered services to covered veterans by integrating complementary and alternative medicine services with other services provided by the Department at the medical centers designated under subsection (c)(1).

(e)

Covered veterans— For purposes of the program, a covered veteran is any veteran who—

(1)

has a mental health condition diagnosed by a clinician of the Department;

(2)

experiences chronic pain; or

(3)

has a chronic condition being treated by a clinician of the Department.

(f)

Covered services—

(1)

In general— For purposes of the program, covered services are services consisting of complementary and alternative medicine as selected by the Secretary.

(2)

Administration of services— Covered services shall be administered under the program as follows:

(A)

Covered services shall be administered by clinicians employed by the Secretary for purposes of this section who, to the extent practicable, shall provide services consisting of complementary and alternative medicine, including those clinicians who solely provide such services.

(B)

Covered services shall be included as part of the Patient Aligned Care Teams initiative of the Office of Patient Care Services, Primary Care Program Office, in coordination with the Office of Patient Centered Care and Cultural Transformation.

(C)

Covered services shall be made available to both—

(i)

covered veterans with mental health conditions, pain conditions, or chronic conditions described in subsection (e) who have received conventional treatments from the Department for such conditions; and

(ii)

covered veterans with mental health conditions, pain conditions, or chronic conditions described in subsection (e) who have not received conventional treatments from the Department for such conditions.

(g)

Voluntary participation— The participation of a veteran in the program shall be at the election of the veteran and in consultation with a clinician of the Department.

(h)

Reports to Congress—

(1)

Quarterly reports— Not later than 90 days after the date of the commencement of the program and not less frequently than once every 90 days thereafter for the duration of the program, 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 efforts of the Secretary to carry out the program, including a description of the outreach conducted by the Secretary to veterans and community organizations to inform such organizations about the program.

(2)

Final report—

(A)

In general— Not later than 180 days after the completion of the program, 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 program.

(B)

Contents— The report submitted under subparagraph (A) shall include the following:

(i)

The findings and conclusions of the Secretary with respect to the program, including with respect to—

(I)

the utilization and efficacy of the complementary and alternative medicine services established under the program;

(II)

an assessment of the benefit of the program to covered veterans in mental health diagnoses, pain management, and treatment of chronic illness; and

(III)

the comparative effectiveness of various complementary and alternative medicine therapies.

(ii)

Barriers identified under subsection (a)(2) that were not resolved.

(iii)

Such recommendations for the continuation or expansion of the program as the Secretary considers appropriate.

(i)

Complementary and alternative medicine defined— In this section, the term complementary and alternative medicine shall have the meaning given that term in section 331(e) of this Act.

(j)

Effective date— This section shall take effect on the date that is one year after the date of the enactment of this Act.

Sec. 333 Studies of barriers encountered by veterans in receiving, and administrators and clinicians in providing, complementary and alternative medicine services furnished by the Department of Veterans Affairs

(a)

Studies required—

(1)

In general— The Secretary of Veterans Affairs shall conduct comprehensive studies of the barriers encountered by veterans in receiving, and administrators and clinicians in providing, complementary and alternative medicine services furnished by the Department of Veterans Affairs.

(2)

Studies conducted—

(A)

Veterans— In conducting the study of veterans, the Secretary shall—

(i)

survey veterans who seek or receive hospital care or medical services furnished by the Department, as well as veterans who do not seek or receive such care or services;

(ii)

administer the survey to a representative sample of veterans from each Veterans Integrated Service Network; and

(iii)

ensure that the sample of veterans surveyed is of sufficient size for the study results to be statistically significant.

(B)

Administrators and clinicians— In conducting the study of clinicians and administrators, the Secretary shall—

(i)

survey administrators of the Department who are involved in the provision of health care services;

(ii)

survey clinicians that have provided complementary and alternative medicine services through the program established under section 332 of this Act, after those clinicians have provided those services through such program for at least 90 days; and

(iii)

administer the survey to administrators under clause (i)—

(I)

before the introduction of complementary and alternative medicine services through such program; and

(II)

not earlier than 90 days after the introduction of complementary and alternative medicine services through such program.

(b)

Elements of studies—

(1)

Veterans— In conducting the study of veterans required by subsection (a), the Secretary shall study the following:

(A)

The perceived barriers associated with obtaining complementary and alternative medicine services from the Department.

(B)

The satisfaction of veterans with complementary and alternative medicine services in primary care.

(C)

The degree to which veterans are aware of eligibility requirements for, and the scope of services available under, complementary and alternative medicine services furnished by the Department.

(D)

The effectiveness of outreach to veterans on the availability of complementary and alternative medicine for veterans.

(E)

Such other barriers as the Secretary considers appropriate.

(2)

Administrators and clinicians— In conducting the study of administrators and clinicians required by subsection (a), the Secretary shall study the following:

(A)

The extent of the integration of complementary and alternative medicine services within the services provided by the Department.

(B)

The perception by administrators and clinicians of the structural and attitudinal barriers to the delivery of high quality complementary and alternative medicine services by the Department.

(C)

Strategies that have been used to reduce or eliminate such barriers and the results of such strategies.

(D)

The satisfaction of administrators and clinicians regarding the integration of complementary and alternative medicine services within the services provided by the Department.

(E)

The perception by administrators and clinicians of the value of specific complementary and alternative medicine services for inpatient and outpatient veteran populations.

(c)

Discharge by contract— The Secretary shall enter into a contract with a qualified independent entity or organization to carry out the studies required by this section.

(d)

Mandatory review of data by the National Research Advisory Council—

(1)

In general— The Secretary shall ensure that the head of the National Research Advisory Council reviews the results of the studies conducted under this section.

(2)

Submittal of findings— The head of the National Research Advisory Council shall submit findings with respect to the studies to the Under Secretary for Health and to other pertinent program offices within the Department with responsibilities relating to health care services for veterans.

(e)

Reports—

(1)

Report on implementation— Not later than one year after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the status of the implementation of this section.

(2)

Report on study—

(A)

In general— Not later than 45 days after the date of the completion of the study, the Secretary shall submit to Congress a report on the study required by subsection (a).

(B)

Contents— The report required by subparagraph (A) shall include the following:

(i)

Recommendations for such administrative and legislative proposals and actions as the Secretary considers appropriate.

(ii)

The findings of the head of the National Research Advisory Council and of the Under Secretary for Health.

(f)

Authorization of appropriations— There is authorized to be appropriated for fiscal year 2015 for the Department of Veterans Affairs, $2,000,000 to carry out this section.

(g)

Complementary and alternative medicine defined— In this section, the term complementary and alternative medicine shall have the meaning given that term in section 331(e) of this Act.

Sec. 334 Program on use of wellness programs as complementary approach to mental health care for veterans and family members of veterans

(a)

Program required—

(1)

In general— The Secretary of Veterans Affairs shall carry out a program through the award of grants to public or private nonprofit entities to assess the feasibility and advisability of using wellness programs to complement the provision of mental health care to veterans and family members eligible for counseling under section 1712A(a)(1)(C) of title 38, United States Code.

(2)

Matters to be addressed— The program shall be carried out so as to assess the following:

(A)

Means of improving coordination between Federal, State, local, and community providers of health care in the provision of mental health care to veterans and family members described in paragraph (1).

(B)

Means of enhancing outreach, and coordination of outreach, by and among providers of health care referred to in subparagraph (A) on the mental health care services available to veterans and family members described in paragraph (1).

(C)

Means of using wellness programs of providers of health care referred to in subparagraph (A) as complements to the provision by the Department of Veterans Affairs of mental health care to veterans and family members described in paragraph (1).

(D)

Whether wellness programs described in subparagraph (C) are effective in enhancing the quality of life and well-being of veterans and family members described in paragraph (1).

(E)

Whether wellness programs described in subparagraph (C) are effective in increasing the adherence of veterans described in paragraph (1) to the primary mental health services provided such veterans by the Department.

(F)

Whether wellness programs described in subparagraph (C) have an impact on the sense of wellbeing of veterans described in paragraph (1) who receive primary mental health services from the Department.

(G)

Whether wellness programs described in subparagraph (C) are effective in encouraging veterans receiving health care from the Department to adopt a more healthy lifestyle.

(b)

Duration— The Secretary shall carry out the program for a period of three years beginning on the date that is one year after the date of the enactment of this Act.

(c)

Locations— The Secretary shall carry out the program at facilities of the Department providing mental health care services to veterans and family members described in subsection (a)(1).

(d)

Grant proposals—

(1)

In general— A public or private nonprofit entity seeking the award of a grant under this section shall submit an application therefor to the Secretary in such form and in such manner as the Secretary may require.

(2)

Application contents— Each application submitted under paragraph (1) shall include the following:

(A)

A plan to coordinate activities under the program, to the extent possible, with the Federal, State, and local providers of services for veterans to enhance the following:

(i)

Awareness by veterans of benefits and health care services provided by the Department.

(ii)

Outreach efforts to increase the use by veterans of services provided by the Department.

(iii)

Educational efforts to inform veterans of the benefits of a healthy and active lifestyle.

(B)

A statement of understanding from the entity submitting the application that, if selected, such entity will be required to report to the Secretary periodically on standardized data and other performance data necessary to evaluate individual outcomes and to facilitate evaluations among entities participating in the program.

(C)

Other requirements that the Secretary may prescribe.

(e)

Grant uses—

(1)

In general— A public or private nonprofit entity awarded a grant under this section shall use the award for purposes prescribed by the Secretary.

(2)

Eligible veterans and family— In carrying out the purposes prescribed by the Secretary in paragraph (1), a public or private nonprofit entity awarded a grant under this section shall use the award to furnish services only to individuals specified in section 1712A(a)(1)(C) of title 38, United States Code.

(f)

Reports—

(1)

Periodic reports—

(A)

In general— Not later than 180 days after the date of the commencement of the program, and every 180 days thereafter, the Secretary shall submit to Congress a report on the program.

(B)

Report elements— Each report required by subparagraph (A) shall include the following:

(i)

The findings and conclusions of the Secretary with respect to the program during the 180-day period preceding the report.

(ii)

An assessment of the benefits of the program to veterans and their family members during the 180-day period preceding the report.

(2)

Final report— Not later than 180 days after the end of the program, the Secretary shall submit to Congress a report detailing the recommendations of the Secretary as to the advisability of continuing or expanding the program.

(g)

Wellness defined— In this section, the term wellness has the meaning given that term in regulations prescribed by the Secretary.

D Mental Health Care

Sec. 341 Inclusion of mental health professionals in the education and training program for health personnel of the Department of Veterans Affairs

(a)

In general— In carrying out the education and training program required under section 7302(a)(1) of title 38, United States Code, the Secretary of Veterans Affairs shall include education and training of marriage and family therapists and licensed professional mental health counselors.

(b)

Funding— The Secretary shall apportion funding for the education and training program equally among the professions included in the program.

(c)

Effective date— This section shall take effect on the date that is one year after the date of the enactment of this Act.

Sec. 342 Education program and peer support program for family members and caregivers of veterans with mental health disorders

(a)

Programs—

(1)

In general— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall establish an education program (in this section referred to as the “education program”) and a peer support program (in this section referred to as the “peer support program”) for the education and training of family members and caregivers of eligible veterans with mental health disorders.

(2)

Definitions— In this section:

(A)

Family member; caregiver— The terms family member and caregiver have the meaning given those terms in section 1720G(d) of title 38, United States Code.

(B)

Eligible veteran— The term eligible veteran means a veteran who is enrolled in the health care system established under section 1705(a) of title 38, United States Code.

(b)

Education program—

(1)

In general— Under the education program, the Secretary shall provide a course of education to family members and caregivers of eligible veterans on matters relating to coping with mental health disorders in veterans.

(2)

Duration—

(A)

In general— The education program shall be carried out during the four-year period beginning on the date of the commencement of the education program.

(B)

Authority for extension— The Secretary may extend the duration of the education program for an additional four years.

(3)

Locations—

(A)

In general— Except as required by subparagraph (D), the Secretary shall carry out the education program at the following facilities of the Department of Veterans Affairs:

(i)

Not less than 10 medical centers of the Department.

(ii)

Not less than 10 clinics of the Department.

(iii)

Not less than 10 Vet Centers (as defined in section 1712A(h) of title 38, United States Code).

(B)

Solicitation of applications— In selecting locations for the education program, the Secretary shall solicit applications from eligible facilities of the Department that are interested in carrying out the education program.

(C)

Considerations— In selecting locations for the education program, the Secretary shall consider the feasibility and advisability of selecting locations in the following areas:

(i)

Rural areas.

(ii)

Areas that are not in close proximity to an active duty installation.

(iii)

Areas in different geographic locations.

(D)

Expansion of locations— Not later than two years after the date of the commencement of the education program, the Secretary shall expand the number of facilities at which the Secretary is carrying out the education program to include the following:

(i)

Not less than 10 additional medical centers of the Department.

(ii)

Not less than 10 additional clinics of the Department.

(iii)

Not less than 10 additional Vet Centers.

(4)

Contracts—

(A)

In general— In carrying out the education program, the Secretary shall enter into contracts with qualified entities described in subparagraph (B) to offer the course of education described in paragraph (5) to family members and caregivers of eligible veterans and covered veterans.

(B)

Qualified entity described— A qualified entity described in this subparagraph is a non-profit entity with experience in mental health education and outreach, including work with children, teens, and young adults, that—

(i)

uses high quality, relevant, and age-appropriate information in educational programming, materials, and coursework, including such programming, materials, and coursework for children, teens, and young adults; and

(ii)

works with agencies, departments, nonprofit mental health organizations, early childhood educators, and mental health providers to develop educational programming, materials, and coursework.

(C)

Priority— In entering into contracts under this paragraph, the Secretary shall give priority to qualified entities that, to the maximum extent practicable, use Internet technology for the delivery of course content in an effort to expand the availability of support services, especially in rural areas.

(5)

Elements— The course of education described in this paragraph shall consist of not less than 10 weeks of education and shall include the following:

(A)

General education on different mental health disorders, including information to improve understanding of the experiences of individuals suffering from those disorders.

(B)

Techniques for handling crisis situations and administering mental health first aid to individuals suffering from mental health disorders.

(C)

Techniques for coping with the stress of living with someone with a mental health disorder.

(D)

Information on additional services available for family members and caregivers through the Department or community organizations and providers related to mental health disorders.

(E)

Such other matters as the Secretary considers appropriate.

(6)

Instructors—

(A)

Training— Each instructor of the course of education described in paragraph (5) shall maintain a level of proficiency in the course of education as determined by the Secretary, and shall submit proof of that level of proficiency to the Secretary at such time and in such manner as the Secretary determines appropriate.

(B)

Individuals who have completed the course as instructors— Commencing as of the date that is two years after the date of the commencement of the education program, any individual who has successfully completed the course of education described in paragraph (5) and has successfully completed such additional training as is required for instructors pursuant to subparagraph (A) may act as an instructor in the course of education.

(c)

Peer support program—

(1)

In general— Under the peer support program, the Secretary shall provide peer support to family members and caregivers of eligible veterans on matters relating to coping with mental health disorders in veterans.

(2)

Locations— The Secretary shall provide peer support under the peer support program at each location at which the Secretary provides education under the education program.

(3)

Elements— Peer support under the peer support program shall consist of meetings in group settings between a peer support coordinator under paragraph (4) and family members and caregivers of eligible veterans on matters relating to coping with mental health disorders in veterans. At each location, those meetings shall be conducted not less often than twice each calendar quarter.

(4)

Peer support coordinator—

(A)

In general— The Secretary, acting through the director of each participating facility, may select an individual who has successfully completed the course of education described in subsection (b)(5) to serve as a peer support coordinator for each such facility to carry out the peer support program.

(B)

Proficiency of instructors— Each peer support coordinator shall maintain a level of proficiency in peer support as determined by the Secretary, and shall submit proof of that level of proficiency to the Secretary at such time and in such manner as the Secretary determines appropriate.

(d)

Surveys—

(1)

In general— The Secretary shall conduct a comprehensive and statistically significant survey of the satisfaction of individuals that have participated in the course of education described in subsection (b)(5) and individuals that have participated in the peer support program that includes the following:

(A)

The general satisfaction of those individuals with the education and assistance provided in the education program and the peer support program.

(B)

The perceived effectiveness of the education program and the peer support program in providing education and assistance that is useful for those individuals.

(C)

The applicability of the education program and the peer support program to the issues faced by those individuals.

(D)

Such other matters as the Secretary considers appropriate.

(E)

A representative sample of the information required by subparagraphs (A) through (D) from each Veterans Integrated Service Network that is participating in the education program and the peer support program.

(2)

Compilation of information— The information compiled as a result of the surveys required by paragraph (1) shall be included in the annual report required by subsection (e)(1).

(e)

Reports—

(1)

Annual report—

(A)

In general— Not later than one year after the date of the commencement of the education program and not later than September 30 each year thereafter until 2017, 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 education program and the peer support program.

(B)

Elements— Each report submitted under subparagraph (A) shall include the following:

(i)

The number of individuals that participated in the course of education described in subsection (b)(5) during the year preceding the submission of the report.

(ii)

The number of individuals that participated in the peer support program during the year preceding the submission of the report.

(iii)

A detailed analysis of the surveys conducted under subsection (d) with respect to the individuals described in clause (i) and (ii).

(iv)

The degree to which veterans and family members and caregivers of veterans are aware of the eligibility requirements for enrollment in the education program and the peer support program.

(v)

Any plans for expansion of the education program and the peer support program.

(vi)

The interim findings and conclusions of the Secretary with respect to the success of the education program and the peer support program.

(2)

Final report—

(A)

In general— Not later than one year after the completion of the education program, 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 feasibility and advisability of continuing the education program and the peer support program.

(B)

Elements— The report submitted under subparagraph (A) shall include the following:

(i)

A detailed analysis of the surveys conducted under subsection (d).

(ii)

The feasibility and advisability of continuing the education program without entering into contracts for the course of education described in subsection (b)(5) and instead using peer support coordinators selected under subsection (c)(4) as instructors of the course of education.

(iii)

The feasibility and advisability of expanding the education program and the peer support program.

Sec. 343 Report on provision of mental health services for families of certain veterans at facilities of the Department

Not later than one year 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 feasibility and advisability of providing services under the program established by section 304(a) of the Caregivers and Veterans Omnibus Health Services Act of 2010 (Public Law 111–163; 38 U.S.C. 1712A note) at medical facility of the Department of Veterans Affairs.

Sec. 344 Annual report on community mental health partnership pilot program

(a)

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 until the completion of the pilot program described in subsection (b), 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 that pilot program.

(b)

Pilot program described— The pilot program described in this subsection is the pilot program conducted by the Veterans Health Administration to connect medical centers of the Department of Veterans Affairs with community-based mental health care providers and substance abuse treatment providers for the purpose of assisting in the treatment of veterans with mental health disorders, commonly known as the “Community Mental Health Partnership Pilot”.

(c)

Elements— Each report submitted under subsection (a) shall include the following:

(1)

The number of sites participating in the pilot program.

(2)

The number of individuals participating in the pilot program at each site.

(3)

A detailed assessment of the effectiveness of, the participation of veterans in, and the satisfaction of veterans with the pilot program.

(4)

An analysis of barriers to the effectiveness of, the participation of veterans in, and the satisfaction of veterans with the pilot program.

(5)

A description of the plans of the Secretary to conduct outreach and provide information to veterans and community mental health providers with respect to the pilot program.

(6)

A description of any plans to expand the pilot program, including plans that focus on the unique needs of veterans located in rural areas.

(7)

An explanation of how the care provided under the pilot program is consistent with the minimum clinical mental health guidelines promulgated by the Veterans Health Administration, including clinical guidelines contained in the Uniform Mental Health Services Handbook of such Administration.

E Dental care eligibility expansion and enhancement

Sec. 351 Restorative dental services for veterans

(a)

In general— Section 1710(c) is amended—

(1)

in the second sentence—

(A)

by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively; and

(B)

by redesignating paragraphs (1) and (2) as subparagraphs (A) and (B), respectively;

(2)

by inserting “(1)” after “(c)”;

(3)

by striking “The Secretary” and inserting the following:

“(2) The Secretary”

(4)

by adding at the end the following new paragraph:

“(3) In addition to the dental services, treatment, and appliances authorized to be furnished by paragraph (2), the Secretary may furnish dental services and treatment, and dental appliances, needed to restore functioning in a veteran that is lost as result of any services or treatment furnished under this subsection.”

(b)

Effective date— The amendments made by subsection (a) shall take effect on the date that is one year after the date of the enactment of this Act.

Sec. 352 Pilot program on expansion of furnishing of dental care to all enrolled veterans

(a)

Pilot program required— Commencing not later than 540 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall carry out a pilot program to assess the feasibility and advisability of furnishing dental care to veterans enrolled in the system of patient enrollment under section 1705 of title 38, United States Code, who are not eligible for dental services and treatment, and related dental appliances, under current authorities.

(b)

Duration of pilot program— The pilot program shall be carried out during the three-year period beginning on the date of the commencement of the pilot program.

(c)

Locations—

(1)

In general— The Secretary shall carry out the pilot program at not fewer than 16 locations as follows:

(A)

Four Department of Veterans Affairs medical centers with an established dental clinic.

(B)

Four Department medical centers with a current contract for the furnishing of dental care.

(C)

Four Community-Based Outpatient Clinics (CBOCs) with space available for the furnishing of services and treatment under the pilot program.

(D)

Four facilities selected from among Federally Qualified Health Centers (FQHCs) and Indian Health Service facilities with established dental clinics, of which—

(i)

at least one facility shall be such an Indian Health Service facility; and

(ii)

any Indian Health Service facility so selected shall be selected in consultation with the Secretary of Health and Human Services.

(2)

Considerations— In selecting locations for the pilot program, the Secretary shall consider the feasibility and advisability of selecting locations in each of the following:

(A)

Rural areas.

(B)

Areas that are not in close proximity to an active duty military installation.

(C)

Areas representing different geographic locations, such as census tracts established by the Bureau of Census.

(d)

Limitation on number of participating veterans—

(1)

In general— The total number of eligible veterans who may participate in the pilot program may not exceed 30,000.

(2)

Distribution of limitation— In applying the limitation in paragraph (1) to the pilot program, the Secretary shall distribute the limitation across and among locations selected for the pilot program in a manner that takes appropriate account of the size and need of veterans for dental services at each such location.

(e)

Scope of services— The dental services and treatment furnished to veterans under the pilot program shall be consistent with the dental services and treatment furnished by the Secretary to veterans with service-connected disabilities rated 100 percent disabling under the laws administered by the Secretary.

(f)

Voluntary participation— The participation of a veteran in the pilot program shall be at the election of the veteran.

(g)

Limitation on amount of services—

(1)

In general— The total amount the Secretary may expend furnishing dental services and treatment to a veteran participating in the pilot program during any one-year period may not exceed such amount as the Secretary determines appropriate. The amount so determined may not be less than $1,000.

(2)

Consultation— The Secretary shall make the determination under paragraph (1)—

(A)

in consultation with the Director of the Indian Health Service; and

(B)

in consultation with the Director of the Health Resources and Services Administration of the Department of Health and Human Services if one or more Federally Qualified Health Center is selected as a location for the pilot program under subsection (c)(1)(D).

(h)

Copayments— The Secretary may collect copayments for dental services and treatment furnished under the pilot program in accordance with authorities on the collection of copayments for medical care of veterans under chapter 17 of title 38, United States Code.

(i)

Program administration—

(1)

Notice to eligible veterans on pilot program— In carrying out the pilot program, the Secretary shall inform all veterans eligible to participate in the pilot program of the services and treatment available under the pilot program.

(2)

Contracts— In carrying out the pilot program, the Secretary may enter into contracts with appropriate entities for the provision of dental services and treatment under the pilot program. Each such contract shall specify performance standards and metrics and processes for ensuring compliance of the contractor concerned with such performance standards.

(j)

Reports—

(1)

Preliminary reports—

(A)

In general— Not later than each of 540 days and three years after the date of the commencement of the pilot program, 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 pilot program.

(B)

Contents— Each report under subparagraph (A) shall include the following:

(i)

A description of the implementation and operation of the pilot program.

(ii)

The number of veterans receiving services and treatment under the pilot program, and a description of the dental services and treatment furnished to such veterans.

(iii)

An analysis of the costs and benefits of the pilot program, including a comparison of costs and benefits by location type.

(iv)

An assessment of the impact of the pilot program on medical care, wellness, employability, and perceived quality of life of veterans.

(v)

The current findings and conclusions of the Secretary with respect to the pilot program.

(vi)

Such recommendations for the continuation or expansion of the pilot program as the Secretary considers appropriate.

(2)

Final report—

(A)

In general— Not later than 180 days after the completion of the pilot program, 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 pilot program.

(B)

Contents— The report under subparagraph (A) shall include the following:

(i)

The findings and conclusions of the Secretary with respect to the pilot program.

(ii)

Such recommendations for the continuation or expansion of the pilot program as the Secretary considers appropriate.

(k)

(l)

Effective date— This section shall take effect on the date that is one year after the date of the enactment of this Act.

Sec. 353 Program on education to promote dental health in veterans

(a)

Program required—

(1)

In general— The Secretary of Veterans Affairs shall carry out a program of education to promote dental health for veterans who are enrolled in the system of patient enrollment of the Department of Veterans Affairs under section 1705 of title 38, United States Code.

(2)

Construction— Nothing in the program shall be deemed to alter or revise the eligibility of any veteran for dental care under the laws administered by the Secretary.

(b)

Elements— The program required by subsection (a) shall provide education for veterans on the following:

(1)

The association between dental health and overall health and well-being.

(2)

Proper techniques for dental care.

(3)

Signs and symptoms of commonly occurring dental conditions.

(4)

Treatment options for commonly occurring dental issues.

(5)

Options for obtaining access to dental care, including information on eligibility for dental care through the Department and on purchasing private dental insurance.

(6)

Available and accessible options for obtaining low or no-cost dental care, including through dental schools and Federally Qualified Health Centers (FQHCs).

(7)

Such other matters relating to dental health as the Secretary considers appropriate.

(c)

Delivery of educational materials—

(1)

In general— The Secretary shall provide educational materials to veterans under the program required by subsection (a) through a variety of mechanisms, including the following:

(A)

The availability and distribution of print materials at Department facilities (including at medical centers, clinics, Vet Centers, and readjustment counseling centers) and to providers (including members of Patient Aligned Care Teams).

(B)

The availability and distribution of materials over the Internet, including through webinars and My HealtheVet.

(C)

Presentations of information, including both small group and large group presentations.

(2)

Selection of mechanisms— In selecting mechanisms for purposes of this subsection, the Secretary shall select mechanisms designed to maximize the number of veterans who receive education under the program.

(d)

(e)

Effective date— This section shall take effect on the date that is one year after the date of the enactment of this Act.

Sec. 354 Information on dental services for inclusion in electronic medical records under dental insurance pilot program

(a)

In general— Commencing not later than 540 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall expand the dental insurance pilot program established by section 17.169 of title 38, Code of Federal Regulations, to establish a mechanism by which private sector dental care providers shall forward to the Department of Veterans Affairs information on dental care furnished to individuals under the pilot program for inclusion in the electronic medical records of the Department with respect to such individuals.

(b)

Construction with current pilot program requirements—

(1)

In general— Nothing in this section shall be construed to revise eligibility for participation in, or the locations of, the pilot program referred to in subsection (a).

(2)

Duration— The Secretary may continue the pilot program for two years in addition to the duration otherwise provided for the pilot program in section 17.169 of title 38, Code of Federal Regulations, if the Secretary determines that the continuation is needed to assess the mechanism required by subsection (a).

(3)

Voluntary participation in mechanism— The participation in the mechanism required by subsection (a) of an individual otherwise participating in the pilot program shall be at the election of the individual.

(c)

Inclusion of information on mechanism in reports— Each report to Congress on the pilot program after the date of the date of the commencement of the mechanism required by subsection (a) shall include information on the mechanism, including a current assessment of the feasability and advisability of using the mechanism to include information on dental care furnished individuals in the electronic medical records of the Department with respect to such individuals.

(d)

Effective date— This section shall take effect on the date that is one year after the date of the enactment of this Act.

Sec. 355 Authorization of appropriations

There is authorized to be appropriated for the Department of Veterans Affairs for fiscal year 2015 $305,000,000 to carry out this subtitle and the amendments made by this subtitle. The amount so authorized to be appropriated shall be available for obligation for the five-year period beginning on the date that is one year after the date of the enactment of this Act.

F Health care related to sexual trauma

Sec. 361 Expansion of eligibility for sexual trauma counseling and treatment to veterans on inactive duty training

Section 1720D(a)(1) is amended by striking “or active duty for training” and inserting “, active duty for training, or inactive duty training”.

Sec. 362 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 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.”

(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. 363 Department of Veterans Affairs screening mechanism to detect incidents of domestic abuse

(a)

In general— Not later than two years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall develop and implement a screening mechanism to be used when a veteran seeks healthcare services from the Department of Veterans Affairs to detect if the veteran has been a victim of domestic abuse for purposes of improving the treatment of the veteran and assessing the prevalence of domestic abuse in the veteran population.

(b)

Readily available screening tools— In developing and implementing a screening mechanism under subsection (a), the Secretary may incorporate into the screening mechanism such readily available screening tools as the Secretary considers appropriate for the screening mechanism.

(c)

Domestic abuse defined— In this section, the term domestic abuse means behavior with respect to an individual that—

(1)

constitutes—

(A)

a pattern of behavior resulting in physical or emotional abuse, economic control, or interference with the personal liberty of that individual;

(B)

a violation of Federal or State law involving the use, attempted use, or threatened use of force or violence against that individual; or

(C)

a violation of a lawful order issued for the protection of that individual; and

(2)

is committed by a person who—

(A)

is a current or former spouse or domestic partner of that individual;

(B)

shares a child in common with that individual;

(C)

is a current or former intimate partner of that individual that shares or has shared a common domicile with that individual;

(D)

is a caregiver or family caregiver of that individual (as such terms are defined in section 1720G(d) of title 38, United States Code); or

(E)

is in any other type of relationship with that individual that the Secretary may specify for purposes of this section.

Sec. 364 Reports on military sexual trauma and domestic abuse

(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)

Report on domestic abuse among veterans— Not later than two years after the implementation of the screening mechanism required by section 363(a) of this Act, the Secretary of Veterans Affairs and the Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention, shall jointly submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on domestic abuse among veterans that includes the following:

(1)

A summary of the types, outcomes, and circumstances of incidents of domestic abuse that have been reported by veterans during the two-year period preceding the submission of the report.

(2)

A summary of the treatments available from the Department of Veterans Affairs for veterans who experience domestic abuse and an assessment of the effectiveness of those treatments.

(3)

Data and analysis on any correlation between an incident of military sexual trauma or sexual trauma experienced after the age of 18 and domestic abuse.

(4)

Any other issues that the Secretary of Veterans Affairs or the Director of the Centers for Disease Control and Prevention determines appropriate.

(c)

Reports on transition of military sexual trauma and domestic abuse 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 and domestic abuse 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 or domestic abuse 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 or domestic abuse, including permitting veterans access to information and evidence necessary to develop or support such claims.

(d)

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)

Domestic abuse— The term domestic abuse has the meaning given that term in section 363(c) of this Act.

(3)

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 or active duty for training.

(4)

Sexual harassment— The term sexual harassment means repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character.

(5)

Sexual trauma— The term sexual trauma shall have the meaning given that term by the Secretary of Veterans Affairs for purposes of this section.

(e)

Effective date— This section shall take effect on the date that is 270 days after the date of the enactment of this Act.

G Reproductive treatment and services

Sec. 371 Clarification that fertility counseling and treatment are medical services which the Secretary may furnish to veterans like other medical services

Section 1701(6), as amended by section 306(b)(1) of this Act, is further amended by adding at the end the following new subparagraph:

“(I) Fertility counseling and treatment, including treatment using assisted reproductive technology.”

Sec. 372 Reproductive treatment and care for spouses and surrogates of veterans

(a)

In general— Subchapter VIII of chapter 17 is amended by adding at the end the following new section:

“1788. Reproductive treatment and care for spouses and surrogates of veterans

“(a) In general—The Secretary shall furnish fertility counseling and treatment, including through the use of assisted reproductive technology, to a spouse or surrogate of a severely wounded, ill, or injured veteran who has an infertility condition incurred or aggravated in line of duty in the active military, naval, or air service and who is enrolled in the system of annual patient enrollment established under section 1705(a) of this title if the spouse or surrogate and the veteran apply jointly for such counseling and treatment through a process prescribed by the Secretary.

“(b) Coordination of care for other spouses and surrogates—In the case of a spouse or surrogate of a veteran not described in subsection (a) who is seeking fertility counseling and treatment, the Secretary may coordinate fertility counseling and treatment for such spouse or surrogate.

“(c) Construction—Nothing in this section shall be construed to require the Secretary—

“(1) to find or certify a surrogate for a veteran or to connect a surrogate with a veteran; or

“(2) to furnish maternity care to a spouse or surrogate of a veteran.

“(d) Assisted reproductive technology defined—In this section, the term assisted reproductive technology includes in vitro fertilization and other fertility treatments in which both eggs and sperm are handled when clinically appropriate.”

(b)

Clerical amendment— The table of sections at the beginning of chapter 17 is amended by inserting after the item relating to section 1787 the following new item:

Sec. 373 Adoption assistance for severely wounded veterans

(a)

In general— Subchapter VIII of chapter 17, as amended by section 372(a) of this Act, is further amended by adding at the end the following new section:

“1789. Adoption assistance

“(a) In general—The Secretary may pay an amount, not to exceed the limitation amount, to assist a covered veteran in the adoption of one or more children.

“(b) Covered veteran—For purposes of this section, a covered veteran is any severely wounded, ill, or injured veteran who—

“(1) has an infertility condition incurred or aggravated in line of duty in the active military, naval, or air service; and

“(2) is enrolled in the system of annual patient enrollment established under section 1705(a) of this title.

“(c) Limitation amount—For purposes of this section, the limitation amount is the amount equal to the lesser of—

“(1) the cost the Department would incur if the Secretary were to provide a covered veteran with one cycle of fertility treatment through the use of assisted reproductive technology under section 1788 of this title, as determined by the Secretary; or

“(2) the cost the Department would incur by paying the expenses of three adoptions by covered veterans, as determined by the Secretary.

“(d) Assisted reproductive technology defined—In this section, the term assisted reproductive technology has the meaning given that term in section 1788 of this title.”

(b)

Clerical amendment— The table of sections at the beginning of chapter 17, as amended by section 372(b) of this Act, is further amended by inserting after the item relating to section 1788 the following new item:

Sec. 374 Regulations on furnishing of fertility counseling and treatment and adoption assistance by Department of Veterans Affairs

(a)

In general— Not later than 540 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall prescribe regulations—

(1)

on the furnishing of fertility treatment to veterans using assisted reproductive technology;

(2)

to carry out section 1788 of title 38, United States Code, as added by section 372 of this Act; and

(3)

to carry out section 1789 of such title, as added by section 373 of this Act.

(b)

Limitation— Notwithstanding any other provision of law, during the period beginning on the date of the enactment of this Act and ending on the date on which the Secretary prescribes regulations under subsection (a), the Secretary may not furnish—

(1)

to a veteran any fertility treatment that uses an assisted reproductive technology that the Secretary has not used in the provision of a fertility treatment to a veteran before the date of the enactment of this Act;

(2)

any fertility counseling or treatment under section 1788 of such title, as added by section 372 of this Act; or

(3)

any assistance under section 1789 of such title, as added by section 373 of this Act.

(c)

Assisted reproductive technology defined— In this section, the term assisted reproductive technology has the meaning given the term in section 1788 of such title, as added by section 372 of this Act.

Sec. 375 Coordination between Department of Veterans Affairs and Department of Defense on furnishing of fertility counseling and treatment

The Secretary of Veterans Affairs and the Secretary of Defense shall share best practices and facilitate referrals, as they consider appropriate, on the furnishing of fertility counseling and treatment.

Sec. 376 Facilitation of reproduction and infertility research

(a)

In general— Subchapter II of chapter 73, as amended by section 325(a) of this Act, is further amended by adding at the end the following new section:

“7330C. Facilitation of reproduction and infertility research

“(a) Facilitation of research required—The Secretary shall facilitate research conducted collaboratively by the Secretary of Defense and the Secretary of Health and Human Services to improve the ability of the Department of Veterans Affairs to meet the long-term reproductive health care needs of veterans who have a genitourinary service-connected disability or a condition that was incurred or aggravated in line of duty in the active military, naval, or air service, such as a spinal cord injury, that affects the veterans' ability to reproduce.

“(b) Dissemination of information—The Secretary shall ensure that information produced by the research facilitated under this section that may be useful for other activities of the Veterans Health Administration is disseminated throughout the Veterans Health Administration.”

(b)

Clerical amendment— The table of sections at the beginning of chapter 73, as amended by section 325(b) of this Act, is further amended by inserting after the item relating to section 7330B the following new item:

(c)

Report— Not later than three years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to Congress a report on the research activities conducted by the Secretary under section 7330C of title 38, United States Code, as added by subsection (a).

Sec. 377 Annual report on provision of fertility counseling and treatment furnished by Department of Veterans Affairs

(a)

In general— Not later than one year after the date of the enactment of this Act and not less frequently than annually 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 the fertility counseling and treatment furnished by the Department of Veterans Affairs during the year preceding the submittal of the report.

(b)

Elements— Each report submitted under subsection (a) shall include, for the period covered by the report, the following:

(1)

The number of veterans who received fertility counseling or treatment furnished by the Department of Veterans Affairs, disaggregated by era of military service of such veterans.

(2)

The number of spouses and surrogates of veterans who received fertility counseling or treatment furnished by the Department.

(3)

The cost to the Department of furnishing fertility counseling and treatment, disaggregated by cost of services and administration.

(4)

The average cost to the Department per recipient of such counseling and treatment.

(5)

In cases in which the Department furnished fertility treatment through the use of assisted reproductive technology, the average number of cycles per person furnished.

(6)

A description of how fertility counseling and treatment services of the Department are coordinated with similar services of the Department of Defense.

Sec. 378 Program on assistance for child care for certain veterans

(a)

Assistance for child care for certain veterans receiving health care—

(1)

In general— Subchapter I of chapter 17 is amended by adding at the end the following new section:

“1709B. Assistance for child care for certain veterans receiving health care

“(a) Program required—The Secretary shall carry out a program to provide, subject to subsection (b), assistance to qualified veterans described in subsection (c) to obtain child care so that such veterans can receive health care services described in subsection (c).

“(b) Limitation on period of payments—Assistance may only be provided to a qualified veteran under this section for receipt of child care during the period that the qualified veteran—

“(1) receives health care services described in subsection (c) at a facility of the Department; and

“(2) requires travel to and from such facility for the receipt of such health care services.

“(c) Qualified veterans—For purposes of this section, a qualified veteran is a veteran who is—

“(1) the primary caretaker of a child or children; and

“(2)

“(A) receiving from the Department—

“(i) regular mental health care services;

“(ii) intensive mental health care services; or

“(iii) such other intensive health care services that the Secretary determines that provision of assistance to the veteran to obtain child care would improve access to such health care services by the veteran; or

“(B) in need of regular or intensive mental health care services from the Department, and but for lack of child care services, would receive such health care services from the Department.

“(d) Locations—The Secretary shall carry out the program in no fewer than three Veterans Integrated Service Networks selected by the Secretary for purposes of the program.

“(e) Forms of child care assistance

“(1) Child care assistance under this section may include the following:

“(A) Stipends for the payment of child care offered by licensed child care centers (either directly or through a voucher program) which shall be, to the extent practicable, modeled after the Department of Veterans Affairs Child Care Subsidy Program established pursuant to section 630 of the Treasury and General Government Appropriations Act, 2002 (Public Law 107–67; 115 Stat. 552).

“(B) Direct provision of child care at an on-site facility of the Department.

“(C) Payments to private child care agencies.

“(D) Collaboration with facilities or programs of other Federal departments or agencies.

“(E) Such other forms of assistance as the Secretary considers appropriate.

“(2) In the case that child care assistance under this section is provided as a stipend under paragraph (1)(A), such stipend shall cover the full cost of such child care.”

(2)

Clerical amendment— The table of sections at the beginning of chapter 17 is amended by inserting after the item relating to section 1709A the following new item:

(3)

Conforming amendment— Section 205(e) of the Caregivers and Veterans Omnibus Health Services Act of 2010 (Public Law 111–163; 38 U.S.C. 1710 note) is amended by inserting “but not after the date of the enactment of the Comprehensive Veterans Health and Benefits and Military Retirement Pay Restoration Act of 2014” before the period at the end.

(b)

Assistance for child care for individuals receiving readjustment counseling and related mental health services—

(1)

In general— Subchapter I of chapter 17, as amended by subsection (a)(1) of this section, is further amended by adding at the end the following new section:

“1709C. Assistance for child care for individuals receiving readjustment counseling and related mental health services

“(a) Program required—The Secretary shall carry out a program to provide, subject to subsection (b), assistance to qualified individuals described in subsection (c) to obtain child care so that such individuals can receive readjustment counseling and related mental health services.

“(b) Limitation on period of payments—Assistance may only be provided to a qualified individual under this section for receipt of child care during the period that the qualified individual receives readjustment counseling and related health care services at a Vet Center.

“(c) Qualified individuals—For purposes of this section, a qualified individual is an individual who is—

“(1) the primary caretaker of a child or children; and

“(2)

“(A) receiving from the Department regular readjustment counseling and related mental health services; or

“(B) in need of readjustment counseling and related mental health services from the Department, and but for lack of child care services, would receive such counseling and services from the Department.

“(d) Locations—The Secretary shall carry out the program under this section in no fewer than three Readjustment Counseling Service Regions selected by the Secretary for purposes of the program.

“(e) Forms of child care assistance

“(1) Child care assistance under this section may include the following:

“(B) Payments to private child care agencies.

“(C) Collaboration with facilities or programs of other Federal departments or agencies.

“(D) Such other forms of assistance as the Secretary considers appropriate.

“(2) In the case that child care assistance under this subsection is provided as a stipend under paragraph (1)(A), such stipend shall cover the full cost of such child care.

“(f) Vet Center defined—In this section, the term Vet Center means a center for readjustment counseling and related mental health services for individuals under section 1712A of this title.”

(2)

Clerical amendment— The table of sections at the beginning of chapter 17, as amended by subsection (a)(2) of this section, is further amended by inserting after the item relating to section 1709B the following new item:

Sec. 379 Counseling in retreat settings for women veterans newly separated from service in the Armed Forces

(a)

Counseling in retreat settings—

(1)

In general— Subchapter II of chapter 17 is amended by adding at the end the following new section:

“1720H. Counseling in retreat settings for women veterans newly separated from service in the Armed Forces

“(a) In general—The Secretary shall provide, through the Readjustment Counseling Service of the Veterans Health Administration, reintegration and readjustment services described in subsection (c) in group retreat settings to women veterans who are recently separated from service in the Armed Forces after a prolonged deployment.

“(b) Election of veteran—The receipt of services under this section by a woman veteran shall be at the election of the veteran.

“(c) Covered services—The services provided to a woman veteran under this section shall include the following:

“(1) Information on reintegration into the veteran’s family, employment, and community.

“(2) Financial counseling.

“(3) Occupational counseling.

“(4) Information and counseling on stress reduction.

“(5) Information and counseling on conflict resolution.

“(6) Such other information and counseling as the Secretary considers appropriate to assist the veteran in reintegration into the veteran’s family, employment, and community.”

(2)

Clerical amendment— The table of sections at the beginning of chapter 17 is amended by inserting after the item relating to section 1720G the following new item:

(b)

Repeal of superseded pilot program authority— Section 203 of the Caregivers and Veterans Omnibus Health Services Act of 2010 (Public Law 111–163; 38 U.S.C. 1712A note) is hereby repealed.

H Major medical facility leases

Sec. 381 Authorization of major medical facility leases

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 the Cobb County 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.

Sec. 382 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— 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—

(1)

an amount equal to total payments under the full term of the lease; or

(2)

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.

(c)

Transparency—

(1)

Compliance— Subsection (b) of section 8104 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 copy 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.