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Title I — Health Care Matters

S. 2413 · 113th Congress · Jun 2, 2014 · Lineage

I Health Care Matters

A Improvement of Access to Care by Strengthening Management, Technology, and Metrics

Sec. 101 Implementation of upgraded Department of Veterans Affairs electronic scheduling system for appointments for receipt of health care from the Department

(a)
Implementation—
(1)
In general— Not later than March 31, 2016, the Secretary of Veterans Affairs shall fully implement an upgraded and centralized electronic scheduling system described in subsection (b) for appointments by eligible individuals for health care from the Department of Veterans Affairs.
(2)
Agile software development methodologies— In implementing the upgraded electronic scheduling system required by paragraph (1), the Secretary shall use agile software development methodologies to fully implement portions of such system every 180 days beginning on the date on which the Secretary begins the implementation of such system, or enters into a contract for the implementation of such system, and ending on the date on which such system is fully implemented.
(b)
Electronic scheduling system— The upgraded electronic scheduling system described in this subsection shall include mechanisms to achieve the following:
(1)
An efficient and effective graphical user interface with a calendar view for use by employees of the Department in scheduling appointments that enables error-free scheduling of the health care resources of the Department.
(2)
A capability to assist employees of the Department to easily and consistently implement policies of the Department with respect to scheduling of appointments, including with respect to priority for appointments for certain eligible individuals.
(3)
A capability for employees of the Department to sort and view through a unified interface the availability for each health care provider of the Department or other health care resource of the Department.
(4)
A capability for employees of the Department to sort and view appointments for and appointment requests made by a particular eligible individual.
(5)
A capability for seamless coordination of appointments for primary care, specialty care, consultations, or any other health care matter among facilities of the Department.
(6)
A capability for eligible individuals to access the system remotely and schedule appointments directly through the system.
(7)
An electronic timestamp of each activity made by an eligible individual or on behalf of such individual with respect to an appointment or the scheduling of an appointment that shall be kept in the medical record of such individual.
(8)
A seamless connection to the Computerized Patient Record System of the Department so that employees of the Department, when scheduling an appointment for an eligible individual, have access to recommendations from the health care provider of such individual with respect to when such individual should receive an appointment.
(9)
A capability to provide automated reminders to eligible individuals on upcoming appointments through various electronic and voice media.
(10)
A capability to provide automated reminders to employees of the Department when an eligible individual who is on the wait-list for an appointment becomes eligible to schedule an appointment.
(11)
A dashboard capability to support efforts to track the following metrics in aggregate and by medical facility with respect to health care provided to eligible individuals under the laws administered by the Secretary:
(A)
The number of days into the future that the schedules of health care providers are available to schedule an appointment.
(B)
The number of providers available to see patients each day.
(C)
The number of support personnel working each day.
(D)
The types of appointments available.
(E)
The rate at which patients fail to appear for appointments.
(F)
The number of appointments canceled by a patient on a daily basis.
(G)
The number of appointments canceled by a health care provider on a daily basis.
(H)
The number of patients on the wait list at any given time.
(I)
The number of appointments scheduled on a daily basis.
(J)
The number of appointments available to be scheduled on a daily basis.
(K)
The number of patients seen on a daily, weekly, and monthly basis.
(L)
Wait-times for an appointment with a health care provider of the Department.
(M)
Wait-times for an appointment with a non-Department health care provider.
(N)
Wait-times for a referral to a specialist or consult.
(12)
A capability to provide data on the capacity of medical facilities of the Department for purposes of determining the resources needed by the Department to provide health care to eligible individuals.
(13)
Any other capabilities as specified by the Secretary for purposes of this section.
(c)
Plan—
(1)
In general— Not later than 90 days 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 plan for implementing the upgraded electronic scheduling system required by subsection (a).
(2)
Elements— The plan required by paragraph (1) shall include the following:
(A)
A description of the priorities of the Secretary for implementing the requirements of the system under subsection (b).
(B)
A detailed description of the manner in which the Secretary will fully implement such system, including deadlines for completing each such requirement.
(3)
Update— Not later than 90 days after the submittal of the plan required by paragraph (1), and not less frequently than every 90 days thereafter until such system is fully implemented, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives an update on the status of the implementation of such plan.
(d)
Use of amounts— The Secretary may use amounts available to the Department of Veterans Affairs for the appropriations account under the heading “Medical Services” in implementing and carrying out the upgraded electronic scheduling system required by subsection (a).
(e)
Eligible individual defined— In this section, the term eligible individual means an individual eligible for hospital, nursing home, domiciliary, medical care, or other health care under the laws administered by the Secretary of Veterans Affairs.

Sec. 102 Independent assessment of the scheduling process for medical appointments for care from Department of Veterans Affairs

(a)
Independent assessment—
(1)
Contract— Not later than 30 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall enter into a contract with an independent third party to assess the process at each medical facility of the Department of Veterans Affairs for scheduling appointments for veterans to receive hospital care, medical services, or other health care from the Department.
(2)
Elements— In carrying out the assessment required by paragraph (1), the independent third party shall do the following:
(A)
Review all training materials pertaining to scheduling of appointments at each medical facility of the Department.
(B)
Assess whether all employees of the Department conducting tasks related to scheduling are properly trained for conducting such tasks.
(C)
Assess whether changes in the technology or system used in scheduling appointments are necessary to limit access to the system to only those employees that have been properly trained in conducting such tasks.
(D)
Assess whether health care providers of the Department are making changes to their schedules that hinder the ability of employees conducting such tasks to perform such tasks.
(E)
Assess whether the establishment of a centralized call center throughout the Department for scheduling appointments at medical facilities of the Department would improve the process of scheduling such appointments.
(F)
Assess whether booking templates for each medical facility or clinic of the Department would improve the process of scheduling such appointments.
(G)
Recommend any actions to be taken by the Department to improve the process for scheduling such appointments, including the following:
(i)
Changes in training materials provided to employees of the Department with respect to conducting tasks related to scheduling such appointments.
(ii)
Changes in monitoring and assessment conducted by the Department of wait-times of veterans for such appointments.
(iii)
Changes in the system used to schedule such appointments, including changes to improve how the Department—
(I)
measures wait-times of veterans for such appointments;
(II)
monitors the availability of health care providers of the Department; and
(III)
provides veterans the ability to schedule such appointments.
(iv)
Such other actions as the independent third party considers appropriate.
(3)
Timing— The independent third party carrying out the assessment required by paragraph (1) shall complete such assessment not later than 180 days after entering into the contract described in such paragraph.
(b)
Report— Not later than 90 days after the date on which the independent third party completes the assessment 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 assessment.

Sec. 103 Modification of liability for breach of period of obligated service under Health Professionals Educational Assistance Program for primary care physicians

Section 7617 is amended—
(1)
in subsection (c)(1), by striking “If a participant” and inserting “Except as provided in subsection (d), if a participant”; and
(2)
by adding at the end the following new subsection:

“(d) Liability shall not arise under subsection (c) in the case of a participant otherwise covered by that subsection who has pursued a course of education or training in primary care if—

“(1) the participant—

“(A) does not obtain, or fails to maintain, employment as a Department employee due to staffing changes approved by the Under Secretary for Health; or

“(B) does not obtain, or fails to maintain, employment in a position of primary care physician in the Veterans Health Administration due, as determined by the Secretary, to a number of primary care physicians in the Administration that is excess to the needs of the Administration; and

“(2) the participant agrees to accept and maintain employment as a primary care physician with another department or agency of the Federal Government (with such employment to be under such terms and conditions as are jointly agreed upon by the participant, the Secretary, and the head of such department or agency, including terms and conditions relating to a period of obligated service as a primary care physician with such department or agency) if such employment is offered to the participant by the Secretary and the head of such department or agency.”

Sec. 104 Program of education at Uniformed Services University of the Health Sciences with specialization in primary care

(a)
Program required under Health Professionals Educational Assistance Program—
(1)
In general— Chapter 76 is amended by adding after subchapter VII the following new subchapter:

“VIII Program of Education at Uniformed Services University of the Health Sciences With Specialization in Primary Care

“7691. Authority for program

“As part of the Educational Assistance Program, the Secretary shall, in collaboration with the Secretary of Defense, carry out a program to permit individuals to enroll in the Uniformed Services University of the Health Sciences under chapter 104 of title 10 to pursue a medical education with a specialization in primary care. The program shall be known as the Department of Veterans Affairs Primary Care Educational Assistance Program (in this chapter referred to as the “Primary Care Educational Assistance Program”).

“7692. Selection; agreement; ineligibility for certain other educational assistance

“(a) Selection

“(1) Medical students at the Uniformed Services University of the Health Sciences pursuant to the Primary Care Educational Assistance Program shall be selected by the Secretary, in consultation with the Secretary of Defense, in accordance with procedures established by the Secretaries for purposes of the Program.

“(2) The procedures referred to in paragraph (1) shall emphasize the basic requirement that students demonstrate a motivation and dedication to a medical career in primary care.

“(3) The number of medical students selected each year for first-year enrollment in the University pursuant to this subsection shall be jointly determined by the Secretary and the Secretary of Defense.

“(b) Agreement—An agreement between the Secretary and a participant in the Primary Care Educational Assistance Program shall (in addition to the requirements set forth in section 7604 of this title) include the following:

“(1) The Secretary's agreement to cover the costs of the participant's education and training at the Uniformed Services University of the Health Sciences under chapter 104 of title 10 as if the participant were a medical student enrolled in the University pursuant to section 2114 of title 10.

“(2) The participant's agreement to serve as a full-time employee in the Veterans Health Administration in a position as a primary care physician for a period of time (in this subchapter referred to as the “period of obligated service”) of one calendar year for each school year or part thereof for which the participant was a medical student at the Uniformed Services University of the Health Sciences pursuant to the Primary Care Educational Assistance Program, but for not less than one year.

“(c) Ineligibility for other educational assistance—An individual who receives education and training under the Primary Care Educational Assistance Program shall not be eligible for other assistance under this chapter in connection with such education and training.

“7693. Obligated service

“(a) In general—Each participant in the Primary Care Educational Assistance Program shall provide service as a full-time employee of the Department in the Veterans Health Administration in a primary care position for the period of obligated service provided in the agreement of the participant entered into for purposes of this subchapter. Such service shall be provided in a full-time primary care clinical practice in an assignment or location determined by the Secretary.

“(b) Service commencement date

“(1) Not later than 60 days before a participant's service commencement date, the Secretary shall notify the participant of that service commencement date. That date is the date for the beginning of the participant's period of obligated service.

“(2) As soon as possible after a participant's service commencement date, the Secretary shall—

“(A) in the case of a participant who is not a full-time employee in the Veterans Health Administration, appoint the participant as such an employee; and

“(B) in the case of a participant who is an employee in the Veterans Health Administration but is not serving in a position for which the participant's course of education or training prepared the participant, assign the participant to such a position.

“(3) A participant's service commencement for purposes of this subsection date is the date upon which the participant becomes licensed to practice medicine in a State.

“(c) Commencement of obligated service—A participant in the Primary Care Educational Assistance Program shall be considered to have begun serving the participant's period of obligated service—

“(1) on the date on which the participant is appointed as a full-time employee in the Veterans Health Administration pursuant to subsection (b)(2)(A); or

“(2) if the participant is a full-time employee in the Veterans Health Administration and assigned to a position pursuant to subsection (b)(2)(B), on the date on which the participant is so assigned to such position.

“7694. Breach of agreement: liability

“(a) Liability during course of education or training

“(1) A participant in the Primary Care Educational Assistance Program shall be liable to the United States for the amount which has been paid on behalf of the participant under the agreement entered into for purposes of this subchapter if any of the following occurs:

“(A) The participant fails to maintain an acceptable level of academic standing in the Uniformed Services University of the Health Sciences.

“(B) The participant is dismissed from the Uniformed Services University of the Health Sciences for disciplinary reasons.

“(C) The participant voluntarily terminates the course of medical education and training in the Uniformed Services University of the Health Sciences before the completion of such course of education and training.

“(D) The participant fails to become licensed to practice medicine in a State during a period of time determined under regulations prescribed by the Secretary.

“(2) Liability under this subsection is in lieu of any service obligation arising under a participant's agreement for purposes of this subchapter.

“(b) Liability during period of obligated service

“(1) Except as provided in subsection (c) and subject to paragraph (2), if a participant in the Primary Care Educational Assistance Program breaches the agreement entered into for purposes of this subchapter by failing for any reason to complete the participant's period of obligated service, the United States shall be entitled to recover from the participant an amount equal to—

“(A) the total amount paid under this subchapter on behalf of the participant; multiplied by

“(B) a fraction—

“(i) the numerator of which is—

“(I) the total number of months in the participant's period of obligated service; minus

“(II) the number of months served by the participant pursuant to the agreement; and

“(ii) the denominator of which is the total number of months in the participant's period of obligated service.

“(2) Any period of internship or residency training of a participant shall not be treated as satisfying the participant's period of obligated service for purposes of this subsection.

“(c) Exceptions—Liability shall not arise under subsection (b) in the case of a participant otherwise covered by that subsection if—

“(1) the participant—

“(A) does not obtain, or fails to maintain, employment as a Department employee due to staffing changes approved by the Under Secretary for Health; or

“(B) does not obtain, or fails to maintain, employment in a position of primary care physician in the Veterans Health Administration due, as determined by the Secretary, to a number of primary care physicians in the Administration that is excess to the needs of the Administration; and

“(2) the participant agrees to accept and maintain employment as a primary care physician with another department or agency of the Federal Government (with such employment to be under such terms and conditions as are jointly agreed upon by the participant, the Secretary, and the head of such department or agency, including terms and conditions relating to a period of obligated service as a primary care physician with such department or agency) if such employment is offered to the participant by the Secretary and the head of such department or agency.

“7695. Funding

“(a) In general—Amounts for the Primary Care Educational Assistance Program shall be derived from amounts available to the Secretary for the Veterans Health Administration.

“(b) Transfer

“(1) The Secretary shall transfer to the Secretary of Defense amounts required by the Secretary of Defense to carry out the Primary Care Educational Assistance Program.

“(2) Amounts transferred to the Secretary of Defense pursuant to paragraph (1) shall be credited to the appropriation or account providing funding for the Uniformed Services University of the Health Sciences. Amounts so credited shall be merged with amounts in the appropriation or account to which credited and shall be available, subject to the terms and conditions applicable to such appropriation or account, for the Uniformed Services University of the Health Sciences.”

(2)
Clerical amendment— The table of sections at the beginning of chapter 76 is amended by adding after the item relating to section 7684 the following:
(b)
Inclusion of program in Health Professionals Educational Assistance Program— Section 7601(a) is amended—
(1)
in paragraph (4), by striking “; and” and inserting a semicolon;
(2)
in paragraph (5), by striking the period at the end and inserting “; and”; and
(3)
by adding at the end the following new paragraph:

“(6) the enrollment of individuals in the Uniformed Services University of the Health Sciences for specialization in primary care provided for in subchapter VIII of this chapter.”

(c)
Application requirements—
(1)
In general— Subsection (a)(1) of section 7603 is amended in the matter preceding subparagraph (A) by striking “, or VI” and inserting “, VI, or VIII”.
(2)
No priority for applications— Subsection (d) of such section is amended—
(A)
by striking “In selecting” and inserting “(1) Except as provided in paragraph (2), in selecting”; and
(B)
by adding at the end the following new paragraph:

“(2) Paragraph (1) shall not apply with respect to applicants for participation in the Program of Education at Uniformed Services University of the Health Sciences With Specialization in Primary Care pursuant to subchapter VIII of this chapter.”

(d)
Agreement requirements— Section 7604 is amended by striking “, or VI” each place it appears and inserting “, VI, or VIII”.

Sec. 105 Treatment of staffing shortage and biannual report on staffing of medical facilities of the Department of Veterans Affairs

(a)
Staffing shortage—
(1)
In general— Not later than 180 days after the date of the enactment of this Act, and not later than September 30 each year thereafter, the Secretary of Veterans Affairs shall determine, and publish in the Federal Register, the five occupations of health care providers of the Department of Veterans Affairs for which there is the largest staffing shortage throughout the Department.
(2)
Recruitment and appointment— Notwithstanding sections 3304 and 3309 through 3318 of title 5, United States Code, the Secretary may, upon a determination by the Secretary under paragraph (1) or a modification to such determination under paragraph (2), that there is a staffing shortage throughout the Department with respect to a particular occupation of health care provider, recruit and directly appoint highly qualified health care providers to a position to serve as a health care provider in that particular occupation for the Department.
(3)
Priority in Health Professionals Educational Assistance Program to certain providers— Section 7612(b)(5) is amended—
(A)
in subparagraph (A), by striking “and” at the end;
(B)
by redesignating subparagraph (B) as subparagraph (C); and
(C)
by inserting after subparagraph (A) the following new subparagraph (B):

“(B) shall give priority to applicants pursuing a course of education or training towards a career in an occupation for which the Secretary has, in the most current determination published in the Federal Register pursuant to section 105(a)(1) of the Restoring Veterans Trust Act of 2014, determined that there is one of the largest staffing shortage throughout the Department with respect to such occupation; and”

(b)
Reports—
(1)
In general— Not later than 180 days after the date of the enactment of this Act, and not later than December 31 of each even numbered year thereafter until 2024, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report assessing the staffing of each medical facility of the Department of Veterans Affairs.
(2)
Elements— Each report submitted under paragraph (1) shall include the following:
(A)
The results of a system-wide assessment of all medical facilities of the Department to ensure the following:
(i)
Appropriate staffing levels for health care providers to meet the goals of the Secretary for timely access to care for veterans.
(ii)
Appropriate staffing levels for support personnel, including clerks.
(iii)
Appropriate sizes for clinical panels.
(iv)
Appropriate numbers of full-time staff, or full-time equivalent, dedicated to direct care of patients.
(v)
Appropriate physical plant space to meet the capacity needs of the Department in that area.
(vi)
Such other factors as the Secretary considers necessary.
(B)
A plan for addressing any issues identified in the assessment described in subparagraph (A), including a timeline for addressing such issues.
(C)
A list of the current wait times and workload levels for the following clinics in each medical facility:
(i)
Mental health.
(ii)
Primary care.
(iii)
Gastroenterology.
(iv)
Women’s health.
(v)
Such other clinics as the Secretary considers appropriate.
(D)
A description of the results of the determination of the Secretary under paragraph (1) of subsection (a) and a plan to use direct appointment authority under paragraph (2) of such subsection to fill staffing shortages, including recommendations for improving the speed at which the credentialing and privileging process can be conducted.
(E)
The current staffing models of the Department for the following clinics, including recommendations for changes to such models:
(i)
Mental health.
(ii)
Primary care.
(iii)
Gastroenterology.
(iv)
Women’s health.
(v)
Such other clinics as the Secretary considers appropriate.
(F)
A detailed analysis of succession planning at medical facilities of the Department, including the following:
(i)
The number of positions in medical facilities throughout the Department that are not filled by a permanent employee.
(ii)
The length of time each such position described in clause (i) remained vacant or filled by a temporary or acting employee.
(iii)
A description of any barriers to filling the positions described in clause (i).
(iv)
A plan for filling any positions that are vacant or filled by a temporary or acting employee for more than 180 days.
(v)
A plan for handling emergency circumstances, such administrative leave or sudden medical leave for senior officials.
(G)
The number of health care providers who have been removed from their position or have retired, by provider type, during the two-year period preceding the submittal of the report.
(H)
Of the health care providers specified in subparagraph (G) that have been removed from their position, the following:
(i)
The number of such health care providers who were reassigned to another position in the Department.
(ii)
The number of such health care providers who left the Department.

Sec. 106 Clinic management training program of the Department of Veterans Affairs

(a)
In general— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall implement a clinic management training program to provide in-person, standardized education on health care management to all managers of, and health care providers at, medical facilities of the Department of Veterans Affairs.
(b)
Elements— The clinic management training program required by subsection (a) shall include the following:
(1)
Training on how to manage the schedules of health care providers of the Department, including the following:
(A)
Maintaining such schedules in a manner that allows appointments to be booked at least eight weeks in advance.
(B)
Proper planning procedures for vacation, leave, and graduate medical education training schedules.
(2)
Training on the appropriate number of appointments that a health care provider should conduct on a daily basis, based on specialty.
(3)
Training on how to determine whether there are enough available appointment slots to manage demand for different appointment types and mechanisms for alerting management of insufficient slots.
(4)
Training on how to properly use the data produced by the scheduling dashboard required by section 101(b)(11) of this Act to meet demand for health care, including the following:
(A)
Training on determining the next available appointment for each health care provider at the medical facility.
(B)
Training on determining the number of health care providers needed to meet demand for health care at the medical facility.
(C)
Training on determining the number of exam rooms needed to meet demand for such health care in an efficient manner.
(5)
Training on how to properly use the appointment scheduling system of the Department, including any new scheduling system implemented by the Department.
(6)
Training on how to optimize the use of technology, including the following:
(A)
Telemedicine.
(B)
Electronic mail.
(C)
Text messaging.
(D)
Such other technologies as specified by the Secretary.
(7)
Training on how to properly use physical plant space at medical facilities of the Department to ensure efficient flow and privacy for patients and staff.

Sec. 107 Inclusion of Department of Veterans Affairs facilities in National Health Service Corps Scholarship and loan repayment programs

(a)
In general— The Secretary of Health and Human Services shall use the funds transferred under subsection (e) to award scholarship and loan repayment contracts under sections 338A and 338B of the Public Health Service Act (42 U.S.C. 254l, 254l–1) to eligible individuals who agree to a period of obligated service under section 338A(f)(1) or 338B(f)(1) of such Act, as applicable, at a health facility of the Department of Veterans Affairs.
(b)
Health professional shortage areas— For purposes of selecting individuals eligible for the scholarships and loan repayment contracts under subsection (a), all health facilities of the Department of Veterans Affairs shall be deemed health professional shortage areas, as defined in section 332 of the Public Health Service Act (42 U.S.C. 254e).
(c)
Requirement— The Secretary of Health and Human Services shall ensure that a minimum of 5 scholarships or loan repayment contracts are awarded to individuals who agree to a period of obligated service at Veterans Affairs facilities in each State.
(d)
Applicability of NHSC program requirements— Except as otherwise provided in this section, the terms of the National Health Service Corps Scholarship Program and the National Health Service Corps Loan Repayment Program shall apply to participants awarded a grant or loan repayment contract under subsection (a) in the same manner that such terms apply to participants awarded a grant or loan repayment contract under section 338A or 338B of the Public Health Service Act.
(e)
Inclusion of geriatricians— For purposes of awarding scholarships and loan repayments contracts to eligible individuals who agree to a period of obligated service at a health facility of the Department of Veterans Affairs pursuant to this section, in sections 338A and 338B of the Public Health Service Act (42 U.S.C. 254l, 254l–1), the term primary health services shall include geriatrics.
(f)
Funding— The Secretary of Veterans Affairs shall transfer $20,000,000 from accounts of the Veterans Health Administration to the Secretary of Health and Human Services to award scholarships and loan repayment contracts, as described in subsection (a). All funds so transferred shall be used exclusively for the purposes described in such subsection.

Sec. 108 Improvement of access by veterans to health care from non-Department of Veterans Affairs providers

(a)
Improvement of access—
(1)
In general— The Secretary of Veterans Affairs shall ensure timely access of all veterans to the hospital care, medical services, and other health care for which such veterans are eligible under the laws administered by the Secretary through the enhanced use of authorities specified in paragraph (2) on the provision of such care and services through non-Department of Veterans Affairs providers (commonly referred to as “non-Department of Veterans Affairs medical care”).
(2)
Authorities on provision of care through non-Department providers— The authorities specified in this paragraph are the following:
(A)
Section 1703 of title 38, United States Code, relating to contracts for the provision of hospital care and medical services through non-Department facilities.
(B)
Section 1725 of such title, relating to reimbursement of certain veterans for the reasonable value of emergency treatment at non-Department facilities.
(C)
Section 1728 of such title, relating to reimbursement of certain veterans for customary and usual charges of emergency treatment from sources other than the Department.
(D)
Section 1786 of such title, relating to health care services furnished to newborn children of women veterans who are receiving maternity care furnished by the Department at a non-Department facility.
(E)
Any other authority under the laws administered by the Secretary to provide hospital care, medical services, or other health care from a non-Department provider, including the following:
(i)
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))).
(ii)
The Department of Defense.
(iii)
The Indian Health Service.
(3)
Requirements— In ensuring timely access of all veterans to the care and services described in paragraph (1) through the enhanced use of authorities specified in paragraph (2), the Secretary shall require the following:
(A)
That each veteran who has not received hospital care, medical services, or other health care from the Department and is seeking an appointment for primary care under the laws administered by the Secretary receive an appointment for primary care at a time consistent with timeliness measures established by the Secretary for purposes of providing primary care to all veterans.
(B)
That the determination whether to refer a veteran for specialty care through a non-Department provider shall take into account the urgency and acuity of such veteran's need for such care, including—
(i)
the severity of the condition of such veteran requiring specialty care; and
(ii)
the wait-time for an appointment with a specialist with respect to such condition at the nearest medical facility of the Department with the capacity to provide such care.
(C)
That the determination whether a veteran shall receive hospital care, medical services, or other health care from the Department through facilities of the Department or through non-Department providers pursuant to the authorities specified in paragraph (2) shall take into account, in the manner specified by the Secretary, the following:
(i)
The distance the veteran would be required to travel to receive care or services through a non-Department provider compared to the distance the veteran would be required to travel to receive care or services from a medical facility of the Department.
(ii)
Any factors that might limit the ability of the veteran to travel, including age, access to transportation, and infirmity.
(iii)
The wait-time for the provision of care or services through a non-Department provider compared to the wait-time for the provision of care or services from a medical facility of the Department.
(D)
That the Department maximize the use of hospital care, medical services, and other health care available to the Department through non-Department providers, including providers available to provide such care and services as follows:
(i)
Pursuant to contracts under the Patient-Centered Community Care Program of the Department.
(ii)
Pursuant to contracts between a facility or facilities of the Department and a local facility or provider.
(iii)
Pursuant to contracts with Federally-qualified health centers (as defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B))), the Department of Defense, or the Indian Health Service.
(iv)
On a fee-for-service basis.
(b)
Medical records— In providing hospital care, medical services, and other health care to veterans through non-Department providers pursuant to the authorities specified in paragraph (2), the Secretary shall ensure that any such provider submits to the Department any medical record related to the care and services provided to a veteran by that provider for inclusion in the electronic medical record of such veteran maintained by the Department upon the completion of the provision of such care and services to such veteran.
(c)
Reports—
(1)
Initial report— Not later than 45 days 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 on the implementation of the requirements under subsections (a) and (b), including a plan to enforce the proper implementation of such requirements systematically throughout the Department.
(2)
Periodic reports— Not later than 90 days after the submittal of the report required by paragraph (1), and every 90 days thereafter for one year, 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 that includes the following:
(A)
The progress of the Secretary in carrying out the plan under paragraph (1) to enforce the proper implementation of the requirements under subsections (a) and (b) systematically throughout the Department.
(B)
The impact of the implementation of such requirements on wait-times for veterans to receive hospital care, medical services, and other health care, disaggregated by—
(i)
new patients;
(ii)
existing patients;
(iii)
primary care; and
(iv)
specialty care.
(C)
Any recommendations for changes or improvements to such requirements.
(D)
Any requests for additional funding necessary to carry out such requirements.

Sec. 109 Extension of and report on joint incentives program of Department of Veterans Affairs and Department of Defense

(a)
Extension— Section 8111(d)(3) is amended by striking “September 30, 2015” and inserting “September 30, 2020”.
(b)
Reports—
(1)
Report on implementation of recommendations— Not later than 60 days after the date of the enactment of this Act, the Secretary of Veterans Affairs and the Secretary of Defense shall jointly submit to Congress a report on the implementation by the Department of Veterans Affairs and the Department of Defense of the findings and recommendations of the Comptroller General of the United States in the September 2012 report entitled “VA and DoD Health Care: Department-Level Actions Needed to Assess Collaboration Performance, Address Barriers, and Identify Opportunities” (GAO–12–992).
(2)
Comptroller General report—
(A)
In general— Not later than one year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report assessing and providing recommendations for improvement to the program to identify, provide incentives to, implement, fund, and evaluate creative coordination and sharing initiatives between the Department of Veterans Affairs and the Department of Defense required under section 8111(d) of such title.
(B)
Elements— The report required by subparagraph (A) shall include the following:
(i)
An assessment of the extent to which the program described in subparagraph (A) has accomplished the goal of such program to improve the access to, and quality and cost effectiveness of, the health care provided by the Veterans Health Administration and the Military Health System to the beneficiaries of both the Department of Veterans Affairs and the Department of Defense.
(ii)
An assessment of whether administration of such program through the Health Executive Committee of the Department of Veterans Affairs-Department of Defense Joint Executive Committee established under section 320 of such title provides sufficient leadership attention and oversight to ensure maximum benefits to the Department of Veterans Affairs and the Department of Defense through collaborative efforts.
(iii)
An assessment of whether additional authorities to jointly construct, lease, or acquire facilities would facilitate additional collaborative efforts under such program.
(iv)
An assessment of whether the funding for such program is sufficient to ensure consistent identification of potential opportunities for collaboration and oversight of existing collaborations to ensure a meaningful partnership between the Department of Veterans Affairs and the Department of Defense and remove any barriers to integration or collaboration.
(v)
An assessment of whether existing processes for identifying opportunities for collaboration are sufficient to ensure maximum collaboration between the Veterans Health Administration and the Military Health System.
(vi)
Such legislative or administrative recommendations for improvement to such program as the Comptroller General considers appropriate to enhance the use of such program to increase access to health care.

Sec. 110 Transfer of authority for payments for hospital care, medical services, and other health care from non-Department providers to the Chief Business Office of the Veterans Health Administration of the Department

(a)
Transfer of authority—
(1)
In general— Effective on October 1, 2014, the Secretary of Veterans Affairs shall transfer the authority to pay for hospital care, medical services, and other health care through non-Department providers to the Chief Business Office of the Veterans Health Administration of the Department of Veterans Affairs from the Veterans Integrated Service Networks and medical centers of the Department of Veterans Affairs.
(2)
Manner of care— The Chief Business Office shall work in consultation with the Office of Clinical Operations and Management of the Department of Veterans Affairs to ensure that care and services described in paragraph (1) is provided in a manner that is clinically appropriate and effective.
(3)
No delay in payment— The transfer of authority under paragraph (1) shall be carried out in a manner that does not delay or impede any payment by the Department for hospital care, medical services, or other health care provided through a non-Department provider under the laws administered by the Secretary.
(b)
Budgetary effect— The Secretary shall, for each fiscal year that begins after the date of the enactment of this Act—
(1)
include in the budget for the Chief Business Office of the Veterans Health Administration amounts to pay for hospital care, medical services, and other health care provided through non-Department providers, including any amounts necessary to carry out the transfer of authority to pay for such care and services under subsection (a), including any increase in staff; and
(2)
not include in the budget of each Veterans Integrated Service Network and medical center of the Department amounts to pay for such care and services.
(c)
Removal from performance goals— For each fiscal year that begins after the date of the enactment of this Act, the Secretary shall not include in the performance goals of any employee of a Veterans Integrated Service Network or medical center of the Department any performance goal that might disincentivize the payment of Department amounts to provide hospital care, medical services, or other health care through a non-Department provider.

Sec. 110A Contracting for hospital care, medical services, and other health care

(a)
Use of contracts with certain entities—
(1)
In general— In providing hospital care, medical services, and other health care under the laws administered by the Secretary of Veterans Affairs through the use of contracts, the Secretary shall prioritize the use of contracts or agreements with Federally Qualified Health Centers (FQHCs), medical facilities receiving funding from the Indian Health Service, and the Department of Defense.
(2)
Plan on increased use of contracts— The Secretary of Veterans Affairs shall, in consultation with the Secretary of Defense, the Secretary of Health and Human Services, and the Director of the Indian Health Service, develop a plan to increase the use of contracts described in paragraph (1) to improve the ability of the Department of Veterans Affairs to provide hospital care, medical services, and other health care to veterans.
(3)
Report— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to Congress a report on the plan required by paragraph (2).
(b)
Best practices— The Secretary shall modify the guidance of the Department of Veterans Affairs on contracts for hospital care, medical services, and other health care in order to provide for the incorporation into such contracts of standardized requirements for 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 hospital care, medical services, and other health care on per-patient basis.
(2)
Such other best practices requirements as the Secretary considers appropriate.
(c)
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. 110B Enhancement of collaboration between Department of Veterans Affairs and Indian Health Service

(a)
Outreach to tribal-Run medical facilities— The Secretary of Veterans Affairs shall, in consultation with the Director of the Indian Health Service, conduct outreach to each medical facility operated by an Indian tribe or tribal organization through a contract or compact with the Indian Health Service under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) to raise awareness of the ability of such facilities, Indian tribes, and tribal organizations to enter into agreements with the Department of Veterans Affairs under which the Secretary reimburses such facilities, Indian tribes, or tribal organizations, as the case may be, for health care provided to veterans eligible for health care at such facilities.
(b)
Metrics for memorandum of understanding performance— The Secretary of Veterans Affairs shall implement performance metrics for assessing the performance by the Department of Veterans Affairs and the Indian Health Service under the memorandum of understanding entitled “Memorandum of Understanding between the Department of Veterans Affairs (VA) and the Indian Health Service (IHS)” in increasing access to health care, improving quality and coordination of health care, promoting effective patient-centered collaboration and partnerships between the Department and the Service, and ensuring health-promotion and disease-prevention services are appropriately funded and available for beneficiaries under both health care systems.
(c)
Report— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs and the Director of the Indian Health Service shall jointly submit to Congress a report on the feasibility and advisability of the following:
(1)
Entering into agreements for the reimbursement by the Secretary of the costs of direct care services provided through organizations receiving amounts pursuant to grants made or contracts entered into under section 503 of the Indian Health Care Improvement Act (25 U.S.C. 1653) to veterans who are otherwise eligible to receive health care from such organizations.
(2)
Including the reimbursement of the costs of direct care services provided to veterans who are not Indians in agreements between the Department and the following:
(A)
The Indian Health Service.
(B)
An Indian tribe or tribal organization operating a medical facility through a contract or compact with the Indian Health Service under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.).
(C)
A medical facility of the Indian Health Service.
(d)
Definitions— In this section:
(1)
Indian— The terms Indian and Indian tribe have the meanings given those terms in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603).
(2)
Medical facility of the Indian Health Service— The term medical facility of the Indian Health Service includes a facility operated by an Indian tribe or tribal organization through a contract or compact with the Indian Health Service under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.).
(3)
Tribal organization— The term tribal organization has the meaning given the term in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b).

Sec. 110C Enhancement of collaboration between Department of Veterans Affairs and Native Hawaiian health care systems

(a)
In general— The Secretary of Veterans Affairs shall, in consultation with Papa Ola Lokahi and such other organizations involved in the delivery of health care to Native Hawaiians as the Secretary considers appropriate, enter into contracts or agreements with Native Hawaiian health care systems that are in receipt of funds from the Secretary of Health and Human Services pursuant to grants awarded or contracts entered into under section 6(a) of the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11705(a)) for the reimbursement of direct care services provided to eligible veterans as specified in such contracts or agreements.
(b)
Definitions— In this section, the terms Native Hawaiian, Native Hawaiian health care system, and Papa Ola Lokahi have the meanings given those terms in section 12 of the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11711).

Sec. 110D Improvement of access of veterans to mobile vet centers of the Department of Veterans Affairs

(a)
Improvement of access—
(1)
In general— The Secretary of Veterans Affairs shall improve the access of veterans to telemedicine and other health care through the use of mobile vet centers of the Department of Veterans Affairs by providing standardized requirements for the operation of such centers.
(2)
Requirements— The standardized requirements required by paragraph (1) shall include the following:
(A)
The number of days each mobile vet center of the Department is expected to travel per year.
(B)
The number of locations each center is expected to visit per year.
(C)
The number of appointments each center is expected to conduct per year.
(D)
The method and timing of notifications given by each center to individuals in the area to which such center is traveling, including notifications informing veterans of the availability to schedule appointments at the center.
(3)
Use of telemedicine— The Secretary shall ensure that each mobile vet center of the Department has the capability to provide telemedicine services.
(b)
Reports— Not later than one year after the date of the enactment of this Act, and not later than September 30 each year thereafter, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the following:
(1)
The use of mobile vet centers to provide telemedicine services to veterans during the year preceding the submittal of the report, including the following:
(A)
The number of days each mobile vet center was open to provide such services.
(B)
The number of days each mobile vet center traveled to a location other than the headquarters of the mobile vet center to provide such services.
(C)
The number of appointments each center conducted to provide such services on average per month and in total during such year.
(2)
An analysis of the effectiveness of using mobile vet centers to provide health care services to veterans through the use of telemedicine.
(3)
Any recommendations for an increase in the number of mobile vet centers of the Department.
(4)
Any recommendations for an increase in the telemedicine capabilities of each mobile vet center.
(5)
The feasibility and advisability of using temporary health care providers, including locum tenens, to provide direct health care services to veterans at mobile vet centers.
(6)
Such other recommendations on improvement of the use of mobile vet centers by the Department as the Secretary considers appropriate.

Sec. 110E Commission on Access to Care

(a)
Establishment of commission—
(1)
In general— There is established the Commission on Access to Care (in this section referred to as the “Commission”) to examine the access of veterans to health care from the Department of Veterans Affairs and strategically examine how best to organize the Veterans Health Administration, locate health care resources, and deliver health care to veterans during the next 10 to 20 years.
(2)
Membership—
(A)
Voting members— The Commission shall be composed of 10 voting members who are appointed by the President as follows:
(i)
At least two members who represent an organization recognized by the Secretary of Veterans Affairs for the representation of veterans under section 5902 of title 38, United States Code.
(ii)
At least one member from among persons who are experts concerning a public or private hospital system.
(iii)
At least one member from among persons who are familiar with government health care systems, including those systems of the Department of Defense, the Indian Health Service, and Federally-qualified health centers (as defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B))).
(iv)
At least two members from among persons who are familiar with the Veterans Health Administration.
(B)
Nonvoting members— In addition to members appointed under subparagraph (A), the Commission shall be composed of 10 nonvoting members who are appointed by the President as follows:
(i)
At least two members who represent an organization recognized by the Secretary of Veterans Affairs for the representation of veterans under section 5902 of title 38, United States Code.
(ii)
At least one member from among persons who are experts in a public or private hospital system.
(iii)
At least one member from among persons who are familiar with government health care systems, including those systems of the Department of Defense, the Indian Health Service, and Federally-qualified health centers (as defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B))).
(iv)
At least two members from among persons who are familiar with the Veterans Health Administration.
(C)
Date— The appointments of members of the Commission shall be made not later than 60 days after the date of the enactment of this Act.
(3)
Period of appointment; vacancies— Members shall be appointed for the life of the Commission. Any vacancy in the Commission shall not affect its powers, but shall be filled in the same manner as the original appointment.
(4)
Initial meeting— Not later than 15 days after the date on which seven voting members of the Commission have been appointed, the Commission shall hold its first meeting.
(5)
Meetings— The Commission shall meet at the call of the Chairperson.
(6)
Quorum— A majority of the members of the Commission shall constitute a quorum, but a lesser number of members may hold hearings.
(7)
Chairperson and Vice Chairperson— The Commission shall select a Chairperson and Vice Chairperson from among its members.
(b)
Duties of commission—
(1)
Evaluation and assessment— The Commission shall undertake a comprehensive evaluation and assessment of access to health care at the Department of Veterans Affairs.
(2)
Matters evaluated and assessed— The matters evaluated and assessed by the Commission shall include the following:
(A)
The appropriateness of current standards of the Department of Veterans Affairs concerning access to health care.
(B)
The measurement of such standards.
(C)
The appropriateness of performance standards and incentives in relation to standards described in subparagraph (A).
(D)
Staffing levels throughout the Veterans Health Administration and whether they are sufficient to meet current demand for health care from the Administration.
(3)
Reports— The Commission shall submit to the President, through the Secretary of Veterans Affairs, reports as follows:
(A)
Not later than 90 days after the date of the initial meeting of the Commission, an interim report on—
(i)
the findings of the Commission with respect to the evaluation and assessment required by this subsection; and
(ii)
such recommendations as the Commission may have for legislative or administrative action to improve access to health care through the Veterans Health Administration.
(B)
Not later than 180 days after the date of the initial meeting of the Commission, a final report on—
(i)
the findings of the Commission with respect to the evaluation and assessment required by this subsection; and
(ii)
such recommendations as the Commission may have for legislative or administrative action to improve access to health care through the Veterans Health Administration.
(c)
Powers of the commission—
(1)
Hearings— The Commission may hold such hearings, sit and act at such times and places, take such testimony, and receive such evidence as the Commission considers advisable to carry out this section.
(2)
Information from Federal agencies— The Commission may secure directly from any Federal department or agency such information as the Commission considers necessary to carry out this section. Upon request of the Chairperson of the Commission, the head of such department or agency shall furnish such information to the Commission.
(d)
Commission personnel matters—
(1)
Compensation of members— Each member of the Commission who is not an officer or employee of the Federal Government shall be compensated at a rate equal to the daily equivalent of the annual rate of basic pay prescribed for level IV of the Executive Schedule under section 5315 of title 5, United States Code, for each day (including travel time) during which such member is engaged in the performance of the duties of the Commission. All members of the Commission who are officers or employees of the United States shall serve without compensation in addition to that received for their services as officers or employees of the United States.
(2)
Travel expenses— The members of the Commission shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of chapter 57 of title 5, United States Code, while away from their homes or regular places of business in the performance of services for the Commission.
(3)
Staff—
(A)
In general— The Chairperson of the Commission may, without regard to the civil service laws and regulations, appoint and terminate an executive director and such other additional personnel as may be necessary to enable the Commission to perform its duties. The employment of an executive director shall be subject to confirmation by the Commission.
(B)
Compensation— The Chairperson of the Commission may fix the compensation of the executive director and other personnel without regard to chapter 51 and subchapter III of chapter 53 of title 5, United States Code, relating to classification of positions and General Schedule pay rates, except that the rate of pay for the executive director and other personnel may not exceed the rate payable for level V of the Executive Schedule under section 5316 of such title.
(4)
Detail of government employees— Any Federal Government employee may be detailed to the Commission without reimbursement, and such detail shall be without interruption or loss of civil service status or privilege.
(5)
Procurement of temporary and intermittent services— The Chairperson of the Commission may procure temporary and intermittent services under section 3109(b) of title 5, United States Code, at rates for individuals which do not exceed the daily equivalent of the annual rate of basic pay prescribed for level V of the Executive Schedule under section 5316 of such title.
(e)
Termination of the commission— The Commission shall terminate 30 days after the date on which the Commission submits its report under subsection (b)(3)(B).
(f)
Funding— The Secretary of Veterans Affairs shall make available to the Commission from amounts appropriated or otherwise made available to the Secretary such amounts as the Secretary and the Chairperson of the Commission jointly consider appropriate for the Commission to perform its duties under this section.
(g)
Executive action—
(1)
Action on recommendations— The President shall require the Secretary of Veterans Affairs and such other heads of relevant Federal departments and agencies to implement each recommendation set forth in a report submitted under subsection (b)(3) that the President—
(A)
considers feasible and advisable; and
(B)
determines can be implemented without further legislative action.
(2)
Reports— Not later than 60 days after the date on which the President receives a report under subsection (b)(3), the President shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives and such other committees of Congress as the President considers appropriate a report setting forth the following:
(A)
An assessment of the feasibility and advisability of each recommendation contained in the report received by the President.
(B)
For each recommendation assessed as feasible and advisable under subparagraph (A) the following:
(i)
Whether such recommendation requires legislative action.
(ii)
If such recommendation requires legislative action, a recommendation concerning such legislative action.
(iii)
A description of any administrative action already taken to carry out such recommendation.
(iv)
A description of any administrative action the President intends to be taken to carry out such recommendation and by whom.

Sec. 110F Removal of Senior Executive Service employees of the Department of Veterans Affairs for performance

(a)
Removal or transfer—
(1)
In general— Chapter 7 is amended by adding at the end the following new section:

“713. Senior Executive Service: removal based on performance

“(a) In general—The Secretary may remove any individual from the Senior Executive Service if the Secretary determines the performance of the individual warrants such removal. If the Secretary so removes such an individual, the Secretary may—

“(1) remove the individual from the civil service (as defined in section 2101 of title 5); or

“(2) transfer the individual to a General Schedule position at any grade of the General Schedule for which the individual is qualified and that the Secretary determines is appropriate.

“(b) Notice to Congress—Not later than 30 days after removing or transferring an individual from the Senior Executive Service under paragraph (1), the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives notice in writing of such removal or transfer and the reason for such removal or transfer.

“(c) Appeal of removal or transfer—Any removal or transfer under subsection (a) may be appealed to the Merit Systems Protection Board under section 7701 of title 5 not later than 7 days after such removal or transfer.

“(d) Expedited review by Merit Systems Protection Board

“(1) The Merit Systems Protection Board shall expedite any appeal under section 7701 of title 5 of a removal or transfer under subsection (a) and, in any such case, shall issue a decision not later than 21 days after the date of the appeal.

“(2) In any case in which the Merit Systems Protection Board determines that it cannot issue a decision in accordance with the 21-day requirement under paragraph (1), the Merit Systems Protection Board shall submit to Congress a report that explains the reason why the Merit Systems Protection Board is unable to issue a decision in accordance with such requirement in such case.

“(3) There is authorized to be appropriated such sums as may be necessary for the Merit Systems Protection Board to expedite appeals under paragraph (1).

“(4) The Merit Systems Protection Board may not stay any personnel action taken under this section.”

(2)
Clerical amendment— The table of sections at the beginning of such chapter is amended by adding at the end the following new item:
(b)
Establishment of expedited review process—
(1)
In general— Not later than 30 days after the date of the enactment of this Act, the Merit Systems Protection Board shall establish and put into effect a process to conduct expedited reviews in accordance with section 713(d) of title 38, United States Code.
(2)
Inapplicability of certain regulations— Section 1201.22 of title 5, Code of Federal Regulations, as in effect on the day before the date of the enactment of this Act, shall not apply to expedited reviews carried out under section 713(d) of title 38, United States Code.
(3)
Report by Merit Systems Protection Board— Not later than 30 days after the date of the enactment of this Act, the Merit Systems Protection Board shall submit to Congress a report on the actions the Board plans to take to conduct expedited reviews under section 713(d) of title 38, United States Code, as added by subsection (a). Such report shall include a description of the resources the Board determines will be necessary to conduct such reviews and a description of whether any resources will be necessary to conduct such reviews that were not available to the Board on the day before the date of the enactment of this Act.
(c)
Temporary exemption from certain limitation on initiation of removal from Senior Executive Service— During the 120-day period beginning on the date of the enactment of this Act, an action to remove an individual from the Senior Executive Service at the Department of Veterans Affairs pursuant to section 713 of title 38, United States Code, as added by subsection (a), or section 7543 of title 5, United States Code, may be initiated, notwithstanding section 3592(b) of title 5, United States Code, or any other provision of law.
(d)
Construction— Nothing in this section or section 713 of title 38, United States Code, as added by subsection (a), shall be construed to apply to an appeal of a removal, transfer, or other personnel action that was pending before the date of the enactment of this Act.

Sec. 110G Authorization of emergency appropriations

There is authorized to be appropriated for the Department of Veterans Affairs such sums as may be necessary to carry out sections 103 through 110C of this Act.

B Expansion and Improvements of Benefits Generally

Sec. 111 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. 112 Expansion of assistance and support services for caregivers of veterans

(a)
Expansion of eligible veterans— Subsection (a)(2)(B) of section 1720G is amended—
(1)
by striking “service on or after September 11, 2001; and” and inserting “service—

“(i) on or after September 11, 2001; or

“(ii) that—

“(I) is rated as 50 percent or more disabling on the schedule of rating for disabilities of the Department; and

“(II) requires the maximum amount and degree of personal care services allowed under that schedule.”

(b)
Support services provided under program of general caregiver support services— Subsection (b)(3)(A) of such section is amended—
(1)
in clause (i)—
(A)
by redesignating subclauses (II) and (III) as subclauses (III) and (IV), respectively; and
(B)
by inserting after subclause (I) the following new subclause (II):

“(II) for caregivers undergoing educational sessions pursuant to subclause (I), payment of necessary travel, lodging, and per diem expenses incurred by such caregivers in undergoing such educational sessions in such amounts as the Secretary shall prescribe for purposes of this subclause;”

(2)
by striking clause (iii) and inserting the following new clause:

“(iii) Respite care of not less than 30 days annually that is medically and age-appropriate, including in-home care and 24-hour per day care of the veteran commensurate with the care provided by the caregiver to permit extended respite.”

(3)
by redesignating clause (iv) as clause (v); and
(4)
by inserting after clause (iii) the following new clause (iv):

“(iv) Such mental health services as the Secretary considers appropriate.”

(c)
Effective date— The amendments made by this section shall take effect on October 1, 2015.

Sec. 113 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. 114 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 114(c) of the Restoring Veterans Trust 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. 115 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. 116 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. 117 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, 2016”.
(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 to the Department to carry out this section the following:

“(1) For fiscal year 2014, $2,000,000.

“(2) For each of fiscal years 2015 and 2016, $4,000,000.”

(c)
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 on—
(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. 118 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 Restoring Veterans Trust 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. 119 Reauthorization and modification of pilot program of enhanced contract care authority for health care needs of veterans

Section 403 of the Veterans' Mental Health and Other Care Improvements Act of 2008 (Public Law 110–387; 38 U.S.C. 1703 note) is amended—
(1)
in subsection (a)—
(A)
in paragraph (2), by striking “120 days after the date of the enactment of this Act” and inserting “90 days after the date of the enactment of the Restoring Veterans Trust Act of 2014”; and
(B)
by amending paragraph (4) to read as follows:

“(4) Program locations—The Secretary shall carry out the pilot program at locations in the following Veterans Integrated Service Networks (and such other locations as the Secretary considers appropriate):

“(A) Veterans Integrated Service Network 1.

“(B) Veterans Integrated Service Network 6.

“(C) Veterans Integrated Service Network 15.

“(D) Veterans Integrated Service Network 18.

“(E) Veterans Integrated Service Network 19.”

(2)
by amending subsection (b) to read as follows:

“(b) Covered veterans—For purposes of the pilot program under this section, a covered veteran is any rural or highly rural veteran who—

“(1) is—

“(A) enrolled in the system of patient enrollment established under section 1705(a) of title 38, United States Code;

“(B) eligible for health care under the laws administered by the Secretary and enrolls in such system of patient enrollment not later than 30 days after the veteran begins receiving covered health services under the pilot program; or

“(C) eligible for health care under section 1710(e)(3) of such title; and

“(2) resides in a location that is—

“(A) more than 60 minutes driving distance from the nearest Department health care facility providing primary care services, if the veteran is seeking such services;

“(B) more than 120 minutes driving distance from the nearest Department health care facility providing acute hospital care, if the veteran is seeking such care; or

“(C) more than 240 minutes driving distance from the nearest Department health care facility providing tertiary care, if the veteran is seeking such care.”

(3)
by redesignating subsection (h) as subsection (j);
(4)
by inserting after subsection (g) the following new subsections:

“(h) Appointments—In carrying out the pilot program under this section, the Secretary shall ensure that medical appointments for veterans occur during the 30-day period beginning on the date that is 15 days after the date on which the appointment is requested.

“(i) Outreach—The Secretary shall ensure that a veteran eligible for the pilot program under this section is informed of such program.”

(5)
in paragraph (2)(B) of subsection (j), as redesignated by paragraph (3) of this section, by striking the semicolon at the end and inserting “; and”.

C Health Care Administration

Sec. 121 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. 122 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. 123 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. 124 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. 125 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. 126 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. 127 Report on provision of telemedicine services

(a)
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 following:
(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. 128 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.

D Complementary and Alternative Medicine

Sec. 131 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. 132 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 131(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. 133 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 132 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 131(e) of this Act.

Sec. 134 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 well-being 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.

E Mental Health Care

Sec. 141 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. 142 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 facilities of the Department of Veterans Affairs.

Sec. 143 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.

F Dental Care Eligibility Expansion and Enhancement

Sec. 151 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 a 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. 152 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 with capacity available for the furnishing of services and treatment under the pilot program.
(B)
Four Department medical centers with a current contract for the furnishing of dental care.
(C)
Four Community-Based Outpatient Clinics (CBOCs) with capacity 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)
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)).
(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. 153 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)
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)).
(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. 154 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.

G Health Care Related to Sexual Trauma

Sec. 161 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. 162 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. 163 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. 164 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 163(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 163(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.

H Reproductive treatment and services

Sec. 171 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 114(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. 172 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. 173 Adoption assistance for severely wounded veterans

(a)
In general— Subchapter VIII of chapter 17, as amended by section 172(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 172(b) of this Act, is further amended by inserting after the item relating to section 1788 the following new item:

Sec. 174 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 172 of this Act; and
(3)
to carry out section 1789 of such title, as added by section 173 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 172 of this Act; or
(3)
any assistance under section 1789 of such title, as added by section 173 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 172 of this Act.

Sec. 175 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. 176 Facilitation of reproduction and infertility research

(a)
In general— Subchapter II of chapter 73, as amended by section 124(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 124(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. 177 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. 178 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 Restoring Veterans Trust 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:

“(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) 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. 179 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.

I Major Medical Facility Leases

Sec. 181 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. 182 Budgetary treatment of Department of Veterans Affairs major medical facilities leases

(a)
Findings— Congress finds the following:
(1)
Title 31, United States Code, requires the Department of Veterans Affairs to record the full cost of its contractual obligation against funds available at the time a contract is executed.
(2)
Office of Management and Budget Circular A–11 provides guidance to agencies in meeting the statutory requirements under title 31, United States Code, with respect to leases.
(3)
For operating leases, Office of Management and Budget Circular A–11 requires the Department of Veterans Affairs to record up-front budget authority in an “amount equal to total payments under the full term of the lease or [an] amount sufficient to cover first year lease payments plus cancellation costs”.
(b)
Requirement for obligation of full cost—
(1)
In general— Subject to the availability of appropriations provided in advance, in exercising the authority of the Secretary of Veterans Affairs to enter into leases provided in this Act, the Secretary shall record, pursuant to section 1501 of title 31, United States Code, as the full cost of the contractual obligation at the time a contract is executed either—
(A)
an amount equal to total payments under the full term of the lease; or
(B)
if the lease specifies payments to be made in the event the lease is terminated before its full term, an amount sufficient to cover the first year lease payments plus the specified cancellation costs.
(2)
Self-insuring authority— The requirements of paragraph (1) may be satisfied through the use of a self-insuring authority consistent with Office of Management and Budget Circular A–11.
(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 detailed summary of the proposed lease;

“(C) a description and analysis of any differences between the prospectus submitted pursuant to subsection (b) and the proposed lease; and

“(D) a scoring analysis demonstrating that the proposed lease fully complies with Office of Management and Budget Circular A–11.

“(2) Each committee described in paragraph (1) shall ensure that any information submitted to the committee under such paragraph is treated by the committee with the same level of confidentiality as is required by law of the Secretary and subject to the same statutory penalties for unauthorized disclosure or use as the Secretary.

“(3) Not more than 30 days after entering into a major medical facility lease, the Secretary shall submit to each committee described in paragraph (1) a report on any material differences between the lease that was entered into and the proposed lease described under such paragraph, including how the lease that was entered into changes the previously submitted scoring analysis described in subparagraph (D) of such paragraph.”

(d)
Rule of construction— Nothing in this section, or the amendments made by this section, shall be construed to in any way relieve the Department of Veterans Affairs from any statutory or regulatory obligations or requirements existing prior to the enactment of this section and such amendments.