Division U — Joseph Maxwell Cleland and Robert Joseph Dole Memorial Veterans Benefits and Health Care Improvement Act of 2022

“(i) the Mexican border period;

“(ii) World War I; or

“(iii) World War II;”

Ҥ 7414. Compliance with requirements for examining qualifications and clinical abilities of health care professionals

“(a) Compliance With Credentialing Requirements.—The Secretary shall ensure that each medical center of the Department, in a consistent manner—

“(1) compiles, verifies, and reviews documentation for each health care professional of the Department at such medical center regarding, at a minimum—

“(A) the professional licensure, certification, or registration of the health care professional;

“(B) whether the health care professional holds a Drug Enforcement Administration registration; and

“(C) the education, training, experience, malpractice history, and clinical competence of the health care professional; and

“(2) continuously monitors any changes to the matters under paragraph (1), including with respect to suspensions, restrictions, limitations, probations, denials, revocations, and other changes, relating to the failure of a health care professional to meet generally accepted standards of clinical practice in a manner that presents reasonable concern for the safety of patients.

“(b) Registration Regarding Controlled Substances.—

(1) Except as provided in paragraph (2), the Secretary shall ensure that each covered health care professional holds an active Drug Enforcement Administration registration.

“(2) The Secretary shall—

“(A) determine the circumstances in which a medical center of the Department must obtain a waiver under section 302(d) of the Controlled Substances Act (21 U.S.C. 822(d)) with respect to covered health care professionals; and

“(B) establish a process for medical centers to request such waivers.

“(3) In carrying out paragraph (1), the Secretary shall ensure that each medical center of the Department monitors the Drug Enforcement Administration registrations of covered health care professionals at such medical center in a manner that ensures the medical center is made aware of any change in status in the registration by not later than seven days after such change in status.

“(4) If a covered health care professional does not hold an active Drug Enforcement Administration registration, the Secretary shall carry out any of the following actions, as the Secretary determines appropriate:

“(A) Obtain a waiver pursuant to paragraph (2).

“(B) Transfer the health care professional to a position that does not require prescribing, dispensing, administering, or conducting research with controlled substances.

“(C) Take appropriate actions under subchapter V of this chapter, with respect to an employee of the Department, or take appropriate contract administration actions, with respect to a contractor of the Department.

“(c) Reviews of Concerns Relating to Quality of Clinical Care.—

(1) The Secretary shall ensure that each medical center of the Department, in a consistent manner, carries out—

“(A) ongoing, retrospective, and comprehensive monitoring of the performance and quality of the health care delivered by each health care professional of the Department located at the medical center, including with respect to the safety of such care; and

“(B) timely and documented reviews of such care if an individual notifies the Secretary of any potential concerns relating to a failure of a health care professional of the Department to meet generally accepted standards of clinical practice in a manner that presents reasonable concern for the safety of patients.

“(2) The Secretary shall establish a policy to carry out paragraph (1), including with respect to—

“(A) determining the period by which a medical center of the Department must initiate the review of a concern described in subparagraph (B) of such paragraph following the date on which the concern is received; and

“(B) ensuring the compliance of each medical center with such policy.

“(d) Compliance With Requirements for Reporting Quality of Care Concerns.—If the Secretary substantiates a concern relating to the clinical competency of, or quality of care delivered by, a health care professional of the Department (including a former health care professional of the Department), the Secretary shall ensure that the appropriate medical center of the Department timely notifies the following entities of such concern, as appropriate:

“(1) The appropriate licensing, registration, or certification body in each State in which the health care professional is licensed, registered, or certified.

“(2) The Drug Enforcement Administration.

“(3) The National Practitioner Data Bank established pursuant to the Health Care Quality Improvement Act of 1986 (42 U.S.C. 11101 et seq.).

“(4) Any other relevant entity.

“(e) Prohibition on Certain Settlement Agreement Terms.—

(1) The Secretary may not enter into a settlement agreement relating to an adverse action against a health care professional of the Department if such agreement includes terms that require the Secretary to conceal from the personnel file of the employee a serious medical error or lapse in clinical practice that constitutes a substantial failure to meet generally accepted standards of clinical practice as to raise reasonable concern for the safety of patients.

“(2) Nothing in paragraph (1) limits—

“(A) the right of an employee to appeal a quality of care determination; or

“(B) the rights of an employee under sections 1214 and 1221 of title 5.

“(f) Training.—Not less frequently than annually, the Secretary shall provide mandatory training on the following duties to employees of the Department who are responsible for performing such duties:

“(1) Compiling, validating, or reviewing the credentials of health care professionals of the Department.

“(2) Reviewing the quality of clinical care delivered by health care professionals of the Department.

“(3) Taking adverse privileging actions or making determinations relating to other disciplinary actions or employment actions against health care professionals of the Department for reasons relating to the failure of a health care professional to meet generally accepted standards of clinical practice in a manner that presents reasonable concern for the safety of patients.

“(4) Making notifications under subsection (d).

“(g) Definitions.—In this section:

“(1) The term ‘controlled substance’ has the meaning given that term in section 102 of the Controlled Substances Act (21 U.S.C. 802).

“(2) The term ‘covered health care professional’ means an individual employed in a position as a health care professional of the Department, or a contractor of the Department, that requires the individual to be authorized to prescribe, dispense, administer, or conduct research with, controlled substances.

“(3) The term ‘Drug Enforcement Administration registration’ means registration with the Drug Enforcement Administration under section 303 of the Controlled Substances Act (21 U.S.C. 823) 302 of the Controlled Substances Act (21 U.S.C. 822) by health care practitioners authorized to dispense, prescribe, administer, or conduct research with, controlled substances.

“(4) The term ‘health care professional of the Department’ means an individual working for the Department in a position described in section 7401 of this title, including a contractor of the Department serving in such a position.”

“7414. Compliance with requirements for examining qualifications and clinical abilities of health care professionals.”.

“(3) Any veteran who has been determined by the Secretary to be catastrophically disabled, as defined in section 17.36(e) of title 38, Code of Federal Regulations, or successor regulations, and on whose behalf the Secretary is paying a per diem for nursing home or domiciliary care in a State home under this chapter.”

Ҥ 7330D. Inapplicability of Paperwork Reduction Act to research activities

“Subchapter I of chapter 35 of title 44 (commonly referred to as the ‘Paperwork Reduction Act’) shall not apply to the voluntary collection of information during the conduct of research by the Veterans Health Administration, including the Office of Research and Development, or individuals or entities affiliated with the Veterans Health Administration.”

“(1) “7330D. Inapplicability of Paperwork Reduction Act to research activities.”.

“SUBCHAPTER V— RESEARCH AND DEVELOPMENT

Ҥ 7381. Office of Research and Development

“(a) Office of Research and Development.—There is in the Veterans Health Administration an Office of Research and Development (in this section referred to as the ‘Office’).

“(b) Purposes.—The function of the Office is to serve veterans through a full spectrum of research (including pre-clinical, clinical, and health systems science), technology transfer, and application.

“(c) Chief Research and Development Officer.—The head of the Office is the Chief Research and Development Officer.

“(d) Organization and Personnel.—The Office shall be organized in such manner, and its personnel shall perform such duties and have such titles, as the Secretary may prescribe.

Ҥ 7382. Research personnel

“(a) Waiver of Intergovernmental Personnel Act Mobility Program Limits.—The Secretary may waive the limit on the period and number of assignments required under section 3372(a) of title 5 with respect to an individual who performs research for the Department under the mobility program under subchapter VI of chapter 33 of such title (commonly referred to as the ‘Intergovernmental Personnel Act Mobility Program’).

“(b) Outside Earned Income for Research for the Department.—

(1) Compensation from a nonprofit corporation established under subchapter IV of this chapter, or a university affiliated with the Department, may be paid, without regard to section 209 of title 18, to an employee described in paragraph (2), for research conducted pursuant to section 7303 of this title if—

“(A) the research has been approved in accordance with procedures prescribed by the Under Secretary for Health;

“(B) the employee conducts research under the supervision of personnel of the Department; and

“(C) the Secretary agreed to the terms of such compensation in writing.

“(2) An employee described in this subsection is an employee who has an appointment within the Department, whether with or without compensation, and without regard to the source of such compensation.”

“subchapter v— research and development

“7381. Office of Research and Development.

“7382. Research personnel.”.

Ҥ 1722C. Copayments: prohibition on collection of copayments for first three mental health care outpatient visits of veterans

“(a) Prohibition.—Except as provided in subsection (b), notwithstanding section 1710(g) of this title or any other provision of law, the Secretary may not impose or collect a copayment for the first three mental health care outpatient visits of a veteran in a calendar year for which the veteran would otherwise be required to pay a copayment under the laws administered by the Secretary.

“(b) Copayment for Medications.—The prohibition under subsection (a) shall not apply with respect to the imposition or collection of copayments for medications pursuant to section 1722A of this title.

“(c) Mental Health Care Outpatient Visit Defined.—In this section, the term ‘mental health care outpatient visit’ means an outpatient visit with a qualified mental health professional for the primary purpose of seeking mental health care or treatment for substance abuse disorder.

“(d) Sunset.—This section shall terminate on the date that is five years after the date of the enactment of the Joseph Maxwell Cleland and Robert Joseph Dole Memorial Veterans Benefits and Health Care Improvement Act of 2022.”

Ҥ 1704A. Independent assessments of health care delivery systems and management processes

“(a) Independent Assessments.—

(1) Not less frequently than once every 10 years, the Secretary shall enter into one or more contracts with a private sector entity or entities described in subsection (d) to conduct an independent assessment of the hospital care, medical services, and other health care furnished by the Department.

“(2) Each assessment required under paragraph (1) shall address each of the following:

“(A) Current and projected demographics and unique health care needs of the patient population served by the Department.

“(B) The accuracy of models and forecasting methods used by the Department to project health care demand, including with respect to veteran demographics, rates of use of health care furnished by the Department, the inflation of health care costs, and such other factors as may be determined relevant by the Secretary.

“(C) The reliability and accuracy of models and forecasting methods used by the Department to project the budgetary needs of the Veterans Health Administration and how such models and forecasting methods inform budgetary trends.

“(D) The authorities and mechanisms under which the Secretary may furnish hospital care, medical services, and other health care at facilities of the Department and non-Department facilities, including through Federal and private sector partners and at joint medical facilities, and the effect of such authorities and mechanisms on eligibility and access to care.

“(E) The organization, workflow processes, and tools used by the Department to support clinical staffing, access to care, effective length-of-stay management and care transitions, positive patient experience, accurate documentation, and subsequent coding of inpatient services.

“(F) The efforts of the Department to recruit and retain staff at levels necessary to carry out the functions of the Veterans Health Administration and the process used by the Department to determine staffing levels necessary for such functions.

“(G) The staffing level at each medical facility of the Department and the productivity of each health care provider at the medical facility, compared with health care industry performance metrics, which may include the following:

“(i) An assessment of the case load of, and number of patients treated by, each health care provider at such medical facility during an average week.

“(ii) An assessment of the time spent by each such health care provider on matters other than the case load of the health care provider, including time spent by the health care provider as follows:

“(I) At a medical facility that is affiliated with the Department.

“(II) Conducting research.

“(III) Training or supervising other health care professionals of the Department.

“(iii) An assessment of the complexity of health care conditions per patient treated by each health care provider at such medical facility during an average week.

“(H) The information technology strategies of the Department with respect to furnishing and managing health care, including an identification of any weaknesses or opportunities with respect to the technology used by the Department, especially those strategies with respect to clinical documentation of hospital care, medical services, and other health care, including any clinical images and associated textual reports, furnished by the Department in facilities of the Department or non-Department facilities.

“(I) Business processes of the Veterans Health Administration, including processes relating to furnishing non-Department health care, insurance identification, third-party revenue collection, and vendor reimbursement, including an identification of mechanisms as follows:

“(i) To avoid the payment of penalties to vendors.

“(ii) To increase the collection of amounts owed to the Department for hospital care, medical services, or other health care provided by the Department for which reimbursement from a third party is authorized and to ensure that such amounts collected are accurate.

“(iii) To increase the collection of any other amounts owed to the Department with respect to hospital care, medical services, or other health care and to ensure that such amounts collected are accurate.

“(iv) To increase the accuracy and timeliness of payments by the Department to vendors and providers.

“(v) To reduce expenditures while improving the quality of care furnished.

“(J) The purchase, distribution, and use of pharmaceuticals, medical and surgical supplies, medical devices, and health care-related services by the Department, including the following:

“(i) The prices paid for, standardization of, and use by, the Department with respect to the following:

“(I) Pharmaceuticals.

“(II) Medical and surgical supplies.

“(III) Medical devices.

“(ii) The use by the Department of group purchasing arrangements to purchase pharmaceuticals, medical and surgical supplies, medical devices, and health care-related services.

“(iii) The strategy and systems used by the Department to distribute pharmaceuticals, medical and surgical supplies, medical devices, and health care-related services to Veterans Integrated Service Networks and medical facilities of the Department.

“(K) The competency of Department leadership with respect to culture, accountability, reform readiness, leadership development, physician alignment, employee engagement, succession planning, and performance management.

“(L) The effectiveness of the authorities and programs of the Department to educate and train health personnel pursuant to section 7302 of this title.

“(M) The conduct of medical and prosthetic research of the Department.

“(N) The provision of assistance by the Department to Federal agencies and personnel involved in responding to a disaster or emergency.

“(O) Such additional matters as may be determined relevant by the Secretary.

“(b) Timing.—The private sector entity or entities carrying out an assessment pursuant to subsection (a) shall complete such assessment not later than 18 months after entering into the contract described in such paragraph.

“(c) Leveraging of Existing Data and Contracts.—To the extent practicable, the private sector entity or entities carrying out an assessment pursuant to subsection (a) shall—

“(1) make maximum use of existing data that has been compiled by the Department, compiled for the Department, or purchased by the Department, including data that has been collected for—

“(A) the performance of quadrennial market assessments under section 7330C of this title;

“(B) the quarterly publication of information on staffing and vacancies with respect to the Veterans Health Administration pursuant to section 505 of the VA MISSION Act of 2018 (Public Law 115–182; 38 U.S.C. 301 note); and

“(C) the conduct of annual audits pursuant to section 3102 of the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020 (Public Law 116–315; 38 U.S.C. 1701 note).

“(2) maximize the use of existing contracts and other agreements of the Department for studies, analysis, data collection, or research in order to efficiently fulfill the requirements of this section.

“(d) Private Sector Entities Described.—A private sector entity described in this subsection is a private entity that—

“(1) has experience and proven outcomes in optimizing the performance of national health care delivery systems, including the Veterans Health Administration, other federal health care systems, and systems in the private, non-profit, or public health care sector;

“(2) specializes in implementing large-scale organizational and cultural transformations, especially with respect to health care delivery systems; and

“(3) is not currently under contract with the Department to provide direct or indirect patient care or related clinical care services or supplies under the laws administered by the Secretary.

“(e) Program Integrator.—

(1) If the Secretary enters into contracts with more than one private sector entity under subsection (a) with respect to a single assessment under such subsection, the Secretary shall designate one such entity as the program integrator.

“(2) The program integrator designated pursuant to paragraph (1) shall be responsible for coordinating the outcomes of the assessments conducted by the private sector entities pursuant to such contracts.

“(f) Reports.—

(1)

(A) Not later than 60 days after completing an assessment pursuant to subsection (a), the private sector entity or entities carrying out such assessment shall submit to the Secretary and the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the findings and recommendations of the private sector entity or entities with respect to such assessment.

“(B) Each report under subparagraph (A) with respect to an assessment shall include an identification of the following:

“(i) Any changes with respect to the matters included in such assessment since the date that is the later of the following:

“(I) The date on which the independent assessment under section 201 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note) was completed.

“(II) The date on which the last assessment under subsection (a) was completed.

“(ii) Any recommendations regarding matters to be covered by subsequent assessments under subsection (a), including any additional matters to include for assessment or previously assessed matters to exclude.

“(2) Not later than 30 days after receiving a report under paragraph (1), the Secretary shall publish such report in the Federal Register and on a publicly accessible internet website of the Department.

“(3) Not later than 90 days after receiving a report under paragraph (1), 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 outlining the feasibility and advisability of implementing the recommendations made by the private sector entity or entities in such report received, including an identification of the timeline, cost, and any legislative authorities necessary for such implementation.

“(g) Sunset.—The requirement to enter into contracts under subsection (a) shall terminate on December 31, 2055.”

“1704A. Independent assessments of health care delivery systems and management processes.”.

“(i)

(1) The Secretary, in consultation with the advisory group established under paragraph (3)(A), shall prescribe regulations and issue guidance to assist lenders in evaluating the sufficiency of the residual income of a veteran pursuant to paragraph (2).

“(2)

(A) Pursuant to the regulations and guidance prescribed under paragraph (1), in the case of a loan to a veteran to be guaranteed under this chapter, if the veteran provides to the lender an energy efficiency report described in subparagraph (B) —

“(i) the evaluation by the lender of the sufficiency of the residual income of the veteran shall include a consideration of the estimate of the expected energy cost savings contained in the report; and

“(ii) the lender may apply the underwriting expertise of the lender in adjusting the residual income of the veteran in accordance with the information in the report.

“(B) An energy efficiency report described in this subparagraph is a report made with respect to a home for which a loan is to be guaranteed under this chapter that includes each of the following:

“(i) An estimate of the expected energy cost savings specific to the home, based on specific information about the home, including savings relating to electricity or natural gas, oil, and any other fuel regularly used to supply energy to the home.

“(ii) Any information required to be included pursuant to the regulations and guidance and regulations prescribed by the Secretary under paragraph (1).

“(iii) Information with respect to the energy efficiency of the home as determined pursuant to—

“(I) the Residential Energy Service Network’s Home Energy Rating System (commonly know as ‘HERS’) by an individual certified by such Network; or

“(II) an other method determined appropriate by the Secretary, in consultation with the advisory group under paragraph (3), including with respect to third-party quality assurance procedures.

“(3)

(A) To assist the Secretary in carrying out this subsection, the Secretary shall establish an advisory group consisting of individuals representing the interests of—

“(i) mortgage lenders;

“(ii) appraisers;

“(iii) energy raters and residential energy consumption experts;

“(iv) energy efficiency organizations;

“(v) real estate agents;

“(vi) home builders and remodelers;

“(vii) consumer advocates;

“(viii) veterans’ service organizations; and

“(ix) other persons determined appropriate by the Secretary.

“(B) The advisory group established under subparagraph (A) shall not be subject to the Federal Advisory Committee Act (5 U.S.C. App.).

“(4) The Secretary shall ensure that marketing materials that the Secretary provides to veterans with respect to loans guaranteed under this chapter include information regarding the use of energy efficiency reports under this subsection.

“(5) Not later than one year after the date on which the Secretary issues the regulations and guidance pursuant to paragraph (2), and every year thereafter, the Secretary shall submit to Congress and make publicly available a report that includes the following information for the year covered by the report:

“(A) An enumeration of the number of loans guaranteed under this chapter for which a veteran provided to the Secretary an energy efficiency report under this subsection, including the number of such loans for which cost savings were taken into account pursuant to paragraph (1).

“(B) Of the number of loans enumerated under subparagraph (A), an enumeration of the default rates and rates of foreclosure, including how such enumeration compares with the default rates and rates of foreclosure for guaranteed loans for which no energy efficiency report is provided.”

“(4) Death of transferor.—

“(A) In general.—The death of an individual transferring an entitlement under this section shall not affect the use of the entitlement by the dependent to whom the entitlement is transferred.

“(B) Death prior to transfer to designated transferees.—

(i) In the case of an eligible individual whom the Secretary has approved to transfer the individual’s entitlement under this section who, at the time of death, is entitled to educational assistance under this chapter and has designated a transferee or transferees under subsection (e) but has not transferred all of such entitlement to such transferee or transferees, the Secretary shall transfer the entitlement of the individual under this section by evenly distributing the amount of such entitlement between all such transferees who would not be precluded from using some or all of the transferred benefits due to the expiration of time limitations found in paragraph (5) of this subsection or section 3321 of this title, notwithstanding the limitations under subsection (f).

“(ii) If a transferee cannot use all of the transferred benefits under clause (i) because of expiration of a time limitation, the unused benefits will be distributed among the other designated transferees who would not be precluded from using some or all of the transferred benefits due to expiration of time limitations found in paragraph (5) of this subsection or section 3321 of this title, unless or until there are no transferees who would not be precluded from using the transferred benefits because of expiration of a time limitation.”

Ҥ 3691A. Withdrawal or leave of absence from certain education

“(a) In General.—

(1) A covered member may, after receiving orders to enter a period of covered service, withdraw or take a leave of absence from covered education.

“(2)

(A) The institution concerned may not take any adverse action against a covered member on the basis that such covered member withdraws or takes a leave of absence under paragraph (1).

“(B) Adverse actions under subparagraph (A) include the following:

“(i) The assignment of a failing grade to a covered member for covered education.

“(ii) The reduction of the grade point average of a covered member for covered education.

“(iii) The characterization of any absence of a covered member from covered education as unexcused.

“(iv) The assessment of any financial penalty against a covered member.

“(b) Withdrawal.—If a covered member withdraws from covered education under subsection (a), the institution concerned shall refund all tuition and fees (including payments for housing) for the academic term from which the covered member withdraws.

“(c) Leave of Absence.—If a covered member takes a leave of absence from covered education under subsection (a), the institution concerned shall—

“(1) assign a grade of ‘incomplete’ (or equivalent) to the covered member for covered education for the academic term from which the covered member takes such leave of absence; and

“(2) to the extent practicable, permit the covered member, upon completion of the period covered service, to complete such academic term.

“(d) Definitions.—In this section:

“(1) The term ‘covered education’ means a course of education—

“(A) at an institution of higher education; and

“(B) paid for with educational assistance furnished under a law administered by the Secretary.

“(2) The term ‘covered member’ means a member of the Armed Forces (including the reserve components) enrolled in covered education.

“(3) The term ‘covered service’ means—

“(A) active service or inactive-duty training, as such terms are defined in section 101 of title 10; or

“(B) State active duty, as defined in section 4303 of this title.

“(4) The term ‘institution concerned’ means, with respect to a covered member, the institution of higher education where the covered member is enrolled in covered education.

“(5) The term ‘institution of higher education’ has the meaning given such term in section 101 of the Higher Education Act of 1965 (20 U.S.C. 1001).

“(6) The term ‘period of covered service’ means the period beginning on the date on which a covered member enters covered service and ending on the date on which the covered member is released from covered service or dies while in covered service.”

“3691A. Withdrawal or leave of absence from certain education.”.

“(h)

(1) In the case of a veteran who is eligible for a vocational rehabilitation program under this chapter and who is prevented from participating in the vocational rehabilitation program within the period of eligibility prescribed in subsection (a) because of a covered reason, as determined by the Secretary, such period of eligibility—

“(A) shall not run during the period the veteran is so prevented from participating in such program; and

“(B) shall again begin running on a date determined by the Secretary that is—

“(i) not earlier than the first day after the veteran is able to resume participation in a vocational rehabilitation program under this chapter; and

“(ii) not later than 90 days after that day.

“(2) In this subsection, a covered reason is—

“(A) the temporary or permanent closure of an educational institution by reason of an emergency situation; or

“(B) another reason that prevents the veteran from participating in the vocational rehabilitation program, as determined by the Secretary.”