Sec. 200 Short title
This title may be cited as the “Jason Simcakoski Memorial Act”.
Title II — Health care matters
II Health care matters
A Expansion and improvement of health care benefits
Sec. 201 Improved access to appropriate immunizations for veterans
Inclusion of recommended adult immunizations as medical services—
Covered benefit— Subparagraph (F) of section 1701(9) of title 38, United States Code, 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;”
Recommended adult immunization schedule defined— Section 1701 of such title is amended by adding at the end 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.”
Inclusion of recommended adult immunizations in annual report— Section 1704(1)(A) of such title is amended—
in clause (i), by striking “and” at the end;
in clause (ii), by striking the period at the end and inserting “; and”; and
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.”
Report to Congress—
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.
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).
Rule of construction— Nothing in this section or the amendments made by this section may be construed to require a veteran to receive an immunization that the veteran does not want to receive.
Sec. 202 Expansion of provision of chiropractic care and services to veterans
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—
by inserting “(1)” before “The program”; and
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 two years after the date of the enactment of the Jason Simcakoski Memorial Act, and at not fewer than 50 percent of all medical centers in each Veterans Integrated Service Network by not later than three years after such date of enactment.”
Expanded chiropractor services available to veterans—
Medical services— Paragraph (6) of section 1701 of title 38, United States Code, is amended by adding at the end the following new subparagraph:
“(H) Chiropractic services.”
Rehabilitative services— Paragraph (8) of such section is amended by inserting “chiropractic,” after “counseling,”.
Preventive health services— Paragraph (9) of such section is amended—
by redesignating subparagraphs (F) through (K) as subparagraphs (G) through (L), respectively; and
by inserting after subparagraph (E) the following new subparagraph (F):
“(F) periodic and preventive chiropractic examinations and services;”
Sec. 203 Priority of medal of honor recipients in health care system of Department of Veterans Affairs
Enrollment priority—
In general— Section 1705(a) of title 38, United States Code, is amended—
in paragraph (1), by striking the period at the end and inserting the following: “and veterans who were awarded the medal of honor under section 3741, 6241, or 8741 of title 10 or section 491 of title 14.”; and
in paragraph (3), by striking “veterans who were awarded the medal of honor under section 3741, 6241, or 8741 of title 10 or section 491 of title 14,”.
Application— The priority of enrollment of medal of honor recipients in the system of annual patient enrollment established and operated under section 1705(a) of such title, as amended by paragraph (1), shall apply to each such recipient, regardless of the date on which the medal is awarded.
Eligibility— Section 1710(a)(2)(D) of such title is amended by inserting after “war” the following: “, who was awarded the medal of honor under section 3741, 6241, or 8741 of title 10 or section 491 of title 14,”.
Extended care services— Section 1710B(c)(2) of such title is amended—
in subparagraph (B), by striking “or”;
in subparagraph (C), by striking the period at the end and inserting “; or”; and
by adding at the end the following new subparagraph:
“(D) to a veteran who was awarded the medal of honor under section 3741, 6241, or 8741 of title 10 or section 491 of title 14.”
Copayment for medications— Section 1722A(a)(3) of such title is amended—
in subparagraph (B), by striking “or”;
in subparagraph (C), by striking the period at the end and inserting “; or”; and
by adding at the end the following new subparagraph:
“(D) to a veteran who was awarded the medal of honor under section 3741, 6241, or 8741 of title 10 or section 491 of title 14.”
B Mental health care
Sec. 211 Veterans Expedited Recovery Commission
Establishment— There is established the Veterans Expedited Recovery Commission (in this section referred to as the “Commission”).
Duties— The Commission shall perform the following duties:
Examine the efficacy of the evidence-based therapy model used by the Department of Veterans Affairs for treating mental health conditions of veterans and identify areas to improve wellness-based outcomes.
Conduct a patient-centered survey within each of the Veterans Integrated Service Networks to examine—
the experience of veterans with the Department when seeking medical assistance for mental health conditions through the health care system of the Department;
the experience of veterans with non-Department medical facilities and health professionals for treating mental health conditions;
the preferences of veterans regarding available treatments for mental health conditions and which methods the veterans believe to be most effective;
the experience, if any, of veterans with respect to the complementary and integrative health services described in subparagraphs (A) through (I) of paragraph (3);
the prevalence of prescribing prescription medication among veterans seeking treatment through the health care system of the Department as remedies for addressing mental health conditions; and
the outreach efforts of the Secretary of Veterans Affairs regarding the availability of benefits and treatments for veterans for addressing mental health conditions, including by identifying ways to reduce barriers to and gaps in such benefits and treatments.
Examine available research on complementary and integrative health services for mental health conditions and identify what benefits could be made with the inclusion of such treatments for veterans, including with respect to—
music therapy;
equine therapy;
training and caring for service dogs;
yoga therapy;
acupuncture therapy;
meditation therapy;
outdoor sports therapy;
hyperbaric oxygen therapy; and
such other therapies as the Commission determines appropriate.
Study the potential increase of claims relating to mental health conditions submitted to the Secretary by veterans who served in Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn, including an assessment of the resources available within the Department to ensure that quality health care demands relating to such claims can be delivered in a timely manner.
Membership—
Number and appointment—
In general— The Commission shall be composed of 10 members, appointed as follows:
Two members appointed by the Speaker of the House of Representatives, at least one of whom shall be a veteran.
Two members appointed by the Minority Leader of the House of Representatives, at least one of whom shall be a veteran.
Two members appointed by the Majority Leader of the Senate, at least one of whom shall be a veteran.
Two members appointed by the Minority Leader of the Senate, at least one of whom shall be a veteran.
Two members appointed by the President, at least one of whom shall be a veteran.
Qualifications— Members of the Commission shall be individuals who—
are of recognized standing and distinction within the medical community with a background in treating mental health;
have experience working with the military and veteran population; and
do not have a financial interest in any of the complementary and integrative health services reviewed by the Commission.
Chair— The President shall designate a member of the Commission to be the Chair.
Period of Appointment— Members of the Commission shall be appointed for the life of the Commission.
Vacancy— A vacancy in the Commission shall be filled in the manner in which the original appointment was made.
Appointment Deadline— The appointment of members of the Commission in this section shall be made not later than 90 days after the date of the enactment of this Act.
Powers of Commission—
Meeting—
Initial meeting— The Commission shall hold its first meeting not later than 30 days after a majority of members are appointed to the Commission.
Meeting— The Commission shall regularly meet at the call of the Chair. Such meetings may be carried out through the use of telephonic or other appropriate telecommunication technology if the Commission determines that such technology will allow the members to communicate simultaneously.
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 the responsibilities of the Commission.
Information from Federal Agencies— The Commission may secure directly from any Federal agency such information as the Commission considers necessary to carry out the duties of the Commission under subsection (b).
Information from nongovernmental organizations— In carrying out the duties of the Commission under subsection (b), the Commission may seek guidance through consultation with foundations, veterans service organizations, nonprofit groups, faith-based organizations, private and public institutions of higher education, and such other organizations as the Commission determines appropriate.
Commission Records— The Commission shall keep an accurate and complete record of the actions and meetings of the Commission. Such record shall be made available for public inspection and the Comptroller General of the United States may audit and examine such record.
Personnel Matters— Upon request of the Chair of the Commission, the head of any Federal agency may detail, on a reimbursable basis, any personnel of that agency to assist the Commission in carrying out the duties of the Commission.
Compensation of Members; Travel Expenses— Each member shall serve without pay, except that each member shall receive travel expenses to perform the duties of the Commission under subsection (b), including per diem in lieu of subsistence, at rates authorized under subchapter I of chapter 57 of title 5, United States Code.
Staff— The Chair, in accordance with rules agreed upon by the Commission, may appoint and fix the compensation of a staff director and such other personnel as may be necessary to enable the Commission to carry out its functions, without regard to the provisions of title 5, United States Code, governing appointments in the competitive service or chapter 51 and subchapter III of chapter 53 of such title relating to classification and General Schedule pay rates, except that no rate of pay fixed under this subsection may exceed the equivalent of the rate payable for a position at level IV of the Executive Schedule under section 5315 of such title.
Personnel as Federal employees—
In general— The executive director and any personnel of the Commission are employees under section 2105 of title 5, United States Code, for purposes of chapters 63, 81, 83, 84, 85, 87, 89, and 90 of such title.
Members of the Commission— Subparagraph (A) shall not be construed to apply to members of the Commission.
Contracting— The Commission may, to such extent and in such amounts as are provided in appropriations Acts, enter into contracts to enable the Commission to discharge the duties of the Commission under this section.
Expert and Consultant Services— The Commission may procure the services of experts and consultants in accordance with section 3109 of title 5, United States Code, at rates not to exceed the daily rate paid to a person occupying a position at level IV of the Executive Schedule under section 5315 of such title.
Postal Service— The Commission may use the United States mails in the same manner and under the same conditions as a Federal agency.
Physical Facilities and Equipment— Upon the request of the Commission, the Administrator of General Services shall provide to the Commission, on a reimbursable basis, the administrative support services necessary for the Commission to carry out its responsibilities under this section. These administrative services may include human resource management, budget, leasing, accounting, and payroll services.
Reports—
Interim Reports—
Cooperation by heads of Federal agencies— Not later than 60 days after the date on which the Commission first meets, and not less frequently than once during each 30-day period thereafter ending on the date on which the Commission submits the final report under paragraph (2), the Commission shall submit to the Committee on Veterans’ Affairs of the Senate, the Committee on Veterans’ Affairs of the House of Representatives, and the President a report detailing the level of cooperation the Secretary of Veterans Affairs (and the heads of other Federal agencies) has provided to the Commission.
Other reports— In carrying out the duties of the Commission under subsection (b), at times that the Commission determines appropriate, the Commission shall submit to the Committee on Veterans’ Affairs of the Senate, the Committee on Veterans’ Affairs of the House of Representatives, and such other entities as the Commission determines appropriate an interim report with respect to the findings identified by the Commission.
Final report—
In general— Not later than 18 months after the date on which the Commission first meets, the Commission shall submit to the Committee on Veterans’ Affairs of the Senate, the Committee on Veterans’ Affairs of the House of Representatives, the President, and the Secretary of Veterans Affairs a final report on the findings of the Commission.
Elements— The report required by subparagraph (A) shall include the following:
Recommendations to implement in a feasible, timely, and cost-effective manner any solutions and remedies identified by the Commission in carrying out the duties of the Commission under subsection (b).
An analysis of the evidence-based therapy model used by the Secretary for treating veterans with mental health conditions and an examination of the prevalence and efficacy of prescription drugs as a means of treatment.
The findings of the patient-centered survey conducted within each of the Veterans Integrated Service Networks under subsection (b)(2).
An examination of the complementary and integrative health services described in subsection (b)(3) and the potential benefits of incorporating such services in the therapy model used by the Secretary for treating veterans with mental health conditions.
Plan— Not later than 90 days after the date on which the Commission submits the final report under paragraph (2), 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:
An action plan for implementing the recommendations set forth by the Commission in such report regarding solutions and remedies for improving wellness-based outcomes for veterans with mental health conditions.
A feasible timeframe on when complementary and integrative health services described in subsection (b)(3) can be implemented throughout the Department.
With respect to each recommendation set forth by the Commission, including regarding any complementary and integrative health service, that the Secretary determines is not appropriate or feasible to implement, a justification for each such determination and an alternative solution to improve the efficacy of the therapy model used by the Secretary for treating veterans with mental health conditions.
Termination of Commission— The Commission shall terminate 30 days after the Commission submits the final report under subsection (e)(2).
Complementary and integrative health defined— In this section, the term complementary and integrative health has the meaning given that term or any subsequent similar term by the National Institutes of Health.
Sec. 212 Mental health treatment for veterans who served in classified missions
Sense of Congress— It is the sense of Congress that veterans who experience combat-related mental health wounds should have immediate, appropriate, and consistent access to comprehensive mental health care.
In general— Subchapter II of chapter 17 of title 38, United States Code, is amended by adding at the end the following new section:
“1720H. Mental health treatment for veterans who served in classified missions
“(a) Establishment of standards
“(1) The Secretary shall establish standards and procedures to ensure that each eligible veteran may access mental health care furnished by the Secretary in a manner that fully accommodates the obligation of the veteran to not improperly disclose classified information.
“(2) In establishing standards and procedures under paragraph (1), the Secretary shall consult with the Secretary of Defense to ensure that such standards and procedures are consistent with the policies on classified information of the Department of Defense.
“(3) The Secretary shall disseminate guidance to employees of the Veterans Health Administration, including mental health professionals, on the standards and procedures established under paragraph (1) and how to best engage eligible veterans during the course of mental health treatment with respect to classified information.
“(b) Identification—In carrying out this section, the Secretary shall ensure that a veteran may elect to identify as an eligible veteran on an appropriate form.
“(c) Definitions—In this section:
“(1) The term classified information means any information or material that has been determined by an official of the United States pursuant to law to require protection against unauthorized disclosure for reasons of national security.
“(2) The term eligible veteran means a veteran who—
“(A) is enrolled in the system of annual patient enrollment established and operated under section 1705(a) of this title;
“(B) is seeking mental health treatment; and
“(C) in the course of serving in the Armed Forces, participated in a sensitive mission or served in a sensitive unit.
“(3) The term sensitive mission means a mission of the Armed Forces that, at the time at which a eligible veteran seeks treatment, is classified.
“(4) The term sensitive unit has the meaning given that term in section 130b(c)(4) of title 10.”
Clerical amendment— The table of sections at the beginning of chapter 17 of such title is amended by inserting after the item relating to section 1720G the following new item:
Sec. 213 Inclusion of mental health professionals in education and training program for health personnel of the Department of Veterans Affairs
In general— In carrying out the program of education and training 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.
Effective date— Subsection (a) shall take effect on the date that is one year after the date of the enactment of this Act.
Sec. 214 Expansion of qualifications for licensed mental health counselors of the Department of Veterans Affairs to include doctoral degrees
Section 7402(b)(11)(A) of title 38, United States Code, is amended by inserting “or doctoral degree” after “master's degree”.
C Improvement of medical workforce
Sec. 221 Modification of hours of employment for physicians and physician assistants employed by the Department of Veterans Affairs
Section 7423(a) of title 38, United States Code, is amended—
by striking “(a) The hours” and inserting “(a)(1) Except as provided in paragraph (2), the hours”; and
by adding at the end the following new paragraph:
“(2) The Secretary may modify the hours of employment for a physician or physician assistant appointed in the Administration under any provision of this chapter on a full-time basis to be more than or less than 80 hours in a biweekly pay period if the total hours of employment for such employee in a calendar year does not exceed 2,080 hours.”
Sec. 222 Requirement that physician assistants employed by the Department of Veterans Affairs receive competitive pay
In general— Section 7451(a)(2) of title 38, United States Code, is amended—
by redesignating subparagraph (B) as subparagraph (C);
by inserting after subparagraph (A) the following new subparagraph (B):
“(B) Physician assistant.”
in subparagraph (C), as redesignated by paragraph (1), by striking “and registered nurse” and inserting “registered nurse, and physician assistant”.
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. 223 Extension of period for increase in graduate medical education residency positions at medical facilities of the Department of Veterans Affairs
In general— Paragraph (2) of section 301(b) of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 7302 note) is amended—
in the paragraph heading, by striking “Five-year” and inserting “Ten-year”; and
in subparagraph (A), by striking “5-year period” and inserting “10-year period”.
Report— Paragraph (3)(A) of such section is amended by striking “until 2019” and inserting “until 2024”.
Sec. 224 Additional requirements for hiring of health care providers by Department of Veterans Affairs
In general— The Secretary of Veterans Affairs shall, as part of the hiring process for each health care provider considered for a position at the Department of Veterans Affairs after the date specified in subsection (c), require from the medical board of each State in which the health care provider holds or has held a medical license—
information on any violation of the requirements of the medical license of the health care provider; and
information on whether the health care provider has entered into any settlement agreement for a disciplinary charge relating to the practice of medicine by the health care provider.
Regulations— The Secretary shall prescribe regulations to carry out this section.
Date specified—
In general— The date specified in this subsection is the date on which the Secretary prescribes regulations to carry out this section.
Publication— The Secretary shall publish in the Federal Register the date specified in this subsection not later than 30 days before such date.
Sec. 225 Provision of information on health care providers of Department of Veterans Affairs to State medical boards
In general— Notwithstanding section 552a of title 5, United States Code, the Secretary of Veterans Affairs shall, with respect to each health care provider of the Department of Veterans Affairs that violates a requirement of the medical license of the health care provider after the date of the enactment of this Act, provide to the medical board of each State in which the health care provider is licensed or practices all relevant information contained in the State Licensing Board Reporting File or any successor file of the Department with respect to such violation.
No request required— The Secretary shall provide the information required in subsection (a) to a medical board described in such subsection notwithstanding that such board may not have formally requested such information from the Department.
Sec. 226 Report on medical workforce of the Department of Veterans Affairs
In general— Not later than 120 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 medical workforce of the Department of Veterans Affairs.
Elements— The report required by subsection (a) shall include the following:
With respect to licensed professional mental health counselors and marriage and family therapists of the Department—
how many such counselors and therapists are currently enrolled in the mental health professionals trainee program of the Department;
how many such counselors and therapists are expected to enroll in the mental health professionals trainee program of the Department during the 180-day period beginning on the date of the submittal of the report;
a description of the eligibility criteria for such counselors and therapists as compared to other behavioral health professions in the Department;
a description of the objectives, goals, and timing of the Department with respect to increasing the representation of such counselors and therapists in the behavioral health workforce of the Department; and
a description of the actions taken by the Secretary, in consultation with the Director of the Office of Personnel Management, to create an occupational series for such counselors and therapists and a timeline for the creation of such an occupational series.
A breakdown of spending by the Department in connection with the education debt reduction program of the Department under subchapter VII of chapter 76 of title 38, United States Code, including—
the amount spent by the Department in debt reduction payments during the three-year period preceding the submittal of the report disaggregated by the medical profession of the individual receiving the payments;
a description of how the Department prioritizes such spending by medical profession, including an assessment of whether such priority reflects the five occupations identified in the most recent determination by the Inspector General of the Department of Veterans Affairs as having the largest staffing shortages in the Veterans Health Administration; and
a description of the actions taken by the Secretary to increase the effectiveness of such spending for purposes of recruitment of health care providers to the Department, including efforts to more consistently include eligibility for the education debt reduction program in vacancy announcements of positions for health care providers at the Department.
A description of any impediments to the delivery by the Department of telemedicine services to veterans and any actions taken by the Department to address such impediments, including with respect to—
restrictions under Federal or State law;
licensing or credentialing issues for health care providers, including non-Department health care providers, practicing telemedicine with a veteran located in a different State;
the effect of limited broadband access or limited information technology capabilities on the delivery of health care;
the distance a veteran is required to travel, if the veteran is required to travel, to access a facility or clinic with telemedicine capabilities;
the effect on the provision of telemedicine services to veterans of policies of and limited liability protection for certain entities; and
issues relating to reimbursement and travel limitations for veterans that affect the participation of non-Department health care providers in the telemedicine program.
An update on the efforts of the Secretary to offer training opportunities in telemedicine to medical residents in medical facilities of the Department that use telemedicine, consistent with medical residency program requirements established by the Accreditation Council for Graduate Medical Education, as required in section 108(b) of the Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012 (Public Law 112–154; 38 U.S.C. 7406 note).
An assessment of the development and implementation by the Secretary of succession planning policies to address the prevalence of vacancies in positions in the Veterans Health Administration of more than 180 days, including the development of an enterprise position management system to more effectively identify, track, and resolve such vacancies.
A description of the actions taken by the Secretary, in consultation with the Director of the Office of Personnel Management, to address any impediments to the timely appointment and determination of qualifications for Directors of Veterans Integrated Service Networks and Medical Center Directors of the Department.
Sec. 227 Report on compliance by Department of Veterans Affairs with reviews of health care providers leaving the Department or transferring to other facilities
Not later than 180 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 compliance by the Department of Veterans Affairs with the policy of the Department—
to conduct a review of each health care provider of the Department who transfers to another medical facility of the Department or leaves the Department to determine whether there are any concerns, complaints, or allegations of violations relating to the medical practice of the health care provider; and
to take appropriate action with respect to any such concern, complaint, or allegation.
D Family caregivers
Sec. 231 Expansion of family caregiver program of Department of Veterans Affairs
Family caregiver program—
Expansion of eligibility—
In general— Subsection (a)(2)(B) of section 1720G of title 38, United States Code, is amended to read as follows:
“(B) for assistance provided under this subsection—
“(i) before the date on which the Secretary submits to Congress a certification that the Department has fully implemented the information technology system required by section 232(a) of the Jason Simcakoski Memorial Act, has a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service on or after September 11, 2001;
“(ii) during the two-year period beginning on the date specified in clause (i), has a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service—
“(I) on or before May 7, 1975; or
“(II) on or after September 11, 2001; or
“(iii) after the date that is two years after the date specified in clause (i), has a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service; and”
Publication in Federal Register— Not later than 30 days after the date on which the Secretary of Veterans Affairs submits to Congress the certification described in subsection (a)(2)(B)(i) of section 1720G of such title, as amended by subparagraph (A) of this paragraph, the Secretary shall publish the date specified in such subsection in the Federal Register.
Expansion of needed services in eligibility criteria— Subsection (a)(2)(C) of such section is amended—
in clause (ii), by striking “; or” and inserting a semicolon;
by redesignating clause (iii) as clause (iv); and
by inserting after clause (ii) the following new clause (iii):
“(iii) a need for regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired; or”
Expansion of services provided— Subsection (a)(3)(A)(ii) of such section is amended—
in subclause (IV), by striking “; and” and inserting a semicolon;
in subclause (V), by striking the period at the end and inserting “; and”; and
by adding at the end the following new subclause:
“(VI) through the use of contracts with, or the provision of grants to, public or private entities—
“(aa) financial planning services relating to the needs of injured veterans and their caregivers; and
“(bb) legal services, including legal advice and consultation, relating to the needs of injured veterans and their caregivers.”
Modification of stipend calculation— Subsection (a)(3)(C) of such section is amended—
by redesignating clause (iii) as clause (iv); and
by inserting after clause (ii) the following new clause (iii):
“(iii) In determining the amount and degree of personal care services provided under clause (i) with respect to an eligible veteran whose need for personal care services is based in whole or in part on a need for supervision or protection under paragraph (2)(C)(ii) or regular or extensive instruction or supervision under paragraph (2)(C)(iii), the Secretary shall take into account the following:
“(I) The assessment by the family caregiver of the needs and limitations of the veteran.
“(II) The extent to which the veteran can function safely and independently in the absence of such supervision, protection, or instruction.
“(III) The amount of time required for the family caregiver to provide such supervision, protection, or instruction to the veteran.”
Periodic evaluation of need for certain services— Subsection (a)(3) of such section is amended by adding at the end the following new subparagraph:
“(D) In providing instruction, preparation, and training under subparagraph (A)(i)(I) and technical support under subparagraph (A)(i)(II) to each family caregiver who is approved as a provider of personal care services for an eligible veteran under paragraph (6), the Secretary shall periodically evaluate the needs of the eligible veteran and the skills of the family caregiver of such veteran to determine if additional instruction, preparation, training, or technical support under those subparagraphs is necessary.”
Use of primary care teams— Subsection (a)(5) of such section is amended, in the matter preceding subparagraph (A), by inserting “(in collaboration with the primary care team for the eligible veteran to the maximum extent practicable)” after “evaluate”.
Assistance for family caregivers— Subsection (a) of such section is amended by adding at the end the following new paragraph:
“(11)
“(A) In providing assistance under this subsection to family caregivers of eligible veterans, the Secretary may enter into contracts, provider agreements, and memoranda of understanding with Federal agencies, States, and private, nonprofit, and other entities to provide such assistance to such family caregivers.
“(B) The Secretary may provide assistance under this paragraph only if such assistance is reasonably accessible to the family caregiver and is substantially equivalent or better in quality to similar services provided by the Department.
“(C) The Secretary may provide fair compensation to Federal agencies, States, and other entities that provide assistance under this paragraph.”
Modification of definition of personal care services— Subsection (d)(4) of such section is amended—
in subparagraph (A), by striking “independent”;
by redesignating subparagraph (B) as subparagraph (D); and
by inserting after subparagraph (A) the following new subparagraphs:
“(B) Supervision or protection based on symptoms or residuals of neurological or other impairment or injury.
“(C) Regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired.”
Sec. 232 Implementation of information technology system of Department of Veterans Affairs to assess and improve the family caregiver program
Implementation of new system—
In general— Not later than December 31, 2016, the Secretary of Veterans Affairs shall implement an information technology system that fully supports the Program and allows for data assessment and comprehensive monitoring of the Program.
Elements of system— The information technology system required to be implemented under paragraph (1) shall include the following:
The ability to easily retrieve data that will allow all aspects of the Program (at the medical center and aggregate levels) and the workload trends for the Program to be assessed and comprehensively monitored.
The ability to manage data with respect to a number of caregivers that is more than the number of caregivers that the Secretary expects to apply for the Program.
The ability to integrate the system with other relevant information technology systems of the Veterans Health Administration.
Assessment of Program— Not later than 180 days after implementing the system described in subsection (a), the Secretary shall, through the Under Secretary for Health, use data from the system and other relevant data to conduct an assessment of how key aspects of the Program are structured and carried out.
Ongoing monitoring of and modifications to Program—
Monitoring— The Secretary shall use the system implemented under subsection (a) to monitor and assess the workload of the Program, including monitoring and assessment of data on—
the status of applications, appeals, and home visits in connection with the Program; and
the use by caregivers participating in the Program of other support services under the Program such as respite care.
Modifications— Based on the monitoring and assessment conducted under paragraph (1), the Secretary shall identify and implement such modifications to the Program as the Secretary considers necessary to ensure the Program is functioning as intended and providing veterans and caregivers participating in the Program with services in a timely manner.
Reports—
Initial report—
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, the Committee on Veterans' Affairs of the House of Representatives, and the Comptroller General of the United States a report that includes—
the status of the planning, development, and deployment of the system required to be implemented under subsection (a), including any changes in the timeline for the implementation of the system; and
an assessment of the needs of family caregivers of veterans described in subparagraph (B), the resources needed for the inclusion of such family caregivers in the Program, and such changes to the Program as the Secretary considers necessary to ensure the successful expansion of the Program to include such family caregivers.
Veterans described— Veterans described in this subparagraph are veterans who are eligible for the Program under clause (ii) or (iii) of section 1720G(a)(2)(B) of title 38, United States Code, as amended by section 231(a)(1) of this Act, solely due to a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service before September 11, 2001.
Notification by Comptroller General— The Comptroller General shall review the report submitted under paragraph (1) and notify the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives with respect to the progress of the Secretary in—
fully implementing the system required under subsection (a); and
implementing a process for using such system to monitor and assess the Program under subsection (c)(1) and modify the Program as considered necessary under subsection (c)(2).
Final report—
In general— Not later than December 31, 2017, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate, the Committee on Veterans’ Affairs of the House of Representatives, and the Comptroller General a report on the implementation of subsections (a) through (c).
Elements— The report required by subparagraph (A) shall include the following:
A certification by the Secretary with respect to whether the information technology system described in subsection (a) has been implemented.
A description of how the Secretary has implemented such system.
A description of the modifications to the Program, if any, that were identified and implemented under subsection (c)(2).
A description of how the Secretary is using such system to monitor the workload of the Program.
Definitions— In this section:
Active military, naval, or air service— The term active military, naval, or air service has the meaning given that term in section 101 of title 38, United States Code.
Program— The term Program means the program of comprehensive assistance for family caregivers under section 1720G(a) of title 38, United States Code, as amended by section 231 of this Act.
Sec. 233 Modifications to annual evaluation report on caregiver program of Department of Veterans Affairs
Barriers to care and services— Subparagraph (A)(iv) of section 101(c)(2) of the Caregivers and Veterans Omnibus Health Services Act of 2010 (Public Law 111–163; 38 U.S.C. 1720G note) is amended by inserting “, including a description of any barriers to accessing and receiving care and services under such programs” before the semicolon.
Sufficiency of training for family caregiver program— Subparagraph (B) of such section is amended—
in clause (i), by striking “; and” and inserting a semicolon;
in clause (ii), by striking the period at the end and inserting “; and”; and
by adding at the end the following new clause:
“(iii) an evaluation of the sufficiency and consistency of the training provided to family caregivers under such program in preparing family caregivers to provide care to veterans under such program.”
Sec. 234 Advisory committee on caregiver policy
Establishment— There is established in the Department of Veterans Affairs an advisory committee on policies relating to caregivers of veterans (in this section referred to as the “Committee”).
Composition— The Committee shall be composed of the following:
A Chair selected by the Secretary of Veterans Affairs.
A representative from each of the following agencies or organizations selected by the head of such agency or organization:
The Department of Veterans Affairs.
The Department of Defense.
The Department of Health and Human Services.
The Department of Labor.
The Centers for Medicare and Medicaid Services.
Not fewer than seven individuals who are not employees of the Federal Government selected by the Secretary from among the following individuals:
Academic experts in fields relating to caregivers.
Clinicians.
Caregivers.
Individuals in receipt of caregiver services.
Such other individuals with expertise that is relevant to the duties of the Committee as the Secretary considers appropriate.
Duties— The duties of the Committee are as follows:
To regularly review and recommend policies of the Department of Veterans Affairs relating to caregivers of veterans.
To examine and advise the implementation of such policies.
To evaluate the effectiveness of such policies.
To recommend standards of care for caregiver services and respite care services provided to a caregiver or veteran by a nonprofit or private sector entity.
To develop recommendations for legislative or administrative action to enhance the provision of services to caregivers and veterans, including eliminating gaps in such services and eliminating disparities in eligibility for such services.
To make recommendations on coordination with State and local agencies and relevant nonprofit organizations on maximizing the use and effectiveness of resources for caregivers of veterans.
Reports—
Annual report to Secretary—
In general— Not later than September 1, 2017, and not less frequently than annually thereafter until the termination date specified in subsection (e), the Chair of the Committee shall submit to the Secretary a report on policies and services of the Department of Veterans Affairs relating to caregivers of veterans.
Elements— Each report required by subparagraph (A) shall include the following:
An assessment of the policies of the Department relating to caregivers of veterans and services provided pursuant to such policies as of the date of the submittal of the report.
A description of any recommendations made by the Committee to improve the coordination of services for caregivers of veterans between the Department and the entities specified in subparagraphs (B) through (E) of subsection (b)(2) and to eliminate barriers to the effective use of such services, including with respect to eligibility criteria.
An evaluation of the effectiveness of the Department in providing services for caregivers of veterans.
An evaluation of the quality and sufficiency of services for caregivers of veterans available from nongovernmental organizations.
A description of any gaps identified by the Committee in care or services provided by caregivers to veterans and recommendations for legislative or administrative action to address such gaps.
Such other matters or recommendations as the Chair considers appropriate.
Transmittal to Congress— Not later than 90 days after the receipt of a report under paragraph (1), the Secretary shall transmit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a copy of such report, together with such comments and recommendations concerning such report as the Secretary considers appropriate.
Termination— The Committee shall terminate on December 31, 2022.
Sec. 235 Comprehensive study on seriously injured veterans and their caregivers
Study required— During the period specified in subsection (d), the Secretary of Veterans Affairs shall provide for the conduct by an independent entity of a comprehensive study on the following:
Veterans who have incurred a serious injury or illness, including a mental health injury or illness.
Individuals who are acting as caregivers for veterans.
Elements— The comprehensive study required by subsection (a) shall include the following with respect to each veteran included in such study:
The health of the veteran and, if applicable, the impact of the caregiver of such veteran on the health of such veteran.
The employment status of the veteran and, if applicable, the impact of the caregiver of such veteran on the employment status of such veteran.
The financial status and needs of the veteran.
The use by the veteran of benefits available to such veteran from the Department of Veterans Affairs.
Such other information as the Secretary considers appropriate.
Contract— The Secretary shall enter into a contract with an appropriate independent entity to conduct the study required by subsection (a).
Period specified— The period specified in this subsection is the one-year period beginning on the date that is four years after the date specified in section 1720G(a)(2)(B)(i) of title 38, United States Code, as amended by section 231(a)(1) of this Act.
Report— Not later than 30 days after the end of the period specified in subsection (d), 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 the study required by subsection (a).
E Health care administration
Sec. 241 Requirement that Department of Veterans Affairs collect health-plan contract information from veterans
In general— Subchapter I of chapter 17 is amended by inserting after section 1705 the following new section:
“1705A. Management of health care: information regarding health-plan contracts
“(a) In general
“(1) Any individual who seeks hospital care or medical services under this chapter shall provide to the Secretary such current information as the Secretary may require to identify any health-plan contract under which such individual is covered.
“(2) The information required to be provided to the Secretary under paragraph (1) with respect to a health-plan contract shall include, as applicable, the following:
“(A) The name of the entity providing coverage under the health-plan contract.
“(B) If coverage under the health-plan contract is in the name of an individual other than the individual required to provide information under this section, the name of the policy holder of the health-plan contract.
“(C) The identification number for the health-plan contract.
“(D) The group code for the health-plan contract.
“(b) Action To collect information—The Secretary may take such action as the Secretary considers appropriate to collect the information required under subsection (a).
“(c) Effect on services from Department—The Secretary may not deny any services under this chapter to an individual solely due to the fact that the individual fails to provide information required under subsection (a).
“(d) Health-plan contract defined—In this section, the term health-plan contract has the meaning given that term in section 1725(f) of this title.”
Clerical amendment— The table of sections at the beginning of chapter 17 of such title is amended by inserting after the item relating to section 1705 the following new item:
Sec. 242 Expansion of availability of prosthetic and orthotic care for veterans
Establishment or expansion of advanced degree programs To expand availability 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.
Report—
In general— Not later than one year after the effective date specified in subsection (d), 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).
Development of plan— The Secretary shall develop the plan required under paragraph (1) 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.
Funding—
Authorization of appropriations— There is authorized to be appropriated for fiscal year 2017 for the Department of Veterans Affairs, $5,000,000 to carry out this section.
Availability— The amount authorized to be appropriated by paragraph (1) shall remain available for expenditure until September 30, 2019.
Effective date— This section shall take effect on the date that is one year after the date of the enactment of this Act.
Sec. 243 Revival of Intermediate Care Technician Pilot Program of Department of Veterans Affairs
Revival— The Secretary of Veterans Affairs shall revive the Intermediate Care Technician Pilot Program of the Department of Veterans Affairs that was carried out by the Secretary between January 2013 and February 2014.
Technicians—
Selection— The Secretary shall select not fewer than 72 intermediate care technicians to participate in the pilot program.
Facilities—
In general— Any intermediate care technician hired pursuant to paragraph (1) may be assigned to a medical facility of the Department as determined by the Secretary for purposes of this section.
Priority— In assigning intermediate care technicians under subparagraph (A), the Secretary shall give priority to facilities at which veterans have the longest wait times for appointments for the receipt of hospital care or medical services from the Department, as determined by the Secretary for purposes of this section.
Termination— The Secretary shall carry out the pilot program under subsection (a) during the three-year period beginning on the effective date specified in subsection (e).
Definitions— In this section, the terms hospital care and medical services have the meanings given those terms in section 1701 of title 38, United States Code.
Effective date— This section shall take effect on the date that is one year after the date of the enactment of this Act.
Sec. 244 Transfer of health care provider credentialing data from Secretary of Defense to Secretary of Veterans Affairs
In general— In a case in which the Secretary of Veterans Affairs hires a covered health care provider, the Secretary of Defense shall, after receiving a request from the Secretary of Veterans Affairs for the credentialing data of the Secretary of Defense relating to such health care provider, transfer to the Secretary of Veterans Affairs such credentialing data.
Covered health care providers— For purposes of this section, a covered provider is a health care provider who—
is or was employed by the Secretary of Defense;
provides or provided health care related services as part of such employment; and
was credentialed by the Secretary of Defense.
Policies and regulations— The Secretary of Veterans Affairs and the Secretary of Defense shall establish such policies and prescribe such regulations as may be necessary to carry out this section.
Credentialing defined— In this section, the term credentialing means the systematic process of screening and evaluating qualifications and other credentials, including licensure, required education, relevant training and experience, and current competence and health status.
Effective date— This section shall take effect on the date that is one year after the date of the enactment of this Act.
Sec. 245 Authority to place certain veterans in non-Department of Veterans Affairs medical foster homes upon request
In general— Section 1720 of title 38, United States Code, is amended by adding at the end the following new subsection:
“(h)
“(1) Subject to paragraph (2), at the request of a veteran for whom the Secretary is required to provide nursing home care under section 1710A of this title, the Secretary may place the veteran in a medical foster home that meets Department standards, at the expense of the United States, pursuant to a contract or agreement entered into between the Secretary and the medical foster home for such purpose. A veteran who is placed in a medical foster home under this subsection shall agree, as a condition of such placement, to accept home health services furnished by the Secretary under section 1717 of this title.
“(2) Not more than 900 veterans placed in a medical foster home, whether placed before, on, or after the enactment of the Jason Simcakoski Memorial Act, may have their care covered at the expense of the United States under paragraph (1).
“(3) In this subsection, the term medical foster home means a home designed to provide noninstitutional, long-term, supportive care for veterans who are unable to live independently and prefer a family setting.
“(4) The authority of the Secretary under this subsection terminates on September 30, 2019.”
Effective date— Subsection (h) of such section, as added by subsection (a), shall take effect on October 1, 2016.
Sec. 246 Examination and treatment by Department of Veterans Affairs for emergency medical conditions and women in labor
In general— Subchapter VIII of chapter 17 of title 38, United States Code, is amended by inserting after section 1784 the following new section:
“1784A. Examination and treatment for emergency medical conditions and women in labor
“(a) In general—In the case of a hospital of the Department that has an emergency department, if any individual comes to the hospital or the campus of the hospital and a request is made on behalf of the individual for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists.
“(b) Necessary stabilizing treatment for emergency medical conditions and labor
“(1) If any individual comes to a hospital of the Department that has an emergency department or the campus of such a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either—
“(A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition; or
“(B) for transfer of the individual to another medical facility in accordance with subsection (c).
“(2) A hospital is deemed to meet the requirement of paragraph (1)(A) with respect to an individual if the hospital offers the individual the further medical examination and treatment described in that paragraph and informs the individual (or a person acting on behalf of the individual) of the risks and benefits to the individual of such examination and treatment, but the individual (or a person acting on behalf of the individual) refuses to consent to the examination and treatment. The hospital shall take all reasonable steps to secure the written informed consent of the individual (or person) to refuse such examination and treatment.
“(3) A hospital is deemed to meet the requirement of paragraph (1)(B) with respect to an individual if the hospital offers to transfer the individual to another medical facility in accordance with subsection (c) and informs the individual (or a person acting on behalf of the individual) of the risks and benefits to the individual of such transfer, but the individual (or a person acting on behalf of the individual) refuses to consent to the transfer. The hospital shall take all reasonable steps to secure the written informed consent of the individual (or person) to refuse such transfer.
“(c) Restricting transfers until individual stabilized
“(1) If an individual at a hospital of the Department has an emergency medical condition that has not been stabilized, the hospital may not transfer the individual unless—
“(A)
“(i) the individual (or a legally responsible person acting on behalf of the individual), after being informed of the obligations of the hospital under this section and of the risk of transfer, requests, in writing, transfer to another medical facility;
“(ii) a physician of the Department has signed a certification that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual and, in the case of labor, to the unborn child from effecting the transfer; or
“(iii) if a physician of the Department is not physically present in the emergency department at the time an individual is transferred, a qualified medical person (as defined by the Secretary for purposes of this section) has signed a certification described in clause (ii) after a physician of the Department, in consultation with the person, has made the determination described in such clause, and subsequently countersigns the certification; and
“(B) the transfer is an appropriate transfer to that facility.
“(2) A certification described in clause (ii) or (iii) of paragraph (1)(A) shall include a summary of the risks and benefits upon which the certification is based.
“(3) For purposes of paragraph (1)(B), an appropriate transfer to a medical facility is a transfer—
“(A) in which the transferring hospital provides the medical treatment within its capacity that minimizes the risks to the health of the individual and, in the case of a woman in labor, the health of the unborn child;
“(B) in which the receiving facility—
“(i) has available space and qualified personnel for the treatment of the individual; and
“(ii) has agreed to accept transfer of the individual and to provide appropriate medical treatment;
“(C) in which the transferring hospital sends to the receiving facility all medical records (or copies thereof) available at the time of the transfer relating to the emergency medical condition for which the individual has presented, including—
“(i) observations of signs or symptoms;
“(ii) preliminary diagnosis;
“(iii) treatment provided;
“(iv) the results of any tests; and
“(v) the informed written request or certification (or copy thereof) provided under paragraph (1)(A);
“(D) in which the transfer is effected through qualified personnel and transportation equipment, including the use of necessary and medically appropriate life support measures during the transfer; and
“(E) that meets such other requirements as the Secretary considers necessary in the interest of the health and safety of the individual or individuals transferred.
“(d) Payment to the Department—The Secretary shall charge for any care or services provided under this section in accordance with billing and reimbursement authorities available to the Secretary under other provisions of law.
“(e) Definitions—In this section:
“(1) The term campus means, with respect to a hospital of the Department—
“(A) the physical area immediately adjacent to the main buildings of the hospital;
“(B) other areas and structures that are not strictly contiguous to the main buildings but are located not more than 250 yards from the main buildings; and
“(C) any other areas determined by the Secretary to be part of the campus of the hospital.
“(2) The term emergency medical condition means—
“(A) a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in—
“(i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;
“(ii) serious impairment to bodily functions; or
“(iii) serious dysfunction of any bodily organ or part; or
“(B) with respect to a pregnant woman who is having contractions—
“(i) that there is inadequate time to effect a safe transfer to another hospital before delivery; or
“(ii) that transfer may pose a threat to the health or safety of the woman or the unborn child.
“(3)
“(A) The term to stabilize means—
“(i) with respect to an emergency medical condition described in paragraph (2)(A), to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility; or
“(ii) with respect to an emergency medical condition described in paragraph (2)(B), to deliver (including the placenta).
“(B) The term stabilized means—
“(i) with respect to an emergency medical condition described in paragraph (2)(A), that no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer of the individual from a facility; or
“(ii) with respect to an emergency medical condition described in paragraph (2)(B), that the woman has delivered (including the placenta).
“(4) The term transfer means the movement (including the discharge) of an individual outside the facilities of a hospital of the Department at the direction of any person employed by (or affiliated or associated, directly or indirectly, with) the hospital, but does not include such a movement of an individual who—
“(A) has been declared dead; or
“(B) leaves the facility without the permission of any such person.”
Clerical amendment— The table of sections at the beginning of chapter 17 of such title is amended by inserting after the item relating to section 1784 the following new item:
Sec. 247 Comptroller General audit of budget of Veterans Health Administration
In general— Subchapter II of chapter 73 of title 38, United States Code, is amended by adding at the end the following new section:
“7330B. Comptroller General audit of budget of Veterans Health Administration
“(a) In general—The Comptroller General of the United States shall periodically conduct an audit of elements of the budget of the Veterans Health Administration, including the budget formulation, execution, allocation, and use of funds.
“(b) Selection of elements
“(1) In selecting elements of the budget of the Veterans Health Administration for purposes of an audit under subsection (a), the Comptroller General shall take into consideration—
“(A) knowledge of the programs of the Veterans Health Administration;
“(B) current issues;
“(C) national priorities; and
“(D) priorities expressed by the appropriate congressional committees.
“(2) Not later than 30 days before conducting an audit under subsection (a), the Comptroller General shall submit to the appropriate congressional committees notice of the elements selected by the Comptroller General for purposes of the audit.
“(c) Appropriate congressional committees—In this section, the term appropriate congressional committees means—
“(1) the Committee on Veterans’ Affairs, the Committee on Appropriations, and the Committee on the Budget of the Senate; and
“(2) the Committee on Veterans’ Affairs, the Committee on Appropriations, and the Committee on the Budget of the House of Representatives.”
Clerical amendment— The table of sections at the beginning of chapter 73 of such title is amended by inserting after the item relating to section 7330A the following new item:
Sec. 248 Annual report on Veterans Health Administration and furnishing of hospital care, medical services, and nursing home care
In general— Subchapter II of chapter 73 of title 38, United States Code, as amended by section 247(a), is further amended by adding at the end the following new section:
“7330C. Annual report on Veterans Health Administration and furnishing of hospital care, medical services, and nursing home care
“(a) Report required—Not later than March 1 of each of years 2018 through 2022, 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, for the calendar year preceding the calendar year during which the report is submitted—
“(1) the furnishing of hospital care, medical services, and nursing home care under the laws administered by the Secretary; and
“(2) the administration of the furnishing of such care and services by the Veterans Health Administration.
“(b) Elements—Each report required by subsection (a) shall include each of the following for the year covered by the report:
“(1) An evaluation of the effectiveness of the Veterans Health Administration in increasing the access of veterans to hospital care, medical services, and nursing home care furnished by the Secretary for which such veterans are eligible.
“(2) An evaluation of the effectiveness of the Veterans Health Administration in improving the quality of health care provided to veterans, without increasing the costs incurred for such health care by the Federal Government or veterans, including relevant information for each medical center and Veterans Integrated Service Network of the Department set forth separately.
“(3) An assessment of—
“(A) the workload of physicians and other employees of the Veterans Health Administration;
“(B) patient demographics and utilization rates;
“(C) physician compensation;
“(D) the productivity of physicians and other employees of the Veterans Health Administration;
“(E) the percentage of hospital care, medical services, and nursing home care provided to veterans in facilities of the Department and in non-Department facilities and any changes in such percentages compared to the year preceding the year covered by the report;
“(F) pharmaceutical prices; and
“(G) third-party health billings owed to the Department, including the total amount of such billings and the total amount collected by the Department, set forth separately for claims greater than $1,000 and for claims equal to or less than $1,000.
“(c) Definitions—In this section, the terms hospital care, medical services, nursing home care, facilities of the Department, and non-Department facilities have the meanings given those terms in section 1701 of this title.”
Clerical amendment— The table of sections at the beginning of chapter 73 of such title, as amended by section 247(b), is further amended by inserting after the item relating to section 7330B the following new item:
F Opioid therapy and pain management
Sec. 251 Guidelines on management of opioid therapy by Department of Veterans Affairs and Department of Defense and implementation of such guidelines by Department of Veterans Affairs
Guidelines—
In general— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs and the Secretary of Defense shall jointly update the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain to include the following:
Guidelines developed by the Centers for Disease Control and Prevention for safely prescribing opioids for the treatment of chronic, noncancer related pain in outpatient settings.
Enhanced guidance with respect to absolute contraindications for opioid therapy, including guidance with respect to the following:
The coadministration of drugs, including benzodiazepines, that are capable of inducing a life-limiting drug-drug interaction.
The treatment of patients with current acute psychiatric instability or substance use disorder or patients at risk of suicide.
The use of opioid therapy to treat patients without any pain, including to treat mental health disorders other than opioid use disorder.
Enhanced guidance with respect to the treatment of patients with behaviors or comorbidities, such as post-traumatic stress disorder, psychiatric disorders, or a history of substance abuse or addiction, that require consultation or comanagement of opioid therapy with one or more specialists in pain management, mental health, or addictions.
Enhanced guidance with respect to the conduct by health care providers of an effectiveness assessment for patients receiving opioid therapy, including patients on long-term opioid therapy, to determine—
whether opioid therapy is meeting the expected goals of the patient and health care provider of relieving pain and improving function; and
whether opioid therapy should be continued.
Requirements that each health care provider of the Department of Veterans Affairs, before initiating opioid therapy to treat a patient, use the Opioid Therapy Risk Report tool of the Department, including by accessing the most recent patient information from the prescription drug monitoring program of each State, as required to be included in such tool under section 252(d)(1), to assess the risk for adverse outcomes of opioid therapy for the patient, including the concurrent use of controlled substances such as benzodiazepines, as part of the comprehensive assessment conducted by the health care provider.
Guidelines to inform the methodologies used by health care providers of the Department of Veterans Affairs and the Department of Defense to safely titrate and taper opioid therapy when adjusting or discontinuing the use of opioid therapy, including—
prescription of the lowest effective dose based on patient need;
use of opioids only for a limited period of time; and
augmentation of opioid therapy with other pain management therapies and modalities.
Enhanced recommendations with respect to the use of routine and random urine drug tests for all patients before and during opioid therapy to help prevent substance abuse, dependence, and diversion, including—
that such tests should occur not less frequently than annually or as otherwise determined according to patient treatment protocols; and
that health care providers should appropriately interpret and respond to the results from such tests to tailor pain therapy, safeguards, and risk management strategies to each patient.
Guidance that health care providers discuss with patients, before initiating opioid therapy, options for pain management therapies without the use of opioids and options to augment opioid therapy with other clinical and complementary and integrative health services to minimize opioid dependence.
Rule of construction— Nothing in this subsection shall be construed to prevent the Secretary of Veterans Affairs and the Secretary of Defense from considering all relevant evidence, as appropriate, in updating the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, as required under paragraph (1), or from ensuring that the final clinical practice guideline updated under such paragraph remains applicable to the patient populations of the Department of Veterans Affairs and the Department of Defense.
Consultation before update— Before updating the clinical practice guideline under subsection (a), the Secretary of Veterans Affairs and the Secretary of Defense shall jointly consult with the Pain Management Working Group of the Health Executive Committee of the Department of Veterans Affairs-Department of Defense Joint Executive Committee established under section 320 of title 38, United States Code.
Controlled substance defined— In this section, the term controlled substance has the meaning given that term in section 102 of the Controlled Substances Act (21 U.S.C. 802).
Sec. 252 Improvement of opioid safety measures by Department of Veterans Affairs
Expansion of Opioid Safety Initiative— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall expand the Opioid Safety Initiative of the Department of Veterans Affairs to include all medical facilities of the Department.
Pain management education and training—
In general— In carrying out the Opioid Safety Initiative of the Department, the Secretary shall require all employees of the Department responsible for prescribing opioids to receive education and training described in paragraph (2).
Education and training— Education and training described in this paragraph is education and training on pain management and safe opioid prescribing practices for purposes of safely and effectively managing patients with chronic pain, including education and training on the following:
The implementation of and full compliance with the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, including any update to such guideline.
The use of evidence-based pain management therapies, including cognitive-behavioral therapy, nonopioid alternatives, and non-drug methods and procedures for managing pain and related health conditions including complementary and integrative health services.
Screening and identification of patients with substance use disorder, including drug-seeking behavior, before prescribing opioids, assessment of the risk potential for patients developing an addiction, and referral of patients to appropriate addiction treatment professionals if addiction is identified or strongly suspected.
Communication with patients on the potential harm associated with the use of opioids and other controlled substances, including the need to safely store and dispose of supplies relating to the use of opioids and other controlled substances.
Such other education and training as the Secretary considers appropriate to ensure that veterans receive safe and high-quality pain management care from the Department.
Use of existing program— In providing education and training described in paragraph (2), the Secretary shall use the Interdisciplinary Chronic Pain Management Training Team Program of the Department (or any successor program).
Pain management teams—
In general— In carrying out the Opioid Safety Initiative of the Department, the director of each medical facility of the Department shall identify and designate a pain management team of health care professionals, which may include board certified pain medicine specialists, responsible for coordinating and overseeing pain management therapy at such facility for patients experiencing acute and chronic pain that is noncancer related.
Establishment of protocols—
In general— In consultation with the Directors of the Veterans Integrated Service Networks, the Secretary shall establish standard protocols for the designation of pain management teams at each medical facility of the Department.
Consultation on prescription of opioids— Each protocol established for a medical facility under subparagraph (A) shall ensure that any health care provider without expertise in prescribing analgesics or who has not completed the education and training under subsection (b), such as a mental health care provider, does not prescribe opioids to a patient unless that health care provider—
consults with a health care provider with pain management expertise or who is on the pain management team of the medical facility; and
refers the patient to that pain management team for any subsequent prescriptions and related therapy.
Report—
In general— Not later than one year after the date of the enactment of this Act, the director of each medical facility of the Department shall submit to the Under Secretary for Health of the Department and the Director of the Veterans Integrated Service Network in which the medical facility is located a report identifying the health care professionals that have been designated as members of the pain management team at the medical facility under paragraph (1).
Elements— Each report submitted under subparagraph (A) with respect to a medical facility of the Department shall include—
a certification as to whether all members of the pain management team at the medical facility have completed the education and training required under subsection (b);
a plan for the management and referral of patients to such pain management team if health care providers without expertise in prescribing analgesics prescribe opioid medications to treat acute and chronic pain that is noncancer related; and
a certification as to whether the medical facility—
fully complies with the stepped-care model of pain management and other pain management policies of the Department; or
does not fully comply with the stepped-care model of pain management and other pain management policies of the Department but is carrying out a corrective plan of action to ensure such full compliance.
Tracking and monitoring of opioid use—
Prescription drug monitoring programs of States— In carrying out the Opioid Safety Initiative and the Opioid Therapy Risk Report tool of the Department, the Secretary shall—
ensure access by health care providers of the Department to information on controlled substances, including opioids and benzodiazepines, prescribed to veterans who receive care outside the Department through the prescription drug monitoring program of each State with such a program, including by seeking to enter into memoranda of understanding with States to allow shared access of such information between States and the Department;
include such information in the Opioid Therapy Risk Report tool of the Department; and
require health care providers of the Department to submit to the prescription drug monitoring program of each State with such a program information on prescriptions of controlled substances received by veterans in that State under the laws administered by the Secretary.
Report on tracking of data on opioid use— Not later than 18 months 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 feasibility and advisability of improving the Opioid Therapy Risk Report tool of the Department to allow for more advanced real-time tracking of and access to data on—
the key clinical indicators with respect to the totality of opioid use by veterans;
concurrent prescribing by health care providers of the Department of opioids in different health care settings, including data on concurrent prescribing of opioids to treat mental health disorders other than opioid use disorder; and
mail-order prescriptions of opioids prescribed to veterans under the laws administered by the Secretary.
Availability of opioid receptor antagonists—
Increased availability and use—
In general— The Secretary shall increase the availability of opioid receptor antagonists approved by the Food and Drug Administration, such as naloxone, to veterans.
Availability, training, and distribution— In carrying out subparagraph (A), the Secretary shall, not later than 90 days after the date of the enactment of this Act—
equip each pharmacy of the Department with opioid receptor antagonists approved by the Food and Drug Administration to be dispensed to outpatients as needed; and
expand the Overdose Education and Naloxone Distribution program of the Department to ensure that all veterans in receipt of health care under the laws administered by the Secretary who are at risk of opioid overdose may access such opioid receptor antagonists and training on the proper administration of such opioid receptor antagonists.
Veterans who are at risk— For purposes of subparagraph (B), veterans who are at risk of opioid overdose include—
veterans receiving long-term opioid therapy;
veterans receiving opioid therapy who have a history of substance use disorder or prior instances of overdose; and
veterans who are at risk as determined by a health care provider who is treating the veteran.
Report— Not later than 120 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 compliance with paragraph (1) that includes an assessment of any remaining steps to be implemented by the Secretary to comply with such paragraph.
Inclusion of certain information and capabilities in Opioid Therapy Risk Report tool—
Information— The Secretary shall include in the Opioid Therapy Risk Report tool of the Department—
information on the most recent time the tool was accessed by a health care provider of the Department with respect to each veteran; and
information on the results of the most recent urine drug test for each veteran.
Capabilities— The Secretary shall include in the Opioid Therapy Risk Report tool the ability of health care providers of the Department to determine whether a health care provider of the Department prescribed opioids to a veteran without checking the information in the tool with respect to the veteran.
Notification of risk in computerized health record— The Secretary shall modify the Computerized Patient Record System of the Department to ensure that any health care provider that accesses the record of a veteran, regardless of the reason the veteran seeks care from the health care provider, will be immediately notified whether the veteran—
is receiving opioid therapy and has a history of substance use disorder or prior instances of overdose;
has a history of opioid abuse; or
is at risk of becoming an opioid abuser as determined by a health care provider who is treating the veteran.
Definitions— In this section:
Controlled substance— The term controlled substance has the meaning given that term in section 102 of the Controlled Substances Act (21 U.S.C. 802).
State— The term State means each of the several States, territories, and possessions of the United States, the District of Columbia, and the Commonwealth of Puerto Rico.
Sec. 253 Enhancement of joint working group on pain management of the Department of Veterans Affairs and the Department of Defense
In general— Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs and the Secretary of Defense shall ensure that the Pain Management Working Group of the Health Executive Committee of the Department of Veterans Affairs-Department of Defense Joint Executive Committee established under section 320 of title 38, United States Code, includes a focus on the following:
The opioid prescribing practices of health care providers of each Department.
The ability of each Department to manage acute and chronic pain among individuals receiving health care from that Department, including training health care providers with respect to pain management.
The use by each Department of complementary and integrative health in treating such individuals.
The concurrent use by health care providers of each Department of opioids for patients who take prescription drugs, including benzodiazepines, to treat mental health disorders.
The use of care transition plans by health care providers of each Department to address case management issues for patients receiving opioid therapy who transition between inpatient and outpatient settings.
The coordination in coverage of and consistent access to medications prescribed for patients transitioning from receiving health care from the Department of Defense to receiving health care from the Department of Veterans Affairs.
The ability of each Department to properly screen, identify, and refer for treatment patients with substance abuse disorders who are seeking treatment for acute and chronic pain management conditions.
Coordination and consultation— The Secretary of Veterans Affairs and the Secretary of Defense shall ensure that the working group described in subsection (a)—
coordinates the activities of the working group with other relevant working groups established under section 320 of title 38, United States Code, including the working groups on evidence based practice, patient safety, pharmacy, and psychological health;
consults with other relevant Federal agencies, including the Centers for Disease Control and Prevention, with respect to the activities of the working group;
consults with the Department of Veterans Affairs and the Department of Defense with respect to the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, or any successor guideline, before any update to the guideline is released; and
reviews and comments on the guideline described in paragraph (3) before any update to such guideline is released.
Consultation— The Secretary of Veterans Affairs and the Secretary of Defense shall ensure that the working group described in subsection (a) is able to meaningfully consult with respect to the updated guideline required under subsection (a) of section 251, as required by subsection (b) of such section, not later than one year after the date of the enactment of this Act.
Sec. 254 Review, investigation, and report on use of opioids in treatment by Department of Veterans Affairs
Comptroller General report—
In general— Not later than two years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the Opioid Safety Initiative of the Department of Veterans Affairs and the opioid prescribing practices of health care providers of the Department.
Elements— The report submitted under paragraph (1) shall include the following:
An assessment of the implementation and monitoring by the Veterans Health Administration of the Opioid Safety Initiative of the Department, including examining, as appropriate, the following:
How the Department monitors the key clinical outcomes of such safety initiative (for example, the percentage of unique veterans visiting each medical center of the Department that are prescribed an opioid or an opioid and benzodiazepine concurrently) and how the Department uses that information—
to improve prescribing practices; and
to identify high prescribing or otherwise inappropriate prescribing practices by health care providers.
How the Department monitors the use of the Opioid Therapy Risk Report tool of the Department (as developed through such safety initiative) and compliance with such tool by medical facilities and health care providers of the Department, including any findings by the Department of prescription rates or prescription practices by medical facilities or health care providers that are inappropriate.
The implementation of academic detailing programs within the Veterans Integrated Service Networks of the Department and how such programs are being used to improve opioid prescribing practices.
Information with respect to known deaths resulting from sentinel events involving veterans prescribed opioids by a health care provider of the Department.
Information made available under the Opioid Therapy Risk Report tool of the Department with respect to the following:
Overall prescription rates and, if available, indications used by health care providers for prescribing chronic opioid therapy to treat noncancer, non-palliative care, and non-hospice care patients.
The prescription rates and indications used by health care providers of the Department for prescribing benzodiazepines and chronic opioid therapy concurrently.
The practice by health care providers of the Department of prescribing opioids to treat patients without any known pain, including to treat patients with mental health disorders other than an opioid use disorder.
An evaluation of processes of the Department to oversee opioid use among veterans, including processes to identify and remedy potential overprescribing of opioids by health care providers of the Department, and an evaluation of the use and effectiveness of such processes.
An evaluation of processes of the Department to oversee and ensure the implementation by medical centers of the Department of the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy, as updated under section 251(a), including any figures or approaches used by the Department to assess implementation and compliance with such guideline by medical centers and whether any medical centers are operating action plans to improve compliance with such guideline.
An assessment of the data that the Department has developed to review the opioid prescribing practices of health care providers of the Department, as required by this subtitle, including a review of how the Department identifies the practices of individual health care providers that warrant further review based on—
prescribing levels;
health conditions for which the health care provider is prescribing opioids or opioids and benzodiazepines concurrently; or
other practices of the health care provider.
Review of prescription rates— 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, with respect to each medical facility of the Department of Veterans Affairs, collect and review information on opioids prescribed by health care providers at the facility to treat noncancer, non-palliative care, and non-hospice care patients, including information on—
the prescription rate at which each health care provider at the facility prescribed opioids, and benzodiazepines and opioids concurrently, to such patients and the aggregate of such prescription rates for all health care providers at the facility;
the prescription rate at which each health care provider at the facility prescribed benzodiazepines or opioids to such patients to treat conditions for which benzodiazepines or opioids are not a recommended treatment and the aggregate of such prescription rates for all health care providers at the facility;
the prescription rate at which each health care provider at the facility prescribed or dispensed mail-order prescriptions of opioids to such patients while such patients were being treated with opioids on an inpatient-basis and the aggregate of such prescription rates for all health care providers at the facility; and
the prescription rate at which each health care provider at the facility prescribed opioids to such patients who were also concurrently prescribed opioids by a health care provider who is not a health care provider of the Department and the aggregate of such prescription rates for all health care providers at the facility.
Investigation of prescription rates— If the Secretary determines that a prescription rate described in subsection (b) with respect to a health care provider or medical facility of the Department conflicts with or is otherwise inconsistent with the standards of appropriate and safe care, the Secretary shall—
through the Office of the Medical Inspector of the Veterans Health Administration, conduct a full investigation of the health care provider or medical facility, as the case may be;
immediately notify the Committee on Veterans’ Affairs of the Senate, the Committee on Veterans’ Affairs of the House of Representatives, and each Member of the Senate and the House of Representatives who represents the area in which the health care provider or medical facility, as the case may be, is located; and
include information relating to such determination, prescription rate, and health care provider or medical facility, as the case may be, in the report required under subsection (d).
Report on opioid therapy—
In general— Not later than one year after the date of the enactment of this Act, and not less frequently than annually thereafter through 2026, 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 contains, for the one-year period preceding the submittal of the report, the following:
The number of patients and the percentage of the patient population of the Department of Veterans Affairs who were prescribed opioids, and benzodiazepines and opioids concurrently, by a health care provider of the Department.
The number of patients and the percentage of the patient population of the Department without any documented pain who were prescribed opioids by a health care provider of the Department, including those who were prescribed benzodiazepines and opioids concurrently.
The number of noncancer, non-palliative care, and non-hospice care patients and the percentage of such patients who were treated with opioids by a health care provider of the Department on an inpatient-basis and who were also sent prescription opioids by mail by the Department while being treated on an inpatient-basis.
The number of noncancer, non-palliative care, and non-hospice care patients and the percentage of such patients who were prescribed opioids concurrently by a health care provider of the Department and a health care provider who is not a health care provider of the Department.
With respect to each medical facility of the Department, the number of times a pharmacist at the facility overrode a critical drug interaction warning with respect to an interaction between opioids and another medication before dispensing such other medication to a veteran.
The results of the review conducted under subsection (b) (including a summary of such review at the Veterans Integrated Service Network level) and the investigation conducted under subsection (c) (including information described in subsection (c)(3)), compiled in such a manner as the Secretary determines appropriate to ensure that the information is easily accessible.
Subsequent reports— Each report submitted under paragraph (1) after the date that is two years after the date of the enactment of this Act shall include an assessment of the compliance of the Department with the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, including any update to such guideline.
Prescription rate defined— In this section, the term prescription rate means, with respect to a health care provider or medical facility of the Department, each of the following:
The number of patients treated with opioids by the health care provider or at the medical facility, as the case may be, divided by the total number of pharmacy users of that health care provider or medical facility.
The average number of morphine equivalents per day prescribed by the health care provider or at the medical facility, as the case may be, to patients being treated with opioids.
Of the patients being treated with opioids by the health care provider or at the medical facility, as the case may be, the average number of prescriptions of opioids per patient.
Sec. 255 Elimination of copayment requirement for veterans receiving opioid antagonists or education on use of opioid antagonists
Copayment for opioid antagonists— Section 1722A(a) of title 38, United States Code, is amended by adding at the end the following new paragraph:
“(4) Paragraph (1) does not apply to opioid antagonists furnished under this chapter to a veteran who is at high risk for overdose of a specific medication or substance in order to reverse the effect of such an overdose.”
Copayment for education on use of opioid antagonists— Section 1710(g)(3) of such title is amended—
by striking “with respect to home health services” and inserting “with respect to the following:
“(A) Home health services”
by adding at the end the following new subparagraph:
“(B) Education on the use of opioid antagonists to reverse the effects of overdoses of specific medications or substances.”
G Patient advocacy and outreach
Sec. 261 Establishment of Office of Patient Advocacy of the Department of Veterans Affairs
In general— Subchapter I of chapter 73 of title 38, United States Code, is amended by adding at the end the following new section:
“7309A. Office of Patient Advocacy
“(a) Establishment—There is established in the Department within the Office of the Under Secretary for Health an office to be known as the “Office of Patient Advocacy” (in this section referred to as the “Office”).
“(b) Head
“(1) The Director of the Office of Patient Advocacy shall be the head of the Office.
“(2) The Director of the Office of Patient Advocacy shall be appointed by the Under Secretary for Health from among individuals qualified to perform the duties of the position and shall report directly to the Under Secretary for Health.
“(c) Function
“(1) The function of the Office is to carry out the Patient Advocacy Program of the Department.
“(2) In carrying out the Patient Advocacy Program of the Department, the Director shall ensure that patient advocates of the Department—
“(A) advocate on behalf of veterans with respect to health care received and sought by veterans under the laws administered by the Secretary;
“(B) carry out the responsibilities specified in subsection (d); and
“(C) receive training in patient advocacy.
“(d) Patient advocacy responsibilities—The responsibilities of each patient advocate at a medical facility of the Department are the following:
“(1) To resolve complaints by veterans with respect to health care furnished under the laws administered by the Secretary that cannot be resolved at the point of service or at a higher level easily accessible to the veteran.
“(2) To present at various meetings and to various committees the issues experienced by veterans in receiving such health care at such medical facility.
“(3) To express to veterans their rights and responsibilities as patients in receiving such health care.
“(4) To manage the Patient Advocate Tracking System of the Department at such medical facility.
“(5) To compile data at such medical facility of complaints made by veterans with respect to the receipt of such health care at such medical facility and the satisfaction of veterans with such health care at such medical facility to determine whether there are trends in such data.
“(6) To ensure that a process is in place for the distribution of the data compiled under paragraph (5) to appropriate leaders, committees, services, and staff of the Department.
“(7) To identify, not less frequently than quarterly, opportunities for improvements in the furnishing of such health care to veterans at such medical facility based on complaints by veterans.
“(8) To ensure that any significant complaint by a veteran with respect to such health care is brought to the attention of appropriate staff of the Department to trigger an assessment of whether there needs to be a further analysis of the problem at the facility-wide level.
“(9) To support any patient advocacy programs carried out by the Department.
“(10) To ensure that all appeals and final decisions with respect to the receipt of such health care are entered into the Patient Advocate Tracking System of the Department.
“(11) To understand all laws, directives, and other rules with respect to the rights and responsibilities of veterans in receiving such health care, including the appeals processes available to veterans.
“(12) To ensure that veterans receiving mental health care, or the surrogate decision-makers for such veterans, are aware of the rights of veterans to seek representation from systems established under section 103 of the Protection and Advocacy for Mentally Ill Individuals Act of 1986 (42 U.S.C. 10803) to protect and advocate the rights of individuals with mental illness and to investigate incidents of abuse and neglect of such individuals.
“(13) To fulfill requirements established by the Secretary with respect to the inspection of controlled substances.
“(14) To document potentially threatening behavior and report such behavior to appropriate authorities.
“(e) Training—In providing training to patient advocates under subsection (c)(2)(C), the Director shall ensure that such training is consistent throughout the Department.
“(f) Controlled substance defined—In this section, the term controlled substance has the meaning given that term in section 102 of the Controlled Substances Act (21 U.S.C. 802).”
Clerical amendment— The table of sections at the beginning of chapter 73 of such title is amended by inserting after the item relating to section 7309 the following new item:
Date fully operational— The Secretary of Veterans Affairs shall ensure that the Office of Patient Advocacy established under section 7309A of title 38, United States Code, as added by subsection (a), is fully operational not later than the date that is one year after the date of the enactment of this Act.
Sec. 262 Community meetings on improving care from Department of Veterans Affairs
Community meetings—
Medical centers— Not later than 90 days after the date of the enactment of this Act, and not less frequently than once every 90 days thereafter, each medical center of the Department of Veterans Affairs shall host a community meeting open to the public on improving health care from the Department.
Community-based outpatient clinics— Not later than one year after the date of the enactment of this Act, and not less frequently than annually thereafter, each community-based outpatient clinic of the Department shall host a community meeting open to the public on improving health care from the Department.
Attendance by Director of Veterans Integrated Service Network or designee—
In general— Subject to paragraph (2), each community meeting hosted by a medical center or community-based outpatient clinic under subsection (a) shall be attended by the Director of the Veterans Integrated Service Network in which the medical center or community-based outpatient clinic, as the case may be, is located, or an employee designated by the Director who works in the office of the Director.
Attendance by Director— Each Director of a Veterans Integrated Service Network shall attend not fewer than one community meeting under subsection (a) hosted by each medical center located in the Veterans Integrated Service Network each year.
Notice— With respect to any community meeting at a medical facility of the Department under subsection (a), the Secretary of Veterans Affairs shall notify the Committee on Veterans’ Affairs of the Senate, the Committee on Veterans’ Affairs of the House of Representatives, and each Member of Congress who represents the area in which the medical facility is located of such meeting not later than 10 days before such meeting occurs.
Sec. 263 Outreach to veterans regarding effect of certain delayed payments by Chief Business Office of Department of Veterans Affairs
Outreach—
In general— The Secretary of Veterans Affairs shall conduct outreach, including through national and local veterans service organizations, to inform veterans of how to resolve credit issues caused by delayed payment of a claim for emergency hospital care, medical services, or other emergency health care furnished through a non-Department of Veterans Affairs provider.
Telephone number— The Secretary shall establish a toll-free telephone number for veterans to report credit issues described in paragraph (1) to the Chief Business Office of the Department of Veterans Affairs.
Annual report—
Report required—
In general— During the five-year period beginning on the date of the enactment of this Act, the Secretary shall annually submit to Congress a report on the effectiveness of the Chief Business Office of the Department in providing timely payment of proper invoices for emergency hospital care, medical services, or other emergency health care furnished through non-Department providers by the required payment date during both the five-year period preceding the date of the report and the one-year period preceding such date.
Payments by VISNs— For any part of the period covered by a report under this subsection that occurred before October 1, 2014, the report shall evaluate the provision of payments described in subparagraph (A) by the Veterans Integrated Service Networks.
Matters included— Each report submitted under paragraph (1) shall include, for each period covered by the report, the following:
The number of veterans who contacted the Secretary regarding a delayed payment that negatively affected, or will potentially negatively affect, the credit of the veteran.
The total amount of interest penalties paid by the Secretary under section 3902 of title 31, United States Code, by reason of a delayed payment.
The number of proper invoices submitted, listed in a table for each quarter and fiscal year of each such period that includes—
the total amount owed by the Secretary under the proper invoices;
the payment status of each proper invoice, as of the date of the report; and
the period that elapsed until each proper invoice was paid, including an explanation of any delayed payment.
Any comments by the Secretary regarding delayed payments made by health care providers.
A description of the best practices that the Chief Business Office of the Department uses to provide timely payment of proper invoices, including a plan to improve such timely payments.
Quarterly reports on pending claims—
In general— During the five-year period beginning on the date of the enactment of this Act, the Chief Business Office of the Department shall submit to Congress quarterly reports on the number of pending claims for reimbursement for emergency hospital care, medical services, and other emergency health care furnished through non-Department providers.
Elements— Each report submitted under paragraph (1) shall include, with respect to pending claims described in such paragraph, the following:
The total number of such pending claims for each hospital system of the Department, as of the last day of the quarter covered by the report.
The total number of veterans who submitted such a pending claim in each State, as of such day.
The aggregate amount of all such pending claims in each State, as of such day.
As of such day—
the number of such pending claims that have been pending for 30 days or longer;
the number of such pending claims that have been pending for 90 days or longer; and
the number of such pending claims that have been pending for one year or longer.
For each hospital system, for the quarter covered by the report—
the number of claims for reimbursement for emergency hospital care, medical services, and other emergency health care furnished through non-Department providers approved during such quarter;
the number of such claims denied during such quarter; and
the number of such claims denied listed by each denial reason group.
Comptroller General study—
In general— The Comptroller General of the United States shall conduct a study that evaluates the effectiveness of the Chief Business Office of the Department in providing timely payment of proper invoices for emergency hospital care, medical services, or other emergency health care furnished through non-Department providers by the required payment date.
Submittal— The Comptroller General shall submit to Congress a report on the study conducted under paragraph (1), including the total amount of interest penalties paid by the Secretary under section 3902 of title 31, United States Code, by reason of a delayed payment.
Definitions— In this section:
The term delayed payment means a proper invoice that is not paid by the Secretary of Veterans Affairs until after the required payment date.
The term proper invoice has the meaning given that term in section 3901(a) of title 31, United States Code.
The term required payment date means the date that payment is due under a contract pursuant to section 3903(a) of title 31, United States Code.
Sec. 264 Improvement of awareness of patient advocacy program and patient bill of rights of Department of Veterans Affairs
Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall, in as many prominent locations as appropriate to be seen by the largest percentage of patients and family members of patients at each medical facility of the Department of Veterans Affairs—
display the purposes of the Patient Advocacy Program of the Department and the contact information for the patient advocate at such medical facility; and
display the rights and responsibilities of—
patients and family members of patients at such medical facility; and
with respect to community living centers and other residential facilities of the Department, residents and family members of residents at such medical facility.
Sec. 265 Comptroller General Report on Patient Advocacy Program of Department of Veterans Affairs
In general— Not later than three years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the Patient Advocacy Program of the Department of Veterans Affairs (in this section referred to as the “Program”).
Elements— The report required by subsection (a)—
shall include—
such recommendations and proposals for improving or modifying the Program as the Comptroller General considers appropriate; and
such other information with respect to the Program as the Comptroller General considers appropriate; and
may include—
a description of the Program, including—
the purposes of the Program;
the activities carried out under the Program; and
an assessment by the Secretary of Veterans Affairs of the sufficiency of the Program in achieving the purposes of the Program;
an assessment of the sufficiency of staffing of employees of the Department responsible for carrying out the Program;
an assessment of the sufficiency of the training of such employees; and
an assessment of—
awareness of the Program among veterans and their family members; and
the use of the Program by veterans and their family members.
H Administration of non-Department health care
Sec. 271 Payment of non-Department of Veterans Affairs health care providers
Payment of providers—
In general— Subchapter I of chapter 17 of title 38, United States Code, is amended by inserting after section 1703 the following new section:
“1703A. Payment of non-Department health care providers
“(a) Prompt payment compliance—The Secretary shall ensure that payments made to non-Department health care providers pursuant to an agreement under this chapter comply with chapter 39 of title 31 (commonly referred to as the “Prompt Payment Act”) and the requirements of this section. If there is a conflict between the requirements of the Prompt Payment Act and the requirements of this section, the Secretary shall comply with the requirements of this section.
“(b) Submittal of claim
“(1) A non-Department health care provider that seeks reimbursement under this section for care or services furnished under the laws administered by the Secretary shall submit to the Secretary a claim for reimbursement not later than 180 days after furnishing such care or services.
“(2) On and after January 1, 2019, the Secretary shall not accept any claim under this section that is submitted to the Secretary in a manner other than electronically.
“(c) Payment schedule
“(1) The Secretary shall reimburse a non-Department health care provider for care or services furnished under the laws administered by the Secretary—
“(A) in the case of a clean claim submitted to the Secretary electronically, not later than 30 days after receiving the claim; or
“(B) in the case of a clean claim submitted to the Secretary in a manner other than electronically, not later than 45 days after receiving the claim.
“(2)
“(A) If the Secretary determines that a claim received from a non-Department health care provider for care or services furnished under the laws administered by the Secretary is a non-clean claim, the Secretary shall submit to the provider, not later than 30 days after receiving the claim—
“(i) a notification that the claim is a non-clean claim;
“(ii) an explanation of why the claim has been determined to be a non-clean claim; and
“(iii) an identification of the information or documentation that is required to make the claim a clean claim.
“(B) If the Secretary does not comply with the requirements of subparagraph (A) with respect to a claim, the claim shall be deemed a clean claim for purposes of paragraph (1).
“(3) Upon receipt by the Secretary of information or documentation described in subparagraph (A)(iii) with respect to a claim, the Secretary shall reimburse a non-Department health care provider for care or services furnished under the laws administered by the Secretary—
“(A) in the case of a claim submitted to the Secretary electronically, not later than 30 days after receiving such information or documentation; or
“(B) in the case of a claim submitted to the Secretary in a manner other than electronically, not later than 45 days after receiving such information or documentation.
“(4) If the Secretary fails to comply with the deadlines for payment set forth in this subsection with respect to a claim, interest shall accrue on the amount owed under such claim in accordance with section 3902 of title 31, United States Code.
“(d) Information and documentation required
“(1) The Secretary shall provide to all non-Department health care providers that furnish care or services under the laws administered by the Secretary a list of information and documentation that is required to establish a clean claim under this section.
“(2) The Secretary shall consult with entities in the health care industry, in the public and private sector, to determine the information and documentation to include in the list under paragraph (1).
“(3) If the Secretary modifies the information and documentation included in the list under paragraph (1), the Secretary shall notify all non-Department health care providers that furnish care or services under the laws administered by the Secretary not later than 30 days before such modifications take effect.
“(e) Definitions—In this section:
“(1) The term clean claim means a claim for reimbursement for care or services furnished by a non-Department health care provider under the laws administered by the Secretary, on a nationally recognized standard format, that includes the information and documentation necessary to adjudicate the claim.
“(2) The term non-clean claim means a claim for reimbursement for care or services furnished by a non-Department health care provider under the laws administered by the Secretary, on a nationally recognized standard format, that does not include the information and documentation necessary to adjudicate the claim.
“(3) The term non-Department health care provider means a health care provider that is not a health care provider of the Department.”
Clerical amendment— The table of sections at the beginning of chapter 17 of such title is amended by inserting after the item related to section 1703 the following new item:
Electronic submittal of claims for reimbursement—
Prohibition on acceptance of non-electronic claims—
In general— Except as provided in subparagraph (B), on and after January 1, 2019, the Secretary of Veterans Affairs shall not accept any claim for reimbursement under section 1703A of title 38, United States Code, as added by subsection (a), that is submitted to the Secretary in a manner other than electronically, including medical records in connection with such a claim.
Exception— If the Secretary determines that accepting claims and medical records in a manner other than electronically is necessary for the timely processing of claims for reimbursement under such section 1703A due to a failure or malfunction of the electronic interface established under paragraph (2), the Secretary—
may accept claims and medical records in a manner other than electronically for a period not to exceed 90 days; and
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—
the reason for accepting claims and medical records in a manner other than electronically;
the duration of time that the Department of Veterans Affairs will accept claims and medical records in a manner other than electronically; and
the steps that the Department is taking to resolve such failure or malfunction.
Electronic interface—
In general— Not later than January 1, 2019, the Chief Information Officer of the Department of Veterans Affairs shall establish an electronic interface for health care providers to submit claims for reimbursement under such section 1703A.
Functions— The electronic interface established under subparagraph (A) shall include the following functions:
A function through which a health care provider may input all relevant data required for claims submittal and reimbursement.
A function through which a health care provider may upload medical records to accompany a claim for reimbursement.
A function through which a health care provider may ascertain the status of a pending claim for reimbursement that—
indicates whether the claim is a clean claim or a non-clean claim; and
in the event that a submitted claim is indicated as a non-clean claim, provides—
an explanation of why the claim has been determined to be a non-clean claim; and
an identification of the information or documentation that is required to make the claim a clean claim.
A function through which a health care provider is notified when a claim for reimbursement is accepted or rejected.
Such other features as the Secretary considers necessary.
Protection of information—
In general— The electronic interface established under subparagraph (A) shall be developed and implemented based on industry-accepted information security and privacy engineering principles and best practices and shall provide for the following:
The elicitation, analysis, and prioritization of functional and nonfunctional information security and privacy requirements for such interface, including specific security and privacy services and architectural requirements relating to security and privacy based on a thorough analysis of all reasonably anticipated cyber and noncyber threats to the security and privacy of electronic protected health information made available through such interface.
The elicitation, analysis, and prioritization of secure development requirements relating to such interface.
The assurance that the prioritized information security and privacy requirements of such interface—
are correctly implemented in the design and implementation of such interface throughout the system development lifecycle; and
satisfy the information objectives of such interface relating to security and privacy throughout the system development lifecycle.
Definitions— In this subparagraph:
Electronic protected health information— The term electronic protected health information has the meaning given that term in section 160.103 of title 45, Code of Federal Regulations, as in effect on the date of the enactment of this Act.
Secure development requirements— The term secure development requirements means, with respect to the electronic interface established under subparagraph (A), activities that are required to be completed during the system development lifecycle of such interface, such as secure coding principles and test methodologies.
Analysis of available technology for electronic interface—
In general— Not later than January 1, 2017, or before entering into a contract to procure or design and build the electronic interface described in paragraph (2) or making a decision to internally design and build such electronic interface, whichever occurs first, the Secretary shall—
conduct an analysis of commercially available technology that may satisfy the requirements of such electronic interface set forth in such paragraph; and
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 such analysis.
Elements— The report required under subparagraph (A)(ii) shall include the following:
An evaluation of commercially available systems that may satisfy the requirements of paragraph (2).
The estimated cost of procuring a commercially available system if a suitable commercially available system exists.
If no suitable commercially available system exists, an assessment of the feasibility of modifying a commercially available system to meet the requirements of paragraph (2), including the estimated cost associated with such modifications.
If no suitable commercially available system exists and modifying a commercially available system is not feasible, an assessment of the estimated cost and time that would be required to contract with a commercial entity to design and build an electronic interface that meets the requirements of paragraph (2).
If the Secretary determines that the Department has the capabilities required to design and build an electronic interface that meets the requirements of paragraph (2), an assessment of the estimated cost and time that would be required to design and build such electronic interface.
A description of the decision of the Secretary regarding how the Department plans to establish the electronic interface required under paragraph (2) and the justification of the Secretary for such decision.
Limitation on use of amounts— The Secretary may not spend any amounts to procure or design and build the electronic interface described in paragraph (2) until the date that is 60 days after the date on which the Secretary submits the report required under paragraph (3)(A)(ii).
Sec. 272 Authorization of agreements between the Department of Veterans Affairs and non-Department providers
In general— Subchapter I of chapter 17 of title 38, United States Code, as amended by section 271(a)(1), is further amended by inserting after section 1703A the following new section:
“1703B. Veterans Care Agreements
“(a) Agreements To furnish care
“(1) In addition to the authority of the Secretary under this chapter to furnish hospital care, medical services, and extended care at facilities of the Department and under contracts or sharing agreements entered into under authorities other than this section, the Secretary may furnish hospital care, medical services, and extended care through the use of agreements entered into under this section. An agreement entered into under this section may be referred to as a “Veterans Care Agreement”.
“(2)
“(A) The Secretary may enter into agreements under this section with eligible providers that are certified under subsection (d) if the Secretary is not feasibly able to furnish care or services described in paragraph (1) at facilities of the Department.
“(B) The Secretary is not feasibly able to furnish care or services described in paragraph (1) at facilities of the Department if the Secretary determines that the medical condition of the veteran, the travel involved, the nature of the care or services required, or a combination of those factors make the use of facilities of the Department impracticable or inadvisable.
“(3) An eligible provider, at its discretion, may opt to enter into an agreement under this section instead of a contract or sharing agreement under authorities other than this section.
“(b) Receipt of care
“(1) Eligibility of a veteran under this section for care or services described in subsection (a)(1) shall be determined as if such care or services were furnished in a facility of the Department and provisions of this title applicable to veterans receiving such care or services in a facility of the Department shall apply to veterans receiving such care or services under this section.
“(2) In carrying out this section, the Secretary—
“(A) may not direct veterans seeking care or services described in subsection (a)(1) to health care providers that have entered into contracts or sharing agreements under authorities other than this section, except for agreements under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note); and
“(B) shall ensure that veterans have the option to determine whether to receive such care or services from a health care provider described in subparagraph (A) or an eligible provider that has entered into an agreement under this section.
“(c) Eligible providers—For purposes of this section, an eligible provider is one of the following:
“(1) A provider of services that has enrolled and entered into a provider agreement under section 1866(a) of the Social Security Act (42 U.S.C. 1395cc(a)).
“(2) A physician or supplier that has enrolled and entered into a participation agreement under section 1842(h) of such Act (42 U.S.C. 1395u(h)).
“(3) A provider of items and services receiving payment under a State plan under title XIX of such Act (42 U.S.C. 1396 et seq.) or a waiver of such a plan.
“(4) A health care provider that is—
“(A) an Aging and Disability Resource Center, an area agency on aging, or a State agency (as defined in section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002)); or
“(B) a center for independent living (as defined in section 702 of the Rehabilitation Act of 1973 (29 U.S.C. 796a)).
“(5) A provider that is located in—
“(A) an area that is designated as a health professional shortage area (as defined in section 332 of the Public Health Service Act (42 U.S.C. 254e)); or
“(B) a county that is not in a metropolitan statistical area.
“(6) Such other health care providers as the Secretary considers appropriate for purposes of this section.
“(d) Certification of eligible providers
“(1) The Secretary shall establish a process for the certification of eligible providers under this section that shall, at a minimum, set forth the following.
“(A) Procedures for the submittal of applications for certification and deadlines for actions taken by the Secretary with respect to such applications.
“(B) Standards and procedures for approval and denial of certification, duration of certification, revocation of certification, and recertification.
“(C) Procedures for assessing eligible providers based on the risk of fraud, waste, and abuse of such providers similar to the level of screening under section 1866(j)(2)(B) of the Social Security Act (42 U.S.C. 1395cc(j)(2)(B)) and the standards set forth under section 9.104 of title 48, Code of Federal Regulations, or any successor regulation.
“(2) The Secretary shall deny or revoke certification to an eligible provider under this subsection if the Secretary determines that the eligible provider is currently—
“(A) excluded from participation in a Federal health care program (as defined in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a–7b(f))) under section 1128 or 1128A of the Social Security Act (42 U.S.C. 1320a–7 and 1320a–7a); or
“(B) identified as an excluded source on the list maintained in the System for Award Management, or any successor system.
“(e) Terms of agreements—Each agreement entered into with an eligible provider under this section shall include provisions requiring the eligible provider to do the following:
“(1) To accept payment for care or services furnished under this section at rates established by the Secretary for purposes of this section, which shall be, to the extent practicable, the rates paid by the United States for such care or services to providers of services and suppliers under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
“(2) To accept payment under paragraph (1) as payment in full for care or services furnished under this section and to not seek any payment for such care or services from the recipient of such care or services.
“(3) To furnish under this section only the care or services authorized by the Department under this section unless the eligible provider receives prior written consent from the Department to furnish care or services outside the scope of such authorization.
“(4) To bill the Department for care or services furnished under this section in accordance with a methodology established by the Secretary for purposes of this section.
“(5) Not to seek to recover or collect from a health-plan contract or third party, as those terms are defined in section 1729 of this title, for any care or services for which payment is made by the Department under this section.
“(6) To provide medical records for veterans furnished care or services under this section to the Department in a time frame and format specified by the Secretary for purposes of this section.
“(7) To meet such other terms and conditions, including quality of care assurance standards, as the Secretary may specify for purposes of this section.
“(f) Termination of agreements
“(1) An eligible provider may terminate an agreement with the Secretary under this section at such time and upon such notice to the Secretary as the Secretary may specify for purposes of this section.
“(2) The Secretary may terminate an agreement with an eligible provider under this section at such time and upon such notice to the eligible provider as the Secretary may specify for purposes of this section, if the Secretary—
“(A) determines that the eligible provider failed to comply substantially with the provisions of the agreement or with the provisions of this section and the regulations prescribed thereunder;
“(B) determines that the eligible provider is—
“(i) excluded from participation in a Federal health care program (as defined in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a–7b(f))) under section 1128 or 1128A of the Social Security Act (42 U.S.C. 1320a–7 and 1320a–7a); or
“(ii) identified as an excluded source on the list maintained in the System for Award Management, or any successor system;
“(C) ascertains that the eligible provider has been convicted of a felony or other serious offense under Federal or State law and determines that the continued participation of the eligible provider would be detrimental to the best interests of veterans or the Department; or
“(D) determines that it is reasonable to terminate the agreement based on the health care needs of a veteran or veterans.
“(g) Periodic review of certain agreements
“(1) Not less frequently than once every two years, the Secretary shall review each Veterans Care Agreement of material size entered into during the two-year period preceding the review to determine whether it is feasible and advisable to furnish the hospital care, medical services, or extended care furnished under such agreement at facilities of the Department or through contracts or sharing agreements entered into under authorities other than this section.
“(2)
“(A) Subject to subparagraph (B), a Veterans Care Agreement is of material size as determined by the Secretary for purposes of this section.
“(B) A Veterans Care Agreement entered into after September 30, 2016, for the purchase of extended care services is of material size if the purchase of such services under the agreement exceeds $1,000,000 annually. The Secretary may adjust such amount to account for changes in the cost of health care based upon recognized health care market surveys and other available data and shall publish any such adjustments in the Federal Register.
“(h) Treatment of certain laws
“(1) An agreement under this section may be entered into without regard to any law that would require the Secretary to use competitive procedures in selecting the party with which to enter into the agreement.
“(2)
“(A) Except as provided in subparagraph (B), and unless otherwise provided in this section or section 277 of the Jason Simcakoski Memorial Act or regulations prescribed pursuant to this section or such section 277, an eligible provider that enters into an agreement under this section is not subject to, in the carrying out of the agreement, any law to which an eligible provider described in subsection (b)(1), (b)(2), or (b)(3) is not subject under the original Medicare fee-for-service program under parts A and B of title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) or the Medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.).
“(B) The exclusion under subparagraph (A) does not apply to laws regarding integrity, ethics, fraud, or that subject a person to civil or criminal penalties.
“(3) Title VII of the Civil Rights Act of 1964 (42 U.S.C. 2000e et seq.) shall apply with respect to an eligible provider that enters into an agreement under this section to the same extent as such title applies with respect to the eligible provider in providing care or services through an agreement or arrangement other than under this section.
“(i) Monitoring of quality of care—The Secretary shall establish a system or systems, consistent with survey and certification procedures used by the Centers for Medicare & Medicaid Services and State survey agencies to the extent practicable—
“(1) to monitor the quality of care and services furnished to veterans under this section; and
“(2) to assess the quality of care and services furnished by an eligible provider under this section for purposes of determining whether to renew an agreement under this section with the eligible provider.
“(j) Dispute resolution—The Secretary shall establish administrative procedures for eligible providers with which the Secretary has entered into an agreement under this section to present any dispute arising under or related to the agreement.
“(k) Termination of authority—The Secretary may not enter into an agreement under this section, other than for the provision of extended care or hospice care, after September 30, 2017.
“(l) Rule of construction—Nothing in this section shall be construed to alter any contract or agreement entered into between the Department and a State home (as that term is used in subchapter V of this chapter) before the date of the enactment of the Jason Simcakoski Memorial Act.
“(m) Annual report—Not later than one year after the date of the enactment of the Jason Simcakoski Memorial Act, and not less frequently than annually thereafter, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report that contains the following:
“(1) The total number of agreements entered into with eligible providers under this section.
“(2) A list of the medical centers of the Department that have entered into agreements with eligible providers under this section.”
Regulations— The Secretary of Veterans Affairs shall prescribe an interim final rule to carry out section 1703B of such title, as added by subsection (a), not later than one year after the date of the enactment of this Act.
Clerical amendment— The table of sections at the beginning of chapter 17 of such title, as amended by section 271(a)(2), is further amended by inserting after the item related to section 1703A the following new item:
Sec. 273 Elimination of requirement to act as secondary payer for care relating to non-service-connected disabilities under Choice Program
In general— Section 101(e) of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note) is amended—
by striking paragraphs (2) and (3);
by redesignating paragraph (4) as paragraph (3); and
by inserting after paragraph (1) the following new paragraph (2):
“(2) Responsibility for costs of certain care—In any case in which an eligible veteran is furnished hospital care or medical services under this section for a non-service-connected disability described in subsection (a)(2) of section 1729 of title 38, United States Code, the Secretary shall recover or collect reasonable charges for such care or services from a health-care plan described in paragraph (3) in accordance with such section.”
Conforming amendment— Paragraph (1) of such section is amended by striking “paragraph (4)” and inserting “paragraph (3)”.
Emergency designations—
In general— This section is designated as an emergency requirement pursuant to section 4(g) of the Statutory Pay-As-You-Go Act of 2010 (2 U.S.C. 933(g)).
Designation in Senate— In the Senate, this section is designated as an emergency requirement pursuant to section 403(a) of S. Con. Res. 13 (111th Congress), the concurrent resolution on the budget for fiscal year 2010.
Sec. 274 Requirement for advance appropriations for the Medical Community Care account of the Department of Veterans Affairs
In general— Section 117(c) of title 38, United States Code, is amended by adding at the end the following new paragraph:
“(7) Veterans Health Administration, Medical Community Care.”
Conforming amendment— Section 1105(a)(37) of title 31, United States Code, is amended by adding at the end the following new subparagraph:
“(G) Veterans Health Administration, Medical Community Care.”
Applicability— The amendments made by this section shall apply to fiscal years beginning on and after October 1, 2016.
Sec. 275 Annual transfer of amounts within Department of Veterans Affairs to pay for health care from non-Department health care providers
Section 106 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note) is amended by adding at the end the following new subsection:
“(c) Transfer of amounts—During a fiscal year, to accommodate any variances in demand for hospital care, medical services, or other health care through non-Department of Veterans Affairs health care providers, the Secretary of Veterans Affairs may transfer amounts between the Medical Services appropriations account of the Department and the appropriations account of the Department for non-Department provider programs described in section 4003 of the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015 (Public Law 114–41; 38 U.S.C. 1701 note).”
Sec. 276 Authorization of use of certain amounts appropriated to the Veterans Choice Fund for other non-Department of Veterans Affairs care
In general— Section 802 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note) is amended—
in subsection (c)—
in paragraph (1)—
by striking “Except as provided by paragraph (3), any” and inserting “Any”; and
by striking “by the Secretary of Veterans Affairs” and all that follows through the period at the end and inserting “by the Secretary of Veterans Affairs—
“(A) to carry out section 101, including, subject to paragraph (2), any administrative requirements of such section; and
“(B) to furnish health care to individuals under chapter 17 of title 38, United States Code, at non-Department facilities, including pursuant to authority other than the authority under section 101.”
by striking paragraph (3) and inserting the following new paragraphs:
“(3) Treatment of amounts—Amounts made available to the Secretary under this subsection shall be used to supplement, not supplant, amounts made available to the Secretary in appropriations Acts for the purpose of furnishing health care at non-Department facilities.
“(4) Non-Department facilities defined—In this subsection, the term non-Department facilities has the meaning given that term in section 1701 of title 38, United States Code.”
in subsection (d)(1), by striking “only for the program” and all that follows through the period at the end and inserting “only for the purposes specified in subsection (c)(1).”.
Emergency designations—
In general— This section is designated as an emergency requirement pursuant to section 4(g) of the Statutory Pay-As-You-Go Act of 2010 (2 U.S.C. 933(g)).
Designation in Senate— In the Senate, this section is designated as an emergency requirement pursuant to section 403(a) of S. Con. Res. 13 (111th Congress), the concurrent resolution on the budget for fiscal year 2010.
Sec. 277 Applicability of Directive of Office of Federal Contract Compliance Programs
In general— Notwithstanding the treatment of certain laws under subsection (h) of section 1703B of title 38, United States Code, as added by section 272(a) of this Act, Directive 2014–01 of the Office of Federal Contract Compliance Programs of the Department of Labor (effective as of May 7, 2014) shall apply to any entity entering into an agreement under such section 1703B in the same manner as such directive applies to subcontractors under the TRICARE program for the duration of the moratorium provided under such directive.
Applicability period— The directive described in subsection (a), and the moratorium provided under such directive, shall not be altered or rescinded before May 7, 2019.
TRICARE program defined— In this section, the term TRICARE program has the meaning given that term in section 1072 of title 10, United States Code.
I Research on toxic exposure
Sec. 281 Definitions
In this subtitle:
Armed Forces— The term Armed Forces means the United States Army, Navy, Marine Corps, Air Force, and Coast Guard.
Descendant— The term descendant means, with respect to an individual, the biological child or grandchild of that individual.
Toxic exposure— The term toxic exposure means a condition in which an individual inhaled or ingested an agent determined to be hazardous to the health of the individual or the agent came in contact with the skin or eyes of the individual in a manner that could be hazardous to the health of the individual.
Veteran— The term veteran has the meaning given that term in section 101 of title 38, United States Code.
Sec. 282 National Academy of Medicine assessment on research relating to the descendants of individuals with toxic exposure
In general—
Agreement— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall seek to enter into an agreement with the National Academy of Medicine under which the National Academy of Medicine conducts an assessment on scientific research relating to the descendants of individuals with toxic exposure.
Alternate organization—
In general— If the Secretary is unable within the period prescribed in paragraph (1) to enter into an agreement described in such paragraph with the National Academy of Medicine on terms acceptable to the Secretary, the Secretary shall seek to enter into such an agreement with another appropriate organization that—
is not part of the Federal Government;
operates as a not-for-profit entity; and
has expertise and objectivity comparable to that of the National Academy of Medicine.
Treatment— If the Secretary enters into an agreement with another organization as described in subparagraph (A), any reference in this section to the National Academy of Medicine shall be treated as a reference to the other organization.
Elements— The assessment conducted pursuant to the agreement entered into under subsection (a) shall include the following:
A scientific review of the scientific literature regarding toxicological and epidemiological research on descendants of individuals with toxic exposure.
An assessment of areas requiring further scientific study relating to the descendants of veterans with toxic exposure.
An assessment of the scope and methodology required to conduct adequate scientific research relating to the descendants of individuals with toxic exposure, including—
the types of individuals to be studied, including veterans with toxic exposure and the descendants of those veterans;
the number of veterans and descendants described in subparagraph (A) to be studied;
the potential alternatives for participation in such a study, including whether it would be necessary for participants to travel in order to participate;
the approximate amount of time and resources needed to prepare and conduct the research; and
the appropriate Federal agencies to participate in the research, including the Department of Defense and the Department of Veterans Affairs.
The establishment of categories, including definitions for each such category, to be used in assessing the evidence that a particular health condition is related to toxic exposure, such as—
sufficient evidence of a causal relationship;
sufficient evidence of an association;
limited or suggestive evidence of an association;
inadequate or insufficient evidence to determine whether an association exists; and
limited or suggestive evidence of no association.
An analysis of—
the feasibility of conducting scientific research to address the areas that require further study as described under paragraph (2);
the value and relevance of the information that could result from such scientific research; and
for purposes of conducting further research, the feasibility and advisability of accessing additional information held by a Federal agency that may be sensitive.
An identification of a research entity or entities with—
expertise in conducting research on health conditions of descendants of individuals with toxic exposure; and
an ability to conduct research on those health conditions to address areas requiring further scientific study as described under paragraph (2).
Report— The agreement entered into under subsection (a) shall require the National Academy of Medicine to submit, not later than two years after entering into such agreement, to the Secretary of Veterans Affairs, the Committee on Veterans’ Affairs of the Senate, and the Committee on Veterans’ Affairs of the House of Representatives—
the results of the assessment conducted pursuant to such agreement, including such recommendations as the National Academy of Medicine considers appropriate regarding the scope and methodology required to conduct adequate scientific research relating to the descendants of veterans with toxic exposure; and
a determination regarding whether the results of such assessment indicate that it is feasible to conduct further research regarding health conditions of descendants of veterans with toxic exposure, including an explanation of the basis for the determination.
Certification—
In general— Not later than 90 days after receiving the results of the assessment and determination under subsection (c), 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 certification of the understanding of the Secretary, based on such results and determination, regarding the feasibility of conducting further research regarding health conditions of descendants of veterans with toxic exposure that is expressed by such results and determination.
Basis for certification— The certification submitted under paragraph (1) shall include an explanation of the basis for the certification.
Sec. 283 Advisory board on research relating to health conditions of descendants of veterans with toxic exposure while serving in the Armed Forces
Establishment— Unless the Secretary of Veterans Affairs certifies under section 282(d) that the results of the assessment and determination under section 282(c) indicate that it is not feasible to conduct further research regarding health conditions of descendants of veterans with toxic exposure, not later than 180 days after receiving such results and determination, the Secretary shall establish an advisory board (in this section referred to as the “Advisory Board”) to advise the Secretary in the selection of a research entity or entities under section 284, advise such entity or entities in conducting research under such section, and advise the Secretary with respect to the activities of such entity or entities under such section.
Membership—
Composition— The Secretary, in consultation with the National Academy of Medicine, the Director of the National Institute of Environmental Health Sciences, and such other heads of Federal agencies as the Secretary determines appropriate—
shall select not more than 13 voting members of the Advisory Board, of whom—
not less than two shall be members of organizations exempt from taxation under section 501(c)(19) of the Internal Revenue Code of 1986;
not less than two shall be descendants of veterans with toxic exposure while serving as members of the Armed Forces; and
not less than seven shall be health professionals, scientists, or academics who are not employees of the Federal Government and have expertise in—
birth defects;
developmental disabilities;
epigenetics;
public health;
the science of environmental exposure or environmental exposure assessment;
the science of toxic substances; or
medical and research ethics; and
may select not more than two nonvoting members who are employees of the Federal Government and who are otherwise described in subparagraph (A)(iii).
Chair— The Secretary shall select a Chair from among the members of the Advisory Board selected under paragraph (1)(A).
Terms—
In general— Each member of the Advisory Board shall serve a term of two or three years as determined by the Secretary.
Reappointment— At the end of the term of a member of the Advisory Board, the Secretary may reselect the member for another term, except that no member may serve more than four consecutive terms.
Duties— The Advisory Board shall—
advise the Secretary in the selection of a research entity or entities to conduct research under section 284 from among those identified under section 282(b)(6);
advise such entity or entities and assess the activities of such entity or entities in conducting such research;
develop a research strategy for such entity or entities based on, but not limited to, the results of the assessment conducted under section 282;
advise the Secretary with respect to the activities of such entity or entities under section 284;
submit recommendations to be included by such entity or entities in the report under section 284(d)(2)(C); and
not less frequently than semiannually, meet with the Secretary and representatives of such entity or entities on the research conducted by such entity or entities under section 284.
Meetings— The Advisory Board shall meet at the call of the Chair, but not less frequently than semiannually.
Compensation— The members of the Advisory Board shall serve without compensation.
Expenses— The Secretary of Veterans Affairs shall determine the appropriate expenses of the Advisory Board.
Personnel—
In general— The Chair may, without regard to the civil service laws and regulations, appoint an executive director of the Advisory Board, who shall be a civilian employee of the Department of Veterans Affairs, and such other personnel as may be necessary to enable the Advisory Board to perform its duties.
Approval— The appointment of an executive director under paragraph (1) shall be subject to approval by the Advisory Board.
Compensation— The Chair may fix the compensation of the executive director and other personnel without regard to the provisions of chapter 51 and subchapter III of chapter 53 of title 5, United States Code, 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.
Sec. 284 Research relating to health conditions of descendants of veterans with toxic exposure while serving in the Armed Forces
In general— Unless the Secretary of Veterans Affairs certifies under section 282(d) that the results of the assessment and determination under section 282(c) indicate that it is not feasible to conduct further research regarding health conditions of descendants of veterans with toxic exposure, not later than one year after receiving such results and determination, the Secretary shall (in consultation with the advisory board established under section 283 (in this section referred to as the “Advisory Board”)) enter into an agreement with one or more research entities identified under section 282(b)(6) (excluding an entity of the Department of Veterans Affairs) to conduct research on health conditions of descendants of veterans with toxic exposure while serving as members of the Armed Forces (in this section referred to as the “research entity or entities”).
Research—
In general— To the extent included in the research strategy developed by the Advisory Board under section 283(c)(3), the research entity or entities shall conduct research on health conditions of descendants of veterans with toxic exposure while serving as members of the Armed Forces.
Studies— In conducting research under paragraph (1), the research entity or entities may study any veteran, at the election of the veteran, identified under section 282(b)(3)(A) as a type of individual to be studied in order to conduct adequate scientific research relating to the descendants of veterans with toxic exposure.
Categorization— In conducting research under paragraph (1), the research entity or entities shall assess, using the categories established under section 282(b)(4), the extent to which a health condition of a descendant of a veteran is related to the toxic exposure of the veteran while serving as a member of the Armed Forces.
Availability of records—
In general— The Secretary of Defense, the Secretary of Veterans Affairs, and the head of each Federal agency identified under section 282(b)(3)(E) shall make available to the research entity or entities records held by the Department of Veterans Affairs, the Department of Defense, the Armed Forces, that Federal agency, or any other source under the jurisdiction of any such Federal agency or the Armed Forces, as appropriate, that the research entity or entities determine are necessary to carry out this section.
Mechanism for access— The Secretary of Veterans Affairs, the Secretary of Defense, and the head of each Federal agency identified under section 282(b)(3)(E) shall jointly establish a mechanism for access by the research entity or entities to records made available under paragraph (1).
Annual report—
In general— Not later than one year after commencing the conduct of research under this section, and not later than September 30 each year thereafter, each research entity with which the Secretary has entered into an agreement under subsection (a) shall, in consultation with the Advisory Board, submit to the Secretary of Veterans Affairs, the Committee on Veterans’ Affairs of the Senate, and the Committee on Veterans’ Affairs of the House of Representatives a report on the functions of such entity under this section during the year preceding the submittal of the report.
Elements— Each report submitted under paragraph (1) shall include the following:
A summary of the research efforts that have been completed during the year preceding the submittal of the report and that are ongoing as of the date of the submittal of the report.
A description of any findings made during such year in carrying out such research efforts.
Recommendations for administrative or legislative action made by the Advisory Board based on such findings, which may include recommendations for further research under this section.
Upon request— Upon the request of any organization exempt from taxation under section 501(c)(19) of the Internal Revenue Code of 1986, the Secretary of Veterans Affairs may transmit to such organization a copy of a report received by the Secretary under paragraph (1).
J Other health care matters
Sec. 291 Authorization of certain major medical facility projects of the Department of Veterans Affairs
Authorization— The Secretary of Veterans Affairs may carry out the following major medical facility projects, with each project to be carried out in an amount not to exceed the amount specified for that project:
Seismic corrections to buildings, including retrofitting and replacement of high-risk buildings, in San Francisco, California, in an amount not to exceed $180,480,000.
Seismic corrections to facilities, including facilities to support homeless veterans, at the medical center in West Los Angeles, California, in an amount not to exceed $105,500,000.
Seismic corrections to the mental health and community living center in Long Beach, California, in an amount not to exceed $287,100,000.
Construction of an outpatient clinic, administrative space, cemetery, and columbarium in Alameda, California, in an amount not to exceed $87,332,000.
Realignment of medical facilities in Livermore, California, in an amount not to exceed $194,430,000.
Construction of a medical center in Louisville, Kentucky, in an amount not to exceed $150,000,000.
Construction of a replacement community living center in Perry Point, Maryland, in an amount not to exceed $92,700,000.
Seismic corrections and other renovations to several buildings and construction of a specialty care building in American Lake, Washington, in an amount not to exceed $16,260,000.
Authorization of appropriations for construction— There is authorized to be appropriated to the Secretary of Veterans Affairs for fiscal year 2016 or the year in which funds are appropriated for the Construction, Major Projects, account, $1,113,802,000 for the projects authorized in subsection (a).
Limitation— The projects authorized in subsection (a) may only be carried out using—
funds appropriated for fiscal year 2016 pursuant to the authorization of appropriations in subsection (b);
funds available for Construction, Major Projects, for a fiscal year before fiscal year 2016 that remain available for obligation;
funds available for Construction, Major Projects, for a fiscal year after fiscal year 2016 that remain available for obligation;
funds appropriated for Construction, Major Projects, for fiscal year 2016 for a category of activity not specific to a project;
funds appropriated for Construction, Major Projects, for a fiscal year before fiscal year 2016 for a category of activity not specific to a project; and
funds appropriated for Construction, Major Projects, for a fiscal year after fiscal year 2016 for a category of activity not specific to a project.
Sec. 292 Identification and tracking of biological implants used in Department of Veterans Affairs medical facilities
In general— Subchapter II of chapter 73 of title 38, United States Code, as amended by section 248(a), is further amended by adding at the end the following new section:
“7330D. Identification and tracking of biological implants
“(a) Standard identification system for biological implants
“(1) The Secretary shall adopt the unique device identification system developed for medical devices by the Food and Drug Administration under section 519(f) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360i(f)), or implement a comparable standard identification system, for use in identifying biological implants intended for use in medical procedures conducted in medical facilities of the Department.
“(2) In adopting or implementing a standard identification system for biological implants under paragraph (1), the Secretary shall permit a vendor to use any of the accredited entities identified by the Food and Drug Administration as an issuing agency pursuant to section 830.100 of title 21, Code of Federal Regulations, or any successor regulation.
“(b) Biological implant tracking system
“(1) The Secretary shall implement a system for tracking the biological implants described in subsection (a) from human donor or animal source to implantation.
“(2) The tracking system implemented under paragraph (1) shall be compatible with the identification system adopted or implemented under subsection (a).
“(3) The Secretary shall implement inventory controls compatible with the tracking system implemented under paragraph (1) so that all patients who have received, in a medical facility of the Department, a biological implant subject to a recall can be notified of the recall if, based on the evaluation by appropriate medical personnel of the Department of the risks and benefits, the Secretary determines such notification is appropriate.
“(c) Consistency with Food and Drug Administration regulations—To the extent that a conflict arises between this section and a provision of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.) or section 351 or 361 of the Public Health Service Act (42 U.S.C. 262 and 264) (including any regulations issued under such provisions), the provision of the Federal Food, Drug, and Cosmetic Act or Public Health Service Act (including any regulations issued under such provisions) shall apply.
“(d) Biological implant defined—In this section, the term biological implant means any human cell, tissue, or cellular or tissue-based product or animal product—
“(1) under the meaning given the term human cells, tissues, or cellular or tissue-based products in section 1271.3 of title 21, Code of Federal Regulations, or any successor regulation; or
“(2) that is regulated as a device under section 201(h) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321(h)).”
Clerical amendment— The table of sections at the beginning of chapter 73 of such title, as amended by section 248(b), is further amended by inserting after the item relating to section 7330C the following new item:
Implementation deadlines—
Standard identification system— The Secretary of Veterans Affairs shall adopt or implement the standard identification system for biological implants required by subsection (a) of section 7330D of title 38, United States Code, as added by subsection (a), with respect to biological implants described in—
subsection (d)(1) of such section, by not later than the date that is 180 days after the date of the enactment of this Act; and
subsection (d)(2) of such section, in compliance with the compliance dates established by the Food and Drug Administration under section 519(f) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360i(f)).
Tracking system— The Secretary of Veterans Affairs shall implement the biological implant tracking system required by section 7330D(b) of title 38, United States Code, as added by subsection (a), by not later than the date that is 180 days after the date of the enactment of this Act.
Reporting requirement—
In general— If the biological implant tracking system required by section 7330D(b) of title 38, United States Code, as added by subsection (a), is not operational by the date that is 180 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 explaining why the system is not operational for each month until such time as the system is operational.
Elements— Each report submitted under paragraph (1) shall include a description of the following:
Each impediment to the implementation of the system described in such paragraph.
Steps being taken to remediate each such impediment.
Target dates for a solution to each such impediment.
Sec. 293 Procurement of biological implants used in Department of Veterans Affairs medical facilities
Procurement—
In general— Subchapter II of chapter 81 of title 38, United States Code, as amended by section 132(a), is further amended by adding at the end the following new section:
“8130. Procurement of biological implants
“(a) In general
“(1) The Secretary may procure biological implants of human origin only from vendors that meet the following conditions:
“(A) The vendor uses the standard identification system adopted or implemented by the Secretary under section 7330D(a) of this title and has safeguards to ensure that a distinct identifier has been in place at each step of distribution of each biological implant from its donor.
“(B) The vendor is registered as required by the Food and Drug Administration under subpart B of part 1271 of title 21, Code of Federal Regulations, or any successor regulation, and in the case of a vendor that uses a tissue distribution intermediary or a tissue processor, the vendor provides assurances that the tissue distribution intermediary or tissue processor is registered as required by the Food and Drug Administration.
“(C) The vendor ensures that donor eligibility determinations and such other records as the Secretary may require accompany each biological implant at all times, regardless of the country of origin of the donor of the biological material.
“(D) The vendor agrees to cooperate with all biological implant recalls conducted on the initiative of the vendor, on the initiative of the original product manufacturer used by the vendor, by the request of the Food and Drug Administration, or by a statutory order of the Food and Drug Administration.
“(E) The vendor agrees to notify the Secretary of any adverse event or reaction report it provides to the Food and Drug Administration, as required by sections 1271.3 and 1271.350 of title 21, Code of Federal Regulations, or any successor regulation, or any warning letter from the Food and Drug Administration issued to the vendor or a tissue processor or tissue distribution intermediary used by the vendor by not later than 60 days after the vendor receives such report or warning letter.
“(F) The vendor agrees to retain all records associated with the procurement of a biological implant by the Department for at least 10 years after the date of the procurement of the biological implant.
“(G) The vendor provides assurances that the biological implants provided by the vendor are acquired only from tissue processors that maintain active accreditation with the American Association of Tissue Banks or a similar national accreditation specific to biological implants.
“(2) The Secretary may procure biological implants of nonhuman origin only from vendors that meet the following conditions:
“(A) The vendor uses the standard identification system adopted or implemented by the Secretary under section 7330D(a) of this title.
“(B) The vendor is registered as an establishment as required by the Food and Drug Administration under sections 807.20 and 807.40 of title 21, Code of Federal Regulations, or any successor regulation (or is not required to register pursuant to section 807.65(a) of such title, or any successor regulation), and in the case of a vendor that is not the original product manufacturer of such implants, the vendor provides assurances that the original product manufacturer is registered as required by the Food and Drug Administration (or is not required to register).
“(C) The vendor agrees to cooperate with all biological implant recalls conducted on the initiative of the vendor, on the initiative of the original product manufacturer used by the vendor, by the request of the Food and Drug Administration, or by a statutory order of the Food and Drug Administration.
“(D) The vendor agrees to notify the Secretary of any adverse event report it provides to the Food and Drug Administration as required under part 803 of title 21, Code of Federal Regulations, or any successor regulation, or any warning letter from the Food and Drug Administration issued to the vendor or the original product manufacturer used by the vendor by not later than 60 days after the vendor receives such report or warning letter.
“(E) The vendor agrees to retain all records associated with the procurement of a biological implant by the Department for at least 10 years after the date of the procurement of the biological implant.
“(3)
“(A) The Secretary shall procure biological implants under the Federal Supply Schedules of the General Services Administration unless such implants are not available under such Schedules.
“(B) With respect to biological implants listed on the Federal Supply Schedules, the Secretary shall accommodate reasonable vendor requests to undertake outreach efforts to educate medical professionals of the Department about the use and efficacy of such biological implants.
“(C) In the case of biological implants that are unavailable for procurement under the Federal Supply Schedules, the Secretary shall procure such implants using competitive procedures in accordance with applicable law and the Federal Acquisition Regulation, including through the use of a national contract.
“(4) In procuring biological implants under this section, the Secretary shall permit a vendor to use any of the accredited entities identified by the Food and Drug Administration as an issuing agency pursuant to section 830.100 of title 21, Code of Federal Regulations, or any successor regulation.
“(5) Section 8123 of this title shall not apply to the procurement of biological implants.
“(b) Penalties—In addition to any applicable penalty under any other provision of law, any procurement employee of the Department who is found responsible for a biological implant procurement transaction with intent to avoid or with reckless disregard of the requirements of this section shall be ineligible to hold a certificate of appointment as a contracting officer or to serve as the representative of an ordering officer, contracting officer, or purchase card holder.
“(c) Definitions—In this section:
“(1) The term biological implant has the meaning given that term in section 7330D(d) of this title.
“(2) The term distinct identifier means a distinct identification code that—
“(A) relates a biological implant to the human donor of the implant and to all records pertaining to the implant;
“(B) includes information designed to facilitate effective tracking, using the distinct identification code, from the donor to the recipient and from the recipient to the donor; and
“(C) satisfies the requirements of section 1271.290(c) of title 21, Code of Federal Regulations, or any successor regulation.
“(3) The term tissue distribution intermediary means an agency that acquires and stores human tissue for further distribution and performs no other tissue banking functions.
“(4) The term tissue processor means an entity processing human tissue for use in biological implants, including activities performed on tissue other than donor screening, donor testing, tissue recovery and collection functions, storage, or distribution.”
Clerical amendment— The table of sections at the beginning of chapter 81 of such title, as amended by section 132(c), is further amended by inserting after the item relating to section 8129 the following new item:
Effective date— Section 8130 of title 38, United States Code, as added by subsection (a), shall take effect on the date that is 180 days after the date on which the tracking system required under section 7330D(b) of such title, as added by section 292(a), is implemented.
Special rule for cryopreserved products— During the three-year period beginning on the effective date of section 8130 of title 38, United States Code, as added by subsection (a), biological implants produced and labeled before that effective date may be procured by the Department of Veterans Affairs without relabeling under the standard identification system adopted or implemented under section 7330D of such title, as added by section 292(a).
Sec. 294 Expansion of research and education on and delivery of complementary and integrative health to veterans
Development of plan To expand research, education, and delivery— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall develop a plan to expand materially and substantially the scope of the effectiveness of research and education on, and delivery and integration of, complementary and integrative health services into the health care services provided to veterans.
Elements— The plan required by subsection (a) shall provide for the following:
Research on the following:
The effectiveness of various complementary and integrative health services, including the effectiveness of such services integrated with clinical services.
Approaches to integrating complementary and integrative health services into other health care services provided by the Department of Veterans Affairs.
Education and training for health care professionals of the Department on the following:
complementary and integrative health services selected by the Secretary for purposes of the plan.
Appropriate uses of such services.
Integration of such services into the delivery of health care to veterans.
Research, education, and clinical activities on complementary and integrative health at centers of innovation at medical centers of the Department.
Identification or development of metrics and outcome measures to evaluate the effectiveness of the provision and integration of complementary and integrative health services into the delivery of health care to veterans.
Integration and delivery of complementary and integrative health services with other health care services provided by the Department.
Consultation—
In general— In carrying out subsection (a), the Secretary shall consult with the following:
The Director of the National Center for Complementary and Integrative Health of the National Institutes of Health.
The Commissioner of Food and Drugs.
Institutions of higher education, private research institutes, and individual researchers with extensive experience in complementary and integrative health and the integration of complementary and integrative health practices into the delivery of health care.
Nationally recognized providers of complementary and integrative health.
Such other officials, entities, and individuals with expertise on complementary and integrative health as the Secretary considers appropriate.
Scope of consultation— The Secretary shall undertake consultation under paragraph (1) in carrying out subsection (a) with respect to the following:
To develop the plan.
To identify specific complementary and integrative health practices that, on the basis of research findings or promising clinical interventions, are appropriate to include as services to veterans.
To identify barriers to the effective provision and integration of complementary and integrative health services into the delivery of health care to veterans, and to identify mechanisms for overcoming such barriers.
Complementary and integrative health defined— In this section, the term complementary and integrative health shall have the meaning given that term in section 211(g).
Sec. 295 Pilot program on integration of complementary and integrative health within Department of Veterans Affairs medical centers
Pilot program required— Not later than 180 days after the completion of the development of the plan under section 294, the Secretary of Veterans Affairs shall—
carry out, through the Office of Patient Centered Care and Cultural Transformation of the Department of Veterans Affairs, a pilot program to assess the feasibility and advisability of integrating the delivery of complementary and integrative health 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
in developing the pilot program—
use the plan developed under section 294;
identify and, to the extent practicable, resolve barriers to the provision of complementary and integrative health services selected by the Secretary and the integration of those services with other health care services provided by the Department;
identify means of improving coordination between Federal, State, local, and community providers of health care in the provision of pain management and related health care services to veterans;
identify means of enhancing outreach, and coordination of outreach, by and among providers of health care described in subparagraph (C) regarding the pain management and related health care services available to veterans;
identify means of using wellness-based programs offered by providers of health care described in subparagraph (C) to complement the provision by the Department of pain management and related health care services to veterans; and
assess whether wellness-based programs described in subparagraph (E)—
are effective in enhancing the quality of life and well-being of veterans;
are effective in increasing the adherence of veterans to the primary pain management and related health care services provided such veterans by the Department;
have an effect on the sense of well-being of veterans who receive primary pain management and related health care services from the Department; and
are effective in encouraging veterans receiving health care from the Department to adopt a more healthy lifestyle.
Duration of pilot program— The Secretary shall carry out the pilot program during the three-year period beginning on the date that is 180 days after the completion of the development of the plan under section 294.
Locations—
In general— The Secretary shall carry out the pilot program at not fewer than 15 medical centers of the Department.
Polytrauma centers— Not fewer than two of the medical centers designated under paragraph (1) shall be located at polytrauma rehabilitation centers of the Department.
Medical centers with prescription rate of opioids that conflicts with care standards—
In general— In selecting medical centers under paragraph (1), the Secretary shall give priority to medical centers of the Department at which there is a prescription rate of opioids that conflicts with or is otherwise inconsistent with the standards of appropriate and safe care.
Prescription rate defined— In this paragraph, the term prescription rate means, with respect to a medical center of the Department, each of the following:
The number of patients treated with opioids at the medical center divided by the total number of pharmacy users at the medical center.
The average number of morphine equivalents per day prescribed at the medical center to patients being treated with opioids.
Of the patients being treated with opioids at the medical center, the average number of prescriptions of opioids per patient.
Selection of locations— In carrying out the pilot program, the Secretary shall select locations that include the following areas:
Rural areas.
Areas that are not in close proximity to an active duty military installation.
Areas representing different geographic locations, such as census tracts established by the Bureau of the Census.
Provision of services— Under the pilot program, the Secretary shall provide covered services to covered veterans by integrating complementary and integrative health services with other services provided by the Department at the medical centers designated under subsection (c)(1).
Covered veterans— For purposes of the pilot program, a covered veteran is any veteran who—
has a mental health condition diagnosed by a clinician of the Department;
experiences chronic pain;
has a chronic condition being treated by a clinician of the Department; or
is not described in paragraph (1), (2), or (3) and requests to participate in the pilot program or is referred by a clinician of the Department who is treating the veteran.
Covered services—
In general— For purposes of the pilot program, covered services are services consisting of complementary and integrative health services as selected by the Secretary.
Administration of services— Covered services shall be administered under the pilot program as follows:
Covered services shall be administered by professionals or other instructors with appropriate training and expertise in complementary and integrative health services who are employees of the Department or with whom the Department enters into an agreement to provide such services.
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.
Covered services shall be made available to—
covered veterans who have received conventional treatments from the Department for the conditions for which the covered veteran seeks complementary and integrative health services under the pilot program; and
covered veterans who have not received conventional treatments from the Department for such conditions.
Voluntary participation— The participation of a veteran in the pilot program shall be at the election of the veteran and in consultation with a clinician of the Department.
Report—
In general— Not later than 30 months 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.
Elements— The report submitted under paragraph (1) shall include the following:
The findings and conclusions of the Secretary with respect to the pilot program, including with respect to—
the use and efficacy of the complementary and integrative health services established under the pilot program;
the outreach conducted by the Secretary to inform veterans and community organizations about the pilot program; and
an assessment of the benefit of the pilot program to covered veterans in mental health diagnoses, pain management, and treatment of chronic illness.
A description of barriers identified under subsection (a)(2)(B) that were not resolved.
Such recommendations for the continuation or expansion of the pilot program as the Secretary considers appropriate.
Complementary and integrative health defined— In this section, the term complementary and integrative health shall have the meaning given that term in section 211(g).
Sec. 296 Report on public access to research by Department of Veterans Affairs
In general— Not later than each of 180 days and 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 increasing public access to scientific publications and digital data from research funded by the Department of Veterans Affairs.
Elements— Each report submitted under subsection (a) shall include the following:
An identification of the location or locations in which the public will be able to access the results of research funded by the Department, whether on an Internet website of the Department or through another source.
A description of the progress made by the Department in meeting public access requirements set forth in the notice entitled “Policy and Implementation Plan for Public Access to Scientific Publications and Digital Data from Research Funded by the Department of Veterans Affairs” (80 Fed. Reg. 60751), including the following:
Compliance of Department investigators with requirements relating to ensuring that research funded by the Department is accessible by the public.
Ensuring data management plans of the Department include provisions for long-term preservation of the scientific data resulting from research funded by the Department.
An explanation of the factors used to evaluate the merit of data management plans of research funded by the Veterans Health Administration.
An explanation of the process of the Department in effect that enables stakeholders to petition a change to the embargo period for a specific field and the factors considered during such process.