[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 425 Reported in Senate (RS)]
<DOC>
Calendar No. 716
114th CONGRESS
2d Session
S. 425
[Report No. 114-395]
To amend title 38, United States Code, to provide for a five-year
extension to the homeless veterans reintegration programs and to
provide clarification regarding eligibility for services under such
programs.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
February 10, 2015
Mr. Boozman (for himself, Mr. Tester, Mr. Inhofe, and Mr. Schumer)
introduced the following bill; which was read twice and referred to the
Committee on Veterans' Affairs
December 7, 2016
Reported by Mr. Isakson, with an amendment and an amendment to the
title
[Strike out all after the enacting clause and insert the part printed
in italic]
_______________________________________________________________________
A BILL
To amend title 38, United States Code, to provide for a five-year
extension to the homeless veterans reintegration programs and to
provide clarification regarding eligibility for services under such
programs.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
<DELETED>SECTION 1. SHORT TITLE.</DELETED>
<DELETED> This Act may be cited as the ``Homeless Veterans'
Reintegration Programs Reauthorization Act of 2015''.</DELETED>
<DELETED>SEC. 2. REAUTHORIZATION OF DEPARTMENT OF VETERANS AFFAIRS
HOMELESS VETERANS REINTEGRATION PROGRAMS.</DELETED>
<DELETED> (a) Five-Year Extension of Homeless Veterans Reintegration
Programs.--Section 2021(e)(F) of title 38, United States Code, is
amended by striking ``2015'' and inserting ``2020''.</DELETED>
<DELETED> (b) Five-Year Extension of Homeless Women Veterans and
Homeless Veterans With Children Reintegration Grant Program.--Section
2021A(f)(1) of such title is amended by striking ``2015'' and inserting
``2020''.</DELETED>
<DELETED> (c) Clarification of Eligibility for Services Under
Homeless Veterans Reintegration Programs.--Section 2021(a) of such
title is amended by striking ``reintegration of homeless veterans into
the labor force.'' and inserting the following: ``reintegration into
the labor force of--''</DELETED>
<DELETED> ``(1) homeless veterans;</DELETED>
<DELETED> ``(2) veterans participating in the Department of
Veterans Affairs supported housing program for which rental
assistance is provided pursuant to section 8(o)(19) of the
United States Housing Act of 1937 (42 U.S.C.
1437f(o)(19));</DELETED>
<DELETED> ``(3) Indians who are veterans and receiving
assistance under the Native American Housing Assistance and
Self Determination Act of 1996 (25 U.S.C. 4101 et seq.);
and</DELETED>
<DELETED> ``(4) veterans who are transitioning from being
incarcerated.''.</DELETED>
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Veterans Homeless
Programs, Caregiver Services, and Other Improvements Act of 2015''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--BENEFITS
Sec. 101. Expedited payment of survivors benefits.
Sec. 102. Increase in special pension for Medal of Honor recipients.
TITLE II--EDUCATION MATTERS
Sec. 201. Restoration of entitlement to Post-9/11 Educational
Assistance for veterans affected by
closures of educational institutions.
Sec. 202. Modification and improvement of transfer of unused Post-9/11
Educational Assistance to family members.
Sec. 203. Codification and improvement of election process for Post-9/
11 Educational Assistance.
Sec. 204. Centralized reporting of veteran enrollment by certain
groups, districts, and consortiums of
educational institutions.
Sec. 205. Improved role of State approving agencies in administration
of veterans educational benefits.
Sec. 206. Modification of criteria used to approve courses for purposes
of veterans educational benefits.
Sec. 207. Surveys for compliance of educational institutions and
training establishments with requirements
relating to administration of veterans
educational benefits.
Sec. 208. Modification of requirements for approval for purposes of
educational assistance provided by
Department of Veterans Affairs of programs
designed to prepare individuals for
licensure or certification.
Sec. 209. Expansion of Yellow Ribbon G.I. Education Enhancement
Program.
Sec. 210. Consideration of certain time spent receiving medical care
from Secretary of Defense as active duty
for purposes of eligibility for Post-9/11
Educational Assistance.
TITLE III--HOMELESS VETERANS MATTERS
Sec. 301. Expansion of definition of homeless veteran for purposes of
benefits under the laws administered by the
Secretary of Veterans Affairs.
Sec. 302. Increased per diem payments for transitional housing
assistance that becomes permanent housing
for homeless veterans.
Sec. 303. Expansion of Department of Veterans Affairs authority to
provide dental care to homeless veterans.
Sec. 304. Clarification of eligibility for services under homeless
veterans reintegration programs.
Sec. 305. Program to improve retention of housing by formerly homeless
veterans and veterans at risk of becoming
homeless.
Sec. 306. Pilot program on provision of intensive case management
interventions to homeless veterans who
receive the most health care from the
Department of Veterans Affairs.
Sec. 307. Establishment of National Center on Homelessness Among
Veterans.
Sec. 308. Partnerships with public and private entities to provide
legal services to homeless veterans and
veterans at risk of homelessness.
Sec. 309. Administrative improvements to grant and per diem programs of
Department of Veterans Affairs.
Sec. 310. Repeal of requirement for annual reports on assistance to
homeless veterans.
Sec. 311. Comptroller General of the United States study on homeless
veterans programs of Department of Veterans
Affairs.
Sec. 312. Requirement for Department of Veterans Affairs to assess
comprehensive service programs for homeless
veterans.
Sec. 313. Report on outreach relating to increasing the amount of
housing available to veterans.
TITLE IV--HEALTH CARE MATTERS
Sec. 401. Short title.
Subtitle A--Employment of Directors and Health Care Providers
Sec. 411. Extension of period for increase in graduate medical
education residency positions at medical
facilities of the Department of Veterans
Affairs.
Sec. 412. Modification of hours of employment for physicians and
physician assistants employed by the
Department of Veterans Affairs.
Sec. 413. Requirement that physician assistants employed by the
Department of Veterans Affairs receive
competitive pay.
Sec. 414. Establishment of positions of Directors of Veterans
Integrated Service Networks in Office of
Under Secretary for Health of Department of
Veterans Affairs and modification of
qualifications for Medical Directors.
Sec. 415. Pay for Medical Directors and Directors of Veterans
Integrated Service Networks.
Sec. 416. Additional requirements for hiring of health care providers
by Department of Veterans Affairs.
Sec. 417. Provision of information on health care providers of
Department of Veterans Affairs to State
medical boards.
Sec. 418. Report on compliance by Department of Veterans Affairs with
reviews of health care providers leaving
the Department or transferring to other
facilities.
Subtitle B--Opioid Therapy and Pain Management
Sec. 421. Guidelines on management of opioid therapy by Department of
Veterans Affairs and Department of Defense
and implementation of such guidelines by
Department of Veterans Affairs.
Sec. 422. Improvement of opioid safety measures by Department of
Veterans Affairs.
Sec. 423. Enhancement of joint working group on pain management of the
Department of Veterans Affairs and the
Department of Defense.
Sec. 424. Establishment of pain management boards of Department of
Veterans Affairs.
Sec. 425. Review, investigation, and report on use of opioids in
treatment by Department of Veterans
Affairs.
Subtitle C--Patient Advocacy
Sec. 431. Establishment of Office of Patient Advocacy of the Department
of Veterans Affairs.
Sec. 432. Community meetings on improving care from Department of
Veterans Affairs.
Sec. 433. Improvement of awareness of patient advocacy program and
patient bill of rights of Department of
Veterans Affairs.
Sec. 434. Comptroller General Report on Patient Advocacy Program of
Department of Veterans Affairs.
Subtitle D--Complementary and Integrative Health
Sec. 441. Expansion of research and education on and delivery of
complementary and integrative health to
veterans.
Sec. 442. Pilot program on integration of complementary and integrative
health within Department of Veterans
Affairs medical centers.
Subtitle E--Family Caregivers
Sec. 451. Expansion of family caregiver program of Department of
Veterans Affairs.
Sec. 452. Implementation of information technology system of Department
of Veterans Affairs to assess and improve
the family caregiver program.
Sec. 453. Modifications to annual evaluation report on caregiver
program of Department of Veterans Affairs.
Sec. 454. Advisory committee on caregiver policy.
Sec. 455. Comprehensive study on seriously injured veterans and their
caregivers.
Subtitle F--Health Care Agreements
Sec. 461. Authorization of agreements between the Department of
Veterans Affairs and non-Department
extended care providers.
Sec. 462. Modification of authority to enter into agreements with State
homes to provide nursing home care.
TITLE V--OTHER MATTERS
Sec. 501. Extension of temporary increase in number of judges on United
States Court of Appeals for Veterans
Claims.
Sec. 502. Repeal inapplicability of modification of basic allowance for
housing to benefits under laws administered
by Secretary of Veterans Affairs.
Sec. 503. Department of Veterans Affairs program of internal audits.
Sec. 504. Improvement of training for managers.
TITLE I--BENEFITS
SEC. 101. EXPEDITED PAYMENT OF SURVIVORS BENEFITS.
(a) In General.--Section 5101(a)(1) of title 38, United States
Code, is amended--
(1) by striking ``A specific'' and inserting ``(A) Except
as provided in subparagraph (B), a specific''; and
(2) by adding at the end the following new subparagraph:
``(B)(i) The Secretary may pay benefits under chapters 13 and 15
and sections 2302, 2307, and 5121 of this title to a survivor of a
veteran who has not filed a formal claim if the Secretary determines
that the record contains sufficient evidence to establish the
entitlement of the survivor to such benefits.
``(ii) For purposes of this subparagraph and section 5110 of this
title, the date on which the Secretary is notified of the death of the
veteran shall be treated as the date of the receipt of the survivor's
application for benefits described in clause (i).''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply with respect to claims for benefits based on a death occurring on
or after the date of the enactment of this Act.
SEC. 102. INCREASE IN SPECIAL PENSION FOR MEDAL OF HONOR RECIPIENTS.
(a) In General.--Section 1562(a) of title 38, United States Code,
is amended by striking ``$1,000'' and inserting ``$3,000''.
(b) Effective Date.--
(1) In general.--The amendment made by subsection (a) shall
take effect on the date that is--
(A) except as provided in subparagraph (B), one
year after the date of the enactment of this Act; and
(B) in the case that the date that is one year
after the date of the enactment of this Act is not the
first day of a month, the first day of the first month
beginning after the date that is one year after the
date of the enactment of this Act.
(2) Delay of annual cost of living adjustment.--
(A) In general.--The Secretary shall not make an
increase pursuant to section 1562(e) of such title
effective December 1, 2016, if the amendment made by
subsection (a) takes effect before such date.
(B) Resumption.--In the case that the Secretary,
pursuant to subparagraph (A), does not make an increase
pursuant to section 1562(e) of such title effective
December 1, 2016, the Secretary shall resume making
increases pursuant to such section with the first such
increase effective December 1, 2017.
TITLE II--EDUCATION MATTERS
SEC. 201. RESTORATION OF ENTITLEMENT TO POST-9/11 EDUCATIONAL
ASSISTANCE FOR VETERANS AFFECTED BY CLOSURES OF
EDUCATIONAL INSTITUTIONS.
(a) Educational Assistance.--
(1) In general.--Section 3312 of title 38, United States
Code, is amended by adding at the end the following new
subsection:
``(d) Discontinuation of Education Due to Closure of Educational
Institution.--
``(1) In general.--Any payment of educational assistance
described in paragraph (2) shall not--
``(A) be charged against any entitlement to
educational assistance of the individual concerned
under this chapter; or
``(B) be counted against the aggregate period for
which section 3695 of this title limits the
individual's receipt of educational assistance under
this chapter.
``(2) Description of payment of educational assistance.--
Subject to paragraph (3), the payment of educational assistance
described in this paragraph is the payment of such assistance
to an individual for pursuit of a course or courses under this
chapter if the Secretary finds that the individual--
``(A) was forced to discontinue such course pursuit
as a result of a permanent closure of an educational
institution; and
``(B) did not receive credit, or lost training
time, toward completion of the program of education
being pursued at the time of such closure.
``(3) Period for which payment not charged.--The period for
which, by reason of this subsection, educational assistance is
not charged against entitlement or counted toward the
applicable aggregate period under section 3695 of this title
shall not exceed the aggregate of--
``(A) the portion of the period of enrollment in
the course or courses from which the individual failed
to receive credit or with respect to which the
individual lost training time, as determined under
paragraph (2)(B), and
``(B) the period by which a monthly stipend is
extended under section 3680(a)(2)(B) of this title.''.
(2) Applicability.--Subsection (d) of such section, as
added by paragraph (1), shall apply with respect to courses and
programs of education discontinued as described in paragraph
(2) of such subsection in fiscal year 2015 or any fiscal year
thereafter.
(b) Monthly Housing Stipend.--
(1) In general.--Section 3680(a) of such title is amended--
(A) by striking the matter after paragraph (3)(B);
(B) in paragraph (3), by redesignating
subparagraphs (A) and (B) as clauses (i) and (ii),
respectively;
(C) by redesignating paragraphs (1) through (3) as
subparagraphs (A) through (C), respectively;
(D) in the matter before subparagraph (A), as
redesignated, in the first sentence, by striking
``Payment of'' and inserting ``(1) Except as provided
in paragraph (2), payment of''; and
(E) by adding at the end the following new
paragraph (2):
``(2) Notwithstanding paragraph (1), the Secretary may, pursuant to
such regulations as the Secretary shall prescribe, continue to pay
allowances to eligible veterans and eligible persons enrolled in
courses set forth in paragraph (1)(A)--
``(A) during periods when schools are temporarily closed
under an established policy based on an Executive order of the
President or due to an emergency situation, except that the
total number of weeks for which allowances may continue to be
so payable in any 12-month period may not exceed four weeks; or
``(B) solely for the purpose of awarding a monthly housing
stipend described in section 3313 of this title, during periods
following a permanent school closure, except that payment of
such a stipend may only be continued until the earlier of--
``(i) the date of the end of the term, quarter, or
semester during which the school closure occurred; and
``(ii) the date that is 4 months after the date of
the school closure.''.
(2) Conforming amendment.--Paragraph (1)(C)(ii) of such
section, as redesignated, is amended by striking ``described in
subclause (A) of this clause'' and inserting ``described in
clause (i)''.
SEC. 202. MODIFICATION AND IMPROVEMENT OF TRANSFER OF UNUSED POST-9/11
EDUCATIONAL ASSISTANCE TO FAMILY MEMBERS.
(a) Eligibility Requirements.--Subsection (b)(1) of section 3319 of
title 38, United States Code, is amended--
(1) by striking ``six years'' and inserting ``ten years'';
and
(2) by striking ``four more years'' and inserting ``two
more years''.
(b) Commencement of Use.--Subsection (g)(1)(A) of such section is
amended by striking ``six years'' and inserting ``ten years''.
(c) Rate of Payment.--Subsection (h)(3)(B) of such section is
amended by inserting before the period at the end the following: ``,
except that the amount of the monthly stipend described in subsection
(c)(1)(B) or (g)(3)(A)(ii) of section 3313, as the case may be, shall
be payable in an amount equal to 50 percent of the amount of such
stipend that would otherwise be payable under this chapter to the
individual making the transfer''.
(d) Technical Correction.--Such section is further amended by
striking ``armed forces'' each place it appears and inserting ``Armed
Forces''.
(e) Applicability.--The amendments made by subsections (a) through
(c) shall apply with respect to an election to transfer entitlement
under section 3319 of title 38, United States Code, that is made on or
after the date that is 180 days after the date of the enactment of this
Act.
SEC. 203. CODIFICATION AND IMPROVEMENT OF ELECTION PROCESS FOR POST-9/
11 EDUCATIONAL ASSISTANCE.
(a) In General.--Subchapter III of chapter 33 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 3326. Election to receive educational assistance
``(a) Individuals Eligible to Elect Participation in Post-9/11
Educational Assistance.--An individual may elect to receive educational
assistance under this chapter if such individual--
``(1) as of August 1, 2009--
``(A) is entitled to basic educational assistance
under chapter 30 of this title and has used, but
retains unused, entitlement under that chapter;
``(B) is entitled to educational assistance under
chapter 107, 1606, or 1607 of title 10 and has used,
but retains unused, entitlement under the applicable
chapter;
``(C) is entitled to basic educational assistance
under chapter 30 of this title but has not used any
entitlement under that chapter;
``(D) is entitled to educational assistance under
chapter 107, 1606, or 1607 of title 10 but has not used
any entitlement under such chapter;
``(E) is a member of the Armed Forces who is
eligible for receipt of basic educational assistance
under chapter 30 of this title and is making
contributions toward such assistance under section
3011(b) or 3012(c) of this title; or
``(F) is a member of the Armed Forces who is not
entitled to basic educational assistance under chapter
30 of this title by reason of an election under section
3011(c)(1) or 3012(d)(1) of this title; and
``(2) as of the date of the individual's election under
this paragraph, meets the requirements for entitlement to
educational assistance under this chapter.
``(b) Cessation of Contributions Toward GI Bill.--Effective as of
the first month beginning on or after the date of an election under
subsection (a) of an individual described by paragraph (1)(E) of that
subsection, the obligation of the individual to make contributions
under section 3011(b) or 3012(c) of this title, as applicable, shall
cease, and the requirements of such section shall be deemed to be no
longer applicable to the individual.
``(c) Revocation of Remaining Transferred Entitlement.--
``(1) Election to revoke.--If, on the date an individual
described in paragraph (1)(A) or (1)(C) of subsection (a) makes
an election under that subsection, a transfer of the
entitlement of the individual to basic educational assistance
under section 3020 of this title is in effect and a number of
months of the entitlement so transferred remain unutilized, the
individual may elect to revoke all or a portion of the
entitlement so transferred that remains unutilized.
``(2) Availability of revoked entitlement.--Any entitlement
revoked by an individual under this paragraph shall no longer
be available to the dependent to whom transferred, but shall be
available to the individual instead for educational assistance
under chapter 33 of this title in accordance with the
provisions of this section.
``(3) Availability of unrevoked entitlement.--Any
entitlement described in paragraph (1) that is not revoked by
an individual in accordance with that paragraph shall remain
available to the dependent or dependents concerned in
accordance with the current transfer of such entitlement under
section 3020 of this title.
``(d) Post-9/11 Educational Assistance.--
``(1) In general.--Subject to paragraph (2) and except as
provided in subsection (e), an individual making an election
under subsection (a) shall be entitled to educational
assistance under this chapter in accordance with the provisions
of this chapter, instead of basic educational assistance under
chapter 30 of this title, or educational assistance under
chapter 107, 1606, or 1607 of title 10, as applicable.
``(2) Limitation on entitlement for certain individuals.--
In the case of an individual making an election under
subsection (a) who is described by paragraph (1)(A) of that
subsection, the number of months of entitlement of the
individual to educational assistance under this chapter shall
be the number of months equal to--
``(A) the number of months of unused entitlement of
the individual under chapter 30 of this title, as of
the date of the election, plus
``(B) the number of months, if any, of entitlement
revoked by the individual under subsection (c)(1).
``(e) Continuing Entitlement to Educational Assistance Not
Available Under 9/11 Assistance Program.--
``(1) In general.--In the event educational assistance to
which an individual making an election under subsection (a)
would be entitled under chapter 30 of this title, or chapter
107, 1606, or 1607 of title 10, as applicable, is not
authorized to be available to the individual under the
provisions of this chapter the individual shall remain entitled
to such educational assistance in accordance with the
provisions of the applicable chapter.
``(2) Charge for use of entitlement.--The utilization by an
individual of entitlement under paragraph (1) shall be
chargeable against the entitlement of the individual to
educational assistance under this chapter at the rate of one
month of entitlement under this chapter for each month of
entitlement utilized by the individual under paragraph (1) (as
determined as if such entitlement were utilized under the
provisions of chapter 30 of this title, or chapter 107, 1606,
or 1607 of title 10, as applicable).
``(f) Additional Post-9/11 Assistance for Members Having Made
Contributions Toward GI Bill.--
``(1) Additional assistance.--In the case of an individual
making an election under subsection (a) who is described by
subparagraph (A), (C), or (E) of paragraph (1) of that
subsection, the amount of educational assistance payable to the
individual under this chapter as a monthly stipend payable
under paragraph (1)(B) of section 3313(c) of this title, or
under paragraphs (2) through (7) of that section (as
applicable), shall be the amount otherwise payable as a monthly
stipend under the applicable paragraph increased by the amount
equal to--
``(A) the total amount of contributions toward
basic educational assistance made by the individual
under section 3011(b) or 3012(c) of this title, as of
the date of the election, multiplied by
``(B) the fraction--
``(i) the numerator of which is--
``(I) the number of months of
entitlement to basic educational
assistance under chapter 30 of this
title remaining to the individual at
the time of the election; plus
``(II) the number of months, if
any, of entitlement under chapter 30
revoked by the individual under
subsection (c)(1); and
``(ii) the denominator of which is 36
months.
``(2) Months of remaining entitlement for certain
individuals.--In the case of an individual covered by paragraph
(1) who is described by subsection (a)(1)(E), the number of
months of entitlement to basic educational assistance remaining
to the individual for purposes of paragraph (1)(B)(i)(II) shall
be 36 months.
``(3) Timing of payment.--The amount payable with respect
to an individual under paragraph (1) shall be paid to the
individual together with the last payment of the monthly
stipend payable to the individual under paragraph (1)(B) of
section 3313(c) of this title, or under paragraphs (2) through
(7) of that section (as applicable), before the exhaustion of
the individual's entitlement to educational assistance under
this chapter.
``(g) Continuing Entitlement to Additional Assistance for Critical
Skills or Speciality and Additional Service.--An individual making an
election under subsection (a)(1) who, at the time of the election, is
entitled to increased educational assistance under section 3015(d) of
this title, or section 16131(i) of title 10, or supplemental
educational assistance under subchapter III of chapter 30 of this
title, shall remain entitled to such increased educational assistance
or supplemental educational assistance in the utilization of
entitlement to educational assistance under this chapter, in an amount
equal to the quarter, semester, or term, as applicable, equivalent of
the monthly amount of such increased educational assistance or
supplemental educational assistance payable with respect to the
individual at the time of the election.
``(h) Alternative Election by Secretary.--
``(1) In general.--In the case of an individual who, on or
after January 1, 2016, submits to the Secretary an election
under this section that the Secretary determines is clearly
against the interests of the individual, or who fails to make
an election under this section, the Secretary may make an
alternative election on behalf of the individual that the
Secretary determines is in the best interests of the
individual.
``(2) Notice.--If the Secretary makes an election on behalf
of an individual under this subsection, the Secretary shall
notify the individual by not later than seven days after making
such election and shall provide the individual with a 30-day
period, beginning on the date of the individual's receipt of
such notice, during which the individual may modify or revoke
the election made by the Secretary on the individual's behalf.
The Secretary shall include, as part of such notice, a clear
statement of why the alternative election made by the Secretary
is in the best interests of the individual as compared to the
election submitted by the individual. The Secretary shall
provide the notice required under this paragraph by electronic
means whenever possible.
``(i) Irrevocability of Elections.--An election under subsection
(a) or (c)(1) is irrevocable.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by adding at the end the following new item:
``3326. Election to receive educational assistance.''.
(c) Conforming Repeal.--Subsection (c) of section 5003 of the Post-
9/11 Veterans Educational Assistance Act of 2008 (Public Law 110-252;
38 U.S.C. 3301 note) is hereby repealed.
SEC. 204. CENTRALIZED REPORTING OF VETERAN ENROLLMENT BY CERTAIN
GROUPS, DISTRICTS, AND CONSORTIUMS OF EDUCATIONAL
INSTITUTIONS.
(a) In General.--Section 3684(a) of title 38, United States Code,
is amended--
(1) in paragraph (1), by inserting ``32, 33,'' after
``31,''; and
(2) by adding at the end the following new paragraph:
``(4) For purposes of this subsection, the term `educational
institution' may include a group, district, or consortium of separately
accredited educational institutions located in the same State that are
organized in a manner that facilitates the centralized reporting of the
enrollments in such group, district, or consortium of institutions.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply with respect to reports submitted on or after the date of the
enactment of this Act.
SEC. 205. IMPROVED ROLE OF STATE APPROVING AGENCIES IN ADMINISTRATION
OF VETERANS EDUCATIONAL BENEFITS.
(a) Approval of Certain Courses.--Section 3672(b)(2)(A) of title
38, United States Code, is amended by striking ``the following'' and
all that follows through the colon and inserting the following: ``a
program of education is deemed to be approved for purposes of this
chapter if a State approving agency determines that the program is one
of the following programs:''.
(b) Approval of Other Courses.--Section 3675 of such title
amended--
(1) in subsection (a)(1)--
(A) by striking ``The Secretary or a State
approving agency'' and inserting ``A State approving
agency, or the Secretary when acting in the role of a
State approving agency,''; and
(B) by striking ``offered by proprietary for-profit
educational institutions'' and inserting ``not covered
by section 3672 of this title''; and
(2) in subsection (b)--
(A) in the matter before paragraph (1), by striking
``the Secretary or the State approving agency'' and
inserting ``the State approving agency, or the
Secretary when acting in the role of a State approving
agency,''; and
(B) in paragraph (1), by striking ``the Secretary
or the State approving agency'' and inserting ``the
State approving agency, or the Secretary when acting in
the role of a State approving agency''.
SEC. 206. MODIFICATION OF CRITERIA USED TO APPROVE COURSES FOR PURPOSES
OF VETERANS EDUCATIONAL BENEFITS.
(a) Nonaccredited Courses.--Section 3676(c)(14) of title 38, United
States Code, is amended by inserting before the period the following:
``if the Secretary, in consultation with the State approving agency and
pursuant to regulations prescribed to carry out this paragraph,
determines such criteria are necessary and treat public, private, and
proprietary for-profit educational institutions equitably''.
(b) Accredited Courses.--Section 3675(b)(3) of such title is
amended by striking ``and (3)'' and inserting ``(3), and (14)''.
(c) Application.--The amendment made by subsection (a) shall apply
with respect to--
(1) criteria developed pursuant to paragraph (14) of
subsection (c) of section 3676 of title 38, United States Code,
on or after January 1, 2013; and
(2) an investigation conducted under such subsection that
is covered by a reimbursement of expenses paid by the Secretary
of Veterans Affairs to a State pursuant to section 3674 of such
title on or after October 1, 2015.
SEC. 207. SURVEYS FOR COMPLIANCE OF EDUCATIONAL INSTITUTIONS AND
TRAINING ESTABLISHMENTS WITH REQUIREMENTS RELATING TO
ADMINISTRATION OF VETERANS EDUCATIONAL BENEFITS.
(a) In General.--Section 3693 of title 38, United States Code, is
amended--
(1) by striking subsection (a) and inserting the following
new subsection (a):
``(a)(1)(A) Except as provided in subsection (b), the Secretary
shall conduct an annual compliance survey of educational institutions
and training establishments offering one or more courses approved for
the enrollment of eligible veterans or persons if at least 20 such
veterans or persons are enrolled in any such course.
``(B) The Secretary shall--
``(i) design the compliance surveys to ensure that such
institutions or establishments, as the case may be, and
approved courses are in compliance with all applicable
provisions of chapters 30 through 36 of this title;
``(ii) survey each such educational institution and
training establishment not less than once during every two-year
period; and
``(iii) assign not fewer than one education compliance
specialist to work on compliance surveys in any year for each
40 compliance surveys required to be made under this section
for such year.
``(2) The Secretary, in consultation with the State approving
agencies, shall--
``(A) annually determine the parameters of the surveys
required under paragraph (1); and
``(B) not later than September 1 of each year, make
available to the State approving agencies a list of the
educational institutions and training establishments that will
be surveyed during the fiscal year following the date of making
such list available.''; and
(2) by adding at the end the following new subsection:
``(c) In this section, the terms `educational institution' and
`training establishment' have the meaning given such terms in section
3452 of this title.''.
(b) Conforming Amendments.--Subsection (b) of such section is
amended--
(1) by striking ``subsection (a) of this section for an
annual compliance survey'' and inserting ``subsection (a)(1)
for a compliance survey'';
(2) by striking ``institution'' and inserting ``educational
institution or training establishment''; and
(3) by striking ``institution's demonstrated record of
compliance'' and inserting ``record of compliance of such
institution or establishment''.
SEC. 208. MODIFICATION OF REQUIREMENTS FOR APPROVAL FOR PURPOSES OF
EDUCATIONAL ASSISTANCE PROVIDED BY DEPARTMENT OF VETERANS
AFFAIRS OF PROGRAMS DESIGNED TO PREPARE INDIVIDUALS FOR
LICENSURE OR CERTIFICATION.
(a) Approval of Non-Accredited Courses.--Subsection (c) of section
3676 of title 38, United States Code, as amended by section 206, is
further amended--
(1) by redesignating paragraph (14) as paragraph (16); and
(2) by inserting after paragraph (13) the following new
paragraphs:
``(14) In the case of a course designed to prepare an
individual for licensure or certification in a State, the
course--
``(A) meets any instructional curriculum licensure
or certification requirements of such State; and
``(B) in the case of a course designed to prepare
an individual for licensure to practice law in a State,
is accredited by an accrediting agency or association
recognized by the Secretary of Education under subpart
2 of part H of title IV of the Higher Education Act of
1965 (20 U.S.C. 1099b).
``(15) In the case of a course designed to prepare an
individual for employment pursuant to standards developed by a
board or agency of a State in an occupation that requires
approval, licensure, or certification, the course--
``(A) meets such standards; and
``(B) in the case of a course designed to prepare
an individual for licensure to practice law in a State,
is accredited by an accrediting agency or association
recognized by the Secretary of Education under subpart
2 of part H of title IV of the Higher Education Act of
1965 (20 U.S.C. 1099b).''.
(b) Exceptions.--Such section is further amended by adding at the
end the following new subsection:
``(f)(1) The Secretary may waive the requirements of paragraph (14)
or (15) of subsection (c) in the case of a course of education offered
by an educational institution (either accredited or not accredited) if
the Secretary determines all of the following:
``(A) The course did not meet the requirements of such
paragraph at any time during the two-year period preceding the
date of the waiver.
``(B) The waiver furthers the purposes of the educational
assistance programs administered by the Secretary or would
further the education interests of individuals eligible for
assistance under such programs.
``(C) The educational institution does not provide any
commission, bonus, or other incentive payment based directly or
indirectly on success in securing enrollments or financial aid
to any persons or entities engaged in any student recruiting or
admission activities or in making decisions regarding the award
of student financial assistance, except for the recruitment of
foreign students residing in foreign countries who are not
eligible to receive Federal student assistance.
``(2) Not later than 30 days after the date on which the Secretary
issues a waiver under paragraph (1), the Secretary shall submit to
Congress notice of such waiver and a justification for issuing such
waiver.''.
(c) Approval of Accredited Courses.--Section 3675(b)(3) of such
title, as amended by section 206, is further amended--
(1) by striking ``and (14)'' and inserting ``(14), (15),
and (16)''; and
(2) by inserting before the period at the end the
following: ``(or, with respect to such paragraphs (14) and
(15), the requirements under such paragraphs are waived
pursuant to subsection (f)(1) of section 3676 of this title)''.
(d) Approval of Accredited Standard College Degree Programs Offered
at Public or Not-for-profit Educational Institutions.--Section
3672(b)(2) of such title is amended--
(1) in subparagraph (A)(i), by striking ``An accredited''
and inserting ``Except as provided in subparagraph (C), an
accredited''; and
(2) by adding at the end the following new subparagraph:
``(C) A course that is described in both subparagraph (A)(i) of
this paragraph and in paragraph (14) or (15) of section 3676(c) of this
title shall not be deemed to be approved for purposes of this chapter
unless--
``(i) a State approving agency, or the Secretary when
acting in the role of a State approving agency, determines that
the course meets the applicable criteria in such paragraphs; or
``(ii) the Secretary issues a waiver for such course under
section 3676(f)(1) of this title.''.
(e) Disapproval of Courses.--Section 3679 of such title is amended
by adding at the end the following new subsection:
``(d) Notwithstanding any other provision of this chapter, the
Secretary or the applicable State approving agency shall disapprove a
course of education described in paragraph (14) or (15) of section
3676(c) of this title unless the educational institution providing the
course of education--
``(1) publicly discloses any conditions or additional
requirements, including training, experience, or examinations,
required to obtain the license, certification, or approval for
which the course of education is designed to provide
preparation; and
``(2) makes each disclosure required by paragraph (1) in a
manner that the Secretary considers prominent.''.
(f) Applicability.--If after enrollment in a course of education
that is subject to disapproval by reason of an amendment made by this
Act, an individual pursues one or more courses of education at the same
educational institution while remaining continuously enrolled (other
than during regularly scheduled breaks between courses, semesters, or
terms) at that institution, any course so pursued by the individual at
that institution while so continuously enrolled shall not be subject to
disapproval by reason of such amendment.
SEC. 209. EXPANSION OF YELLOW RIBBON G.I. EDUCATION ENHANCEMENT
PROGRAM.
(a) In General.--Section 3317(a) of title 38, United States Code,
is amended by striking ``in paragraphs (1) and (2)'' and inserting ``in
paragraphs (1), (2), and (9)''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply with respect to academic years beginning after the date that is
one year after the date of the enactment of this Act.
SEC. 210. CONSIDERATION OF CERTAIN TIME SPENT RECEIVING MEDICAL CARE
FROM SECRETARY OF DEFENSE AS ACTIVE DUTY FOR PURPOSES OF
ELIGIBILITY FOR POST-9/11 EDUCATIONAL ASSISTANCE.
(a) In General.--Section 3301(1)(B) of title 38, United States
Code, is amended by inserting ``12301(h),'' after ``12301(g),''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on the date that is one year after the date of the
enactment of this Act and shall apply with respect to assistance
provided under chapter 33 of such title on and after the date that is
one year after the date of the enactment of this Act.
TITLE III--HOMELESS VETERANS MATTERS
SEC. 301. EXPANSION OF DEFINITION OF HOMELESS VETERAN FOR PURPOSES OF
BENEFITS UNDER THE LAWS ADMINISTERED BY THE SECRETARY OF
VETERANS AFFAIRS.
Section 2002(1) of title 38, United States Code, is amended by
striking ``in section 103(a) of the McKinney-Vento Homeless Assistance
Act (42 U.S.C. 11302(a))'' and inserting ``in subsection (a) or (b) of
section 103 of the McKinney-Vento Homeless Assistance Act (42 U.S.C.
11302)''.
SEC. 302. INCREASED PER DIEM PAYMENTS FOR TRANSITIONAL HOUSING
ASSISTANCE THAT BECOMES PERMANENT HOUSING FOR HOMELESS
VETERANS.
Section 2012(a)(2) of title 38, United States Code, is amended--
(1) by redesignating subparagraphs (B) through (D) as
subparagraphs (C) through (E), respectively;
(2) in subparagraph (C), as redesignated, by striking ``in
subparagraph (D)'' and inserting ``in subparagraph (E)'';
(3) in subparagraph (D), as redesignated, by striking
``under subparagraph (B)'' and inserting ``under subparagraph
(C)'';
(4) in subparagraph (E), as redesignated, by striking ``in
subparagraphs (B) and (C)'' and inserting ``in subparagraphs
(C) and (D)''; and
(5) in subparagraph (A)--
(A) by striking ``The rate'' and inserting ``Except
as otherwise provided in subparagraph (B), the rate'';
and
(B) by striking ``under subparagraph (B)'' and all
that follows through the end and inserting the
following: ``under subparagraph (C).
``(B)(i) Except as provided in clause (ii), in no case may the rate
determined under this paragraph exceed the rate authorized for State
homes for domiciliary care under subsection (a)(1)(A) of section 1741
of this title, as the Secretary may increase from time to time under
subsection (c) of that section.
``(ii) In the case of services furnished to a homeless veteran who
is placed in housing that will become permanent housing for the veteran
upon termination of the furnishing of such services to such veteran,
the maximum rate of per diem authorized under this section is 150
percent of the rate described in clause (i).''.
SEC. 303. EXPANSION OF DEPARTMENT OF VETERANS AFFAIRS AUTHORITY TO
PROVIDE DENTAL CARE TO HOMELESS VETERANS.
(a) In General.--Subsection (b) of section 2062 of title 38, United
States Code, is amended to read as follows:
``(b) Eligible Veterans.--(1) Subsection (a) applies to a veteran
who--
``(A) is enrolled for care under section 1705(a) of this
title; and
``(B) for a period of 60 consecutive days, is receiving--
``(i) assistance under section 8(o) of the United
States Housing Act of 1937 (42 U.S.C. 1437f(o)); or
``(ii) care (directly or by contract) in any of the
following settings:
``(I) A domiciliary under section 1710 of
this title.
``(II) A therapeutic residence under
section 2032 of this title.
``(III) Community residential care
coordinated by the Secretary under section 1730
of this title.
``(IV) A setting for which the Secretary
provides funds for a grant and per diem
provider.
``(2) For purposes of paragraph (1), in determining whether a
veteran has received assistance or care for a period of 60 consecutive
days, the Secretary may disregard breaks in the continuity of
assistance or care for which the veteran is not responsible.''.
(b) Effective Date.--Subsection (a) shall take effect on the date
that is one year after the date of the enactment of this Act.
SEC. 304. CLARIFICATION OF ELIGIBILITY FOR SERVICES UNDER HOMELESS
VETERANS REINTEGRATION PROGRAMS.
Section 2021(a) of title 38, United States Code, is amended by
striking ``reintegration of homeless veterans into the labor force.''
and inserting the following: ``reintegration into the labor force of--
''
``(1) homeless veterans;
``(2) veterans participating in the Department of Veterans
Affairs supported housing program for which rental assistance
is provided pursuant to section 8(o)(19) of the United States
Housing Act of 1937 (42 U.S.C. 1437f(o)(19));
``(3) Indians who are veterans and receiving assistance
under the Native American Housing Assistance and Self
Determination Act of 1996 (25 U.S.C. 4101 et seq.); and
``(4) veterans who are transitioning from being
incarcerated.''.
SEC. 305. PROGRAM TO IMPROVE RETENTION OF HOUSING BY FORMERLY HOMELESS
VETERANS AND VETERANS AT RISK OF BECOMING HOMELESS.
(a) Program Required.--
(1) In general.--Subchapter II of chapter 20 of title 38,
United States Code, is amended--
(A) by redesignating section 2013 as section 2014;
and
(B) by inserting after section 2012 the following
new section 2013:
``Sec. 2013. Program to improve retention of housing by formerly
homeless veterans and veterans at risk of becoming
homeless
``(a) Program Required.--The Secretary shall carry out a program
under which the Secretary shall provide case management services to
improve the retention of housing by veterans who were previously
homeless and are transitioning to permanent housing and veterans who
are at risk of becoming homeless.
``(b) Grants.--(1) The Secretary shall carry out the program
through the award of grants.
``(2)(A) In awarding grants under paragraph (1), the Secretary
shall give priority to organizations that demonstrate a capability to
provide case management services as described in subsection (a),
particularly organizations that are successfully providing or have
successfully provided transitional housing services using amounts
provided by the Secretary under sections 2012 and 2061 of this title.
``(B) In giving priority under subparagraph (A), the Secretary
shall give extra priority to an organization described in such
subparagraph that--
``(i) voluntarily stops receiving amounts provided by the
Secretary under sections 2012 and 2061 of this title; and
``(ii) converts a facility that the organization used to
provide transitional housing services into a facility that the
organization uses to provide permanent housing that meets
housing quality standards established under section 8(o)(8)(B)
of the United States Housing Act of 1937 (42 U.S.C.
1437f(o)(8)(B)).
``(C) In any case in which a facility, with respect to which a
person received a grant for construction, rehabilitation, or
acquisition under section 2011 of this title, is converted as described
in subparagraph (B)(ii), such conversion shall be considered to have
been carried out pursuant to the needs of the Department and such
person shall not be considered in non-compliance with the terms of such
grant by reason of such conversion.''.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 20 of such title is amended by striking
the item relating to section 2013 and inserting the following
new items:
``2013. Program to improve retention of housing by formerly homeless
veterans and veterans at risk of becoming
homeless.
``2014. Authorization of appropriations.''.
(b) Regulations.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
prescribe regulations to carry out section 2013 of such title, as added
by subsection (a)(1)(B).
(c) Report.--
(1) In general.--Not later than June 1, 2019, the Secretary
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the program required by section
2013 of such title, as added by subsection (a)(1)(B).
(2) Contents.--The report submitted under paragraph (1)
shall include assessments of the following:
(A) The percentage of veterans who received case
management services under the program who were able to
retain permanent housing by the end of the program,
disaggregated by each recipient of a grant under such
section.
(B) The percentage of veterans who received case
management services under the program who were not in
permanent housing at the end of the program,
disaggregated by housing status and reason for failing
to retain permanent housing under the program.
(C) The use by veterans who received case
management services under the program of housing
assistance furnished by the Department of Veterans
Affairs, including a comparison of the use of such
assistance by such veterans before and after receiving
such services.
(D) An assessment of the employment status of
veterans who received case management services under
the program, including a comparison of the employment
status of such veterans before and after receiving such
services.
SEC. 306. PILOT PROGRAM ON PROVISION OF INTENSIVE CASE MANAGEMENT
INTERVENTIONS TO HOMELESS VETERANS WHO RECEIVE THE MOST
HEALTH CARE FROM THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Pilot Program Required.--Not later than September 1, 2016, the
Secretary of Veterans Affairs shall commence a pilot program to assess
the feasibility and advisability of providing intensive case management
interventions to covered veterans.
(b) Covered Veterans.--For purposes of the pilot program, a covered
veteran is a veteran who is enrolled in--
(1) the homeless registry of the Department; and
(2) the system of annual patient enrollment established and
operated by the Secretary under section 1705(a) of title 38,
United States Code.
(c) Location.--
(1) In general.--The Secretary shall carry out the pilot
program at not fewer than six locations selected by the
Secretary for purposes of the pilot program as follows:
(A) Not fewer than three locations in cities that
have the largest populations of homeless veterans in
the United States.
(B) Not fewer than three locations in suburban or
rural settings.
(2) Interaction and coordination with community
organizations.--In selecting locations under paragraph (1), the
Secretary shall only select locations in areas in which the
Secretary determines that there is a high degree of interaction
and coordination between the Department and community
organizations that provide housing and social services for
veterans, such as outreach, employment, and financial
assistance for homeless veterans, veterans at risk of becoming
homeless, and low-income veterans.
(d) Provision of Intensive Case Management Interventions.--
(1) Minimum number of veterans to receive interventions.--
In carrying out the program at each location selected under
subsection (c), the Secretary shall provide intensive case
management interventions to not fewer than 20 covered veterans
at each such location who the Secretary determines are the
covered veterans at such location who receive the most health
care and related services furnished by the Department of
Veterans Affairs.
(2) Nature of interventions.--The intensive case management
interventions provided to covered veterans under paragraph (1)
shall include assistance with gaining and maintaining access to
such housing and services, including benefits and services to
which covered veterans may be entitled or eligible under the
laws administered by the Secretary, as may be necessary to
improve the stability of their housing and the appropriateness
of the health care that they receive.
(e) Report.--
(1) In general.--Not later than December 1, 2018, the
Secretary shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the House
of Representatives a report on the pilot program carried out
under this section.
(2) Contents.--The report submitted under paragraph (1)
shall include assessments of the following:
(A) The types and frequencies of intensive case
management interventions provided under the pilot
program.
(B) The housing status of each veteran who received
an intensive case management intervention under the
pilot program.
(C) The employment status of each veteran who
received an intensive case management intervention
under the pilot program, including a comparison of the
employment status of such veteran before and after
receiving such intervention.
(D) The use by veterans who received intensive case
management interventions under the pilot program of
health care and related services furnished by the
Department of Veterans Affairs and the costs incurred
by the Department in furnishing such care and services,
including a comparison of the use by such veterans of
such care and services and the costs incurred from
furnishing such care and services before and after
receiving such interventions.
(E) The number of veterans who received intensive
case management interventions under the pilot program,
disaggregated by whether the intensive case management
intervention was provided in a location described in
subparagraph (A) or (B) of subsection (c)(1).
(F) The costs incurred by the Department in
carrying out the pilot program, disaggregated by
provision of intensive case management interventions in
locations described in subparagraphs (A) and (B) of
such subsection.
(G) An estimate of the costs the Department would
have incurred for the provision of health care and
associated services to covered veterans but for the
provision of intensive case management interventions
under the pilot program, disaggregated by provision of
intensive case management interventions in locations
described in subparagraphs (A) and (B) of subsection
(c)(1).
SEC. 307. ESTABLISHMENT OF NATIONAL CENTER ON HOMELESSNESS AMONG
VETERANS.
(a) In General.--Subchapter VII of chapter 20 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 2067. National Center on Homelessness Among Veterans
``(a) In General.--(1) The Secretary shall establish and operate a
center to carry out the functions described in subsection (b).
``(2) The center established under paragraph (1) shall be known as
the `National Center on Homelessness Among Veterans'.
``(3) To the degree practicable, the Secretary shall operate the
center established under paragraph (1) independently of the other
programs of the Department that address homelessness among veterans.
``(b) Functions.--The functions described in this subsection are as
follows:
``(1) To carry out and promote research into the causes and
contributing factors to veteran homelessness.
``(2) To assess the effectiveness of programs of the
Department to meet the needs of homeless veterans.
``(3) To identify and disseminate best practices with
regard to housing stabilization, income support, employment
assistance, community partnerships, and such other matters as
the Secretary considers appropriate with respect to addressing
veteran homelessness.
``(4) To integrate evidence-based and best practices,
policies, and programs into programs of the Department for
homeless veterans and veterans at risk of homelessness and to
ensure that the staff of the Department and community partners
can implement such practices, policies, and programs.
``(5) To serve as a resource center for, and promote and
seek to coordinate the exchange of information regarding, all
research and training activities carried out by the Department
and by other Federal and non-Federal entities with respect to
veteran homelessness.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 20 of such title is amended by inserting after the item
relating to section 2066 the following new item:
``2067. National Center on Homelessness Among Veterans.''.
SEC. 308. PARTNERSHIPS WITH PUBLIC AND PRIVATE ENTITIES TO PROVIDE
LEGAL SERVICES TO HOMELESS VETERANS AND VETERANS AT RISK
OF HOMELESSNESS.
(a) In General.--Chapter 20 of title 38, United States Code, is
amended by inserting after section 2022 the following new section:
``Sec. 2022A. Partnerships with public and private entities to provide
legal services to homeless veterans and veterans at risk
of homelessness
``(a) Partnerships Authorized.--Subject to the availability of
funds for that purpose, the Secretary may enter into partnerships with
public or private entities to fund a portion of the general legal
services specified in subsection (c) that are provided by such entities
to homeless veterans and veterans at risk of homelessness.
``(b) Locations.--(1) The Secretary shall ensure that, to the
extent practicable, partnerships under this section are made with
entities equitably distributed across the geographic regions of the
United States, including rural communities, tribal lands of the United
States, Native Americans, and tribal organizations.
``(2) In this subsection, the terms `Native American' and `tribal
organization' have the meanings given such terms in section 3765 of
this title.
``(c) Legal Services.--Legal services specified in this subsection
include legal services provided by public or private entities that
address the needs of homeless veterans and veterans at risk of
homelessness, such as the following:
``(1) Legal services related to housing, including eviction
defense and representation in landlord-tenant cases.
``(2) Legal services related to family law, including
assistance in court proceedings for child support, divorce, and
estate planning.
``(3) Legal services related to income support, including
assistance in obtaining public benefits.
``(4) Legal services related to criminal defense, including
defense in matters symptomatic of homelessness, such as
outstanding warrants, fines, and driver's license revocation,
to reduce recidivism and facilitate the overcoming of reentry
obstacles in employment or housing.
``(d) Consultation.--In developing and carrying out partnerships
under this section, the Secretary shall, to the extent practicable,
consult with public and private entities--
``(1) for assistance in identifying and contacting
organizations described in subsection (c); and
``(2) to coordinate appropriate outreach relationships with
such organizations.
``(e) Reports.--The Secretary may require entities that have
entered into partnerships under this section to submit to the Secretary
periodic reports on legal services provided to homeless veterans and
veterans at risk of homelessness pursuant to such partnerships.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 20 of such title is amended by adding after the item relating
to section 2022 the following new item:
``2022A. Partnerships with public and private entities to provide legal
services to homeless veterans and veterans
at risk of homelessness.''.
SEC. 309. ADMINISTRATIVE IMPROVEMENTS TO GRANT AND PER DIEM PROGRAMS OF
DEPARTMENT OF VETERANS AFFAIRS.
Section 2012 of title 38, United States Code, is amended--
(1) in subsection (a)(1), in the matter before subparagraph
(A), by inserting ``and except as otherwise provided in this
section'' after ``such purpose''; and
(2) by adding at the end the following new subsection:
``(e) Review and Conditional Renewal.--(1) Each year, the Secretary
shall review each grant recipient and eligible entity that received a
per diem payment under this section for a service furnished to a
veteran during the one-year period preceding the review to evaluate the
performance of the grant recipient or eligible entity during that
period with respect to--
``(A) the success of the grant recipient or eligible entity
in assisting veterans to obtain, transition into, and retain
permanent housing; and
``(B) increasing the income of veterans, whether by helping
veterans obtain employment or by helping veterans obtain
income-related benefits to which such veterans may be eligible
or entitled.
``(2) For any grant recipient or eligible entity whose performance
was evaluated for a year under paragraph (1), the Secretary may only
provide per diem under this section to that grant recipient or eligible
entity in the following year if the Secretary determines that such
performance merits continued receipt of per diem under this section.
``(3) The Secretary shall establish uniform performance targets
throughout the United States for all grant recipients and eligible
entities that receive per diem payments under this section for purposes
of evaluating the performance of each such grant recipient and eligible
entity under this subsection.''.
SEC. 310. REPEAL OF REQUIREMENT FOR ANNUAL REPORTS ON ASSISTANCE TO
HOMELESS VETERANS.
(a) In General.--Section 2065 of title 38, United States Code, is
hereby repealed.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 20 of such title is amended by striking the item relating to
section 2065.
SEC. 311. COMPTROLLER GENERAL OF THE UNITED STATES STUDY ON HOMELESS
VETERANS PROGRAMS OF DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Not later than 270 days after the date of the
enactment of this Act, the Comptroller General of the United States
shall complete a study of programs of the Department of Veterans
Affairs that provide assistance to homeless veterans.
(b) Elements.--The study required by subsection (a) shall include
the following:
(1) An assessment of whether programs described in
subsection (a) are meeting the needs of veterans who are
eligible for assistance provided by such programs, including
any gaps or duplication in the provision of services.
(2) A review of recent efforts of the Secretary of Veterans
Affairs to improve the privacy, safety, and security of female
veterans receiving assistance from such programs.
SEC. 312. REQUIREMENT FOR DEPARTMENT OF VETERANS AFFAIRS TO ASSESS
COMPREHENSIVE SERVICE PROGRAMS FOR HOMELESS VETERANS.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall--
(1) assess and measure the capacity of programs for which
entities receive grants under section 2011 of title 38, United
States Code, or per diem payments under section 2012 or 2061 of
such title; and
(2) assess such programs with respect to--
(A) how well they achieve their stated goals at a
national level;
(B) placements in permanent housing;
(C) placements in employment; and
(D) increases in the regular income of participants
in the programs.
(b) Assessment at National and Local Levels.--In assessing and
measuring under subsection (a)(1), the Secretary shall develop and use
tools to examine the capacity of programs described in such subsection
at both the national and local level in order to assess the following:
(1) Whether sufficient capacity exists to meet the needs of
homeless veterans in each geographic area.
(2) Whether existing capacity meets the needs of the
subpopulations of homeless veterans located in each geographic
area.
(3) The amount of capacity that recipients of grants under
sections 2011 and 2061 and per diem payments under section 2012
of such title have to provide services for which the recipients
are eligible to receive per diem under section
2012(a)(2)(B)(ii) of title 38, United States Code, as added by
section 302(5)(B).
(c) Consideration of Other Resources.--In assessing and measuring
programs under subsection (a)(1), the Secretary shall consider the
availability to such programs of resources made available to such
programs and to homeless veterans, including resources provided by the
Department of Veterans Affairs and by entities other than the
Department.
(d) Use of Information.--The Secretary shall use the information
collected under this section as follows:
(1) To set specific goals to ensure that programs described
in subsection (a) are effectively serving the needs of homeless
veterans.
(2) To assess whether programs described in subsection (a)
are meeting goals set under paragraph (1).
(3) To inform funding allocations for programs described in
subsection (a).
(4) To improve the referral of homeless veterans to
programs described in subsection (a).
(e) Report.--Not later than 180 days after the date on which the
assessment required by subsection (a) is completed, 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 such assessment and such recommendations for legislative and
administrative action as the Secretary may have to improve the programs
and per diem payments described in subsection (a).
SEC. 313. REPORT ON OUTREACH RELATING TO INCREASING THE AMOUNT OF
HOUSING AVAILABLE TO VETERANS.
Not later than one year after the date of the enactment of this
Act, the Secretary of Veterans Affairs shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report describing and assessing the
outreach conducted by the Secretary to realtors, landlords, property
management companies, and developers to educate them about the housing
needs of veterans and the benefits of having veterans as tenants.
TITLE IV--HEALTH CARE MATTERS
SEC. 401. SHORT TITLE.
This title may be cited as the ``Jason Simcakoski Memorial Act''.
Subtitle A--Employment of Directors and Health Care Providers
SEC. 411. 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 ``until 2019'' and inserting ``until 2024''.
SEC. 412. MODIFICATION OF HOURS OF EMPLOYMENT FOR PHYSICIANS AND
PHYSICIAN ASSISTANTS EMPLOYED BY THE DEPARTMENT OF
VETERANS AFFAIRS.
Section 7423(a) of title 38, United States Code, is amended--
(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) The Secretary may modify the hours of employment for a
physician or physician assistant appointed in the Administration under
any provision of this chapter on a full-time basis to be more than or
less than 80 hours in a biweekly pay period if the total hours of
employment for such employee in a calendar year does not exceed 2,080
hours.''.
SEC. 413. REQUIREMENT THAT PHYSICIAN ASSISTANTS EMPLOYED BY THE
DEPARTMENT OF VETERANS AFFAIRS RECEIVE COMPETITIVE PAY.
(a) In General.--Section 7451(a)(2) of title 38, United States
Code, is amended--
(1) by redesignating subparagraph (B) as subparagraph (C);
(2) by inserting after subparagraph (A) the following new
subparagraph (B):
``(B) Physician assistant.''; and
(3) in subparagraph (C), as redesignated by paragraph (1),
by striking ``and registered nurse'' and inserting ``registered
nurse, and physician assistant''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on the date that is one year after the date of the
enactment of this Act.
SEC. 414. ESTABLISHMENT OF POSITIONS OF DIRECTORS OF VETERANS
INTEGRATED SERVICE NETWORKS IN OFFICE OF UNDER SECRETARY
FOR HEALTH OF DEPARTMENT OF VETERANS AFFAIRS AND
MODIFICATION OF QUALIFICATIONS FOR MEDICAL DIRECTORS.
Section 7306(a)(4) of title 38, United States Code, is amended--
(1) by inserting ``and Directors of Veterans Integrated
Service Networks'' after ``Such Medical Directors''; and
(2) by striking ``, who shall be either a qualified doctor
of medicine or a qualified doctor of dental surgery or dental
medicine''.
SEC. 415. PAY FOR MEDICAL DIRECTORS AND DIRECTORS OF VETERANS
INTEGRATED SERVICE NETWORKS.
(a) In General.--Chapter 74 of title 38, United States Code, is
amended by adding at the end the following new subchapter:
``Subchapter VII--Pay for Medical Directors and Directors of Veterans
Integrated Service Networks
``Sec. 7481. Pay for Medical Directors and Directors of Veterans
Integrated Service Networks
``(a) Elements of Pay.--Pay for a Medical Director or Director of a
Veterans Integrated Service Network appointed under section 7306(a)(4)
of this title (in this section referred to as a `Director') shall
consist of basic pay set forth under section 7404(a) of this title and
market pay determined under subsection (b).
``(b) Market Pay.--(1) Each Director is eligible for market pay
determined under this subsection.
``(2) The amount of market pay payable to a Director under this
section shall be determined by the Secretary on a case-by-case basis
and shall consist of pay intended to reflect needs of the Department
with respect to the recruitment and retention (as determined by the
Secretary) of such Director.
``(3) In determining the amount of market pay payable to a Director
under this section, the Secretary shall--
``(A) consult not less than two national surveys on pay for
hospital directors, medical facility directors, or other
similar positions, whether prepared by private, public, or
quasi-public entities, to make a general assessment of the
range of potential pay for the Director; and
``(B) take into account--
``(i) the experience of the Director in managing
facilities or program offices of the Department,
including the complexity of such facilities or offices;
``(ii) the complexity of the facility or facilities
to be managed by the Director;
``(iii) the labor market, in such geographic area
as the Secretary considers relevant, for hospital
directors, medical facility directors, and other
similar positions;
``(iv) the experience of the Director in managing
medical facilities for other Federal agencies, private
entities, or non-profit entities; and
``(v) such other considerations as the Secretary
considers appropriate.
``(4)(A) The Secretary shall evaluate the amount of market pay
payable to a Director under this section not less frequently than once
every two years and may adjust the market pay payable to such Director
as a result of such evaluation.
``(B) A Director whose market pay is evaluated under subparagraph
(A) shall receive written notice of the results of such evaluation.
``(c) Requirements and Limitations on Total Pay.--(1) Not less
frequently than once every two years, the Secretary shall set forth a
Department-wide minimum and maximum amount for total annual pay under
subsection (a) that may be paid to a Director and shall publish each
such amount in the Federal Register.
``(2) The minimum and maximum amounts set forth under paragraph (1)
shall take effect not earlier than the date that is 60 days after the
publication of such amounts under such paragraph.
``(3) The sum of the basic pay set forth under section 7404(a) of
this title and market pay determined under subsection (b) for a
Director for a calendar year--
``(A) may not be less than the most recent minimum amount
set forth under paragraph (1) before the beginning of such
calendar year; and
``(B) may not be more than the most recent maximum amount
set forth under such paragraph before the beginning of such
calendar year.
``(4) The total amount of compensation paid to a Director under
this title in any calendar year may not exceed the amount of annual
compensation (excluding expenses) of the President under section 102 of
title 3.
``(5) The Secretary may not delegate to an officer or employee of
the Department the requirement of the Secretary to set forth a
Department-wide minimum and maximum amount under paragraph (1).
``(d) Treatment of Pay.--Pay under this section shall be considered
pay for all purposes, including retirement benefits under chapters 83
and 84 of title 5 and other benefits.
``(e) Ancillary Effects of Decreases in Pay.--(1) A decrease in pay
of a Director resulting from an adjustment in the amount of market pay
of the Director under subsection (b) shall not be treated as an adverse
action.
``(2) A decrease in the amount of pay of a Director resulting from
an involuntary reassignment in connection with a disciplinary action
taken against the Director is not subject to appeal or judicial
review.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 74 of such title is amended by adding at the end the following:
``subchapter vii. pay for medical directors and directors of veterans
integrated service networks
``7481. Pay for Medical Directors and Directors of Veterans Integrated
Service Networks.''.
(c) Effective Date.--The amendments made by this section shall take
effect on the date that is one year after the date of the enactment of
this Act.
SEC. 416. ADDITIONAL REQUIREMENTS FOR HIRING OF HEALTH CARE PROVIDERS
BY DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--The Secretary of Veterans Affairs shall, as part
of the hiring process for each health care provider considered for a
position at the Department of Veterans Affairs after the date of the
enactment of this Act, require from the medical board of each State in
which the health care provider holds or has held a medical license--
(1) information on any violation of the requirements of the
medical license of the health care provider; and
(2) information on whether the health care provider has
entered into any settlement agreement for a disciplinary charge
relating to the practice of medicine by the health care
provider.
(b) Regulations.--The Secretary shall prescribe regulations to
carry out this section.
SEC. 417. PROVISION OF INFORMATION ON HEALTH CARE PROVIDERS OF
DEPARTMENT OF VETERANS AFFAIRS TO STATE MEDICAL BOARDS.
(a) In General.--Notwithstanding section 552a of title 5, United
States Code, the Secretary of Veterans Affairs shall, with respect to
each health care provider of the Department of Veterans Affairs that
has violated a requirement of their medical license, provide to the
medical board of each State in which the health care provider is
licensed or practices all relevant information contained in the State
Licensing Board Reporting File or any successor file of the Department
with respect to such violation.
(b) No Request Required.--The Secretary shall provide the
information required in subsection (a) to a medical board described in
such subsection notwithstanding that such board may not have formally
requested such information from the Department.
SEC. 418. REPORT ON COMPLIANCE BY DEPARTMENT OF VETERANS AFFAIRS WITH
REVIEWS OF HEALTH CARE PROVIDERS LEAVING THE DEPARTMENT
OR TRANSFERRING TO OTHER FACILITIES.
Not later than two years after the date of the enactment of this
Act, the Secretary of Veterans Affairs shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report on the compliance by the
Department of Veterans Affairs with the policy of the Department--
(1) to conduct a review of each health care provider of the
Department who transfers to another medical facility of the
Department or leaves the Department to determine whether there
are any concerns, complaints, or allegations of violations
relating to the medical practice of the health care provider;
and
(2) to take appropriate action with respect to any such
concern, complaint, or allegation.
Subtitle B--Opioid Therapy and Pain Management
SEC. 421. GUIDELINES ON MANAGEMENT OF OPIOID THERAPY BY DEPARTMENT OF
VETERANS AFFAIRS AND DEPARTMENT OF DEFENSE AND
IMPLEMENTATION OF SUCH GUIDELINES BY DEPARTMENT OF
VETERANS AFFAIRS.
(a) Guidelines.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
and the Secretary of Defense shall jointly update the VA/DOD
Clinical Practice Guideline for Management of Opioid Therapy
for Chronic Pain to include the following:
(A) Except as provided in paragraph (2), guidelines
developed by the Centers for Disease Control and
Prevention for safely prescribing opioids for the
treatment of chronic, non-cancer pain in outpatient
settings upon the release of such guidelines by the
Centers for Disease Control and Prevention.
(B) Enhanced guidance with respect to absolute
contraindications for opioid therapy, including
guidance with respect to the following:
(i) The coadministration of drugs that are
capable of inducing a life-limiting drug-drug
interaction, including benzodiazepines.
(ii) The treatment of patients with current
acute psychiatric instability or substance use
disorder or patients at risk of suicide.
(iii) The use of opioid therapy to treat
patients without any pain, including to treat
mental health disorders other than opioid use
disorder.
(C) Enhanced guidance with respect to the treatment
of patients with behaviors or comorbidities, such as
post-traumatic stress disorder, psychiatric disorders,
or a history of substance abuse or addiction, that
require consultation or comanagement of opioid therapy
with one or more specialists in pain management, mental
health, or addictions.
(D) Enhanced guidance with respect to the conduct
by health care providers of an effectiveness assessment
for patients receiving opioid therapy, including
patients on long-term opioid therapy, to determine--
(i) whether opioid therapy is meeting the
expected goals of the patient and health care
provider of relieving pain and improving
function; and
(ii) whether opioid therapy should be
continued.
(E) Requirements that each health care provider of
the Department of Veterans Affairs, before initiating
opioid therapy to treat a patient, use the Opioid
Therapy Risk Report tool of the Department, including
by accessing the most recent patient information from
the prescription drug monitoring program of each State,
as required to be included in such tool under section
422(d)(1), to assess the risk for adverse outcomes of
opioid therapy for the patient, including the
concurrent use of controlled substances such as
benzodiazepines, as part of the comprehensive
assessment conducted by the health care provider.
(F) Guidelines to govern the methodologies used by
health care providers of the Department of Veterans
Affairs and the Department of Defense to safely titrate
and taper opioid therapy when adjusting or
discontinuing the use of opioid therapy, including--
(i) prescription of the lowest effective
dose based on patient need;
(ii) use of opioids only for a limited
period of time; and
(iii) augmentation of opioid therapy with
other pain management therapies and modalities.
(G) Guidelines with respect to appropriate case
management for patients receiving opioid therapy who
transition between inpatient and outpatient health care
settings, which may include the use of care transition
plans.
(H) Enhanced recommendations with respect to the
use of routine and random urine drug tests for all
patients before and during opioid therapy to help
prevent substance abuse, dependence, and diversion,
including requirements--
(i) that such tests occur not less
frequently than once each year; and
(ii) that health care providers
appropriately interpret and respond to the
results from such tests to tailor pain therapy,
safeguards, and risk management strategies to
each patient.
(I) Guidance that health care providers discuss
with patients, before initiating opioid therapy,
options for pain management therapies without the use
of opioids and options to augment opioid therapy with
other clinical and complementary and integrative health
services to minimize opioid dependence.
(2) Treatment of certain guidelines developed after
deadline.--If the Centers for Disease Control and Prevention
release the guidelines described in paragraph (1)(A) after the
date on which the Secretary of Veterans Affairs and the
Secretary of Defense jointly update the VA/DOD Clinical
Practice Guideline for Management of Opioid Therapy for Chronic
Pain, as required under paragraph (1), the Secretary of
Veterans Affairs and the Secretary of Defense shall jointly
modify such updated clinical practice guideline to include the
guidelines described in paragraph (1)(A).
(b) Consultation Before Update.--Before updating the clinical
practice guideline under subsection (a), the Secretary of Veterans
Affairs and the Secretary of Defense shall jointly consult with the
Pain Management Working Group of the Health Executive Committee of the
Department of Veterans Affairs-Department of Defense Joint Executive
Committee established under section 320 of title 38, United States
Code.
(c) Controlled Substance Defined.--In this section, the term
``controlled substance'' has the meaning given that term in section 102
of the Controlled Substances Act (21 U.S.C. 802).
SEC. 422. IMPROVEMENT OF OPIOID SAFETY MEASURES BY DEPARTMENT OF
VETERANS AFFAIRS.
(a) Expansion of Opioid Safety Initiative.--Not later than 180 days
after the date of the enactment of this Act, the Secretary of Veterans
Affairs shall expand the Opioid Safety Initiative of the Department of
Veterans Affairs to include all medical facilities of the Department.
(b) Pain Management Education and Training.--
(1) In general.--In carrying out the Opioid Safety
Initiative of the Department, the Secretary shall require all
employees of the Department responsible for prescribing opioids
to receive education and training described in paragraph (2).
(2) Education and training.--Education and training
described in this paragraph is education and training on pain
management and safe opioid prescribing practices for purposes
of safely and effectively managing patients with chronic pain
and includes education and training on the following:
(A) The implementation of and full compliance with
the VA/DOD Clinical Practice Guideline for Management
of Opioid Therapy for Chronic Pain, including any
update to such guideline.
(B) The use of evidence-based pain management
therapies, including cognitive-behavioral therapy, non-
opioid alternatives, and non-drug approaches to
managing pain and related health conditions including
complementary and integrative health services.
(C) Screening and identification of patients with
substance use disorder, including drug-seeking
behavior, before prescribing opioids, assessment of the
risk potential for patients developing an addiction,
and referral of patients to appropriate addiction
treatment professionals if addiction is identified or
strongly suspected.
(D) Communication with patients on the potential
harm associated with the use of opioids and other
controlled substances, including the need to safely
store and dispose of supplies relating to the use of
opioids and other controlled substances.
(E) Such other education and training as the
Secretary considers appropriate to ensure that veterans
receive safe, high-quality pain management care from
the Department.
(3) Use of existing program.--In providing education and
training described in paragraph (2), the Secretary shall use
the Interdisciplinary Chronic Pain Management Training Team
Program of the Department.
(c) Pain Management Teams.--
(1) In general.--In carrying out the Opioid Safety
Initiative of the Department, each medical facility of the
Department shall identify and designate a pain management team
of health care professionals, which may include board certified
pain medicine specialists, responsible for coordinating and
overseeing therapy at such facility for patients experiencing
acute and chronic pain that is non-cancer related.
(2) Establishment of protocols.--
(A) In general.--The director of each Veterans
Integrated Service Network shall establish protocols
for the designation of pain management teams at each
medical facility within that Veterans Integrated
Service Network.
(B) Consultation on prescription of opioids.--Each
protocol established for a medical facility under
subparagraph (A) shall ensure that any health care
provider without expertise in prescribing analgesics or
who has not completed the education and training under
subsection (b), such as a mental health care provider,
does not prescribe opioids to a patient unless that
health care provider--
(i) consults with a health care provider
with pain management expertise or who is on the
pain management team of the medical facility;
and
(ii) refers the patient to that pain
management team for any subsequent
prescriptions and related therapy.
(3) Report.--
(A) In general.--Not later than one year after the
date of the enactment of this Act, the head of each
medical facility of the Department shall submit to the
director of the Veterans Integrated Service Network in
which the medical facility is located a report
identifying the health care professionals that have
been designated as members of the pain management team
at the medical facility.
(B) Elements.--Each report submitted under
subparagraph (A) with respect to a medical facility of
the Department shall include--
(i) a certification as to whether all
members of the pain management team at the
medical facility have completed the education
and training required under subsection (b); and
(ii) a plan for the management and referral
of patients to such pain management team if
health care providers without expertise in
prescribing analgesics prescribe opioid
medications to treat acute and chronic pain
that is non-cancer related.
(d) Tracking and Monitoring of Opioid Use.--
(1) Prescription drug monitoring programs of states.--In
carrying out the Opioid Safety Initiative and the Opioid
Therapy Risk Report tool of the Department, the Secretary
shall--
(A) ensure access by health care providers of the
Department to information on controlled substances,
including opioids and benzodiazepines, prescribed to
veterans who receive care outside the Department
through the prescription drug monitoring program of
each State, including by seeking to enter into
memoranda of understanding with States to allow such
access;
(B) include such information in the Opioid Therapy
Risk Report; and
(C) require health care providers of the Department
to submit to the prescription drug monitoring program
of each State information on prescriptions of
controlled substances received by veterans in that
State under the laws administered by the Secretary.
(2) Report on tracking of data on opioid use.--Not later
than 180 days after the date of the enactment of this Act, the
Secretary shall submit to Congress a report on the feasibility
and advisability of improving the Opioid Therapy Risk Report
tool of the Department to allow for more advanced real-time
tracking of and access to data on--
(A) the key clinical indicators with respect to the
totality of opioid use by veterans;
(B) concurrent prescribing by health care providers
of the Department of opioids in different health care
settings, include data on concurrent prescribing of
opioids to treat mental health disorders other than
opioid use disorder; and
(C) mail-order prescriptions of opioids prescribed
to veterans under the laws administered by the
Secretary.
(e) Availability of Opioid Receptor Antagonists.--
(1) Increased availability and use.--
(A) In general.--The Secretary shall increase the
availability of opioid receptor antagonists approved by
the Food and Drug Administration, such as naloxone, to
veterans.
(B) Availability, training, and distribution.--In
carrying out subparagraph (A), the Secretary shall, not
later than 90 days after the date of the enactment of
this Act--
(i) equip each pharmacy of the Department
with opioid receptor antagonists approved by
the Food and Drug Administration to be
dispensed to outpatients as needed; and
(ii) expand the Overdose Education and
Naloxone Distribution program of the Department
to ensure that all veterans in receipt of
health care under the laws administered by the
Secretary who are at risk of opioid overdose
may access such opioid receptor antagonists and
training on the proper administration of such
opioid receptor antagonists.
(C) Veterans who are at risk.--For purposes of
subparagraph (B), veterans who are at risk of opioid
overdose include--
(i) veterans receiving long-term opioid
therapy;
(ii) veterans receiving opioid therapy who
have a history of substance use disorder or
prior instances of overdose; and
(iii) veterans who are at risk as
determined by a health care provider who is
treating the veteran.
(2) Report.--Not later than 120 days after the date of the
enactment of this Act, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives a report
on compliance with paragraph (1) that includes an assessment of
any remaining steps to be carried out by the Department to
comply with such paragraph.
(f) Inclusion of Certain Information and Capabilities in Opioid
Therapy Risk Report Tool.--
(1) Information.--The Secretary shall include in the Opioid
Therapy Risk Report tool of the Department--
(A) information on the most recent time the tool
was accessed by a health care provider of the
Department with respect to each veteran; and
(B) information on the results of the most recent
urine drug test for each veteran.
(2) Capabilities.--The Secretary shall include in the
Opioid Therapy Risk Report tool the ability of health care
providers of the Department to determine whether a health care
provider of the Department prescribed opioids to a veteran
without checking the information in the tool with respect to
the veteran.
(g) Notification of Risk in Computerized Health Record.--The
Secretary shall modify the Computerized Patient Record System of the
Department to ensure that any health care provider that accesses the
record of a veteran, regardless of the reason the veteran seeks care
from the health care provider, will be immediately notified whether the
veteran--
(1) is receiving opioid therapy and has a history of
substance use disorder or prior instances of overdose;
(2) has a history of opioid abuse; or
(3) is at risk of becoming an opioid abuser as determined
by a health care provider who is treating the veteran.
(h) Controlled Substance Defined.--In this section, the term
``controlled substance'' has the meaning given that term in section 102
of the Controlled Substances Act (21 U.S.C. 802).
SEC. 423. ENHANCEMENT OF JOINT WORKING GROUP ON PAIN MANAGEMENT OF THE
DEPARTMENT OF VETERANS AFFAIRS AND THE DEPARTMENT OF
DEFENSE.
(a) In General.--Not later than 90 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs and the
Secretary of Defense shall ensure that the Pain Management Working
Group of the Health Executive Committee of the Department of Veterans
Affairs-Department of Defense Joint Executive Committee established
under section 320 of title 38, United States Code, includes a focus on
the following:
(1) The opioid prescribing practices of health care
providers of each Department.
(2) The ability of each Department to manage acute and
chronic pain among individuals receiving health care from that
Department, including training health care providers with
respect to pain management.
(3) The use by each Department of complementary and
integrative health in treating such individuals.
(4) The concurrent use by health care providers of each
Department of opioids and prescription drugs to treat mental
health disorders, including benzodiazepines.
(5) The practice by health care providers of each
Department of prescribing opioids to treat mental health
disorders.
(6) The coordination in coverage of and consistent access
to medications prescribed for patients transitioning from
receiving health care from the Department of Defense to
receiving health care from the Department of Veterans Affairs.
(7) The ability of each Department to identify and treat
substance use disorders among individuals receiving health care
from that Department.
(b) Coordination and Consultation.--The Secretary of Veterans
Affairs and the Secretary of Defense shall ensure that the working
group described in subsection (a)--
(1) coordinates the activities of the working group with
other relevant working groups established under section 320 of
title 38, United States Code, including the working groups on
evidence based practice, patient safety, pharmacy, and
psychological health;
(2) consults with other relevant Federal agencies,
including the Centers for Disease Control and Prevention, with
respect to the activities of the working group; and
(3) consults with the Department of Veterans Affairs and
the Department of Defense with respect to, reviews, and
comments on the VA/DOD Clinical Practice Guideline for
Management of Opioid Therapy for Chronic Pain, or any successor
guideline, before any update to the guideline is released.
(c) Consultation.--The Secretary of Veterans Affairs and the
Secretary of Defense shall ensure that the working group described in
subsection (a) is able to meaningfully consult with respect to the
updated guideline required under subsection (a) of section 421, as
required by subsection (b) of such section, not later than one year
after the date of the enactment of this Act.
SEC. 424. ESTABLISHMENT OF PAIN MANAGEMENT BOARDS OF DEPARTMENT OF
VETERANS AFFAIRS.
(a) In General.--Subchapter I of chapter 73 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 7309A. Pain management boards
``(a) Establishment.--The Secretary shall establish in each
Veterans Integrated Service Network a Pain Management Board (in this
section referred to as a `Board').
``(b) Activities.--(1) Each Board may--
``(A) consult with health care professionals and other
employees of the Department located in the Veterans Integrated
Service Network covered by the Board, patients who are being
treated at medical facilities of the Department located in such
Veterans Integrated Service Network, and family members of such
patients with respect to the pain management resources and best
practices of the Department;
``(B) oversee compliance by the health care professionals
and other employees of the Department with the best practices
of the Department, including by issuing recommendations to
improve compliance with those best practices;
``(C) provide oversight of the pain management practices of
the pain management teams of each medical facility of the
Department and the health care professionals and other
employees of the Department that are located in the Veterans
Integrated Service Network covered by the Board;
``(D) host educational events, as the Board considers
appropriate, for individuals specified in subparagraph (A) on
pain management and treatment that may include the sharing of
updated research and best practices from medical experts, other
health care systems, and such other Federal agencies as the
Board considers necessary to carry out this subparagraph; and
``(E) host public events, as the Board considers
appropriate, during which health care professionals discuss and
share best practices on pain management and complementary and
integrative health.
``(2)(A) Each Board may provide treatment recommendations for
patients with complex clinical pain who are being treated at a medical
facility of the Department located in the Veterans Integrated Service
Network covered by the Board, and assist in facilitating communication
between such patients and their health care providers, regardless of
whether such treatment is on an in-patient or out-patient basis, and
for whom a request for such recommendations, subject to subparagraph
(C), has been made by an individual described in subparagraph (B).
``(B) An individual described in this subparagraph is one of the
following individuals:
``(i) The patient.
``(ii) The spouse of the patient.
``(iii) A family member of the patient or another
individual if such family member or individual has been
designated by the patient to make health care decisions for the
patient or to receive health care information with respect to
the patient.
``(iv) A physician of the patient.
``(v) An employee of the medical facility of the Department
described in subparagraph (A).
``(C) An individual described in subparagraph (B) may not request
treatment recommendations under subparagraph (A) unless the
individual--
``(i) has requested treatment recommendations from the pain
management team of the medical facility of the Department at
which the patient is receiving treatment; and
``(ii) has received treatment recommendations from such
team and is not satisfied with those treatment recommendations.
``(D) Treatment recommendations provided under subparagraph (A)
shall assist the patient and health care provider in determining the
best treatment plan for the patient and shall not dictate the treatment
plan used by the health care provider.
``(3) Based on treatment recommendations developed under paragraph
(2)(A), consultations conducted under paragraph (1)(A), and educational
and public events hosted under subparagraphs (D) and (E) of paragraph
(1), each Board may provide to health care professionals of the
Department located in the Veterans Integrated Service Network covered
by the Board recommendations on the best practices regarding pain
management in cases of complex clinical pain.
``(4)(A) Not later than January 31 of each year, the Secretary
shall submit to the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of Representatives a
report that contains comprehensive information from each Board (with
all personally identifiable information of patients redacted) on pain
management practices carried out in the Veterans Integrated Service
Network covered by the Board.
``(B) Each report submitted by the Secretary under subparagraph (A)
shall include, for the year preceding the submittal of the report--
``(i) a summary and explanation of the treatment
recommendations provided under paragraph 2(A) during such year;
and
``(ii) the recommendations for best practices provided to
health care professionals under paragraph (3) during such year.
``(5) The Federal Advisory Committee Act (5 U.S.C. App.) shall not
apply to any Board.
``(c) Membership.--(1) Each Board shall include the following
individuals appointed by the Secretary:
``(A) A board certified pain medicine specialist.
``(B) A trained and qualified member of the primary care
team of a medical facility of the Department with experience in
pain care, such as a nurse practitioner.
``(C) A pain psychologist.
``(D) A pain social worker.
``(E) A clinical pharmacist.
``(F) A pain point of contact for a Veterans Integrated
Service Network.
``(G) A physician with addiction and psychopharmacology
expertise and experience.
``(H) An allied health care professional.
``(I) A clinician with expertise in complementary and
integrative health.
``(J) A clinical behavioral therapist.
``(K) A patient advocate.
``(L) A representative of the labor interests of employees
of the Department who are responsible for prescribing drugs.
``(M) Two current or former clinical patients who are
representative of the demographic of patients served by the
Veterans Integrated Service Network covered by the Board.
``(N) A family member of a current or former clinical
patient who is representative of the demographic of patients
served by the Veterans Integrated Service Network covered by
the Board.
``(2) The Secretary shall determine the terms of service of the
members of each Board, taking into consideration the clinical duties of
members who are employees of the Department.
``(3)(A) Members of each Board shall serve without pay and, except
as provided in subparagraph (B), members who are full-time officers or
employees of the United States may not receive additional pay,
allowances, or benefits by reason of their service on the Board.
``(B) Members may receive travel expenses, including per diem in
lieu of subsistence, for travel in connection with their duties as
members of the Board.
``(C)(i) Except as provided in clause (ii), any member who has
clinical duties as an officer or employee of the United States shall be
relieved of such duties during periods in which such relief is
necessary for the member to carry out the duties of the Board.
``(ii) The Secretary shall ensure that carrying out the duties of
the Board does not prevent any member who has clinical duties as an
employee of the Department from furnishing direct clinical care as
appropriate to maintain quality patient care.
``(d) Participation of Certain Members.--(1) In carrying out the
activities of a Board under subsection (b), any member appointed under
subsection (c)(1) solely based on qualifications under subparagraph
(K), (L), (M), or (N) of subsection (c)(1)--
``(A) may not have access to specific information
identifying a patient and other confidential information
relating to a patient; and
``(B) except as provided in paragraph (2), may not
participate in providing treatment recommendations under
subsection (b)(2)(A).
``(2) In carrying out the activities of the Board under subsection
(b), a member appointed under subsection (c)(1) solely based on
qualifications under subparagraph (K) of subsection (c)(1) may be
present during the provision of treatment recommendations under
subsection (b)(2)(A) with the consent and upon the request of the
patient for which such treatment recommendations are provided for
purposes of representing the interests of the patient.
``(e) Employment Protections.--No adverse personnel action may be
made against an employee of the Department in connection with a
communication by the employee with a member of a Board relating to the
activities of the Board under subsection (b) and any such communication
shall be covered by the employment and whistleblower protections
otherwise applicable to communications by employees of the Department.
``(f) Resources of Department.--The Secretary shall make available
to each Board the resources and personnel of the Department necessary
for the Board to carry out the activities of the Board under subsection
(b), including resources and personnel of the General Counsel of the
Department.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 73 of such title is amended by inserting after the item
relating to section 7309 the following new item:
``7309A. Pain management boards.''.
(c) Effective Date.--The amendments made by this section shall take
effect on the date that is one year after the date of the enactment of
this Act.
SEC. 425. REVIEW, INVESTIGATION, AND REPORT ON USE OF OPIOIDS IN
TREATMENT BY DEPARTMENT OF VETERANS AFFAIRS.
(a) Independent Review.--
(1) In general.--Not later than two years after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall enter into a contract with an independent entity with
expertise in assessing clinical prescribing practices to
conduct an independent review of the Opioid Safety Initiative
of the Department of Veterans Affairs and the opioid
prescribing practices of health care providers of the
Department.
(2) Report.--
(A) In general.--Not later than 30 days after
completing the independent review under paragraph (1),
the independent entity that carried out such review
shall submit to the Secretary, 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
independent entity with respect to such review.
(B) Elements.--The report submitted under
subparagraph (A) by the independent entity described in
such subparagraph--
(i) shall include--
(I) recommendations on such
improvements to the Opioid Safety
Initiative of the Department as the
independent entity considers
appropriate;
(II) information with respect to--
(aa) deaths resulting from
sentinel events involving
veterans prescribed opioids by
a health care provider of the
Department;
(bb) overall prescription
rates and prescription
indications of opioids at all
medical facilities of the
Department to treat non-cancer,
non-palliative, and non-hospice
care patients, including
whether such prescription rates
for each medical facility or
health care provider of the
Department conflicts with or is
otherwise inconsistent with the
standards of appropriate and
safe care with respect to such
prescription rates;
(cc) the prescription rates
and prescription indications of
benzodiazepines and opioids
concomitantly by health care
providers of the Department,
including whether such
prescription rates for each
medical facility or health care
provider of the Department
conflicts with or is otherwise
inconsistent with the standards
of appropriate and safe care
with respect to such
prescription rates;
(dd) the practice by health
care providers of the
Department of prescribing
opioids to treat patients
without any pain, including to
treat patients with mental
health disorders other than
opioid use disorder; and
(ee) the effectiveness of
opioid therapy for patients
receiving such therapy,
including the effectiveness of
long-term opioid therapy; and
(III) an assessment of the
compliance of the Department with the
VA/DOD Clinical Practice Guideline for
Management of Opioid Therapy for
Chronic Pain, as updated under section
421(a); and
(ii) may include recommendations with
respect to whether the Department should
implement policies relating to performance
management, such as written warnings or
performance improvement plans, for health care
providers of the Department that are--
(I) not practicing at a level
meeting or exceeding the minimum level
standard of care established by the
Department; and
(II) not following the enhanced
guidance with respect to absolute
contraindications for opioid therapy
set forth in the VA/DOD Clinical
Practice Guideline for Management of
Opioid Therapy for Chronic Pain, as
updated under section 421(a).
(b) Annual Review, Investigation, and Report on Opioid Therapy.--
(1) Annual review of prescription rates.--Not later than
one year after the date of the enactment of this Act, and not
less frequently than annually thereafter, the Secretary of
Veterans Affairs shall, with respect to each medical facility
of the Department of Veterans Affairs, collect and review
information on opioids prescribed by health care providers at
the facility to treat non-cancer, non-palliative, and non-
hospice care patients, including information on--
(A) the prescription rate at which each health care
provider at the facility prescribed benzodiazepines and
opioids concurrently to such patients and the aggregate
such prescription rate for all health care providers at
the facility;
(B) the prescription rate at which each health care
provider at the facility prescribed benzodiazepines or
opioids to such patients to treat conditions for which
opioids or benzodiazepines are not an approved
treatment and the aggregate such prescription rate for
all health care providers at the facility;
(C) the prescription rate at which each health care
provider at the facility prescribed or dispensed mail-
order prescriptions of opioids to such patients while
such patients were being treated with opioids on an
inpatient-basis and the aggregate such prescription
rate for all health care providers at the facility; and
(D) the prescription rate at which each health care
provider at the facility prescribed opioids to such
patients who were also concurrently prescribed opioids
by a health care provider that is not a health care
provider of the Department and the aggregate such
prescription rate for all health care providers at the
facility.
(2) Investigation of prescription rates.--If the Secretary
determines that a prescription rate described in paragraph (1)
with respect to a health care provider or medical facility of
the Department conflicts with or is otherwise inconsistent with
the standards of appropriate and safe care, the Secretary
shall--
(A) include information relating to such
determination, prescription rate, and health care
provider or medical facility, as the case may be, in
the report submitted under paragraph (3)(F);
(B) through the Office of the Medical Inspector of
the Veterans Health Administration, conduct a full
investigation of the health care provider or medical
facility, as the case may be; and
(C) immediately notify the Committee on Veterans'
Affairs of the Senate, the Committee on Veterans'
Affairs of the House of Representatives, and each
Member of the Senate and the House of Representatives
who represents the area in which the health care
provider or medical facility, as the case may be, is
located.
(3) Report on opioid therapy.--Not later than one year
after the date of the enactment of this Act, and not less
frequently than annually thereafter, the Secretary shall submit
to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of Representatives
a report that contains, for the one year period preceding the
submittal of the report, the following:
(A) The number of patients and the percentage of
the patient population of the Department of Veterans
Affairs who were prescribed benzodiazepines and opioids
concurrently by a health care provider of the
Department.
(B) The number of patients and the percentage of
the patient population of the Department without any
pain who were prescribed opioids by a health care
provider of the Department, including those who were
prescribed benzodiazepines and opioids concurrently.
(C) The number of non-cancer, non-palliative, and
non-hospice care patients and the percentage of such
patients who were treated with opioids by a health care
provider of the Department on an inpatient-basis and
who also received prescription opioids by mail from the
Department while being treated on an inpatient-basis.
(D) The number of non-cancer, non-palliative, and
non-hospice care patients and the percentage of such
patients who were prescribed opioids concurrently by a
health care provider of the Department and a health
care provider that is not a health care provider of the
Department.
(E) With respect to each medical facility of the
Department, the number of times a pharmacist at the
facility overrode a critical drug interaction warning
with respect to an interaction between opioids and
another medication before dispensing a medication to a
veteran.
(F) The results of the review conducted under
paragraph (1) (including a summary of such review at
the Veterans Integrated Service Network level) and the
investigation conducted under paragraph (2) (including
information described in paragraph (2)(A)), compiled in
such a manner as the Secretary determines appropriate
to ensure that the information is easily accessible.
(G) An assessment of the compliance of the
Department with the VA/DOD Clinical Practice Guideline
for Management of Opioid Therapy for Chronic Pain,
including any update to such guideline.
(c) Prescription Rate Defined.--In this section, the term
``prescription rate'' means, with respect to a health care provider or
medical facility of the Department, each of the following:
(1) The number of patients treated with opioids by the
health care provider or at the medical facility, as the case
may be, divided by the total number of pharmacy users of that
health care provider or at that medical facility.
(2) The average number of morphine equivalents per day
prescribed by the health care provider or at the medical
facility, as the case may be, to patients being treated with
opioids.
(3) Of the patients being treated with opioids by the
health care provider or at the medical facility, as the case
may be, the average number of prescriptions of opioids per
patient.
Subtitle C--Patient Advocacy
SEC. 431. ESTABLISHMENT OF OFFICE OF PATIENT ADVOCACY OF THE DEPARTMENT
OF VETERANS AFFAIRS.
(a) In General.--Subchapter I of chapter 73 of title 38, United
States Code, as amended by section 424(a), is further amended by adding
at the end the following new section:
``Sec. 7309B. Office of Patient Advocacy
``(a) Establishment.--There is established in the Department within
the Office of the Under Secretary for Health an office to be known as
the `Office of Patient Advocacy' (in this section referred to as the
`Office').
``(b) Head.--(1) The Director of the Office of Patient Advocacy
shall be the head of the Office.
``(2) The Director of the Office of Patient Advocacy shall be
appointed by the Under Secretary for Health from among individuals
qualified to perform the duties of the position and shall report
directly to the Under Secretary for Health.
``(c) Function.--(1) The function of the Office is to carry out the
Patient Advocacy Program of the Department.
``(2) In carrying out the Patient Advocacy Program of the
Department, the Director shall ensure that patient advocates of the
Department--
``(A) advocate on behalf of veterans with respect to health
care received and sought by veterans under the laws
administered by the Secretary;
``(B) carry out the responsibilities specified in
subsection (d); and
``(C) receive training in patient advocacy.
``(d) Patient Advocacy Responsibilities.--The responsibilities of
each patient advocate at a medical facility of the Department are the
following:
``(1) To resolve complaints by veterans with respect to
health care furnished under the laws administered by the
Secretary that cannot be resolved at the point of service or at
a higher level easily accessible to the veteran.
``(2) To present at various meetings and to various
committees the issues experienced by veterans in receiving such
health care at such medical facility.
``(3) To express to veterans their rights and
responsibilities as patients in receiving such health care.
``(4) To manage the Patient Advocate Tracking System of the
Department at such medical facility.
``(5) To compile data at such medical facility of
complaints made by veterans with respect to the receipt of such
health care at such medical facility and the satisfaction of
veterans with such health care at such medical facility to
determine whether there are trends in such data.
``(6) To ensure that a process is in place for the
distribution of the data compiled under paragraph (5) to
appropriate leaders, committees, services, and staff of the
Department.
``(7) To identify, not less frequently than quarterly,
opportunities for improvements in the furnishing of such health
care to veterans at such medical facility based on complaints
by veterans.
``(8) To ensure that any significant complaint by a veteran
with respect to such health care is brought to the attention of
appropriate staff of the Department to trigger an assessment of
whether there needs to be a further analysis of the problem at
the facility-wide level.
``(9) To support any patient advocacy programs carried out
by the Department.
``(10) To ensure that all appeals and final decisions with
respect to the receipt of such health care are entered into the
Patient Advocate Tracking System of the Department.
``(11) To understand all laws, directives, and other rules
with respect to the rights and responsibilities of veterans in
receiving such health care, including the appeals processes
available to veterans.
``(12) To ensure that veterans receiving mental health
care, or the surrogate decision makers for such veterans, are
aware of the rights of veterans to seek representation from
systems established under section 103 of the Protection and
Advocacy for Mentally Ill Individuals Act of 1986 (42 U.S.C.
10803) to protect and advocate the rights of individuals with
mental illness and to investigate incidents of abuse and
neglect of such individuals.
``(13) To fulfill requirements established by the Secretary
with respect to the inspection of controlled substances.
``(14) To document potentially threatening behavior and
report such behavior to appropriate authorities.
``(e) Training.--In providing training to patient advocates under
subsection (c)(2)(C), the Director shall ensure that such training is
consistent throughout the Department.
``(f) Controlled Substance Defined.--In this section, the term
`controlled substance' has the meaning given that term in section 102
of the Controlled Substances Act (21 U.S.C. 802).''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 73 of such title, as amended by section 424(b), is further
amended by adding after the item relating to section 7309A the
following new item:
``7309B. Office of Patient Advocacy.''.
(c) Date Fully Operational.--The Secretary of Veterans Affairs
shall ensure that the Office of Patient Advocacy established in section
7309B of title 38, United States Code, as added by subsection (a), is
fully operational not later than the date that is one year after the
date of the enactment of this Act.
SEC. 432. COMMUNITY MEETINGS ON IMPROVING CARE FROM DEPARTMENT OF
VETERANS AFFAIRS.
(a) Community Meetings.--
(1) Medical centers.--Not later than 90 days after the date
of the enactment of this Act, and not less frequently than once
every 90 days thereafter, each medical center of the Department
of Veterans Affairs shall host a community meeting open to the
public on improving health care from the Department.
(2) Community based outpatient clinics.--Not later than one
year after the date of the enactment of this Act, and not less
frequently than annually thereafter, each community based
outpatient clinic of the Department shall host a community
meeting open to the public on improving health care from the
Department.
(b) Attendance by Director of Veterans Integrated Service Network
or Designee.--
(1) In general.--Subject to paragraph (2), each community
meeting hosted by a medical center or community based
outpatient clinic under subsection (a) shall be attended by the
Director of the Veterans Integrated Service Network in which
the medical center or community based outpatient clinic, as the
case may be, is located, or an employee designated by the
Director who works in the office of the Director .
(2) Attendance by director.--Each Director of a Veterans
Integrated Service Network shall attend not less than one
community meeting under subsection (a) hosted by each medical
center located in the Veterans Integrated Service Network each
year.
(c) Notice.--Each medical center or community based outpatient
clinic hosting a community meeting shall send timely notice of the
community meeting to the Committee on Veterans' Affairs of the Senate,
the Committee on Veterans' Affairs of the House of Representatives, and
each Member of the Senate and the House of Representatives who
represents the area in which the medical facility is located.
SEC. 433. IMPROVEMENT OF AWARENESS OF PATIENT ADVOCACY PROGRAM AND
PATIENT BILL OF RIGHTS OF DEPARTMENT OF VETERANS AFFAIRS.
Not later than 90 days after the date of the enactment of this Act,
the Secretary of Veterans Affairs shall, in as many prominent locations
as appropriate to be seen by the largest percentage of patients and
family members of patients at each medical facility of the Department
of Veterans Affairs--
(1) display the purposes of the Patient Advocacy Program of
the Department and the contact information for the patient
advocate at such medical facility; and
(2) display the rights and responsibilities of--
(A) patients and family members of patients at such
medical facility; and
(B) with respect to community living centers and
other residential facilities of the Department,
residents and family members of residents at such
medical facility.
SEC. 434. COMPTROLLER GENERAL REPORT ON PATIENT ADVOCACY PROGRAM OF
DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Not later than three years after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of Representatives a
report on the Patient Advocacy Program of the Department of Veterans
Affairs (in this section referred to as the ``Program'') as carried out
under the Office of Patient Advocacy of the Department established in
section 7309B of title 38, United States Code, as added by section
431(a).
(b) Elements.--The report required by subsection (a)--
(1) shall include--
(A) such recommendations and proposals for
improving or modifying the Program as the Comptroller
General considers appropriate; and
(B) such other information with respect to the
Program as the Comptroller General considers
appropriate; and
(2) may include--
(A) a description of the Program, including--
(i) the purposes of the Program;
(ii) the activities carried out under the
Program; and
(iii) the sufficiency of the Program in
achieving the purposes of the Program;
(B) an assessment of the sufficiency of staffing of
employees of the Department responsible for carrying
out the Program;
(C) an assessment of the sufficiency of the
training of such employees; and
(D) an assessment of--
(i) awareness of the Program among veterans
and their family members; and
(ii) the use of the Program by veterans and
their family members.
Subtitle D--Complementary and Integrative Health
SEC. 441. EXPANSION OF RESEARCH AND EDUCATION ON AND DELIVERY OF
COMPLEMENTARY AND INTEGRATIVE HEALTH TO VETERANS.
(a) Development of Plan To Expand Research, Education, and
Delivery.--Not later than 180 days after the date of the enactment of
this Act, the Secretary of Veterans Affairs shall develop a plan to
expand materially and substantially the scope of the effectiveness of
research and education on, and delivery and integration of,
complementary and integrative health services into the health care
services provided to veterans.
(b) Elements.--The plan required by subsection (a) shall provide
for the following:
(1) Research on the following:
(A) The effectiveness of various complementary and
integrative health services, including the
effectiveness of such services integrated with clinical
therapies.
(B) Approaches to integrating complementary and
integrative health services into other health care
services provided by the Department.
(2) Education and training for health care professionals of
the Department on the following:
(A) complementary and integrative health services
selected by the Secretary for purposes of the plan.
(B) Appropriate uses of such services.
(C) Integration of such services into the delivery
of health care to veterans.
(3) Research, education, and clinical activities on
complementary and integrative health at centers of innovation
at medical centers of the Department.
(4) Identification or development of metrics and outcome
measures to evaluate the effectiveness of the provision and
integration of complementary and integrative health services
into the delivery of health care to veterans.
(5) Integration and delivery of complementary and
integrative health services with other health care services
provided by the Department.
(c) Consultation.--
(1) In general.--In carrying out subsection (a), the
Secretary shall consult with the following:
(A) The Director of the National Center for
Complementary and Integrative Health of the National
Institutes of Health.
(B) The Commissioner of Food and Drugs.
(C) Institutions of higher education, private
research institutes, and individual researchers with
extensive experience in complementary and integrative
health and the integration of complementary and
integrative health practices into the delivery of
health care.
(D) Nationally recognized providers of
complementary and integrative health.
(E) Such other officials, entities, and individuals
with expertise on complementary and integrative health
as the Secretary considers appropriate.
(2) Scope of consultation.--The Secretary shall undertake
consultation under paragraph (1) in carrying out subsection (a)
with respect to the following:
(A) To develop the plan.
(B) To identify specific complementary and
integrative health practices that, on the basis of
research findings or promising clinical interventions,
are appropriate to include as services to veterans.
(C) To identify barriers to the effective provision
and integration of complementary and integrative health
services into the delivery of health care to veterans,
and to identify mechanisms for overcoming such
barriers.
(d) Complementary and Integrative Health Defined.--In this section,
the term ``complementary and integrative health'' has the meaning given
that term by the National Institutes of Health.
SEC. 442. PILOT PROGRAM ON INTEGRATION OF COMPLEMENTARY AND INTEGRATIVE
HEALTH WITHIN DEPARTMENT OF VETERANS AFFAIRS MEDICAL
CENTERS.
(a) Pilot Program Required.--Not later than 180 days after the
completion of the development of the plan under section 441, the
Secretary of Veterans Affairs shall--
(1) carry out, through the Office of Patient Centered Care
and Cultural Transformation of the Department of Veterans
Affairs, a pilot program to assess the feasibility and
advisability of integrating the delivery of complementary and
integrative health services selected by the Secretary with
other health care services provided by the Department for
veterans with mental health conditions, chronic pain
conditions, other chronic conditions, and such other conditions
as the Secretary determines appropriate; and
(2) in developing the pilot program--
(A) use the plan developed under section 441; and
(B) identify and, to the extent practicable,
resolve barriers to the provision of complementary and
integrative health services selected by the Secretary
and the integration of those services with other health
care services provided by the Department.
(b) Duration of Pilot Program.--The Secretary shall carry out the
pilot program during the three-year period beginning on the date that
is 180 days after the completion of the development of the plan under
section 441.
(c) Locations.--
(1) In general.--The Secretary shall carry out the pilot
program at not fewer than 15 medical centers of the Department.
(2) Polytrauma centers.--Not less than two of the medical
centers designated under paragraph (1) shall be located at
polytrauma rehabilitation centers of the Department.
(3) Medical centers with prescription rate of opioids that
conflicts with care standards.--
(A) In general.--In selecting medical centers under
paragraph (1), the Secretary shall give priority to
medical centers of the Department at which there is a
prescription rate of opioids that conflicts with or is
otherwise inconsistent with the standards of
appropriate and safe care.
(B) Prescription rate defined.--In this paragraph,
the term ``prescription rate'' means, with respect to a
medical center of the Department, each of the
following:
(i) The number of patients treated with
opioids at the medical center divided by the
total number of pharmacy users at the medical
center.
(ii) The average number of morphine
equivalents per day prescribed at the medical
center to patients being treated with opioids.
(iii) Of the patients being treated with
opioids at the medical center, the average
number of prescriptions of opioids per patient.
(4) Selection of locations.--In carrying out the pilot
program, the Secretary shall select locations that include the
following areas:
(A) Rural areas.
(B) Areas that are not in close proximity to an
active duty military installation.
(C) Areas representing different geographic
locations, such as census tracts established by the
Bureau of the Census.
(d) Provision of Services.--Under the pilot program, the Secretary
shall provide covered services to covered veterans by integrating
complementary and integrative health services with other services
provided by the Department at the medical centers designated under
subsection (c)(1).
(e) Covered Veterans.--For purposes of the pilot program, a covered
veteran is any veteran who--
(1) has a mental health condition diagnosed by a clinician
of the Department;
(2) experiences chronic pain;
(3) has a chronic condition being treated by a clinician of
the Department; or
(4) is not described in paragraph (1), (2), or (3) and
requests to participate in the pilot program or is referred by
a clinician of the Department who is treating the veteran.
(f) Covered Services.--
(1) In general.--For purposes of the pilot program, covered
services are services consisting of complementary and
integrative health services as selected by the Secretary.
(2) Administration of services.--Covered services shall be
administered under the pilot program as follows:
(A) Covered services shall be administered by
professionals or other instructors with appropriate
training and expertise in complementary and integrative
health services who are employees of the Department or
with whom the Department enters into an agreement to
provide such services.
(B) Covered services shall be included as part of
the Patient Aligned Care Teams initiative of the Office
of Patient Care Services, Primary Care Program Office,
in coordination with the Office of Patient Centered
Care and Cultural Transformation.
(C) Covered services shall be made available to--
(i) covered veterans who have received
conventional treatments from the Department for
the conditions for which the covered veteran
seeks complementary and integrative health
services under the pilot program; and
(ii) covered veterans who have not received
conventional treatments from the Department for
such conditions.
(g) Voluntary Participation.--The participation of a veteran in the
pilot program shall be at the election of the veteran and in
consultation with a clinician of the Department.
(h) Report.--
(1) In general.--Not later than three years after the date
of the commencement of the pilot program, the Secretary shall
submit to the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of
Representatives a report on the pilot program.
(2) Elements.--The report submitted under paragraph (1)
shall include the following:
(A) The findings and conclusions of the Secretary
with respect to the pilot program, including with
respect to--
(i) the use and efficacy of the
complementary and integrative health services
established under the pilot program;
(ii) the outreach conducted by the
Secretary to inform veterans and community
organizations about the pilot program; and
(iii) an assessment of the benefit of the
pilot program to covered veterans in mental
health diagnoses, pain management, and
treatment of chronic illness.
(B) Barriers identified under subsection (a)(2)(B)
that were not resolved.
(C) Such recommendations for the continuation or
expansion of the pilot program as the Secretary
considers appropriate.
(i) Complementary and Integrative Health Defined.--In this section,
the term ``complementary and integrative health'' shall have the
meaning given that term in section 441(d).
Subtitle E--Family Caregivers
SEC. 451. EXPANSION OF FAMILY CAREGIVER PROGRAM OF DEPARTMENT OF
VETERANS AFFAIRS.
(a) Family Caregiver Program.--
(1) Expansion of eligibility.--
(A) In general.--Subsection (a)(2)(B) of section
1720G of title 38, United States Code, is amended to
read as follows:
``(B) for assistance provided under this subsection--
``(i) before the date on which the Secretary
submits to Congress a certification that the Department
has fully implemented the information technology system
required by section 452(a) of the Jason Simcakoski
Memorial Act, has a serious injury (including traumatic
brain injury, psychological trauma, or other mental
disorder) incurred or aggravated in the line of duty in
the active military, naval, or air service on or after
September 11, 2001;
``(ii) during the two-year period beginning on the
date specified in clause (i), has a serious injury
(including traumatic brain injury, psychological
trauma, or other mental disorder) incurred or
aggravated in the line of duty in the active military,
naval, or air service--
``(I) on or before May 7, 1975; or
``(II) on or after September 11, 2001; or
``(iii) after the date that is two years after the
date specified in clause (i), has a serious injury
(including traumatic brain injury, psychological
trauma, or other mental disorder) incurred or
aggravated in the line of duty in the active military,
naval, or air service; and''.
(B) Publication in federal register.--Not later
than 30 days after the date on which the Secretary of
Veterans Affairs submits to Congress the certification
described in subsection (a)(2)(B)(i) of section 1720G
of such title, as amended by subparagraph (A) of this
paragraph, the Secretary shall publish the date
specified in such subsection in the Federal Register.
(2) Expansion of needed services in eligibility criteria.--
Subsection (a)(2)(C) of such section is amended--
(A) in clause (ii), by striking ``; or'' and
inserting a semicolon;
(B) by redesignating clause (iii) as clause (iv);
and
(C) by inserting after clause (ii) the following
new clause (iii):
``(iii) a need for regular or extensive instruction
or supervision without which the ability of the veteran
to function in daily life would be seriously impaired;
or''.
(3) Expansion of services provided.--Subsection
(a)(3)(A)(ii) of such section is amended--
(A) in subclause (IV), by striking ``; and'' and
inserting a semicolon;
(B) in subclause (V), by striking the period at the
end and inserting ``; and''; and
(C) by adding at the end the following new
subclause:
``(VI) through the use of contracts with, or the
provision of grants to, public or private entities--
``(aa) financial planning services relating
to the needs of injured veterans and their
caregivers; and
``(bb) legal services, including legal
advice and consultation, relating to the needs
of injured veterans and their caregivers.''.
(4) Modification of stipend calculation.--Subsection
(a)(3)(C) of such section is amended--
(A) by redesignating clause (iii) as clause (iv);
and
(B) by inserting after clause (ii) the following
new clause (iii):
``(iii) In determining the amount and degree of personal care
services provided under clause (i) with respect to an eligible veteran
whose need for personal care services is based in whole or in part on a
need for supervision or protection under paragraph (2)(C)(ii) or
regular instruction or supervision under paragraph (2)(C)(iii), the
Secretary shall take into account the following:
``(I) The assessment by the family caregiver of the needs
and limitations of the veteran.
``(II) The extent to which the veteran can function safely
and independently in the absence of such supervision,
protection, or instruction.
``(III) The amount of time required for the family
caregiver to provide such supervision, protection, or
instruction to the veteran.''.
(5) Periodic evaluation of need for certain services.--
Subsection (a)(3) of such section is amended by adding at the
end the following new subparagraph:
``(D) In providing instruction, preparation, and training under
subparagraph (A)(i)(I) and technical support under subparagraph
(A)(i)(II) to each family caregiver who is approved as a provider of
personal care services for an eligible veteran under paragraph (6), the
Secretary shall periodically evaluate the needs of the eligible veteran
and the skills of the family caregiver of such veteran to determine if
additional instruction, preparation, training, or technical support
under those subparagraphs is necessary.''.
(6) Use of primary care teams.--Subsection (a)(5) of such
section is amended, in the matter preceding subparagraph (A),
by inserting ``(in collaboration with the primary care team for
the eligible veteran to the maximum extent practicable)'' after
``evaluate''.
(7) Assistance for family caregivers.--Subsection (a) of
such section is amended by adding at the end the following new
paragraph:
``(11)(A) In providing assistance under this subsection to family
caregivers of eligible veterans, the Secretary may enter into
contracts, provider agreements, and memoranda of understanding with
Federal agencies, States, and private, nonprofit, and other entities to
provide such assistance to such family caregivers.
``(B) The Secretary may provide assistance under this paragraph
only if such assistance is reasonably accessible to the family
caregiver and is substantially equivalent or better in quality to
similar services provided by the Department.
``(C) The Secretary may provide fair compensation to Federal
agencies, States, and other entities that provide assistance under this
paragraph.''.
(b) Modification of Definition of Personal Care Services.--
Subsection (d)(4) of such section is amended--
(1) in subparagraph (A), by striking ``independent'';
(2) by redesignating subparagraph (B) as subparagraph (D);
and
(3) by inserting after subparagraph (A) the following new
subparagraphs:
``(B) Supervision or protection based on symptoms
or residuals of neurological or other impairment or
injury.
``(C) Regular or extensive instruction or
supervision without which the ability of the veteran to
function in daily life would be seriously impaired.''.
SEC. 452. IMPLEMENTATION OF INFORMATION TECHNOLOGY SYSTEM OF DEPARTMENT
OF VETERANS AFFAIRS TO ASSESS AND IMPROVE THE FAMILY
CAREGIVER PROGRAM.
(a) Implementation of New System.--
(1) In general.--Not later than December 31, 2016, the
Secretary of Veterans Affairs shall implement an information
technology system that fully supports the Program and allows
for data assessment and comprehensive monitoring of the
Program.
(2) Elements of system.--The information technology system
required to be implemented under paragraph (1) shall include
the following:
(A) The ability to easily retrieve data that will
allow all aspects of the Program (at the medical center
and aggregate levels) and the workload trends for the
Program to be assessed and comprehensively monitored.
(B) The ability to manage data with respect to a
number of caregivers that is more than the number of
caregivers that the Secretary expects to apply for the
Program.
(C) The ability to integrate the system with other
relevant information technology systems of the Veterans
Health Administration.
(b) Assessment of Program.--Not later than 180 days after
implementing the system described in subsection (a), the Secretary
shall, through the Under Secretary for Health, use data from the system
and other relevant data to conduct an assessment of how key aspects of
the Program are structured and carried out.
(c) Ongoing Monitoring of and Modifications to Program.--
(1) Monitoring.--The Secretary shall use the system
implemented under subsection (a) to monitor and assess the
workload of the Program, including monitoring and assessment of
data on--
(A) the status of applications, appeals, and home
visits in connection with the Program; and
(B) the use by caregivers participating in the
Program of other support services under the Program
such as respite care.
(2) Modifications.--Based on the monitoring and assessment
conducted under paragraph (1), the Secretary shall identify and
implement such modifications to the Program as the Secretary
considers necessary to ensure the Program is functioning as
intended and providing veterans and caregivers participating in
the Program with services in a timely manner.
(d) Reports.--
(1) Initial report.--
(A) In general.--Not later than 90 days after the
date of the enactment of this Act, the Secretary shall
submit to the Committee on Veterans' Affairs of the
Senate, the Committee on Veterans' Affairs of the House
of Representatives, and the Comptroller General of the
United States a report that includes--
(i) the status of the planning,
development, and deployment of the system
required to be implemented under subsection
(a), including any changes in the timeline for
the implementation of the system; and
(ii) an assessment of the needs of family
caregivers of veterans described in
subparagraph (B), the resources needed for the
inclusion of such family caregivers in the
Program, and such changes to the Program as the
Secretary considers necessary to ensure the
successful expansion of the Program to include
such family caregivers.
(B) Veterans described.--Veterans described in this
subparagraph are veterans who are eligible for the
Program under clause (ii) or (iii) of section
1720G(a)(2)(B) of title 38, United States Code, as
amended by section 451(a)(1) of this Act, solely due to
a serious injury (including traumatic brain injury,
psychological trauma, or other mental disorder)
incurred or aggravated in the line of duty in the
active military, naval, or air service before September
11, 2001.
(2) Notification by comptroller general.--The Comptroller
General shall review the report submitted under paragraph (1)
and notify the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of
Representatives with respect to the progress of the Secretary
in--
(A) fully implementing the system required under
subsection (a); and
(B) implementing a process for using such system to
monitor and assess the Program under subsection (c)(1)
and modify the Program as considered necessary under
subsection (c)(2).
(3) Final report.--
(A) In general.--Not later than December 31, 2017,
the Secretary shall submit to the Committee on
Veterans' Affairs of the Senate, the Committee on
Veterans' Affairs of the House of Representatives, and
the Comptroller General a report on the implementation
of subsections (a) through (c).
(B) Elements.--The report required by subparagraph
(A) shall include the following:
(i) A certification by the Secretary with
respect to whether the information technology
system described in subsection (a) has been
implemented.
(ii) A description of how the Secretary has
implemented such system.
(iii) A description of the modifications to
the Program, if any, that were identified and
implemented under subsection (c)(2).
(iv) A description of how the Secretary is
using such system to monitor the workload of
the Program.
(e) Definitions.--In this section:
(1) Active military, naval, or air service.--The term
``active military, naval, or air service'' has the meaning
given that term in section 101 of title 38, United States Code.
(2) Program.--The term ``Program'' means the program of
comprehensive assistance for family caregivers under section
1720G(a) of title 38, United States Code, as amended by section
451 of this Act.
SEC. 453. MODIFICATIONS TO ANNUAL EVALUATION REPORT ON CAREGIVER
PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS.
(a) Barriers to Care and Services.--Subparagraph (A)(iv) of section
101(c)(2) of the Caregivers and Veterans Omnibus Health Services Act of
2010 (Public Law 111-163; 38 U.S.C. 1720G note) is amended by inserting
``, including a description of any barriers to accessing and receiving
care and services under such programs'' before the semicolon.
(b) Sufficiency of Training for Family Caregiver Program.--
Subparagraph (B) of such section is amended--
(1) in clause (i), by striking ``; and'' and inserting a
semicolon;
(2) in clause (ii), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following new clause:
``(iii) an evaluation of the sufficiency
and consistency of the training provided to
family caregivers under such program in
preparing family caregivers to provide care to
veterans under such program.''.
SEC. 454. ADVISORY COMMITTEE ON CAREGIVER POLICY.
(a) Establishment.--There is established in the Department of
Veterans Affairs an advisory committee on policies relating to
caregivers of veterans (in this section referred to as the
``Committee'').
(b) Composition.--The Committee shall be composed of the following:
(1) A chair selected by the Secretary of Veterans Affairs.
(2) A representative from each of the following agencies or
organizations selected by the head of such agency or
organization:
(A) The Department of Veterans Affairs.
(B) The Department of Defense.
(C) The Department of Health and Human Services.
(D) The Department of Labor.
(E) The Centers for Medicare and Medicaid Services.
(3) Not less than seven individuals who are not employees
of the Federal Government selected by the Secretary from among
the following individuals:
(A) Academic experts in fields relating to
caregivers.
(B) Clinicians.
(C) Caregivers.
(D) Individuals in receipt of caregiver services.
(E) Such other individuals with expertise that is
relevant to the duties of the Committee as the
Secretary considers appropriate.
(c) Duties.--The duties of the Committee are as follows:
(1) To regularly review and recommend policies of the
Department of Veterans Affairs relating to caregivers of
veterans.
(2) To examine and advise the implementation of such
policies.
(3) To evaluate the effectiveness of such policies.
(4) To recommend standards of care for caregiver services
and respite care services provided to a caregiver or veteran by
a non-profit or private sector entity.
(5) To develop recommendations for legislative or
administrative action to enhance the provision of services to
caregivers and veterans, including eliminating gaps in such
services and eliminating disparities in eligibility for such
services.
(6) To make recommendations on coordination with State and
local agencies and relevant non-profit organizations on
maximizing the use and effectiveness of resources for
caregivers of veterans.
(d) Reports.--
(1) Annual report to secretary.--
(A) In general.--Not later than December 31, 2016,
and not less frequently than annually thereafter until
the termination date specified in subsection (e), the
chair of the Committee shall submit to the Secretary a
report on policies and services of the Department of
Veterans Affairs relating to caregivers of veterans.
(B) Elements.--Each report required by subparagraph
(A) shall include the following:
(i) An assessment of the policies of the
Department relating to caregivers of veterans
and services provided pursuant to such policies
as of the date of submittal of the report.
(ii) A description of any recommendations
made by the Committee to improve the
coordination of services for caregivers of
veterans between the Department and the
entities specified in subparagraphs (B) through
(E) of subsection (b)(2) and to eliminate
barriers to the effective use of such services,
including with respect to eligibility criteria.
(iii) An evaluation of the effectiveness of
the Department in providing services for
caregivers of veterans.
(iv) An evaluation of the quality and
sufficiency of services for caregivers of
veterans available from non-governmental
organizations.
(v) A description of any gaps identified by
the Committee in care or services provided by
caregivers to veterans and recommendations for
legislative or administrative action to address
such gaps.
(vi) Such other matters or recommendations
as the chair considers appropriate.
(2) Transmittal to congress.--Not later than 90 days after
the receipt of a report under paragraph (1), the Secretary
shall transmit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a copy of such report, together with such
comments and recommendations concerning such report as the
Secretary considers appropriate.
(e) Termination.--The Committee shall terminate on December 31,
2021.
SEC. 455. COMPREHENSIVE STUDY ON SERIOUSLY INJURED VETERANS AND THEIR
CAREGIVERS.
(a) Study Required.--During the period specified in subsection (d),
the Secretary of Veterans Affairs shall provide for the conduct by an
independent entity of a comprehensive study on the following:
(1) Veterans who have incurred a serious injury or illness,
including a mental health injury or illness.
(2) Individuals who are acting as caregivers for veterans.
(b) Elements.--The comprehensive study required by subsection (a)
shall include the following with respect to each veteran included in
such study:
(1) The health of the veteran and, if applicable, the
impact of the caregiver of such veteran on the health of such
veteran.
(2) The employment status of the veteran and, if
applicable, the impact of the caregiver of such veteran on the
employment status of such veteran.
(3) The financial status and needs of the veteran.
(4) The use by the veteran of benefits available to such
veteran from the Department of Veterans Affairs.
(5) Such other information as the Secretary considers
appropriate.
(c) Contract.--The Secretary shall enter into a contract with an
appropriate independent entity to conduct the study required by
subsection (a).
(d) Period Specified.--The period specified in this subsection is
the one-year period beginning on the date that is four years after the
date specified in section 1720G(a)(2)(B)(i) of title 38, United States
Code, as amended by section 451(a)(1) of this Act.
(e) Report.--Not later than 30 days after the end of the period
specified in subsection (d), the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report on the
results of the study required by subsection (a).
Subtitle F--Health Care Agreements
SEC. 461. AUTHORIZATION OF AGREEMENTS BETWEEN THE DEPARTMENT OF
VETERANS AFFAIRS AND NON-DEPARTMENT EXTENDED CARE
PROVIDERS.
(a) In General.--Subchapter I of chapter 17 of title 38, United
States Code, is amended by adding after section 1703 the following new
section:
``Sec. 1703A. Veterans Extended Care Agreements with certain health
care providers
``(a) Agreements to Furnish Extended Care.--(1) In addition to the
authority of the Secretary under this chapter to furnish extended care
at facilities of the Department and under contracts or sharing
agreements entered into under authorities other than this section, the
Secretary may furnish extended care through the use of agreements
entered into under this section. An agreement entered into under this
section may be referred to as a `Veterans Extended Care Agreement'.
``(2) The Secretary may enter into agreements to furnish extended
care under this section with eligible providers that are certified
under subsection (d) if the Secretary is not feasibly able to furnish
extended care at facilities of the Department.
``(3) An eligible provider, at its discretion, may opt to enter
into an agreement under this section instead of a contract or sharing
agreement under authorities other than this section.
``(b) Receipt of Extended Care.--(1) Eligibility of a veteran for
extended care under this section shall be determined as if such care
were furnished in a facility of the Department and provisions of this
title applicable to veterans receiving extended care in a facility of
the Department shall apply to veterans receiving such care under this
section.
``(2) In carrying out this section, the Secretary--
``(A) may not direct veterans seeking extended care to
health care providers that have entered into contracts or
sharing agreements under authorities other than this section;
and
``(B) shall ensure that veterans have the option to
determine whether to receive extended care from a health care
provider described in subparagraph (A) or an eligible provider
that has entered into an agreement under this section.
``(c) Eligible Providers.--For purposes of this section, an
eligible provider is one of the following:
``(1) A provider of services that has enrolled and entered
into a provider agreement under section 1866(a) of the Social
Security Act (42 U.S.C. 1395cc(a)).
``(2) A physician or supplier that has enrolled and entered
into a participation agreement under section 1842(h) of such
Act (42 U.S.C. 1395u(h)).
``(3) A provider of items and services receiving payment
under a State plan under title XIX of such Act (42 U.S.C. 1396
et seq.) or a waiver of such a plan.
``(4) A provider that is--
``(A) an Aging and Disability Resource Center, an
area agency on aging, or a State agency (as defined in
section 102 of the Older Americans Act of 1965 (42
U.S.C. 3002)); or
``(B) a center for independent living (as defined
in section 702 of the Rehabilitation Act of 1973 (29
U.S.C. 796a)).
``(5) Such other health care providers as the Secretary
considers appropriate for purposes of this section.
``(d) Certification of Eligible Providers.--(1) The Secretary shall
establish a process for the certification of eligible providers under
this section that shall, at a minimum, set forth the following.
``(A) Procedures for the submittal of applications for
certification and deadlines for actions taken by the Secretary
with respect to such applications.
``(B) Standards and procedures for approval and denial of
certification, duration of certification, revocation of
certification, and recertification.
``(C) Procedures for assessing eligible providers based on
the risk of fraud, waste, and abuse of such providers similar
to the level of screening under section 1866(j)(2)(B) of the
Social Security Act (42 U.S.C. 1395cc(j)(2)(B)) and the
standards set forth under section 9.104 of title 48, Code of
Federal Regulations, or any successor regulation.
``(2) The Secretary shall deny or revoke certification to an
eligible provider under this subsection if the Secretary determines
that the eligible provider is currently--
``(A) excluded from participation in a Federal health care
program (as defined in section 1128B(f) of the Social Security
Act (42 U.S.C. 1320a-7b(f))) under section 1128 or 1128A of the
Social Security Act (42 U.S.C. 1320a-7 and 1320a-7a); or
``(B) identified as an excluded source on the list
maintained in the System for Award Management, or any successor
system.
``(e) Terms of Agreements.--Each agreement entered into with an
eligible provider under this section shall include provisions requiring
the eligible provider to do the following:
``(1) To accept payment for extended care furnished under
this section at rates established by the Secretary for purposes
of this section, which shall be, to the extent practicable, the
rates paid by the United States for such care to providers of
services and suppliers under the Medicare program under title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
``(2) To accept payment under paragraph (1) as payment in
full for extended care furnished under this section and to not
seek any payment for such care from the recipient of such care.
``(3) To furnish under this section only the extended care
authorized by the Department under this section unless the
eligible provider receives prior written consent from the
Department to furnish extended care outside the scope of such
authorization.
``(4) To bill the Department for extended care furnished
under this section in accordance with a methodology established
by the Secretary for purposes of this section.
``(5) Not to seek to recover or collect from a health-plan
contract or third party, as those terms are defined in section
1729 of this title, for any extended care for which payment is
made by the Department under this section.
``(6) To provide medical records for veterans furnished
extended care under this section to the Department in a time
frame and format specified by the Secretary for purposes of
this section.
``(7) To meet such other terms and conditions, including
quality of care assurance standards, as the Secretary may
specify for purposes of this section.
``(f) Termination of Agreements.--(1) An eligible provider may
terminate an agreement with the Secretary under this section at such
time and upon such notice to the Secretary as the Secretary may specify
for purposes of this section.
``(2) The Secretary may terminate an agreement with an eligible
provider under this section at such time and upon such notice to the
eligible provider as the Secretary may specify for purposes of this
section, if the Secretary--
``(A) determines that the eligible provider failed to
comply substantially with the provisions of the agreement or
with the provisions of this section and the regulations
prescribed thereunder;
``(B) determines that the eligible provider is--
``(i) excluded from participation in a Federal
health care program (as defined in section 1128B(f) of
the Social Security Act (42 U.S.C. 1320a-7b(f))) under
section 1128 or 1128A of the Social Security Act (42
U.S.C. 1320a-7 and 1320a-7a); or
``(ii) identified as an excluded source on the list
maintained in the System for Award Management, or any
successor system;
``(C) ascertains that the eligible provider has been
convicted of a felony or other serious offense under Federal or
State law and determines that the continued participation of
the eligible provider would be detrimental to the best
interests of veterans or the Department; or
``(D) determines that it is reasonable to terminate the
agreement based on the health care needs of a veteran or
veterans.
``(g) Periodic Review of Certain Agreements.--(1) Not less
frequently than once every two years, the Secretary shall review each
Veterans Extended Care Agreement of material size entered into during
the two-year period preceding the review to determine whether it is
feasible and advisable to furnish the extended care furnished under
such agreement at facilities of the Department or through contracts or
sharing agreements entered into under authorities other than this
section.
``(2)(A) Subject to subparagraph (B), a Veterans Extended Care
Agreement is of material size as determined by the Secretary for
purposes of this section.
``(B) A Veterans Extended Care Agreement entered into after
September 30, 2016, is of material size if the purchase of extended
care under the agreement exceeds $1,000,000 annually. The Secretary may
adjust such amount to account for changes in the cost of health care
based upon recognized health care market surveys and other available
data and shall publish any such adjustments in the Federal Register.
``(h) Exclusion of Certain Federal Contracting Provisions.--(1) An
agreement under this section may be entered into without regard to any
law that would require the Secretary to use competitive procedures in
selecting the party with which to enter into the agreement.
``(2)(A) Except as provided in subparagraph (B) and unless
otherwise provided in this section or regulations prescribed pursuant
to this section, an eligible provider that enters into an agreement
under this section is not subject to, in the carrying out of the
agreement, any law that providers of services and suppliers under the
Medicare program under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) are not subject to.
``(B) Notwithstanding subparagraph (A), an eligible provider that
enters into an agreement under this section shall be subject to all
laws regarding integrity, ethics, fraud, or that subject a person to
civil or criminal penalties as if such laws were incorporated into its
provider agreements.
``(i) Quality of Care.--The Secretary shall establish through
regulation a system or systems for--
``(1) monitoring the quality of extended care furnished to
veterans under this section; and
``(2) assessing the quality of extended care furnished by
an eligible provider under this section prior to the renewal of
a Veterans Extended Care Agreement with the eligible provider.
``(j) Dispute Resolution.--(1) The Secretary shall establish
administrative procedures for eligible providers with which the
Secretary has entered an agreement under this section to present any
dispute arising under or related to the agreement.
``(2) Before using any dispute resolution mechanism under chapter
71 of title 41 with respect to a dispute arising under an agreement
under this section, an eligible provider must first exhaust the
administrative procedures established by the Secretary under paragraph
(1).
``(k) Sunset.--The Secretary may not furnish extended care through
the use of an agreement entered into under this section after the date
that is two years after the date of the enactment of the Jason
Simcakoski Memorial Act.''.
(b) Regulations.--The Secretary of Veterans Affairs shall prescribe
an interim final rule to carry out section 1703A of such title, as
added by subsection (a), not later than one year after the date of the
enactment of this Act.
(c) Clerical Amendment.--The table of sections at the beginning of
chapter 17 of such title is amended by inserting after the item related
to section 1703 the following new item:
``1703A. Veterans Extended Care Agreements with certain health care
providers.''.
SEC. 462. MODIFICATION OF AUTHORITY TO ENTER INTO AGREEMENTS WITH STATE
HOMES TO PROVIDE NURSING HOME CARE.
(a) Use of Agreements.--
(1) In general.--Paragraph (1) of section 1745(a) of title
38, United States Code, is amended, in the matter preceding
subparagraph (A), by striking ``a contract (or agreement under
section 1720(c)(1) of this title)'' and inserting ``an
agreement''.
(2) Payment.--Paragraph (2) of such section is amended by
striking ``contract (or agreement)'' each place it appears and
inserting ``agreement''.
(b) Exclusion of Certain Federal Contracting Provisions.--Such
section is amended by adding at the end the following new paragraphs:
``(4)(A) An agreement under paragraph (1) may be entered into
without regard to any law that would require the Secretary to use
competitive procedures in selecting the party with which to enter into
the agreement.
``(B)(i) Except as provided in clause (ii) and unless otherwise
provided in this section or regulations prescribed pursuant to this
section, a State home that enters into an agreement under paragraph (1)
is not subject to, in the carrying out of the agreement, any law that a
provider described in subparagraph (C) is not subject to under the
original Medicare fee-for-service program under parts A and B of title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) or the
Medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.).
``(ii) Notwithstanding clause (i), a State home that enters into an
agreement under paragraph (1) shall be subject to all laws regarding
integrity, ethics, fraud, or that subject a person to civil or criminal
penalties as if such laws were incorporated into its provider
agreements.
``(C) A provider described in this subparagraph is one of the
following:
``(i) A provider of services that has enrolled and entered
into a provider agreement under section 1866(a) of the Social
Security Act (42 U.S.C. 1395cc(a)).
``(ii) A physician or supplier that has enrolled and
entered into a participation agreement under section 1842(h) of
such Act (42 U.S.C. 1395u(h)).
``(iii) A provider of items and services receiving payment
under a State plan under title XIX of such Act (42 U.S.C. 1396
et seq.) or a waiver of such a plan.
``(5) The Secretary may not furnish nursing home care under an
agreement entered into under paragraph (1) after the date that is two
years after the date of the enactment of the Jason Simcakoski Memorial
Act.''.
(c) Effective Date.--The amendments made by this section shall
apply to agreements entered into under section 1745(a) of such title on
and after the date that is 30 days after the date of the enactment of
this Act.
TITLE V--OTHER MATTERS
SEC. 501. EXTENSION OF TEMPORARY INCREASE IN NUMBER OF JUDGES ON UNITED
STATES COURT OF APPEALS FOR VETERANS CLAIMS.
(a) In General.--Subsection (i)(2) of section 7253 of title 38,
United States Code, is amended by striking ``January 1, 2013'' and
inserting ``January 1, 2021''.
(b) Report.--
(1) In general.--Not later than June 30, 2020, the chief
judge of the United States Court of Appeals for Veterans Claims
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 temporary expansions of the
Court under section 7253 of title 38, United States Code.
(2) Contents.--The report required by paragraph (1) shall
include the following:
(A) An assessment of the effect of the expansions
on ensuring appeals are handled in a timely manner.
(B) A description of the ways in which the
complexity levels of the appeals acted on by the Court
may have changed based on service during recent
conflicts compared to those based on service from
previous eras.
(C) A recommendation on whether the number of
judges should be adjusted at the end of the temporary
expansion period, including statistics, projections,
trend analyses, and other information to support the
recommendation.
SEC. 502. REPEAL INAPPLICABILITY OF MODIFICATION OF BASIC ALLOWANCE FOR
HOUSING TO BENEFITS UNDER LAWS ADMINISTERED BY SECRETARY
OF VETERANS AFFAIRS.
(a) Repeal.--Subsection (b) of section 604 of the Carl Levin and
Howard P. ``Buck'' McKeon National Defense Authorization Act for Fiscal
Year 2015 (Public Law 113-291; 37 U.S.C. 403 note) is repealed.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on January 1, 2016.
SEC. 503. DEPARTMENT OF VETERANS AFFAIRS PROGRAM OF INTERNAL AUDITS.
(a) In General.--Subchapter II of chapter 5 of title 38, United
States Code, is amended by inserting after section 527 the following
new section:
``Sec. 527A. Program of internal audits
``(a) Program Required.--(1) The Secretary shall carry out a
program of internal audits and self-analysis to improve the furnishing
of benefits and health care to veterans and their families.
``(2) The Secretary shall carry out the program required by
paragraph (1) through an office the Secretary shall establish for
purposes of the program within the office of the Secretary that is
interdisciplinary and independent of--
``(A) the other offices within the office of the Secretary;
and
``(B) the covered administrations (or functions of such
administrations), staff organizations, and staff offices
identified under subsection (b)(1)(A).
``(b) Program Requirements.--(1) In carrying out the program
required by subsection (a), the Secretary shall--
``(A) conduct periodic risk assessments of the Department
to identify those covered administrations (or functions of such
administrations), staff organizations, and staff offices of the
Department the audit of which would lead towards the greatest
improvement in the furnishing of benefits and health care to
veterans and their families;
``(B) develop plans that are informed by the risk
assessments conducted under paragraph (1) to conduct internal
audits of the covered administrations (or functions of such
administrations), staff organizations, and staff offices
identified under subparagraph (A); and
``(C) conduct internal audits in accordance with the plans
developed pursuant to subparagraph (B).
``(2) The Secretary shall carry out under the program required by
subsection (a) an audit of not fewer than five covered administrations
(or functions of such administrations), staff organizations, or staff
offices of the Department each year.
``(3) In identifying covered administrations (or functions of such
administrations), staff organizations, and staff offices of the
Department under paragraph (1)(A), the Secretary shall accord priority
to the covered administrations and functions of such administrations.
``(4)(A) For purposes of this subsection, the covered
administrations of the Department are the following:
``(i) The National Cemetery Administration.
``(ii) The Veterans Benefits Administration.
``(iii) The Veterans Health Administration.
``(B) For purposes this subsection, the covered staff organizations
of the Department are the following:
``(i) The Office of Acquisition, Logistics, and
Construction.
``(ii) The Advisory Committee Management Office.
``(iii) The Board of Veterans' Appeals.
``(iv) The Center for Faith-Based and Neighborhood
Partnerships.
``(v) The Center for Minority Veterans.
``(vi) The Center for Women Veterans.
``(vii) The Office of General Counsel.
``(viii) The Office of Regulation Policy and Management.
``(ix) The Office of Employment Discrimination Complaint
Adjudication.
``(x) The Office of Interagency Care and Benefits
Coordination.
``(xi) The Office of Small and Disadvantaged Business
Utilization.
``(xii) The Office of Survivors Assistance.
``(xiii) The Veterans' Service Organizations Liaison.
``(C) For purposes of this subsection, the covered staff offices of
the Department are the following:
``(i) The office of the Assistant Secretary for
Congressional and Legislative Affairs.
``(ii) The office of the Assistant Secretary for Human
Resources and Administration.
``(iii) The office of the Assistant Secretary for
Information and Technology.
``(iv) The Office of Management.
``(v) The office of the Assistant Secretary for Operations,
Security, and Preparedness.
``(vi) The office of the Assistant Secretary for Policy and
Planning.
``(vii) The office of the Assistant Secretary for Public
and Intergovernmental Affairs.
``(c) Reports.--(1)(A) Not later than 90 days after completing an
audit under the program required by subsection (a), the Secretary shall
submit to the appropriate committees of Congress a report on the audit.
``(B) Each report submitted under subparagraph (A) with respect to
an audit shall include the following:
``(i) A summary of the audit.
``(ii) The findings of the Secretary with respect to the
audit.
``(iii) Such recommendations as the Secretary may have for
legislative or administrative action to improve the furnishing
of benefits and health care to veterans and their families.
``(iv) Plans to carry out the recommendations submitted
under clause (iii), including timelines for completion of such
plans.
``(2)(A) Not later than September 1 of each year, the Secretary
shall submit to the appropriate committees of Congress a report on the
administration of this section.
``(B) Each report submitted under subparagraph (A) shall include
the following:
``(i) A detailed description of each matter for which a
recommendation was submitted under clause (iii) of paragraph
(1)(B) and with respect to which plans that were submitted
under clause (iv) of such paragraph have not been completed.
``(ii) A plan for the conduct of audits under this section
during the first fiscal year beginning after the fiscal year in
which the report is submitted, which shall include the
following:
``(I) A description of any risk assessments the
Secretary plans to conduct in such fiscal year.
``(II) A summary of each audit the Secretary plans
to conduct in such fiscal year, including a description
of the subject matter of the audit and identification
of the administration, office, or function to be
audited.
``(3) In this subsection, the term `appropriate committees of
Congress' includes--
``(A) the Committee on Veterans' Affairs, the Committee on
Appropriations, and the Committee on Homeland Security and
Governmental Affairs of the Senate; and
``(B) the Committee on Veterans' Affairs, the Committee on
Appropriations, and the Committee on Oversight and Government
Reform of the House of Representatives.''.
(b) First Risk Assessment.--The Secretary of Veterans Affairs shall
complete the first risk assessment required by section 527A(b)(1)(A) of
such title, as added by subsection (a), by not later than 180 days
after the date of the enactment of this Act.
(c) Clerical Amendment.--The table of sections at the beginning of
chapter 5 of such title is amended by inserting after the item relating
to section 527 the following new item:
``527A. Program of internal audits.''.
SEC. 504. IMPROVEMENT OF TRAINING FOR MANAGERS.
The Secretary of Veterans Affairs shall provide to each employee of
the Department of Veterans Affairs who is employed by the Department in
a managerial position periodic training on the following:
(1) The rights of whistleblowers and how to address a
report by an employee of a hostile work environment, reprisal,
or harassment.
(2) How to effectively motivate, manage, and reward the
employees who report to the manager.
(3) How to effectively manage employees who are performing
at an unacceptable level and access assistance from the human
resources office of the Department and the Office of the
General Counsel of the Department with respect to those
employees.
Amend the title so as to read: ``A bill to amend title 38,
United States Code, to improve the benefits and health care
provided by the Department of Veterans Affairs, and for other
purposes.''.
Calendar No. 716
114th CONGRESS
2d Session
S. 425
[Report No. 114-395]
_______________________________________________________________________
A BILL
To amend title 38, United States Code, to provide for a five-year
extension to the homeless veterans reintegration programs and to
provide clarification regarding eligibility for services under such
programs.
_______________________________________________________________________
December 7, 2016
Reported with an amendment and an amendment to the title