Title II — Improving Department of Veterans Affairs health care delivery

S. 2193 · 115th Congress · Dec 5, 2017 · Lineage

II Improving Department of Veterans Affairs health care delivery

A Personnel practices

I Administration

Sec. 201 Licensure of health care professionals of the Department of Veterans Affairs providing treatment via telemedicine

(a)

In general— Chapter 17 is amended by inserting after section 1730A the following new section:

“1730B. Licensure of health care professionals providing treatment via telemedicine

“(a) In general—Notwithstanding any provision of law regarding the licensure of health care professionals, a covered health care professional may practice the health care profession of the health care professional at any location in any State, regardless of where the covered health care professional or the patient is located, if the covered health care professional is using telemedicine to provide treatment to an individual under this chapter.

“(b) Covered health care professionals—For purposes of this section, a covered health care professional is any health care professional who—

“(1) is an employee of the Department appointed under the authority under section 7306, 7401, 7405, 7406, or 7408 of this title or title 5;

“(2) is authorized by the Secretary to provide health care under this chapter;

“(3) is required to adhere to all standards of quality relating to the provision of medicine in accordance with applicable policies of the Department; and

“(4) has an active, current, full, and unrestricted license, registration, or certification in a State to practice the health care profession of the health care professional.

“(c) Property of Federal government—Subsection (a) shall apply to a covered health care professional providing treatment to a patient regardless of whether the covered health care professional or patient is located in a facility owned by the Federal Government during such treatment.

“(d) Relation to State law

“(1) The provisions of this section shall supersede any provisions of the law of any State to the extent that such provision of State law are inconsistent with this section.

“(2) No State shall deny or revoke the license, registration, or certification of a covered health care professional who otherwise meets the qualifications of the State for holding the license, registration, or certification on the basis that the covered health care professional has engaged or intends to engage in activity covered by subsection (a).

“(e) Rule of construction—Nothing in this section may be construed to remove, limit, or otherwise affect any obligation of a covered health care professional under the Controlled Substances Act (21 U.S.C. 801 et seq.).”

(b)

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 1730A the following new item:

(c)

Report on telemedicine—

(1)

In general— Not later than one year after the earlier of the date on which services provided under section 1730B of title 38, United States Code, as added by subsection (a), first occur or regulations are promulgated to carry out such section, 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 effectiveness of the use of telemedicine by the Department of Veterans Affairs.

(2)

Elements— The report required by paragraph (1) shall include an assessment of the following:

(A)

The satisfaction of veterans with telemedicine furnished by the Department.

(B)

The satisfaction of health care providers in providing telemedicine furnished by the Department.

(C)

The effect of telemedicine furnished by the Department on the following:

(i)

The ability of veterans to access health care, whether from the Department or from non-Department health care providers.

(ii)

The frequency of use by veterans of telemedicine.

(iii)

The productivity of health care providers.

(iv)

Wait times for an appointment for the receipt of health care from the Department.

(v)

The use by veterans of in-person services at Department facilities and non-Department facilities.

(D)

The types of appointments for the receipt of telemedicine furnished by the Department that were provided during the one-year period preceding the submittal of the report.

(E)

The number of appointments for the receipt of telemedicine furnished by the Department that were requested during such period, disaggregated by medical facility.

(F)

Savings by the Department, if any, including travel costs, from furnishing health care through the use of telemedicine during such period.

Sec. 202 Role of podiatrists in Department of Veterans Affairs

(a)

Inclusion as physician—

(1)

In general— Subchapter I of chapter 74 is amended by adding at the end the following new section:

“7413. Treatment of podiatrists; clinical oversight standards

“(a) Podiatrists—Except as provided by subsection (b), a doctor of podiatric medicine who is appointed as a podiatrist under section 7401(1) of this title is eligible for any supervisory position in the Veterans Health Administration to the same degree that a physician appointed under such section is eligible for the position.

“(b) Establishment of clinical oversight standards—The Secretary, in consultation with appropriate stakeholders, shall establish standards to ensure that specialists appointed in the Veterans Health Administration to supervisory positions do not provide direct clinical oversight for purposes of peer review or practice evaluation for providers of other clinical specialties.”

(2)

Clerical amendment— The table of sections at the beginning of chapter 74 is amended by inserting after the item relating to section 7412 the following new item:

(b)

Modification and clarification of pay grade—

(1)

Grade— The list in section 7404(b) of such title is amended—

(A)

by striking “PHYSICIAN AND DENTIST SCHEDULE” and inserting “PHYSICIAN AND SURGEON (MD/DO), PODIATRIC SURGEON (DPM), AND DENTIST AND ORAL SURGEON (DDS, DMD) SCHEDULE”;

(B)

by striking, “Physician grade” and inserting “Physician and surgeon grade”; and

(C)

by striking “PODIATRIST, CHIROPRACTOR, AND” and inserting “CHIROPRACTOR AND”.

(2)

Application— The amendments made by paragraph (1) shall apply with respect to a pay period of the Department of Veterans Affairs beginning on or after the date that is 30 days after the date of the enactment of this Act.

Sec. 203 Modification of treatment of certified clinical perfusionists of the Department

(a)

Appointment— Section 7401(1) is amended by inserting “certified clinical perfusionists,” after “physician assistants,”.

(b)

Increases in rates of basic pay— Section 7455(c)(1) is amended by inserting “certified clinical perfusionists,” after “pharmacists,”.

Sec. 204 Amending statutory requirements for the position of the Chief Officer of the Readjustment Counseling Service

Section 7309(b)(2) is amended—

(1)

in subparagraph (B), by striking “in the Readjustment Counseling Service”; and

(2)

in subparagraph (C), by striking “in the Readjustment Counseling Service”.

Sec. 205 Technical amendment to appointment and compensation system for directors of medical centers and directors of Veterans Integrated Service Networks

Section 7404(d) is amended by striking “Except” and inserting “Except for positions described in section 7401(4) of this title and except”.

Sec. 206 Identification and staffing of certain health care vacancies

(a)

In general— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall identify and fully staff—

(1)

all mental health vacancies within the Department of Veterans Affairs; and

(2)

all primary care and mental health vacancies in Patient Aligned Care Teams of the Department.

(b)

Report— Not later than 210 days after the date of the enactment of this Act, the Secretary shall submit to Congress a report that specifies—

(1)

whether the Department has complied with the requirements under subsection (a); and

(2)

if the Secretary has not complied with such requirements—

(A)

how many vacancies described in subsection (a) remain; and

(B)

why the Department was unable to fill such vacancies.

Sec. 207 Department of Veterans Affairs personnel transparency

(a)

Publication of staffing and vacancies—

(1)

Website required— Not later than 30 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall make publicly available on an Internet website of the Department of Veterans Affairs the following information, which shall be displayed by departmental component or, in the case of information relating to Veterans Health Administration positions, by medical facility:

(A)

The number of personnel encumbering positions.

(B)

The number of accessions and de-accessions of personnel during the month preceding the date of the publication of the information.

(C)

The number of vacancies, by occupation.

(D)

The number of active job postings that have been filled during the 30-day period ending on the date of publication of the information, including the length of time for which each position was posted prior to being filled.

(2)

Update of information— The Secretary shall update the information on the website required under paragraph (1) on a monthly basis.

(3)

Treatment of contractor positions— Any Department of Veterans Affairs position that is filled through a contractor employee may not be treated as a Department position for purposes of the information required to be published under paragraph (1).

(4)

Inspector General review— On a semi-annual basis, the Inspector General of the Department shall review the administration of the website required under paragraph (1) and make recommendations relating to the improvement of such administration.

(b)

Report to Congress— The Secretary of Veterans Affairs shall submit to Congress an annual report on the steps the Department is taking to achieve full staffing capacity. Each such report shall include the amount of additional funds necessary to enable the Department to reach full staffing capacity.

Sec. 208 Program on establishment of peer specialists in patient aligned care team settings within medical centers of Department of Veterans Affairs

(a)

Program required— The Secretary of Veterans Affairs shall carry out a program to establish not fewer than two peer specialists in patient aligned care teams at medical centers of the Department of Veterans Affairs to promote the use and integration of services for mental health, substance use disorder, and behavior health in a primary care setting.

(b)

Timeframe for establishment of program— The Secretary shall carry out the program at medical centers of the Department as follows:

(1)

Not later than December 31, 2018, at not fewer than 25 medical centers of the Department.

(2)

Not later than December 31, 2019, at not fewer than 50 medical centers of the Department.

(c)

Selection of locations—

(1)

In general— The Secretary shall select medical centers for the program as follows:

(A)

Not fewer than five shall be medical centers of the Department that are designated by the Secretary as polytrauma centers.

(B)

Not fewer than ten shall be medical centers of the Department that are not designated by the Secretary as polytrauma centers.

(2)

Considerations— In selecting medical centers for the program under paragraph (1), the Secretary shall consider the feasibility and advisability of selecting medical centers in the following areas:

(A)

Rural areas and other areas that are underserved by the Department.

(B)

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

(C)

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

(d)

Gender-Specific services— In carrying out the program at each location selected under subsection (c), the Secretary shall ensure that—

(1)

the needs of female veterans are specifically considered and addressed; and

(2)

female peer specialists are made available to female veterans who are treated at each location.

(e)

Engagement with community providers— At each location selected under subsection (c), the Secretary shall consider ways in which peer specialists can conduct outreach to health care providers in the community who are known to be serving veterans to engage with those providers and veterans served by those providers.

(f)

Reports—

(1)

Periodic reports—

(A)

In general— Not later than 180 days after the date of the enactment of this Act, and not less frequently than once every 180 days thereafter until the Secretary determines that the program is being carried out at the last location to be selected under subsection (c), the Secretary shall submit to Congress a report on the program.

(B)

Elements— Each report required by subparagraph (A) shall, with respect to the 180-day period preceding the submittal of the report, include the following:

(i)

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

(ii)

An assessment of the benefits of the program to veterans and family members of veterans.

(iii)

An assessment of the effectiveness of peer specialists in engaging under subsection (e) with health care providers in the community and veterans served by those providers.

(2)

Final report— Not later than 180 days after the Secretary determines that the program is being carried out at the last location to be selected under subsection (c), the Secretary shall submit to Congress a report detailing the recommendations of the Secretary as to the feasibility and advisability of expanding the program to additional locations.

Sec. 209 Pilot program on increasing the use of medical scribes to maximize the efficiency of physicians at medical facilities of the Department of Veterans Affairs

(a)

In general— Commencing not later than 120 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall carry out a pilot program to increase the use of medical scribes to maximize the efficiency of physicians at medical facilities of the Department of Veterans Affairs.

(b)

Duration— The Secretary shall carry out the pilot program during the 18-month period beginning on the date of the commencement of the pilot program.

(c)

Locations— The Secretary shall carry out the pilot program at not fewer than five medical facilities of the Department—

(1)

at which the Secretary has determined there is a high volume of patients; or

(2)

that are located in rural areas and at which the Secretary has determined there is a shortage of physicians and each physician has a high caseload.

(d)

Contracts—

(1)

In general— In carrying out the pilot program, the Secretary shall enter into a contract with one or more appropriate nongovernmental entities described in paragraph (2).

(2)

Appropriate nongovernmental entities described— An appropriate nongovernmental entity described in this paragraph is an entity that trains and employs professional medical scribes who specialize in the collection of medical data and data entry into electronic health records.

(e)

Collection of data—

(1)

In general— The Secretary shall collect data on the pilot program to determine the effectiveness of the pilot program in increasing the efficiency of physicians at medical facilities of the Department.

(2)

Elements— The data collected under paragraph (1) shall include the following with respect to each medical facility participating in the pilot program:

(A)

The average wait time for a veteran to receive care from a physician at such medical facility before implementation of the pilot program.

(B)

The average wait time for a veteran to receive care from such a physician after implementation of the pilot program.

(C)

The average number of patients that such a physician is able to see on a daily basis before implementation of the pilot program.

(D)

The average number of patients that such a physician is able to see on a daily basis after implementation of the pilot program.

(E)

The average amount of time such a physician spends on documentation on a daily basis before implementation of the pilot program.

(F)

The average amount of time such a physician spends on documentation on a daily basis after implementation of the pilot program.

(G)

The satisfaction and retention scores of each such physician before implementation of the pilot program.

(H)

The satisfaction and retention scores of each such physician after implementation of the pilot program.

(I)

The patient satisfaction scores for each such physician before implementation of the pilot program.

(J)

The patient satisfaction scores for each such physician after implementation of the pilot program.

(K)

The patient satisfaction scores for their health care experience before implementation of the pilot program.

(L)

The patient satisfaction scores for their health care experience after implementation of the pilot program.

(f)

Report—

(1)

In general— Not later than 180 days after the commencement of the pilot program, and not less frequently than once every 180 days thereafter for the duration of the pilot program, the Secretary shall submit to Congress a report on the pilot program.

(2)

Elements— Each report required by paragraph (1) shall include the following:

(A)

The number of medical facilities of the Department that are participating in the pilot program.

(B)

With respect to each such medical facility, an assessment of the effects that participation in the pilot program has had on the following—

(i)

Maximizing the efficiency of physicians at such medical facility.

(ii)

Reducing average wait times for appointments.

(iii)

Improving access of patients to electronic medical records.

(iv)

Mitigating physician shortages by increasing the productivity of physicians.

(C)

All data collected under subsection (e).

(D)

Such recommendations as the Secretary may have with respect to the extension or expansion of the pilot program.

(g)

Medical scribe defined— In this section, the term medical scribe means a member of the medical team hired and trained specifically and exclusively to perform documentation in an electronic health record to maximize the productivity of a physician.

Sec. 210 Sense of Congress regarding Department of Veterans Affairs staffing levels

(a)

Findings— Congress makes the following findings:

(1)

The Department of Veterans Affairs needs to fill at least 35,000 positions.

(2)

Prolonged personnel vacancies in the Department result in staffing shortages that cause veterans to receive delayed benefits and services.

(b)

Sense of Congress— It is the sense of Congress that the Department should make the resolution of staffing shortages a top priority.

II Education and training

Sec. 211 Graduate medical education and residency

(a)

Increase in number of graduate medical education residency positions—

(1)

In general— The Secretary of Veterans Affairs shall increase the number of graduate medical education residency positions at covered facilities by up to 1,500 positions in the 10-year period beginning on the date of the enactment of this Act.

(2)

Covered facilities— For purposes of this section, a covered facility is any of the following:

(A)

A facility of the Department of Veterans Affairs.

(B)

A facility operated by an Indian tribe or a tribal organization, as those terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304).

(C)

A facility operated by the Indian Health Service.

(D)

A Federally-qualified health center, as defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B)).

(E)

A community health center.

(F)

A facility operated by the Department of Defense.

(G)

Such other health care facility as the Secretary considers appropriate for purposes of this section.

(3)

Stipends and benefits— The Secretary may pay stipends and provide benefits for residents in positions under paragraph (1), regardless of whether they have been assigned in a Department facility.

(4)

Parameters for location, affiliate sponsor, and duration— When determining characteristics of residency positions under paragraph (1), the Secretary shall consider the extent to which there is a clinical need for providers, as determined by the following:

(A)

The ratio of veterans to health care providers of the Department for a standardized geographic area surrounding a facility, including a separate ratio for general practitioners and specialists.

(B)

Whether the local community is medically underserved.

(C)

Whether the facility is located in a rural or remote area.

(D)

Such other criteria as the Secretary considers important in determining which facilities are not adequately serving area veterans.

(5)

Parameters for types of specialties— When determining the types of specialties to be included in residency positions under paragraph (1), the Secretary shall consider the following:

(A)

The types of specialties that improve the quality and coverage of medical services provided to veterans.

(B)

The range of clinical specialties covered by providers in standardized geographic areas surrounding facilities.

(C)

Whether the specialty is included in the most recent staffing shortage determination of the Department under section 7412 of title 38, United States Code.

(b)

Application To participate— To participate as a resident in one of the positions increased under subsection (a)(1), an individual shall submit to the Secretary an application therefor together with an agreement described in subsection (d) under which the participant agrees to serve a period of obligated service in the Veterans Health Administration as provided in the agreement in return for payment of stipend and benefit support as provided in the agreement.

(c)

Selection—

(1)

In general— An individual becomes a participant in a residency program under this section upon the Secretary's approval of the individual's application under subsection (b) and the Secretary's acceptance of the agreement under subsection (d) (if required).

(2)

Notice— Upon the Secretary's approval of an individual's participation in the program under paragraph (1), the Secretary shall promptly notify the individual of that approval. Such notice shall be in writing.

(d)

Agreement—

(1)

In general— An agreement between the Secretary and a resident in a position under subsection (a)(1) shall be in writing and shall be signed by the resident containing such terms as the Secretary may specify.

(2)

Requirements— The agreement must specify the terms of the service obligation resulting from participating as a resident under this section, including by requiring a service obligation equal to the number of years of stipend and benefit support.

(e)

Conditions of employment— The Secretary may prescribe the conditions of employment of individuals appointed to positions under subsection (a)(1), including necessary training, and the customary amount and terms of pay for such positions during the period of such employment and training.

(f)

Obligated service—

(1)

In general— Each individual appointed to a position under subsection (a)(1) shall provide service as a full-time employee of the Department for the period of obligated service provided in the agreement of the participant entered into under subsection (d). Such service shall be provided in the full-time clinical practice of such participant's profession or in another health care position in an assignment or location determined by the Secretary.

(2)

Commencement date— Not later than 60 days before the date on which an individual commences serving in a position under subsection (a)(1), the Secretary shall notify the individual of such date. Such date shall be the first day of the individual's period of obligated service.

(g)

Breach of agreement: liability—

(1)

Penalty— An individual appointed under this section to a position under subsection (a)(1) (other than an individual who is liable under paragraph (2)) who fails to accept payment, or instructs the educational institution in which the individual is enrolled not to accept payment, in whole or in part, for a residency under the agreement entered into under subsection (d) of this title shall be liable to the United States for liquidated damages in the amount of $1,500. Such liability is in addition to any period of obligated service or other obligation or liability under the agreement.

(2)

Liability—

(A)

In general— An individual appointed to a position under subsection (a)(1) shall be liable to the United States for the amount which has been paid to or on behalf of the individual under the agreement if any of the following occurs:

(i)

The individual is dismissed from the position for disciplinary reasons.

(ii)

The individual voluntarily terminates the residency before the completion of such course of training.

(iii)

The individual loses the individual's license, registration, or certification to practice the individual's health care profession in a State.

(B)

Liability supplants service obligation— Liability under this paragraph is in lieu of any service obligation arising under the individual's agreement under subsection (d).

(h)

Recovery—

(1)

In general— If an individual breaches the individuals's agreement under subsection (d) by failing (for any reason) to complete such individual's period of obligated service, the United States shall be entitled to recover from the individual an amount equal to the product of—

(A)

three;

(B)

the sum of—

(i)

the amounts paid under this section to or on behalf of the individual; and

(ii)

the interest on such amounts that would be payable if at the time the amounts were paid they were loans bearing interest at the maximum legal prevailing rate, as determined by the Treasurer of the United States; and

(C)

the quotient of—

(i)

the difference between—

(I)

the total number of months in the individual's period of obligated service; and

(II)

the number of months of such period served by the individual; and

(ii)

the total number of months in the individual's period of obligated service.

(2)

Period of recovery— Any amount which the United States is entitled to recover under this subsection shall be paid to the United States not later than the date that is one year after the date of the breach of the agreement.

(i)

Annual report—

(1)

In general— Not later than one year after the date of the enactment of this Act and not less frequently than once each year thereafter, the Secretary shall submit to the appropriate committees of Congress a report on the implementation of this section during the previous year.

(2)

Contents— Each report submitted under paragraph (1) shall include, for the period covered by the report, the following:

(A)

The number of positions described in subsection (a) that were filled.

(B)

The location of each such position.

(C)

The academic affiliate associated with each such position.

(D)

A description of the challenges faced in filling the positions described in subsection (a) and the actions the Secretary has taken to address such challenges.

(3)

Appropriate committees of Congress defined— In this subsection, the term appropriate committees of Congress means—

(A)

the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and

(B)

the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.

Sec. 212 Pilot program to establish or affiliate with graduate medical residency programs at facilities operated by Indian tribes, tribal organizations, and the Indian Health Service in rural areas

(a)

Pilot program required— The Secretary of Veterans Affairs, in consultation with the Director of the Indian Health Service and such other persons as the Secretary considers appropriate, shall carry out a pilot program—

(1)

to establish graduate medical education residency training programs at covered facilities; or

(2)

to affiliate with established programs described in paragraph (1).

(b)

Covered facilities— For purposes of the pilot program, a covered facility is any facility—

(1)

(A)

described in subparagraph (B) or (C) of section 211(a)(2); or

(B)

with an agreement with the Department described in section 101(d)(1); and

(2)

located in a rural or remote area.

(c)

Locations—

(1)

In general— The Secretary shall carry out the pilot program at not more than five covered facilities that have been selected by the Secretary for purposes of the pilot program.

(2)

Criteria— The Secretary shall establish criteria for selecting covered facilities under paragraph (1).

(d)

Duration— The Secretary shall carry out the pilot program during the eight-year period beginning on the date that is 180 days after the date of the enactment of this Act.

(e)

Reimbursement of costs— The Secretary shall reimburse each covered facility participating in the pilot program for the following costs associated with the pilot program:

(1)

Curriculum development.

(2)

Recruitment, training, supervision, and retention of residents and faculty.

(3)

Accreditation of programs of education under the pilot program by the Accreditation Council for Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA).

(4)

The portion of faculty salaries attributable to activities relating to carrying out the pilot program.

(5)

Payment for expenses relating to providing medical education under the pilot program.

(6)

Stipends and benefits.

(f)

Period of obligated service—

(1)

In general— The Secretary shall enter into an agreement with each individual who participates in the pilot program under which such individual agrees to serve under the same terms as established under section 211.

(2)

Loan repayment— During the period of obligated service of an individual under paragraph (1), the individual—

(A)

shall be deemed to be an eligible individual under subsection (b) of section 108 of the Indian Health Care Improvement Act (25 U.S.C. 1616a) for purposes of participation in the Indian Health Service Loan Repayment Program under such section during the portion of such period that the individual serves at a covered facility; and

(B)

shall be deemed to be an eligible individual under section 7682(a) of title 38, United States Code, for purposes of participation in the Department of Veterans Affairs Education Debt Reduction Program under subchapter VII of chapter 76 of such title during the portion of such period that the individual serves at a facility of the Department.

(3)

Concurrent service— Any period of obligated service required of an individual under paragraph (1) shall be served—

(A)

with respect to service at a covered facility, concurrently with any period of obligated service required of the individual by the Indian Health Service; and

(B)

with respect to service at a facility of the Department of Veterans Affairs, concurrently with any period of obligated service required of the individual by the Department.

(g)

Treatment of participants— A residency position into which a participant in the pilot program is placed as part of the pilot program shall be considered a position referred to in section 211(a)(1) for purposes of the limitation on number of new positions authorized under such section.

(h)

Report— Not later than three years before the date on which the pilot program terminates, the Secretary of Veterans Affairs shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the feasibility and advisability of—

(1)

expanding the pilot program to additional locations; and

(2)

making the pilot program or any aspect of the pilot program permanent.

Sec. 213 Reimbursement of continuing professional education requirements for board certified advanced practice registered nurses

(a)

In general— Section 7411 is amended to read as follows:

“7411. Reimbursement of continuing professional education expenses

“The Secretary shall reimburse any full-time board-certified advanced practice registered nurse, physician, or dentist appointed under section 7401(1) of this title for expenses incurred, up to $1,000 per year, for continuing professional education.”

(b)

Clerical amendment— The table of sections at the beginning of chapter 74 is amended by striking the item relating to section 7411 and inserting the following new item:

Sec. 214 Increase in maximum amount of debt that may be reduced under Education Debt Reduction Program of Department of Veterans Affairs

(a)

Increase in amount— Section 7683(d)(1) is amended—

(1)

by striking “$120,000” and inserting “$240,000”; and

(2)

by striking “$24,000” and inserting “$48,000”.

(b)

Study—

(1)

In general— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall—

(A)

conduct a study on the demand for education debt reduction under subchapter VII of chapter 76 of title 38, United States Code; and

(B)

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 findings of the Secretary with respect to the study carried out under subparagraph (A).

(2)

Considerations— In carrying out the study required by paragraph (1)(A), the Secretary shall consider the following:

(A)

The total number of vacancies within the Veterans Health Administration whose applicants are eligible to participate in the Education Debt Reduction Program pursuant to section 7682(a) of such title.

(B)

The types of medical professionals in greatest demand in the United States.

(C)

Projections by the Secretary of the numbers and types of medical professions that meet the needs of veterans.

Sec. 215 Demonstration program on training and employment of alternative dental health care providers for dental health care services for veterans in rural and other underserved communities

(a)

Demonstration program authorized— The Secretary of Veterans Affairs may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to increase access to dental health care services for veterans who are entitled to such services from the Department of Veterans Affairs and reside in rural and other underserved communities.

(b)

Priority— The Secretary shall prioritize the establishment of programs under the demonstration program under this section in States that do not have a facility of the Department that offers on-site dental services.

(c)

Telehealth— For purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care, dental services provided under the demonstration program under this section may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible.

(d)

Authorization of appropriations— There are authorized to be appropriated to the Secretary such sums as are necessary to carry out the demonstration program under this section.

(e)

Alternative dental health care providers defined— In this section, the term alternative dental health care providers has the meaning given that term in section 340G–1(a)(2) of the Public Health Service Act (42 U.S.C. 256g–1(a)(2)).

III Other personnel matters

Sec. 221 Exception on limitation on awards and bonuses for recruitment, relocation, and retention

Section 705(a) of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 703 note) is amended, in the matter preceding paragraph (1), by inserting “other than recruitment, relocation, or retention incentives,” after “title 38, United States Code,”.

Sec. 222 Annual report on performance awards and bonuses awarded to certain high-level employees of the Department

(a)

In general— Chapter 7 is amended by adding at the end the following new section:

“726. Annual report on performance awards and bonuses awarded to certain high-level employees

“(a) In general—Not later than 30 days after the end of each fiscal year, the Secretary shall submit to the appropriate committees of Congress a report that contains, for the most recent fiscal year ending before the submittal of the report, a description of the performance awards and bonuses awarded to Regional Office Directors of the Department, Directors of Medical Centers of the Department, and Directors of Veterans Integrated Service Networks.

“(b) Elements—Each report submitted under subsection (a) shall include the following with respect to each performance award or bonus awarded to an individual described in such subsection:

“(1) The amount of each award or bonus.

“(2) The job title of the individual awarded the award or bonus.

“(3) The location where the individual awarded the award or bonus works.

“(c) Appropriate committees of Congress—In this section, the term appropriate committees of Congress means—

“(1) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and

“(2) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.”

(b)

Clerical amendment— The table of sections at the beginning of chapter 7 is amended by inserting after the item relating to section 725 the following new item:

Sec. 223 Authority to regulate additional pay for certain health care employees of the Department

Section 7454 is amended by adding at the end the following new subsection:

“(d) In this section, the term compensation includes all compensation earned by employees when performing duties authorized by the Secretary or when the employee is approved to use annual, sick, family medical, military, or court leave or during any other paid absence for which pay is not already regulated.”

Sec. 224 Modification of pay cap for nurses

Paragraph (2) of section 7451(c) is amended to read as follows:

“(2)

“(A) The maximum rate of basic pay for any grade for health-care personnel positions referred to in paragraphs (1) and (3) of section 7401 of this title (other than the positions of physician, dentist, and registered nurse) may not exceed the rate of basic pay established for positions in level IV of the Executive Schedule under section 5315 of title 5.

“(B) Pursuant to an adjustment under subsection (d), the maximum rate of basic pay for a registered nurse serving as a nurse executive or a grade for the position of certified registered nurse anesthetist may exceed the rate of basic pay established for positions in level IV of the Executive Schedule under section 5315 of title 5 but may not exceed the rate of basic pay established for positions in level I of the Executive Schedule under section 5312 of title 5.

“(C) Pursuant to an adjustment under subsection (d), the maximum rate of basic pay for all registered nurses not described in subparagraph (B) may exceed the rate of basic pay established for positions in level IV of the Executive Schedule under section 5315 of title 5 but may not exceed the rate of basic pay established for positions in level III of the Executive Schedule under section 5314 of title 5.”

B Improvement of underserved facilities of the Department

Sec. 231 Development of criteria for designation of certain medical facilities of the Department of Veterans Affairs as underserved facilities and plan to address problem of underserved facilities

(a)

In general— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall develop criteria to designate medical centers, ambulatory care facilities, and community based outpatient clinics of the Department of Veterans Affairs as underserved facilities.

(b)

Consideration— Criteria developed under subsection (a) shall include consideration of the following with respect to a facility:

(1)

The ratio of veterans to health care providers of the Department of Veterans Affairs for a standardized geographic area surrounding the facility, including a separate ratio for general practitioners and specialists.

(2)

The range of clinical specialties covered by such providers in such area.

(3)

Whether the local community is medically underserved.

(4)

The type, number, and age of open consults.

(5)

Whether the facility is meeting the wait-time goals of the Department.

(6)

Such other criteria as the Secretary considers important in determining which facilities are not adequately serving area veterans.

(c)

Analysis of facilities— Not less frequently than annually, directors of Veterans Integrated Service Networks of the Department shall perform an analysis to determine which facilities within that Veterans Integrated Service Network qualify as underserved facilities pursuant to criteria developed under subsection (a).

(d)

Annual plan To address underserved facilities—

(1)

Plan required— Not later than one year after the date of the enactment of this Act and not less frequently than once each year, the Secretary shall submit to Congress a plan to address the problem of underserved facilities of the Department, as designated pursuant to criteria developed under subsection (a).

(2)

Contents— Each plan submitted under paragraph (1) shall address the following:

(A)

Increasing personnel or temporary personnel assistance, including mobile deployment teams furnished under section 233.

(B)

Providing special hiring incentives, including under the Education Debt Reduction Program under subchapter VII of chapter 76 of title 38, United States Code, and recruitment, relocation, and retention incentives.

(C)

Using direct hiring authority.

(D)

Improving training opportunities for staff.

(E)

Such other actions as the Secretary considers appropriate.

Sec. 232 Pilot program on tuition reimbursement and loan repayment for health care providers of the Department of Veterans Affairs at underserved facilities

(a)

In general— Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall commence a pilot program to assess the feasibility and advisability of providing incentives to individuals to work at underserved facilities of the Veterans Health Administration by providing tuition reimbursement and loan repayment to medical students and health care providers who commit to serving in underserved facilities selected under subsection (c).

(b)

Duration— The Secretary shall carry out the pilot program during the six-year period beginning on the date of the commencement of the pilot program.

(c)

Selection of locations—

(1)

In general— The Secretary shall select not fewer than three medical centers and seven ambulatory care facilities or community based outpatient clinics of the Department to participate in the pilot program.

(2)

Rural and highly rural areas— Not fewer than two of the medical centers and five of the ambulatory care facilities or community based outpatient clinics selected under paragraph (1) shall be in States or United States territories that are among the ten States or United States territories with—

(A)

the highest percentage of land designated as highly rural pursuant to the rural-urban commuting area codes set forth by the Department of Agriculture; or

(B)

the highest percentage of enrolled veterans living in rural, highly rural, or insular island areas.

(3)

States— Facilities selected under paragraph (1) shall be located in not fewer than eight different States.

(d)

Use of amounts— Of the amounts used to provide tuition reimbursement or loan repayment under the pilot program—

(1)

one-half shall be used to provide tuition reimbursement or loan repayment for individuals practicing in a general practice position; and

(2)

one-half shall be used to provide tuition reimbursement or loan repayment for individuals practicing—

(A)

in a specialist position; or

(B)

in an occupation, other than a position described in paragraph (1), included in the most recent staffing shortage determination of the Department under section 7412 of title 38, United States Code.

(e)

Tuition reimbursement— Under the pilot program, the Secretary may provide to an individual attending medical school and seeking a degree as a Doctor of Medicine or a Doctor of Osteopathic Medicine full tuition reimbursement in exchange for a five-year commitment to serve at an underserved facility selected under subsection (c).

(f)

Student loan repayment— Under the pilot program, in exchange for a three-year commitment to serve at an underserved facility selected under subsection (c), the Secretary may provide—

(1)

to an individual currently serving as a health care provider at an underserved facility, an amount not to exceed $30,000 to apply to any remaining student loan debt of the individual; and

(2)

to an individual other than an individual described in paragraph (1), an amount not to exceed $50,000 to apply to any remaining student loan debt of the individual.

(g)

Breach— An individual who participates in the pilot program and fails to satisfy a period of obligated service under subsection (d) or (e) shall be liable to the United States, in lieu of such obligated service, for the amount that has been paid or is payable to or on behalf of the individual under the pilot program, reduced by the proportion that the number of days served for completion of the period of obligated service bears to the total number of days in the period of obligated service of such individual.

(h)

Expedited hiring— The Secretary shall ensure that the hiring of individuals to serve in the Department under the pilot program is conducted in an expedited manner.

(i)

Continuation in pilot program— An individual participating in the pilot program in an occupation included in a staffing shortage determination of the Department under section 7412 of title 38, United States Code, may continue participating in the pilot program notwithstanding that the occupation is no longer included in such determination under such section.

(j)

Annual report—

(1)

In general— Not later than one year after the date of the enactment of this Act and not less frequently than once each year thereafter, the Secretary shall submit to Congress a report on the pilot program.

(2)

Contents— Each report submitted under paragraph (1) shall include the following:

(A)

The number of participants, including number receiving tuition reimbursement and student loan repayment.

(B)

The number of facilities where participants are located.

(C)

The number of individuals who have applied to participate in the pilot program.

(D)

A list of the five most common occupations of the participants in the pilot program, other than general practice.

(k)

Definitions— In this section:

(1)

Enrolled veteran— The term enrolled veteran means a veteran who is enrolled in the system of annual patient enrollment established and operated under section 1705(a) of title 38, United States Code.

(2)

Underserved facility— The term underserved facility means a medical center, ambulatory care facility, or community based outpatient clinic of the Department of Veterans Affairs designated by the Secretary of Veterans Affairs pursuant to criteria developed under section 231.

Sec. 233 Program to furnish mobile deployment teams to underserved facilities

(a)

In general— The Secretary of Veterans Affairs shall establish a program to furnish mobile deployment teams of medical personnel to underserved facilities.

(b)

Elements— In furnishing mobile deployment teams under subsection (a), the Secretary shall consider the following elements:

(1)

The medical positions of greatest need at underserved facilities.

(2)

The size and composition of teams to be deployed.

(3)

Such other elements as the Secretary considers necessary for effective oversight of the program established under subsection (a).

(c)

Use of annual analysis— The Secretary shall use the results of the annual analysis conducted under section 231(c) to form mobile deployment teams under subsection (a) that are composed of the most needed medical personnel for underserved facilities.

(d)

Underserved facility defined— In this section, the term underserved facility means a medical center, ambulatory care facility, or community based outpatient clinic of the Department of Veterans Affairs designated by the Secretary of Veterans Affairs pursuant to criteria developed under section 231.

Sec. 234 Inclusion of Vet Center employees in education debt reduction program of Department of Veterans Affairs

(a)

In general— The Secretary of Veterans Affairs shall ensure that clinical staff working at Vet Centers are eligible to participate in the education debt reduction program of the Department of Veterans Affairs under subchapter VII of chapter 76 of title 38, United States Code.

(b)

Report— Not later than one year after the date of the enactment of this Act, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the number of participants in the education debt reduction program of the Department under such subchapter who work at Vet Centers.

(c)

Vet Center defined— In this section, the term Vet Center has the meaning given that term in section 1712A(h) of title 38, United States Code.

C Construction and leases

Sec. 241 Definition of major medical facility project and major medical facility lease

(a)

Modification of definition of medical facility— Section 8101(3) is amended by striking “Secretary” and all that follows through “nursing home,” and inserting “Secretary, or as otherwise authorized by law, for the provision of health-care services (including hospital, outpatient clinic, nursing home,”.

(b)

Modification of definitions of major medical facility project and major medical facility lease— Paragraph (3) of section 8104(a) is amended to read as follows:

“(3) For purposes of this subsection:

“(A) The term major medical facility project means a project for the construction, alteration, or acquisition of a medical facility involving a total expenditure of more than $20,000,000, but such term does not include an acquisition by exchange, non-recurring maintenance projects of the Department, or the construction, alteration, or acquisition of a shared Federal medical facility for which the Department’s estimated share of the project costs does not exceed $20,000,000.

“(B) The term major medical facility lease means a lease for space for use as a new medical facility at an average annual rental equal to or greater than the dollar threshold for leases procured through the General Services Administration under section 3307(a)(2) of title 40, which shall be subject to annual adjustment in accordance with section 3307(h) of such title.”

Sec. 242 Facilitating sharing of medical facilities with other Federal agencies

(a)

In general— Subchapter I of chapter 81 is amended by inserting after section 8111A the following new section:

“8111B. Authority to plan, design, construct, or lease a shared medical facility

“(a) In general

“(1) The Secretary may enter into agreements with other Federal agencies for the planning, designing, constructing, or leasing of shared medical facilities with the goal of improving access to, and quality and cost effectiveness of, health care provided by the Department and other Federal agencies.

“(2) Facilities planned, designed, constructed, or leased under paragraph (1) shall be managed by the Under Secretary for Health.

“(b) Transfer of amounts to other Federal agencies

“(1) The Secretary may transfer to another Federal agency amounts appropriated to the Department for “Construction, Minor Projects” for use for the planning, design, or construction of a shared medical facility if the estimated share of the project costs to be borne by the Department does not exceed the threshold for a major medical facility project under section 8104(a)(3)(A) of this title.

“(2) The Secretary may transfer to another Federal agency amounts appropriated to the Department for “Construction, Major Projects” for use for the planning, design, or construction of a shared medical facility if—

“(A) the estimated share of the project costs to be borne by the Department is more than the threshold for a major medical facility project under subsection (a)(3)(A) of section 8104 of this title; and

“(B) the requirements for such a project under such section have been met.

“(3) The Secretary may transfer to another Federal agency amounts appropriated to the applicable appropriations account of the Department for the purpose of leasing space for a shared medical facility if the estimated share of the lease costs to be borne by the Department does not exceed the threshold for a major medical facility lease under section 8104(a)(3)(B) of this title.

“(c) Transfer of amounts to Department

“(1) Amounts transferred to the Department by another Federal agency for the necessary expenses of planning, designing, or constructing a shared medical facility for which the estimated share of the project costs to be borne by the Department does not exceed the threshold for a major medical facility project under section 8104(a)(3)(A) of this title may be deposited in the “Construction, Minor Projects” account of the Department and used for such necessary expenses.

“(2) Amounts transferred to the Department by another Federal agency for the necessary expenses of planning, designing, or constructing a shared medical facility for which the estimated share of the project costs to be borne by the Department is more than the threshold for a major medical facility project under section 8104(a)(3)(A) of this title may be deposited in the “Construction, Major Projects” account of the Department and used for such necessary expenses if the requirements for such project under section 8104 of this title have been met.

“(3) Amounts transferred to the Department by another Federal agency for the purpose of leasing space for a shared medical facility may be credited to the applicable appropriations account of the Department and shall be available without fiscal year limitation.

“(4) Amounts transferred under paragraphs (1) and (2) shall be available for the same time period as amounts in the account to which those amounts are transferred.”

(b)

Clerical amendment— The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 8111A the following new item:

Sec. 243 Review of enhanced use leases

Section 8162(b)(6) is amended to read as follows:

“(6) The Office of Management and Budget shall review each enhanced-use lease before the lease goes into effect to determine whether the lease is in compliance with paragraph (5).”

Sec. 244 Authorization of certain major medical facility projects of the Department of Veterans Affairs

(a)

Authorization— The Secretary of Veterans Affairs may carry out the following major medical facility project, to be carried out in an amount not to exceed the amount specified for that project: Construction of the new East Bay Community Based Outpatient Clinic and all associated site work, utilities, parking, and landscaping, construction of the Central Valley Engineering and Logistics support facility, and enhanced flood plain mitigation at the Central Valley and East Bay Community Based Outpatient Clinics as part of the realignment of medical facilities in Livermore, California, in an amount not to exceed $117,300,000.

(b)

Authorization of appropriations for construction— There is authorized to be appropriated to the Secretary of Veterans Affairs for fiscal year 2018 or the year in which funds are appropriated for the Construction, Major Projects account, $117,300,000 for the project authorized in subsection (a).

(c)

Submittal of information— Not later than 90 days after the date of the enactment of this Act, for the project authorized in section (a), 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 the following information:

(1)

A line item accounting of expenditures relating to construction management carried out by the Department of Veterans Affairs for such project.

(2)

The future amounts that are budgeted to be obligated for construction management carried out by the Department for such project.

(3)

A justification for the expenditures described in paragraph (1) and the future amounts described in paragraph (2).

(4)

Any agreement entered into by the Secretary regarding a non-Department of Veterans Affairs Federal entity providing management services relating to such project, including reimbursement agreements and the costs to the Department for such services.

D Other health care matters

Sec. 251 Program on use of wellness programs as complementary approach to mental health care for veterans and family members of veterans

(a)

Program required—

(1)

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

(2)

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

(A)

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

(B)

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

(C)

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

(D)

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

(E)

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

(F)

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

(G)

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

(b)

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

(c)

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

(d)

Grant proposals—

(1)

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

(2)

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

(A)

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

(i)

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

(ii)

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

(iii)

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

(B)

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

(C)

Other requirements that the Secretary may prescribe.

(e)

Grant uses—

(1)

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

(2)

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

(f)

Reports—

(1)

Periodic reports—

(A)

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

(B)

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

(i)

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

(ii)

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

(2)

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

(g)

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

Sec. 252 Authorization to provide for operations on live donors for purposes of conducting transplant procedures for veterans

(a)

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

“1788. Transplant procedures with live donors and related services

“(a) In general—Subject to subsections (b) and (c), in a case in which a veteran is eligible for a transplant procedure from the Department, the Secretary may provide for an operation on a live donor to carry out such procedure for such veteran, notwithstanding that the live donor may not be eligible for health care from the Department.

“(b) Other services—Subject to the availability of appropriations for such purpose, the Secretary shall furnish to a live donor any care or services before and after conducting the transplant procedure under subsection (a) that may be required in connection with such procedure.

“(c) Use of non-Department facilities—In carrying out this section, the Secretary may provide for the operation described in subsection (a) on a live donor and furnish to the live donor the care and services described in subsection (b) at a non-Department facility pursuant to an agreement entered into by the Secretary under this chapter. The live donor shall be deemed to be an individual eligible for hospital care and medical services at a non-Department facility pursuant to such an agreement solely for the purposes of receiving such operation, care, and services at the non-Department facility.”

(b)

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

Sec. 253 Sense of the Senate

It is the sense of the Senate that—

(1)

a strong and fully resourced Veterans Health Administration is necessary to effectively serve our veterans community;

(2)

veterans overwhelmingly report that they are satisfied with the care they receive at facilities operated by the Administration;

(3)

research has shown that the Administration produces as good or better outcomes for its patients than private health care systems; and

(4)

the Senate opposes any effort that would weaken the Administration or put the Administration on a path toward privatization.