Title VI — Health Care Matters

114th Congress · Approved Dec 16, 2016 · 130 Stat. 1536

TITLE VI Health Care Matters

Subtitle A Medical Care

SEC. 601. Requirement for Advance Appropriations for the Medical Community Care Account of the Department of Veterans Affairs.

(a)

In General.— Section 117(c) is amended by adding at the end the following new paragraph:

“(7) Veterans Health Administration, Medical Community Care.”

(b)

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.”

(c)

Applicability.— The amendments made by this section shall apply to fiscal years beginning on and after October 1, 2017.

SEC. 602. Improved Access to Appropriate Immunizations for Veterans.

(a)

Inclusion of Recommended Adult Immunizations as Medical Services.—

(1)

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

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

(2)

Recommended adult immunization schedule defined.— Section 1701 is amended by adding 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.”

(b)

Inclusion of Recommended Adult Immunizations in Annual Report.— Section 1704(1)(A) is amended—

(1)

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

(2)

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

(3)

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

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

(c)

Report to Congress.—

(1)

In general.— Not later than 2 years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the development and implementation by the Department of Veterans Affairs of quality measures and metrics, including targets for compliance, to ensure that veterans receiving medical services under chapter 17 of title 38, United States Code, receive each immunization on the recommended adult immunization schedule at the time such immunization is indicated on that schedule.

(2)

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

(d)

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. 603. Priority of Medal of Honor Recipients in Health Care System of Department of Veterans Affairs.

(a)

Enrollment Priority.—

(1)

In general.— Section 1705(a) is amended—

(A)

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

(B)

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,”.

(2)

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.

(b)

Eligibility.— Section 1710(a)(2)(D) 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,”.

(c)

Extended Care Services.— Section 1710B(c)(2) is amended—

(1)

in subparagraph (B), by striking “ or”;

(2)

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

(3)

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.”

(d)

Copayment for Medications.— Section 1722A(a)(3) is amended—

(1)

in subparagraph (B), by striking “ or”;

(2)

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

(3)

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.”

SEC. 604. Requirement That Department of Veterans Affairs Collect Health-Plan Contract Information from Veterans.

(a)

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.”

(b)

Clerical Amendment.— The table of sections at the beginning of chapter 17 is amended by inserting after the item relating to section 1705 the following new item:

“1705A. Management of health care: information regarding health-plan contracts.”.

SEC. 605. Mental Health Treatment for Veterans Who Served in Classified Missions.

(a)

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.

(b)

In General.— Subchapter II of chapter 17 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 eligible to receive health care furnished by the Department under 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 an 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.”

(c)

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

“1720H. Mental health treatment for veterans who served in classified missions.”.

SEC. 606. Examination and Treatment by Department of Veterans Affairs for Emergency Medical Conditions and Women in Labor.

(a)

In General.— Subchapter VIII of chapter 17 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) in the case of a pregnant woman, a stage of labor that a medical provider determines indicates—

“(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.”

(b)

Clerical Amendment.— The table of sections at the beginning of chapter 17 is amended by inserting after the item relating to section 1784 the following new item:

“1784A. Examination and treatment for emergency medical conditions and women in labor.”.

Subtitle B Veterans Health Administration

SEC. 611. Time Period Covered by Annual Report on Readjustment Counseling Service.

Section 7309(e)(1) is amended by striking “ calendar year” and inserting “ fiscal year”.

SEC. 612. Annual Report on Veterans Health Administration and Furnishing of Hospital Care, Medical Services, and Nursing Home Care.

(a)

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

“§ 7330B. 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.”

(b)

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

“7330B. Annual report on Veterans Health Administration and furnishing of hospital care, medical services, and nursing home care.”.

SEC. 613. Expansion of Qualifications for Licensed Mental Health Counselors of the Department of Veterans Affairs to Include Doctoral Degrees.

Section 7402(b)(11)(A) is amended by inserting “ or doctoral degree” after “ master’s degree”.

SEC. 614. Modification of Hours of Employment for Physicians Employed by the Department of Veterans Affairs.

Section 7423(a) of title 38, United States Code, is amended—

(1)

by striking “ (a) The hours” and inserting “ (a)(1) Except as provided in paragraph (2), the hours”; and

(2)

by adding at the end the following new paragraph:

“(2)

(A) Upon the advance written request of a covered physician, the Secretary may modify the hours of employment for a physician appointed in the Administration under any provision of this chapter on a full-time basis to be more or less than 80 hours in a biweekly pay period, subject to the requirements in subparagraph (B). For the purpose of determining pay, such a physician shall be deemed to have a biweekly schedule of 80 hours of employment.

“(B) A physician with an irregular work schedule established under subparagraph (A) shall be obligated to account for at least 2,080 hours of employment (through performance of work or use of leave or paid time off) in a calendar year.

“(C) The Secretary may prescribe regulations to implement this paragraph, including regulations making adjustments to address the annual hours requirement for physicians who are covered by this paragraph for only a portion of a calendar year.”

SEC. 615. Repeal of Compensation Panels to Determine Market Pay for Physicians and Dentists.

Section 7431(c) is amended—

(1)

by striking paragraph (4);

(2)

by redesignating paragraphs (5), (6), and (7) as paragraphs (4), (5), and (6), respectively; and

(3)

in paragraph (6), as so redesignated, by striking “ under paragraph (6)” and inserting “ under paragraph (5)”.

SEC. 616. Clarification Regarding Liability for Breach of Agreement under Department of Veterans Affairs Employee Incentive Scholarship Program.

Section 7675(b)(1)(E) is amended by striking “ In the case of a participant who is a part-time student, the” and inserting “ The”.

SEC. 617. Extension of Period for Increase in Graduate Medical Education Residency Positions at Medical Facilities of the Department of Veterans Affairs.

(a)

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—

(1)

in the paragraph heading, by striking “ Five-year” and inserting “ Ten-year”; and

(2)

in subparagraph (A), by striking “ 5-year period” and inserting “ 10-year period”.

(b)

Report.— Paragraph (3)(A) of such section is amended by striking “ 2019” and inserting “ 2024”.

SEC. 618. Report on Public Access to Research by Department of Veterans Affairs.

(a)

In General.— Not later than each of 180 days and 1 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.

(b)

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

(1)

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.

(2)

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:

(A)

Compliance of Department investigators with requirements relating to ensuring that research funded by the Department is accessible by the public.

(B)

Ensuring data management plans of the Department include provisions for long-term preservation of the scientific data resulting from research funded by the Department.

(3)

An explanation of the factors used to evaluate the merit of data management plans of research funded by the Veterans Health Administration.

(4)

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.

SEC. 619. Authorization of Certain Major Medical Facility Projects of the Department of Veterans Affairs.

(a)

In General.— 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:

(1)

Seismic, life safety, and utilities upgrades and expansion of clinical services in Reno, Nevada, in an amount not to exceed $213,800,000.

(2)

Seismic corrections to the mental health and community living center in Long Beach, California, in an amount not to exceed $317,300,000.

(b)

Authorization of Appropriations.— There is authorized to be appropriated to the Secretary of Veterans Affairs for fiscal year 2017 or the year in which funds are appropriated for the Construction, Major Projects, account $531,100,000 for the projects authorized in subsection (a).

(c)

Limitation.— The projects authorized in subsection (a) may only be carried out using—

(1)

funds appropriated for fiscal year 2017 or the year in which funds are appropriated for the Construction, Major Projects, account pursuant to the authorization of appropriations in subsection (b);

(2)

funds available for Construction, Major Projects, for a fiscal year before fiscal year 2017 that remain available for obligation;

(3)

funds available for Construction, Major Projects, for a fiscal year after fiscal year 2017 that remain available for obligation;

(4)

funds appropriated for Construction, Major Projects, for fiscal year 2017 for a category of activity not specific to a project;

(5)

funds appropriated for Construction, Major Projects, for a fiscal year before fiscal year 2017 for a category of activity not specific to a project; and

(6)

funds appropriated for Construction, Major Projects, for a fiscal year after fiscal year 2017 for a category of activity not specific to a project.

Subtitle C Toxic Exposure

SEC. 631. Definitions.

In this subtitle:

(1)

Armed forces.— The term “Armed Forces” means the United States Army, Navy, Marine Corps, Air Force, and Coast Guard.

(2)

Descendant.— The term “descendant” means, with respect to an individual, the biological child or grandchild of that individual.

(3)

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.

(4)

Veteran.— The term “veteran” has the meaning given that term in section 101 of title 38, United States Code.

SEC. 632. National Academy of Medicine Assessment on Research Relating to the Descendants of Individuals with Toxic Exposure.

(a)

In General.—

(1)

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.

(2)

Alternate organization.—

(A)

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—

(i)

is not part of the Federal Government;

(ii)

operates as a not-for-profit entity; and

(iii)

has expertise and objectivity comparable to that of the National Academy of Medicine.

(B)

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.

(b)

Elements.— The assessment conducted pursuant to the agreement entered into under subsection (a) shall include the following:

(1)

A scientific review of the scientific literature regarding toxicological and epidemiological research on descendants of individuals with toxic exposure.

(2)

An assessment of areas requiring further scientific study relating to the descendants of veterans with toxic exposure.

(3)

An assessment of the scope and methodology required to conduct adequate scientific research relating to the descendants of individuals with toxic exposure, including—

(A)

the types of individuals to be studied, including veterans with toxic exposure and the descendants of those veterans;

(B)

the number of veterans and descendants described in subparagraph (A) to be studied;

(C)

the potential alternatives for participation in such a study, including whether it would be necessary for participants to travel in order to participate;

(D)

the approximate amount of time and resources needed to prepare and conduct the research; and

(E)

the appropriate Federal agencies to participate in the research, including the Department of Defense and the Department of Veterans Affairs.

(4)

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—

(A)

sufficient evidence of a causal relationship;

(B)

sufficient evidence of an association;

(C)

limited or suggestive evidence of an association;

(D)

inadequate or insufficient evidence to determine whether an association exists; and

(E)

limited or suggestive evidence of no association.

(5)

An analysis of—

(A)

the feasibility of conducting scientific research to address the areas that require further study as described under paragraph (2);

(B)

the value and relevance of the information that could result from such scientific research; and

(C)

for purposes of conducting further research, the feasibility and advisability of accessing additional information held by a Federal agency that may be sensitive.

(6)

An identification of a research entity or entities with—

(A)

expertise in conducting research on health conditions of descendants of individuals with toxic exposure; and

(B)

an ability to conduct research on those health conditions to address areas requiring further scientific study as described under paragraph (2).

(c)

Report.— The agreement entered into under subsection (a) shall require the National Academy of Medicine to submit, not later than 2 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—

(1)

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

(2)

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.

(d)

Certification.—

(1)

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.

(2)

Basis for certification.— The certification submitted under paragraph (1) shall include an explanation of the basis for the certification.

SEC. 633. Advisory Board on Research Relating to Health Conditions of Descendants of Veterans with Toxic Exposure While Serving in the Armed Forces.

(a)

Establishment.— Unless the Secretary of Veterans Affairs certifies under section 632(d) that the results of the assessment and determination under section 632(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 634, 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.

(b)

Membership.—

(1)

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—

(A)

shall select not more than 13 voting members of the Advisory Board, of whom—

(i)

not less than two shall be members of organizations exempt from taxation under section 501(c)(19) of the Internal Revenue Code of 1986;

(ii)

not less than two shall be descendants of veterans with toxic exposure while serving as members of the Armed Forces; and

(iii)

not less than seven shall be health professionals, scientists, or academics who are not employees of the Federal Government and have expertise in—

(I)

birth defects;

(II)

developmental disabilities;

(III)

epigenetics;

(IV)

public health;

(V)

the science of environmental exposure or environmental exposure assessment;

(VI)

the science of toxic substances; or

(VII)

medical and research ethics; and

(B)

may select not more than two nonvoting members who are employees of the Federal Government and who are otherwise described in subparagraph (A)(iii).

(2)

Chair.— The Secretary shall select a Chair from among the members of the Advisory Board selected under paragraph (1)(A).

(3)

Terms.—

(A)

In general.— Each member of the Advisory Board shall serve a term of 2 or 3 years as determined by the Secretary.

(B)

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 4 consecutive terms.

(c)

Duties.— The Advisory Board shall—

(1)

advise the Secretary in the selection of a research entity or entities to conduct research under section 634 from among those identified under section 632(b)(6);

(2)

advise such entity or entities and assess the activities of such entity or entities in conducting such research;

(3)

develop a research strategy for such entity or entities based on, but not limited to, the results of the assessment conducted under section 632;

(4)

advise the Secretary with respect to the activities of such entity or entities under section 634;

(5)

submit recommendations to be included by such entity or entities in the report under section 634(d)(2)(C); and

(6)

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 634.

(d)

Meetings.— The Advisory Board shall meet at the call of the Chair, but not less frequently than semiannually.

(e)

Compensation.— The members of the Advisory Board shall serve without compensation.

(f)

Expenses.— The Secretary of Veterans Affairs shall determine the appropriate expenses of the Advisory Board.

(g)

Personnel.—

(1)

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.

(2)

Approval.— The appointment of an executive director under paragraph (1) shall be subject to approval by the Advisory Board.

(3)

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. 634. Research Relating to Health Conditions of Descendants of Veterans with Toxic Exposure While Serving in the Armed Forces.

(a)

In General.— Unless the Secretary of Veterans Affairs certifies under section 632(d) that the results of the assessment and determination under section 632(c) indicate that it is not feasible to conduct further research regarding health conditions of descendants of veterans with toxic exposure, not later than 1 year after receiving such results and determination, the Secretary shall (in consultation with the advisory board established under section 633 (in this section referred to as the “Advisory Board”)) enter into an agreement with one or more research entities identified under section 632(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”).

(b)

Research.—

(1)

In general.— To the extent included in the research strategy developed by the Advisory Board under section 633(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.

(2)

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 632(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.

(3)

Categorization.— In conducting research under paragraph (1), the research entity or entities shall assess, using the categories established under section 632(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.

(c)

Availability of Records.—

(1)

In general.— The Secretary of Defense, the Secretary of Veterans Affairs, and the head of each Federal agency identified under section 632(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.

(2)

Mechanism for access.— The Secretary of Veterans Affairs, the Secretary of Defense, and the head of each Federal agency identified under section 632(b)(3)(E) shall jointly establish a mechanism for access by the research entity or entities to records made available under paragraph (1).

(d)

Annual Report.—

(1)

In general.— Not later than 1 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.

(2)

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

(A)

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.

(B)

A description of any findings made during such year in carrying out such research efforts.

(C)

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.

(3)

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).

Title VI — Health Care Matters