115 S1526 IS: Veterans Access to Care Act of 2017
U.S. Senate
2017-07-11
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of contents
(a)
This Act may be cited as the Veterans Access to Care Act of 2017
.
(b)The table of contents for this Act is as follows:Sec. 1. Short title; table of contents. TITLE I—Appropriation of amounts for health care for veterans Sec. 101. Appropriation of amounts for Veterans Choice Program. Sec. 102. Appropriation of amounts for health care from Department of Veterans Affairs. TITLE II—Improvement of health care from Department of Veterans Affairs Sec. 201. Program to increase number of graduate medical education residency positions of Department of Veterans Affairs. Sec. 202. Expansion of eligibility for participation in and services provided under family caregiver program of Department of Veterans Affairs. Sec. 203. Authorization of certain major medical facility leases of the Department of Veterans Affairs. TITLE III—Administration of health care from non-Department of Veterans Affairs providers Sec. 301. Modification of process through which Department of Veterans Affairs records obligations for non-Department care. Sec. 302. Modification of report on amounts available under Veterans Choice Program. TITLE IV—Other matters Sec. 401. Emergency designations. <enum>I</enum><header>Appropriation of amounts for health care for veterans</header> <section id="idA445AADCE9A546489FB864B7C96D946D"><enum>101.</enum><header>Appropriation of amounts for Veterans Choice Program</header> <subsection id="id13D002ADFC95486AA4AD1B3C5BED1F3C"><enum>(a)</enum><header>In general</header> <text display-inline="yes-display-inline">There is authorized to be appropriated, and is appropriated, to the Secretary of Veterans Affairs, out of any funds in the Treasury not otherwise appropriated, $4,300,000,000 to be deposited in the Veterans Choice Fund under section 802 of the Veterans Access, Choice, and Accountability Act of 2014 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1701">38 U.S.C. 1701</external-xref> note).</text>
</subsection><subsection id="id9E52C6EDD9C942F3B95242BAE185AED7"><enum>(b)</enum><header>Availability of amounts</header><text>The amount appropriated under subsection (a) shall be available for obligation or expenditure without fiscal year limitation.</text>
</subsection></section><section id="id7588031afe2e489d930b18dfc76156e1"><enum>102.</enum><header>Appropriation of amounts for health care from Department of Veterans Affairs</header>
<subsection id="ida77ed6cc97554183bb3385b94bd6c99a"><enum>(a)</enum><header>In general</header><text>There is authorized to be appropriated, and is appropriated, to the Secretary of Veterans Affairs, out of any funds in the Treasury not otherwise appropriated, $4,300,000,000 to carry out subsection (c).</text>
</subsection><subsection id="id9D58C62C942D442FBF8206B368364B6A"><enum>(b)</enum><header>Availability of amounts</header><text>The amount appropriated under subsection (a) shall be available for obligation or expenditure without fiscal year limitation.</text>
</subsection><subsection id="id595248da1e524abda8fe10e43f62b362"><enum>(c)</enum><header>Use of amounts</header><text>The amount appropriated under subsection (a) shall be used by the Secretary as follows:</text> <paragraph id="id3549099a656b4ec5b97ed37127e7c730"><enum>(1)</enum><text>To increase the access of veterans to care as follows:</text>
<subparagraph id="id79028f8ec6df43919cfa4df743ed9b5e"><enum>(A)</enum><text>To hire primary care and specialty care physicians for employment in the Department of Veterans Affairs.</text>
</subparagraph><subparagraph id="id7110e1e5bf384906b9fe36d582d3699b"><enum>(B)</enum><text>To hire other medical staff, including the following:</text> <clause id="id21a7e6adf3de4394bc1d89ffde14615c"><enum>(i)</enum><text>Physicians.</text>
</clause><clause id="id6C7ABF58681E4BF5994BDE819FC75699"><enum>(ii)</enum><text>Gynecologists.</text> </clause><clause id="id49fa1b60960c4607b9935c2c9aecd40b"><enum>(iii)</enum><text>Nurses.</text>
</clause><clause id="id870f1c859da14a89b1575e4398f8ecc5"><enum>(iv)</enum><text>Social workers.</text> </clause><clause id="id3b348ec165dc4e6eba6a4acf4cb7e17c"><enum>(v)</enum><text>Mental health professionals.</text>
</clause><clause id="idBDA439426130489484EED4F499EA4727"><enum>(vi)</enum><text>Physician assistants.</text> </clause><clause id="id60577aa8feac49b993f805dc5010c8cb"><enum>(vii)</enum><text>Other health care professionals as the Secretary considers appropriate.</text>
</clause></subparagraph><subparagraph id="id8e4044e64ef94464b8d87d8a0c351816"><enum>(C)</enum><text>To carry out the following:</text> <clause id="id3B08972B495E4A348E7FBB9658802637"><enum>(i)</enum><text>Section 7412 of title 38, United States Code.</text>
</clause><clause id="id54005CA91207465F8D09534DB9BDE52C"><enum>(ii)</enum><text>Section 7302(e) of such title.</text> </clause><clause id="id9FFFAEF00E40439AA824D3CD54CBB82A"><enum>(iii)</enum><text>Subchapters II and VII of chapter 76 of such title.</text>
</clause><clause id="idF88486453667427E809E25337F41D2FC"><enum>(iv)</enum><text>Section 301(b)(2) of the Veterans Access, Choice, and Accountability Act of 2014 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/7302">38 U.S.C. 7302</external-xref> note).</text>
</clause></subparagraph><subparagraph id="id671d92fe0e46417288dd223ea551e86a"><enum>(D)</enum><text>To pay for expenses, equipment, and other costs associated with the hiring of primary care, specialty care physicians, and other medical staff under subparagraphs (A), (B), and (C).</text>
</subparagraph></paragraph><paragraph id="id7edf19c2f7f142a590a1621c9a2cd66f"><enum>(2)</enum><text>To improve the physical infrastructure of the Department as follows:</text> <subparagraph id="id64574eca8966495a853ba1e0c62cfcb5"><enum>(A)</enum><text>To maintain and operate hospitals, nursing homes, domiciliary facilities, and other facilities of the Veterans Health Administration.</text>
</subparagraph><subparagraph id="iddb9066cff21544709c5e467457a05ef5"><enum>(B)</enum><text>To enter into contracts or hire temporary employees to repair, alter, or improve facilities under the jurisdiction of the Department that are not otherwise provided for under this paragraph.</text>
</subparagraph><subparagraph id="id2d13175db1a3444bbe2a4dcab8ff56b8"><enum>(C)</enum><text>To carry out leases for facilities of the Department.</text> </subparagraph><subparagraph id="ide9f862279fd4422397aa79f068061ed5"><enum>(D)</enum><text>To carry out minor construction projects of the Department.</text>
</subparagraph></paragraph><paragraph id="id67501924D8F143B8A790501119B6B99B"><enum>(3)</enum><text>To carry out the program to increase the number of graduate medical education residency positions of the Department under section 201.</text>
</paragraph><paragraph id="id7C220E08559C470E877ED922E2EF5E46"><enum>(4)</enum><text>To carry out the major medical facility leases authorized under section 203.</text> </paragraph></subsection><subsection id="id643fa3f09e344a36a64fdffb37b411d7"><enum>(d)</enum><header>Report</header> <paragraph id="id46d1573ca01f44519650509fbad06658"><enum>(1)</enum><header>In general</header><text>Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the appropriate committees of Congress a report on how the Secretary has obligated the amount appropriated under subsection (a) as of the date of the submittal of the report.</text>
</paragraph><paragraph id="id6e69db00def643b793fa0813fbb88c55"><enum>(2)</enum><header>Appropriate committees of Congress defined</header><text>In this subsection, the term <term>appropriate committees of Congress </term> means—</text> <subparagraph id="id0ea319b3684b400089cd19ff665caf1c"><enum>(A)</enum><text>the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate; and</text>
</subparagraph><subparagraph id="id3ea8d2018e52437f8e2a93998484d7af"><enum>(B)</enum><text>the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives.</text>
</subparagraph></paragraph></subsection><subsection id="id4163f9fdb250455d84c07082ff3de510"><enum>(e)</enum><header>Funding plan</header><text>The Secretary shall submit to Congress a funding plan describing how the Secretary intends to use the amount appropriated under subsection (a).</text>
</subsection></section><enum>II</enum><header>Improvement of health care from Department of Veterans Affairs</header>
<section commented="no" id="id1B55C243EBBF49A4A84D2BA3083E3ABF"><enum>201.</enum><header>Program to increase number of graduate medical education residency positions of Department of
Veterans Affairs</header>
<subsection id="id72d89cce0b0642dd9892e269d0e5921b"><enum>(a)</enum><header>In general</header><text>The Secretary of Veterans Affairs shall conduct a program to increase the number of graduate medical education residency positions at covered facilities by not more than 1,500 positions through the payment of educational assistance to participants in the program.</text>
</subsection><subsection id="id876a1950d14240db90b9f19cc2915ab1"><enum>(b)</enum><header>Application</header><text>To participate in the program under this section, an individual shall submit to the Secretary an application for such participation together with an agreement described in subsection (d) under which the individual agrees to serve a period of obligated service in the Veterans Health Administration as provided in the agreement in return for payment of educational assistance as provided in the agreement.</text>
</subsection><subsection id="idb322a484058a41019187da6bc172fff6"><enum>(c)</enum><header>Approval by Secretary</header>
<paragraph id="id97D65B7A8E624FDDACA4476ECF824F55"><enum>(1)</enum><header>In general</header><text>An individual becomes a participant in the program under this section upon the approval by the Secretary of the application of the individual and the acceptance by the Secretary of an agreement described in subsection (d) with respect to the individual.</text>
</paragraph><paragraph id="id404ae4968dfb415280f3a4b39b7f65b1"><enum>(2)</enum><header>Notification</header><text>Upon the approval by the Secretary under paragraph (1) of the participation of an individual in the program and the acceptance of an agreement described in subsection (d), the Secretary shall promptly notify the individual in writing of that approval and acceptance.</text>
</paragraph></subsection><subsection id="ideb1126b9f100452dac4ce49c7c9c0562"><enum>(d)</enum><header>Agreement</header><text>An agreement between the Secretary and a participant in the program under this section shall be in writing and shall be signed by the participant containing such terms as the Secretary may specify.</text>
</subsection><subsection id="ida8f45fd41ba840cd8628f73160c8ccac"><enum>(e)</enum><header>Conditions for medical residency</header><text>The Secretary may prescribe the conditions of employment of individuals participating in a medical residency under the program under this section, including necessary training, and the customary amount and terms of pay for such individuals during the period of such employment and training as a medical resident.</text>
</subsection><subsection id="idaddf26b9e35448f38d34e9518c53cec4"><enum>(f)</enum><header>Obligated service</header>
<paragraph id="id60AF847BB0054F38A1A3B24490981AEB"><enum>(1)</enum><header>In general</header><text>Each participant in the program under this section shall serve as a full-time employee of the Department of Veterans Affairs for a period of obligated service provided in the agreement entered into by the participant under subsection (d).</text>
</paragraph><paragraph id="id49253C4B766D4B1290ABED49FB871CF8"><enum>(2)</enum><header>Practice area</header><text>Service by a participant under paragraph (1) shall be in the full-time clinical practice of the profession of the participant or in another health care position in an assignment or location determined by the Secretary.</text>
</paragraph><paragraph id="id839b6e2d2377454da594f381accb4fb9"><enum>(3)</enum><header>Notification</header><text>Not later than 60 days before the date of the beginning of the period of obligated service of a participant, the Secretary shall notify the participant of that date.</text>
</paragraph></subsection><subsection id="idbb1e868ba9fa44ccaef8042ac580b80e"><enum>(g)</enum><header>Breach of agreement; liability</header>
<paragraph id="id09FDFF87310141968D04353993B0B0E8"><enum>(1)</enum><header>Liquidated damages for failure to accept payment</header>
<subparagraph id="id3F3843A3BE864EDAA27F838646FE09FE"><enum>(A)</enum><header>In general</header><text>A participant in the program under this section (other than a participant described in paragraph (2)) who fails to accept payment, or instructs the covered facility at which the participant is a medical resident not to accept payment, in whole or in part, of educational assistance under the agreement entered into under subsection (d) shall be liable to the United States for liquidated damages in the amount of $1,500.</text>
</subparagraph><subparagraph id="idA8DA5E79CEFD44DBB9BD76ED2EB0DDE7"><enum>(B)</enum><header>Treatment of other obligations</header><text>Liability for liquidated damages under subparagraph (A) is in addition to any period of obligated service or other obligation or liability under the agreement entered into under subsection (d).</text>
</subparagraph></paragraph><paragraph id="idfa6dcd62848945748b7d88779d76b253"><enum>(2)</enum><header>Liability for certain breaches</header>
<subparagraph id="idF9F47D978D2B433EBEEE4CA132A6FB5B"><enum>(A)</enum><header>In general</header><text>A participant in the program under this section shall be liable to the United States for the amount that has been paid to or on behalf of the participant under the agreement if any of the following occurs:</text>
<clause id="ideb6bf703686042dcba14177bbf95b8d6"><enum>(i)</enum><text>The participant is dismissed from serving as a medical resident at a covered facility for disciplinary reasons.</text>
</clause><clause id="id521b49783d964ef3a3ed89be7e3a4b60"><enum>(ii)</enum><text>The participant voluntarily terminates service as a medical resident at a covered facility before completion of such service.</text>
</clause><clause id="id73c53953f6e94a3ba8354226e30675b5"><enum>(iii)</enum><text>The participant loses his or her license, registration, or certification to practice his or her health care profession in a State.</text>
</clause></subparagraph><subparagraph id="idca2ece9c38b945c9afc808b1d367a812"><enum>(B)</enum><header>Treatment of period of obligated service</header><text>Liability under subparagraph (A) is in lieu of any period of obligated service under the agreement entered into under subsection (d).</text>
</subparagraph></paragraph><paragraph id="idcb6f61e8523f423c974ced2beaadb2ef"><enum>(3)</enum><header>Liability for failing to complete period of service</header>
<subparagraph id="idFC34952109C940009688B7EF80633F3E"><enum>(A)</enum><header>In general</header><text>If a participant in the program under this section breaches the agreement under subsection (d) by failing (for any reason) to complete the period of obligated service of the participant, the United States shall be entitled to recover from the participant an amount determined in accordance with the following formula: A = 3Φ(t − s/t).</text>
</subparagraph><subparagraph id="idc6eacfcb60e14955a9167c2337af528c"><enum>(B)</enum><header>Formula variables</header><text>In the formula specified in subparagraph (A):</text> <clause id="id57df60aa762642f59e2db82032f264b1"><enum>(i)</enum><text><quote>A</quote> is the amount the United States is entitled to recover from the participant.</text>
</clause><clause id="id16e46967135d4a5ea33b381086aafa90"><enum>(ii)</enum><text><quote>Φ</quote> is the sum of—</text> <subclause id="id7043ea84471b48638c77c9171284bc58"><enum>(I)</enum><text>the amounts paid under this section to or on behalf of the participant; and</text>
</subclause><subclause id="id9eaf0178e0024d2ab01e7d04bb73b0cd"><enum>(II)</enum><text>the interest on such amounts which would be payable if at the time the amounts were paid they were loans bearing interest at the maximum legal prevailing rate, as determined by the Treasurer of the United States.</text>
</subclause></clause><clause id="id5219dce0868641229acdb21c71788cb4"><enum>(iii)</enum><text><quote>t</quote> is the total number of months in the period of obligated service of the participant.</text> </clause><clause id="ida16c1eae3452453a9c937f3e6b397a0c"><enum>(iv)</enum><text><quote>s</quote> is the number of months of such period served by the participant.</text>
</clause></subparagraph></paragraph><paragraph id="id0267e626e3084a6791c59901a97358f4"><enum>(4)</enum><header>Payment deadline</header><text>Any amount of damages that the United States is entitled to recover under this subsection shall be paid to the United States within the one-year period beginning on the date of the breach of the agreement under subsection (d).</text>
</paragraph></subsection><subsection id="id5a902f0a226c450eb4ede4dcbb89e918"><enum>(h)</enum><header>Covered facilities defined</header><text>In this section, the term <term>covered facilities</term> means any of the following:</text> <paragraph id="id0e743be487404f939729514d262fdfbc"><enum>(1)</enum><text>A Department facility.</text>
</paragraph><paragraph id="id4ea7ed971fea4b718da8653bfb4f47e5"><enum>(2)</enum><text>A facility operated by an Indian tribe or a tribal organization, as those terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act (<external-xref legal-doc="usc" parsable-cite="usc/25/5304">25 U.S.C. 5304</external-xref>).</text>
</paragraph><paragraph id="id4d90a82a5c5b4db4b7c4af9c7b8f88c3"><enum>(3)</enum><text>A facility operated by the Indian Health Service.</text> </paragraph><paragraph id="id25f4068147cf409aa9b1ab8c3916a545"><enum>(4)</enum><text>A Federally-qualified health center, as defined in section 1905(l)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(l)(2)(B)</external-xref>).</text>
</paragraph><paragraph id="id3cf8bcfbdf3e40c3a06f431f0236fcdb"><enum>(5)</enum><text>A community health center.</text> </paragraph><paragraph id="id64ddde2910cc49e8827802e98956745f"><enum>(6)</enum><text>A facility operated by the Department of Defense.</text>
</paragraph><paragraph id="id08649badfea145fdb3e90d15ffa92d94"><enum>(7)</enum><text>Any other health care facility designated by the Secretary of Veterans Affairs.</text> </paragraph></subsection></section><section id="id48B1BC9E720D4486AFA3AA65759F6CAE"><enum>202.</enum><header>Expansion of eligibility for participation in and services provided under family caregiver program of Department of Veterans Affairs</header> <subsection id="id88DBC7FB2B1E48C99EA788B9BEA1CB38"><enum>(a)</enum><header>Family caregiver program</header> <paragraph id="id6F03DBC1CE5D4A7FA7A34C59D52E5C66"><enum>(1)</enum><header>Expansion of eligibility</header><text>Subsection (a)(2)(B) of section 1720G of title 38, United States Code, is amended by striking <quote>on or after September 11, 2001</quote>.</text>
</paragraph><paragraph id="id37C579CF827A42DB909CD42263F432BD"><enum>(2)</enum><header>Clarification of eligibility for illness</header><text>Such subsection is further amended by inserting <quote>or illness</quote> after <quote>serious injury</quote>.</text> </paragraph><paragraph id="idEBF9941EB37843D3AE0674592C6AC9CE"><enum>(3)</enum><header>Expansion of needed services in eligibility criteria</header><text>Subsection (a)(2)(C) of such section is amended—</text>
<subparagraph id="idCCCDEED2A6B1424EB49506603A640924"><enum>(A)</enum><text>in clause (ii), by striking <quote>; or</quote> and inserting a semicolon;</text> </subparagraph><subparagraph id="id8476F69C3F814B52B6F34A883B8E9EF4"><enum>(B)</enum><text>by redesignating clause (iii) as clause (iv); and</text>
</subparagraph><subparagraph id="id7EA683F98FE4471DB654CDA9501D9E3D"><enum>(C)</enum><text>by inserting after clause (ii) the following new clause (iii):</text> <quoted-block display-inline="no-display-inline" id="id8AE9AB0D62D949179D666E567A4C9C63" style="OLC"> <clause id="id18C18AADBCD34BDE88D8C190C4F00793" indent="up1"><enum>(iii)</enum><text>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</text></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="id364598F2D455404A902C80427D57D8F6"><enum>(4)</enum><header>Expansion of services provided</header><text>Subsection (a)(3)(A)(ii) of such section is amended—</text> <subparagraph id="idDEF11ECEB07F43CBA9FF8DBD5ED6756E"><enum>(A)</enum><text>in subclause (IV), by striking <quote>; and</quote> and inserting a semicolon;</text>
</subparagraph><subparagraph id="id4B22C8A3BA404ED9A5DB13E808446E78"><enum>(B)</enum><text>in subclause (V), by striking the period at the end and inserting a semicolon; and</text> </subparagraph><subparagraph id="id12ACC07CEAC9458292969BA9B9BF85F4"><enum>(C)</enum><text>by adding at the end the following new subclauses:</text>
<quoted-block display-inline="no-display-inline" id="idE093D31BAF9E42D88953943F17B6C566" style="OLC">
<subclause id="id757AB5D0BFD040558295083CB41857C8" indent="up2"><enum>(VI)</enum><text>child care services or a monthly stipend for such services if such services are not readily available from the Department;</text>
</subclause><subclause id="id63564CDAFB0C4794B4CE61218347942D" indent="up2"><enum>(VII)</enum><text>financial planning services relating to the needs of injured and ill veterans and their caregivers; and</text>
</subclause><subclause id="id7BC12F99F6D3430FA55198DA4078037E" indent="up2"><enum>(VIII)</enum><text>legal services, including legal advice and consultation, relating to the needs of injured and ill veterans and their caregivers.</text></subclause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="id5BEA6DD8E0A3400CB229550367E9C8D3"><enum>(5)</enum><header>Expansion of respite care provided</header><text>Subsection (a)(3)(B) of such section is amended by striking <quote>shall be</quote> and all that follows through the period at the end and inserting</text> <quoted-block display-inline="yes-display-inline" id="id28465B6B136F46EB925C432919AD5441" style="OLC"> <text>shall—</text><clause id="id297C4DD88F0D4F39B517B4A7583CC1C6" indent="up2"><enum>(i)</enum><text>be medically and age-appropriate;</text> </clause><clause id="idF816030ACAAA4AF596EB72AD3C773D5C" indent="up2"><enum>(ii)</enum><text>include in-home care; and</text>
</clause><clause id="id9820E7C49C004D7698146804F8C893B2" indent="up2"><enum>(iii)</enum><text>include peer-oriented group activities.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph><paragraph id="id8299A7A7296D43B0963294FE9128F606"><enum>(6)</enum><header>Modification of stipend calculation</header><text>Subsection (a)(3)(C) of such section is amended—</text>
<subparagraph id="id975BEFA4504349CE88E11D240EED77DF"><enum>(A)</enum><text>by redesignating clause (iii) as clause (iv); and</text> </subparagraph><subparagraph id="id650C2488FC514E519383AB42F5DAF790"><enum>(B)</enum><text>by inserting after clause (ii) the following new clause (iii):</text>
<quoted-block display-inline="no-display-inline" id="id3C513E03E1CC46348E8D163C572A6967" style="OLC">
<clause id="idF5B324BC81AE460C8C802E5402029402" indent="up3"><enum>(iii)</enum><text>In determining the amount and degree of personal care services provided under clause (i) with respect to an eligible veteran whose need for personal care services is based in whole or in part on a need for supervision or protection under paragraph (2)(C)(ii) or regular or extensive instruction or supervision under paragraph (2)(C)(iii), the Secretary shall take into account the following:</text>
<subclause id="id71F7A9009FBF41C69BBBE6644F90FF32"><enum>(I)</enum><text>The assessment by the family caregiver of the needs and limitations of the veteran.</text> </subclause><subclause id="id9C252164BB2E4E278212D0D22DFD1279"><enum>(II)</enum><text>The extent to which the veteran can function safely and independently in the absence of such supervision, protection, or instruction.</text>
</subclause><subclause id="id7FAE3F417B484B419B06569D1654353F"><enum>(III)</enum><text>The amount of time required for the family caregiver to provide such supervision, protection, or instruction to the veteran.</text></subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="id2104ACD49D2944889B76B9FA36E3A4F8"><enum>(7)</enum><header>Periodic evaluation of need for certain services</header><text>Subsection (a)(3) of such section is amended by adding at the end the following new subparagraph:</text> <quoted-block display-inline="no-display-inline" id="idE8730E2C93514273B67F5ECA2E31876E" style="OLC"> <subparagraph id="id9986E31418954B6DA1D75DA2C5131F09" indent="up2"><enum>(D)</enum><text>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.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id9AB3E9755D6943EB9251706E5BDDE5AF"><enum>(8)</enum><header>Use of primary care teams</header><text>Subsection (a)(5) of such section is amended, in the matter preceding subparagraph (A), by inserting <quote>(in collaboration with the primary care team for the eligible veteran to the maximum extent practicable)</quote> after <quote>evaluate</quote>.</text>
</paragraph><paragraph id="id42DA787A132B441A8ED9BF09B036E891"><enum>(9)</enum><header>Eligibility of and assistance for family caregivers</header><text>Subsection (a) of such section is amended by adding at the end the following new paragraphs:</text> <quoted-block display-inline="no-display-inline" id="id74436D2B56A34C3D946D2AD29C9B11E1" style="OLC"> <paragraph commented="no" display-inline="no-display-inline" id="id9DF5CC1EB90745F6BF9995337315F7F7" indent="up1"><enum>(11)</enum><text>Notwithstanding any other provision of this subsection, a family caregiver of an eligible veteran who is eligible under paragraph (2) solely because of a serious injury or illness (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, is eligible for assistance under this subsection as follows:</text>
<subparagraph commented="no" display-inline="no-display-inline" id="id67B3AD7ADF844658A6886D280941C4C5"><enum>(A)</enum><text>Not earlier than October 1, 2018, if the family caregiver would merit a monthly personal caregiver stipend under paragraph (3)(A)(ii)(V) in an amount that is in the highest tier specified in the schedule established by the Secretary under paragraph (3)(C)(i).</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id5D491858AF3F4B738F024D2456A8CC46"><enum>(B)</enum><text>Not earlier than October 1, 2020, if the family caregiver would merit such a stipend in an amount that is in the middle tier specified in such schedule.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id2C0A09081A294167B9A85AB5D4CA5137"><enum>(C)</enum><text>Not earlier than October 1, 2022, if the family caregiver would merit such a stipend in an amount that is in the lowest tier specified in such schedule.</text>
</subparagraph></paragraph><paragraph id="idA19DB06C085748AC8B9EDEF939109E4D" indent="up1"><enum>(12)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="idFD051B6ECC0E4070ADBEF76D4F9895F4"><enum>(A)</enum><text>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.</text>
</subparagraph><subparagraph id="id36E34DE8367C42939DDF01D069E5D5C2" indent="up1"><enum>(B)</enum><text>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.</text>
</subparagraph><subparagraph id="id3274BEF12A94424D8D35A32338CEB3AF" indent="up1"><enum>(C)</enum><text>The Secretary may provide fair compensation to Federal agencies, States, and other entities that provide assistance under this paragraph.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="id33D3476F81484730AFC7A5719A5F7585"><enum>(b)</enum><header>Termination of general caregiver support program</header>
<paragraph id="id162EE592CE314E8F90E31DCF9E9D4DE9"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Subsection (b) of such section is amended by adding at the end the following new paragraph:</text> <quoted-block display-inline="no-display-inline" id="id85B43AB0E601474EA5C10EF594AD8863" style="OLC"> <paragraph id="id89D352771DD94B60A4CF8D6CCEF6A848" indent="up1"><enum>(6)</enum><text>The authority of the Secretary to provide support services for caregivers of covered veterans under this subsection shall terminate on October 1, 2022.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id5DC85530A0DA4829853BA885AEF6A498"><enum>(2)</enum><header>Continuation of certain assistance</header><text>The Secretary of Veterans Affairs shall ensure that any activities carried out under subsection (b) of such section on September 30, 2022, are continued under subsection (a) of such section on and after October 1, 2022.</text>
</paragraph></subsection><subsection id="id0B26F363824346C9A153CCF70E2CA6DA"><enum>(c)</enum><header>Modification of definition of family member</header><text>Subparagraph (B) of subsection (d)(3) of such section is amended to read as follows:</text> <quoted-block display-inline="no-display-inline" id="idCF03DFF67D3C4058B71EEF918EBE788C" style="OLC"> <subparagraph id="idAEE4065C811749428F8EEAF710B4EBE0"><enum>(B)</enum><text>is not a member of the family of the veteran and does not provide care to the veteran on a professional basis.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="id43D909F8CA654E5C8EA176490002A078"><enum>(d)</enum><header>Modification of definition of personal care services</header><text>Subsection (d)(4) of such section is amended—</text> <paragraph id="id0CF249A0FB0E46E8898973DBE158C766"><enum>(1)</enum><text>in subparagraph (A), by striking <quote>independent</quote>;</text>
</paragraph><paragraph id="id849DE7C128824D2B9560FA6D90DD7E2E"><enum>(2)</enum><text>by redesignating subparagraph (B) as subparagraph (D); and</text> </paragraph><paragraph id="id27E6B47F41334D9C99FEEB8271F285A1"><enum>(3)</enum><text>by inserting after subparagraph (A) the following new subparagraphs:</text>
<quoted-block display-inline="no-display-inline" id="idC3687BCF4B6F49FB9D3380E4441B44DE" style="OLC">
<subparagraph id="id20D12C4456F940C4AA7A4B5855AC2CDF"><enum>(B)</enum><text>Supervision or protection based on symptoms or residuals of neurological or other impairment or injury.</text>
</subparagraph><subparagraph id="id05FEF71F8AFB4A2DA18AE25B94536B81"><enum>(C)</enum><text>Regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="id19DFCC7A6364417F81C9EB0074F43557"><enum>(e)</enum><header>Annual evaluation report</header><text>Paragraph (2) of section 101(c) of the Caregivers and Veterans Omnibus Health Services Act of 2010 (<external-xref legal-doc="public-law" parsable-cite="pl/111/163">Public Law 111–163</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1720G">38 U.S.C. 1720G</external-xref> note) is amended to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="idc45b5adc1c10442f85f710827c21d282" style="OLC">
<paragraph id="id9e15dc03c5a7495095e31bcc94fc6498"><enum>(2)</enum><header>Contents</header><text>Each report required by paragraph (1) after the date of the enactment of the <short-title>Veterans Choice Act of 2017</short-title> shall include the following with respect to the program of comprehensive assistance for family caregivers required by subsection (a)(1) of such section 1720G:</text>
<subparagraph id="id88061ae503034d37b7f3fc08301dd195"><enum>(A)</enum><text>The number of family caregivers that received assistance under such program.</text> </subparagraph><subparagraph id="id866d560bf0494f718e0bc435e5784351"><enum>(B)</enum><text>The cost to the Department of providing assistance under such program.</text>
</subparagraph><subparagraph id="idedd192d47b2e44c79c02f9f9792bb796"><enum>(C)</enum><text>A description of the outcomes achieved by, and any measurable benefits of, carrying out such program.</text>
</subparagraph><subparagraph id="idb8ff7b22508842debf86cbd198fb94b6"><enum>(D)</enum><text>An assessment of the effectiveness and the efficiency of the implementation of such program, including a description of any barriers to accessing and receiving care and services under such program.</text>
</subparagraph><subparagraph id="id76194ddc1d6b4462bfba91a7cbb1db75"><enum>(E)</enum><text>A description of the outreach activities carried out by the Secretary under such program.</text> </subparagraph><subparagraph id="id880d5958e88b4a759b9a548f6f30e5d5"><enum>(F)</enum><text>An assessment of the manner in which resources are expended by the Secretary under such program, particularly with respect to the provision of monthly personal caregiver stipends under subsection (a)(3)(A)(ii)(V) of such section 1720G.</text>
</subparagraph><subparagraph id="idECBC667098B9452C87FF37CAD0417B53"><enum>(G)</enum><text>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.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id4243140af15446b392c0b9ca6f28e505"><enum>(H)</enum><text>Such recommendations, including recommendations for legislative or administrative action, as the Secretary considers appropriate in light of carrying out such program.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="idF4471B2A842442409DDF4A8FD4D38950"><enum>203.</enum><header>Authorization of certain major medical facility leases of the Department of Veterans Affairs</header>
<text display-inline="no-display-inline">The Secretary of Veterans Affairs may carry out the following major medical facility leases at the locations specified and in an amount for each lease not to exceed the amount specified for such location (not including any estimated cancellation costs):</text>
<paragraph id="iddd7b50574f6c4eb484fc4cf401e17b1d"><enum>(1)</enum><text>For an outpatient clinic, Ann Arbor, Michigan, an amount not to exceed $4,247,000.</text> </paragraph><paragraph id="id758845f6685844008d256ed249796053"><enum>(2)</enum><text>For an outpatient mental health clinic, Birmingham, Alabama, an amount not to exceed $6,649,000.</text>
</paragraph><paragraph id="id1b2988d26bfa46aebc82f8c8d97e17e6"><enum>(3)</enum><text>For research space, Boston, Massachusetts, an amount not to exceed $6,224,000.</text> </paragraph><paragraph id="id526978ebeaf24c61996ce1cb1670e717"><enum>(4)</enum><text>For research space, Charleston, South Carolina, an amount not to exceed $7,274,000.</text>
</paragraph><paragraph id="id6e9a538589b54dde86081c008731c3de"><enum>(5)</enum><text>For an outpatient clinic, Corpus Christi, Texas, an amount not to exceed $6,556,000.</text> </paragraph><paragraph id="idbe5b6c9038074a48b6cd610f8ca20f03"><enum>(6)</enum><text>For an outpatient clinic, Daytona Beach, Florida, an amount not to exceed $12,198,000.</text>
</paragraph><paragraph id="idb10ce2e8aac94fe39b7ba165e09b4ee9"><enum>(7)</enum><text>For Chief Business Office Purchased Care office space, Denver, Colorado, an amount not to exceed $14,784,000.</text>
</paragraph><paragraph id="idda77793f4445436fbef1e593ec574329"><enum>(8)</enum><text>For an outpatient clinic, Fredericksburg, Virginia, an amount not to exceed $45,015,000.</text> </paragraph><paragraph id="idc3be2f0acde34cbdb6696624a12e4973"><enum>(9)</enum><text>For an outpatient clinic, Gainesville, Florida, an amount not to exceed $7,891,000.</text>
</paragraph><paragraph id="id327c4f24b36546dab68dabaf91f4623e"><enum>(10)</enum><text>For an outpatient mental health clinic, Gainesville, Florida, an amount not to exceed $4,320,000.</text> </paragraph><paragraph id="ida61764bfe84941a0aa1dea6edbffb2e3"><enum>(11)</enum><text>For an outpatient clinic, Hampton Roads, Virginia, an amount not to exceed $18,141,000.</text>
</paragraph><paragraph id="idff4d1b6e500742318673afc1ec1110f7"><enum>(12)</enum><text>For a replacement outpatient clinic, Indianapolis, Indiana, an amount not to exceed $7,876,000.</text>
</paragraph><paragraph id="id8ba1e1de1bd14e1c820ece1b1d19faf8"><enum>(13)</enum><text>For a replacement outpatient clinic, Jacksonville, Florida, an amount not to exceed $18,623,000.</text>
</paragraph><paragraph id="idca9ea1c7cba94790b346496062963a78"><enum>(14)</enum><text>For an outpatient clinic, Missoula, Montana, an amount not to exceed $6,942,000.</text> </paragraph><paragraph id="id9c8a3121b2714f4d8e36dea22bf3646a"><enum>(15)</enum><text>For an outpatient mental health clinic, Northern Colorado, Colorado, an amount not to exceed $8,904,000.</text>
</paragraph><paragraph id="idfbd1307da62547faacd8482a3241965c"><enum>(16)</enum><text>For an outpatient clinic, Ocala, Florida, an amount not to exceed $5,026,000.</text> </paragraph><paragraph id="id1b2e304265c441c2b881bbdb78097935"><enum>(17)</enum><text>For an outpatient clinic, Oxnard, California, an amount not to exceed $5,274,000.</text>
</paragraph><paragraph id="id0bc1223e365a4e31928b8b1d00705870"><enum>(18)</enum><text>For an outpatient clinic, Pike County, Georgia, an amount not to exceed $5,565,000.</text> </paragraph><paragraph id="id4cb5bb160f5e4d7b9926b2d092d83720"><enum>(19)</enum><text>For a replacement outpatient clinic, Pittsburgh, Pennsylvania, an amount not to exceed $6,247,000.</text>
</paragraph><paragraph id="id2d79d5cc45dc4bed951768679ada8f29"><enum>(20)</enum><text>For an outpatient clinic, Portland, Maine, an amount not to exceed $6,808,000.</text> </paragraph><paragraph id="ida4a940b0ea244b56a8a4148f863526f1"><enum>(21)</enum><text>For an outpatient clinic, Raleigh, North Carolina, an amount not to exceed $21,870,000.</text>
</paragraph><paragraph id="iddc9ef3cd919e45eaaee20aec08ec6193"><enum>(22)</enum><text>For a replacement outpatient clinic, phase II, Rochester, New York, an amount not to exceed $3,645,000.</text>
</paragraph><paragraph id="id7fecd0dec1fe48dd88054e587e467b50"><enum>(23)</enum><text>For research space, San Diego, California, an amount not to exceed $4,852,000.</text> </paragraph><paragraph id="id812edb0915f5436e99560dca427c3fe5"><enum>(24)</enum><text>For an outpatient clinic, Santa Rosa, California, an amount not to exceed $6,922,000.</text>
</paragraph><paragraph id="id9344fc8f32d24f528ecd3a22e9c47611"><enum>(25)</enum><text>For a replacement mental health clinic, Tampa, Florida, an amount not to exceed $13,387,000.</text> </paragraph><paragraph id="idbd3cee1556064442a79851f82c1ac490"><enum>(26)</enum><text>For a replacement outpatient clinic, Lakeland, Tampa, Florida, an amount not to exceed $10,760,000.</text>
</paragraph><paragraph id="idd0613e714d7d44b8aba186210a65e700"><enum>(27)</enum><text>For a replacement outpatient clinic, Terre Haute, Indiana, an amount not to exceed $4,102,000.</text> </paragraph></section><enum>III</enum><header>Administration of health care from non-Department of Veterans Affairs providers</header> <section id="idD4C94B5F351A42BB817FBDB0F14EF7A7"><enum>301.</enum><header>Modification of process through which Department of Veterans Affairs records obligations for non-Department care</header> <subsection id="id557D0F8AFE5A49C28367E3EF36865882"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Subchapter III of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> of title 38, United States Code, is amended by adding at the end the following new section:</text>
<quoted-block display-inline="no-display-inline" id="id2BA58DE46B5E453399B1583DD09E07C8" style="USC">
<section id="id49712a013967439a969aee15c8be0b4e"><enum>1730B.</enum><header>Recording obligations for care at non-Department facilities</header><text display-inline="no-display-inline">Notwithstanding sections 1341(a)(1) and 1501 of title 31, the Secretary may record as an obligation of the United States Government amounts owed for hospital care or medical services furnished under this chapter at non-Department facilities on the date on which a claim by a health care provider for payment is approved rather than on the date that the hospital care or medical services are authorized by the Secretary.</text></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="id6c794212c2e8482bbf16a78de509f74d"><enum>(b)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of chapter 17 of such title is amended by inserting after the item relating to section 1730A the following new item:</text>
<quoted-block id="ide34e3ca2-d23d-4f39-a2e4-d0134390f95f" style="USC"><toc><toc-entry idref="id49712a013967439a969aee15c8be0b4e" level="section">1730B. Recording obligations for care at non-Department facilities.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="ide3380536cfd24a02a02854bcdc495f1f"><enum>302.</enum><header>Modification of report on amounts available under Veterans Choice Program</header><text display-inline="no-display-inline">Section 101(q)(2) of the Veterans Access, Choice, and Accountability Act of 2014 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1701">38 U.S.C. 1701</external-xref> note) is amended—</text>
<paragraph id="id887657F27342431391752E557786DE4C"><enum>(1)</enum><text>in the matter preceding subparagraph (A), by striking <quote>30 days</quote> and inserting <quote>14 days</quote>;</text> </paragraph><paragraph id="id7578FCD814A34E659D1E3413A1372397"><enum>(2)</enum><text>by redesignating subparagraph (F) as subparagraph (H); and</text>
</paragraph><paragraph id="idB0C47CC3D233413CBC193A9478790167"><enum>(3)</enum><text>by inserting after subparagraph (E) the following new subparagraphs:</text> <quoted-block display-inline="no-display-inline" id="idCFEA2A15D4FE40FA8AFAB9F2B12D03F8" style="OLC"> <subparagraph id="id524AD9ABA9414CF6B5ABD0675A9FA5F4"><enum>(F)</enum><text>An assessment of the rate at which amounts deposited in the Veterans Choice Fund have been exhausted during the 90-day period preceding the submittal of the report, including an identification of any major factors that are causing amounts to be exhausted quickly or slowly.</text>
</subparagraph><subparagraph id="id11F5B0EC5D3E4A02A4830172476E76B2"><enum>(G)</enum><text>An estimate of when amounts in the Veterans Choice Fund will be completely exhausted.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph></section><enum>IV</enum><header>Other matters</header> <section id="id113CD7A5826D41C5ACF4A2249B75E6A9"><enum>401.</enum><header>Emergency designations</header> <subsection id="id9afd8e9b092d4e06932129205772f583"><enum>(a)</enum><header>In general</header><text>This Act is designated as an emergency requirement pursuant to section 4(g) of the Statutory Pay-As-You-Go Act of 2010 (<external-xref legal-doc="usc" parsable-cite="usc/2/933">2 U.S.C. 933(g)</external-xref>).</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="idB68641850DF148758ED7214081F1F303"><enum>(b)</enum><header>Designation in Senate</header><text>In the Senate, this Act is designated as an emergency requirement pursuant to section 403(a) of S. Con. Res. 13 (111th Congress), the concurrent resolution on the budget for fiscal year 2010.</text>
</subsection></section>