[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 141 Enrolled Bill (ENR)]
S.141
One Hundred Eighteenth Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Wednesday,
the third day of January, two thousand and twenty four
An Act
To amend title 38, United States Code, to improve certain programs of
the Department of Veterans Affairs for home and community based services
for veterans, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Senator Elizabeth
Dole 21st Century Veterans Healthcare and Benefits Improvement Act''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--HEALTH CARE MATTERS
Subtitle A--Veterans Community Care Program Matters
Sec. 101. Implementation of provision of care under Veterans Community
Care Program upon determination of eligibility by veteran and
veteran's referring clinician.
Sec. 102. Outreach regarding care and services under Veterans Community
Care Program.
Sec. 103. Annual review and report on waivers of certain payment rates
under Veterans Community Care Program.
Sec. 104. Modification of requirements for standards for quality of care
from Department of Veterans Affairs.
Sec. 105. Pilot program to improve administration of care under Veterans
Community Care Program.
Sec. 106. Pilot program on consolidating approval process of Department
of Veterans Affairs for covered dental care.
Sec. 107. Strategic plan on value-based health care system for Veterans
Health Administration; pilot program.
Sec. 108. Plan on adoption of certain health information standards for
Department of Veterans Affairs and certain health care
providers.
Sec. 109. Report on use of value-based reimbursement models under
Veterans Community Care Program.
Sec. 110. Inspector General assessment of implementation of Veterans
Community Care Program.
Sec. 111. Comptroller General report on dentistry under Veterans
Community Care Program.
Subtitle B--Matters Relating to Nursing Home and Other Long Term Care
and Family Caregivers
Sec. 120. Increase of expenditure cap for noninstitutional care
alternatives to nursing home care.
Sec. 121. Coordination with Program of All-Inclusive Care for the
Elderly.
Sec. 122. Authority for Secretary of Veterans Affairs to award grants or
contracts to entities to improve provision of mental health
support to family caregivers of veterans.
Sec. 123. Home- and community-based services: programs.
Sec. 124. Coordination with assistance and support services for
caregivers.
Sec. 125. Improvements to program of comprehensive assistance for family
caregivers.
Sec. 126. Improvements relating to Homemaker and Home Health Aide
program.
Sec. 127. Pilot program to furnish assisted living services to certain
veterans.
Sec. 128. Provision of medicine, equipment, and supplies available to
Department of Veterans Affairs to State homes.
Sec. 129. Recognition of organizations and individuals to assist
veterans, family members, and caregivers navigating programs
and services of Veterans Health Administration.
Sec. 130. Reviews and other improvements relating to home- and
community-based services.
Sec. 131. GAO report on mental health support for caregivers.
Sec. 132. Development of centralized website for program information.
Sec. 133. Definitions.
Subtitle C--Medical Treatment and Other Matters
Sec. 140. Quarterly report on referrals for non-Department of Veterans
Affairs health care.
Sec. 141. Elimination of certain requirements for certain Department of
Veterans Affairs Assistant Under Secretaries.
Sec. 142. Modification of pay limitation for physicians, podiatrists,
optometrists, and dentists of Department of Veterans Affairs.
Sec. 143. Reimbursement of ambulance cost for care for certain rural
veterans.
Sec. 144. Pilot program to furnish dental care from the Department of
Veterans Affairs to certain veterans diagnosed with ischemic
heart disease.
Sec. 145. Documentation of preferences of veterans for scheduling of
appointments for health care under laws administered by
Secretary of Veterans Affairs.
Sec. 146. Staffing model and performance metrics for certain employees
of the Department of Veterans Affairs.
Sec. 147. Online health education portal for veterans enrolled in
patient enrollment system of Department of Veterans Affairs.
Sec. 148. Limitation on detail of directors of medical centers of
Department of Veterans Affairs to different positions.
Sec. 149. National Veteran Suicide Prevention Annual Report.
Sec. 150. Report on physical infrastructure required by medical
facilities of Department of Veterans Affairs to provide dental
care services.
Sec. 151. Comptroller General report on certain oral health care
programs under laws administered by Secretary of Veterans
Affairs.
Sec. 152. Review of workflows associated with processing referrals
between facilities of the Veterans Health Administration.
Sec. 153. Plan for timely scheduling of appointments at medical
facilities of Department of Veterans Affairs.
Sec. 154. Authorization of appropriations to support initiatives for
mobile mammography services for veterans.
TITLE II--ECONOMIC OPPORTUNITY MATTERS
Subtitle A--Educational Assistance
Sec. 201. Temporary expansion of eligibility for Marine Gunnery Sergeant
John David Fry Scholarship.
Sec. 202. Removal of expiration on entitlement to Marine Gunnery
Sergeant John David Fry Scholarship for surviving spouses.
Sec. 203. Sole liability for transferred educational assistance by an
individual who fails to complete a service agreement.
Sec. 204. Notice to educational institutions of risk-based surveys.
Sec. 205. Relationship of participation by an educational institution in
certain Federal student financial aid programs to approval of
such institution for purposes of Department of Veterans
Affairs educational assistance programs.
Sec. 206. Expansion of Department of Veterans Affairs oversight of
certain educational institutions.
Sec. 207. Requirement that educational institutions approved for
purposes of Department of Veterans Affairs educational
assistance programs provide digital official transcripts.
Sec. 208. Payment of full monthly housing stipend for veterans enrolled
in final semester using educational assistance under Post-9/11
Educational Assistance Program.
Sec. 209. Modification of rules for approval of commercial driver
education programs for purposes of educational assistance
programs of the Department of Veterans Affairs.
Sec. 210. Provision of certificates of eligibility and award letters
using electronic means.
Sec. 211. Retroactive effective date of law regarding charge to
entitlement to educational assistance for individuals who do
not transfer credits from certain closed or disapproved
programs of education.
Sec. 212. Department of Veterans Affairs high technology program.
Sec. 213. Notice of changes to Department of Veterans Affairs policies
and guidance affecting the educational assistance programs of
the Department.
Sec. 214. Payment of VA educational assistance via electronic fund
transfer to a foreign institution of higher education.
Sec. 215. Improving transparency and accountability of educational
institutions for purposes of veterans educational assistance.
Subtitle B--Employment and Training
Sec. 221. Improvements to reemployment rights of members of the Armed
Forces.
Sec. 222. Review of investigations manual of Veterans' Employment and
Training Service.
Sec. 223. Warrior Training Advancement Course.
Subtitle C--Home Loans
Sec. 231. Improvements to program for direct housing loans made to
Native American veterans by the Secretary of Veterans Affairs.
Sec. 232. Native community development financial institution relending
program.
TITLE III--DISABILITY AND MEMORIAL AFFAIRS MATTERS
Sec. 301. Burial allowance for certain veterans who die at home while in
receipt of hospice care furnished by Department of Veterans
Affairs.
Sec. 302. Authority for Secretary of Veterans Affairs to award grants to
States and Indian Tribes to improve outreach to veterans.
Sec. 303. Definition of surviving spouse.
Sec. 304. Ensuring only licensed health care professionals perform
medical disability examinations under certain Department of
Veterans Affairs pilot program.
Sec. 305. Provision of information regarding an agent or attorney to a
licensed health care professional who performs a medical
disability examination under certain Department of Veterans
Affairs pilot program.
Sec. 306. Modernization of Department of Veterans Affairs disability
benefit questionnaires.
Sec. 307. Department of Veterans Affairs automatic processing of certain
claims for temporary disability ratings.
TITLE IV--HOMELESSNESS MATTERS
Sec. 401. Short title.
Sec. 402. Per diem payments provided by the Secretary of Veterans
Affairs for services furnished to homeless veterans.
Sec. 403. Authorization for Secretary of Veterans Affairs to use certain
funds for improved flexibility in assistance to homeless
veterans.
Sec. 404. Access to Department of Veterans Affairs telehealth services.
TITLE V--OVERSIGHT AND INVESTIGATIONS MATTERS
Sec. 501. Department of Veterans Affairs employee training regarding
Office of Inspector General.
Sec. 502. Annual review of security at covered facilities of the
Department of Veterans Affairs.
Sec. 503. Modification of certain housing loan fees.
TITLE I--HEALTH CARE MATTERS
Subtitle A--Veterans Community Care Program Matters
SEC. 101. IMPLEMENTATION OF PROVISION OF CARE UNDER VETERANS
COMMUNITY CARE PROGRAM UPON DETERMINATION OF ELIGIBILITY BY
VETERAN AND VETERAN'S REFERRING CLINICIAN.
(a) In General.--During the period specified in subsection (c), the
Secretary of Veterans Affairs shall implement section 1703(d)(1)(E) of
title 38, United States Code, in compliance with the implementing
regulations for such section under section 17.4010(a)(5) of title 38,
Code of Federal Regulations, such that the determination of eligibility
for care is final and shall be made by the veteran and the veteran's
referring clinician.
(b) Correction of Errors.--A covered veteran and the referring
clinician of such veteran may correct any errors made with respect to a
determination described in subsection (a).
(c) Period Specified.--The period specified in this subsection is
the two-year period beginning on the date that is 90 days after the
date of the enactment of this Act.
(d) Report.--Not later than one year and not later than two years
after the commencement of the period specified by subsection (c), the
Secretary of Veterans Affairs shall submit to Congress a report on the
care provided under section 1703(d)(1)(E) of title 38, United States
Code, during the one-year period preceding the date of the report,
including--
(1) the number of instances of care provided;
(2) the type of care provided; and
(3) the cost of such care.
(e) Rule of Construction.--Nothing in this section shall be
construed to limit the Secretary's authority to prescribe, amend, or
rescind regulations under section 1703 of title 38, United States Code.
(f) Covered Veteran Defined.--In this section, the term ``covered
veteran'' has the meaning given that term in section 1703(b) of title
38, United States Code.
SEC. 102. OUTREACH REGARDING CARE AND SERVICES UNDER VETERANS
COMMUNITY CARE PROGRAM.
(a) Requirement.--Section 1703 of title 38, United States Code, is
amended--
(1) by redesignating subsection (o) as subsection (p); and
(2) by inserting after subsection (n) the following new
subsection (o):
``(o) Outreach Regarding Availability of Care and Services.--(1)
The Secretary shall conduct outreach to inform veterans of the
following:
``(A) The conditions for care or services under subsections (d)
and (e).
``(B) How to request such care or services.
``(C) How to appeal a denial of a request for such care or
services using the clinical appeals process of the Veterans Health
Administration.
``(2) Upon enrollment of a veteran in the system of annual patient
enrollment established and operated under section 1705 of this title,
and not less frequently than every two years thereafter, the Secretary
shall inform the veteran of information described in paragraph (1).
``(3) The Secretary shall ensure that information described in
paragraph (1) is--
``(A) publicly displayed in each medical facility of the
Department;
``(B) prominently displayed on a website of the Department; and
``(C) included in other outreach campaigns and activities
conducted by the Secretary.''.
(b) Solid Start Program.--Section 6320(a)(2)(A) of title 38, United
States Code, is amended by inserting ``, including how to enroll in the
system of annual patient enrollment established and operated under
section 1705 of this title and the ability to seek care and services
under sections 1703 and 1710 of this title'' before the semicolon.
(c) Comptroller General Report on Outreach.--Not later than two
years after the date of the enactment of this Act, the Comptroller
General of the United States shall submit to Congress a report on the
efforts of the Secretary of Veterans Affairs to ensure that veterans
are informed of the conditions for eligibility for care and services
under section 1703 of title 38, United States Code, including such
efforts to conduct outreach pursuant to subsection (o) of such section
(as added by subsection (a)).
SEC. 103. ANNUAL REVIEW AND REPORT ON WAIVERS OF CERTAIN PAYMENT
RATES UNDER VETERANS COMMUNITY CARE PROGRAM.
(a) In General.--Section 1703 of title 38, United States Code, is
further amended--
(1) by redesignating subsection (p) as subsection (q); and
(2) by inserting after subsection (o) the following new
subsection (p):
``(p) Annual Review and Report on Waivers of Payment Rates.--(1) On
an annual basis, the Secretary shall--
``(A) conduct a review of waivers of payment rates under
subsection (i) for Third Party Administrators to identify whether
such waivers help to alleviate community-specific challenges,
including scarcity of medical services associated with access to
health care; and
``(B) submit to Congress a report on the results of such
review.
``(2) Each report under paragraph (1)(B) shall include, with
respect to the period covered by the report--
``(A) a statement, disaggregated by region, of the total number
of waivers described in subparagraph (A) of such paragraph
requested by Third Party Administrators;
``(B) a statement of the total number of such waivers that
were--
``(i) granted by the Secretary;
``(ii) denied by the Secretary; or
``(iii) withdrawn by a Third Party Administrator;
``(C) a description of the process for the review required
under paragraph (1);
``(D) a statement, disaggregated by region, of the average time
to process such waivers;
``(E) an assessment, disaggregated by region, of the extent to
which such waivers that were granted by the Secretary improved
access to health care for covered veterans; and
``(F) a description of trends, if any, identified by the
Secretary with respect to such waivers.
``(3) In this subsection, the term `Third Party Administrator' has
the meaning given such term in section 1703B of this title.''.
(b) Deadline.--The Secretary shall submit the first report required
under subsection (p) of section 1703 of such title (as added by
subsection (a)) not later than 180 days after the date of the enactment
of this Act.
SEC. 104. MODIFICATION OF REQUIREMENTS FOR STANDARDS FOR QUALITY OF
CARE FROM DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Section 1703C of title 38, United States Code, is
amended--
(1) in subsection (a)--
(A) in paragraph (2)--
(i) by striking ``In establishing'' and inserting ``(A)
In establishing''; and
(ii) by adding at the end the following new
subparagraph:
``(B) The Secretary shall ensure that the standards for quality
established under paragraph (1) are comparable to industry
standards to ensure there is adequate data transference between
care furnished by the Department and care furnished by a non-
Department provider.'';
(B) in paragraph (3)(B), by adding at the end the following
new clause:
``(v) Outcomes relating to patient quality of life.'';
(C) in paragraph (4)--
(i) by striking ``and the Centers for Medicare &
Medicaid Services'' and inserting ``the Centers for
Medicare & Medicaid Services, and the Indian Health
Service''; and
(ii) by striking ``and other nongovernmental entities''
and inserting ``and other non-governmental entities
including Third Party Administrators''; and
(D) by striking paragraph (5) and inserting the following
new paragraphs:
``(5) When collecting, considering, and applying data related to
patient care for purposes of establishing standards for quality under
paragraph (1), the Secretary shall ensure no metric is being over or
under analyzed.
``(6) In establishing standards for quality under paragraph (1),
the Secretary shall--
``(A) utilize the most up-to-date practices for extracting and
analyzing relevant data;
``(B) utilize all relevant data available to the Secretary;
``(C) ensure the most efficient use of time and resources
related to the use of data scientists employed by the Department;
and
``(D) collaborate, as appropriate, with entities specified in
paragraph (4).
``(7)(A) Not less frequently than once every five years, the
Secretary shall update the standards for quality established under
paragraph (1) pursuant to the requirements for the establishment of
such standards under this subsection.
``(B) Not later than 30 days after any date on which the Secretary
updates, pursuant to subparagraph (A), the standards for quality under
paragraph (1), the Secretary shall submit to the appropriate committees
of Congress a report on such updated standards for quality.''; and
(2) in subsection (b)--
(A) in paragraph (1)--
(i) by striking ``Not later than 1 year after the date
on which the Secretary establishes standards for quality
under subsection (a)'' and inserting ``Not less frequently
than once every three years''; and
(ii) by inserting ``pursuant to standards for quality
under subsection (a)'' after ``medical facilities of the
Department''; and
(B) in paragraph (2), by inserting ``or updates'' after
``establishes''.
(b) Deadline for Update.--The Secretary, pursuant to paragraph (7)
of section 1703C(a) of title 38, United States Code (as added by
subsection (a)), shall make the first update to the standards for
quality established under paragraph (1) of such section not later than
the date that is five years after the date on which the Secretary
submits the report under paragraph (2) of subsection (d).
(c) Report.--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--
(1) has consulted with entities specified in paragraph (4) of
section 1703C(a) of title 38, United States Code, before the date
of the enactment of this Act in establishing standards for quality
under such section;
(2) has continued to consult with those entities on and after
such date of enactment; and
(3) intends to leverage data sciences to improve standards for
quality care furnished by the Department of Veterans Affairs.
(d) Updates to Quality Care Metrics.--
(1) Initial report.--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 plans to implement the amendments made by subsections
(a).
(2) Deadline; summary report.--Not later than two years after
the date of the enactment of this Act, the Secretary shall--
(A) implement the amendments made by subsection (a),
including by updating the standards for quality established
under section 1703C of title 38, United States Code; and
(B) submit to the appropriate committees of Congress a
report detailing the standards for quality updated pursuant to
such amendments.
(e) Audit of Quality Care Metrics.--
(1) In general.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
enter into one or more contracts with a non-Department entity
described in paragraph (2) to conduct an audit on the quality of
care from the Department of Veterans Affairs, including through
non-Department health care providers pursuant to section 1703 of
title 38 United States Code.
(2) Non-department entity described.--A non-Department entity
described in this paragraph is an entity that--
(A) specializes in analyzing large-scale organizational
data collection and analysis efforts, especially with respect
to the health care sector; and
(B) has experience and proven outcomes in optimizing the
accuracy and comprehensiveness of data collection and analysis
related to the quality of health care services.
(3) Elements.--The audit required under paragraph (1) shall
include the following:
(A) An assessment of the methodology used by the Department
to collect and assess data on the quality of care furnished by
the Department, including any vulnerabilities in such
methodology.
(B) An assessment of the accuracy and reliability of the
data sources used by the Department to compile data on the
quality of care furnished by the Department.
(C) The extent to which the standards the Department uses
to assess the quality of care furnished by the Department are--
(i) comparable with industry standards;
(ii) easily accessible to, and understood by--
(I) veterans;
(II) employees of the Department; and
(III) other individuals, as the private sector
entity considers appropriate.
(D) Any recommendations of such private sector entity with
respect to improvements that the Secretary could administer to
more accurately capture the quality of care furnished by the
Department.
(4) Reports on audit.--
(A) Report on findings and recommendations.--Not later than
60 days after any date on which a private sector entity
described in paragraph (2) completes an audit under paragraph
(1), such private sector entity 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 that includes--
(i) the findings of such audit; and
(ii) recommendations of such private sector entity with
respect to such audit.
(B) Report on planned improvements.--Not later than 60 days
after any date on which the Secretary receives a report under
subparagraph (A), 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
how the Secretary plans to improve the standards for quality of
care of the Department.
(f) Appropriate Committees of Congress Defined.--In this section,
the term ``appropriate committees of Congress'' has the meaning given
such term in section 1703C of title 38, United States Code.
SEC. 105. PILOT PROGRAM TO IMPROVE ADMINISTRATION OF CARE UNDER
VETERANS COMMUNITY CARE PROGRAM.
(a) Establishment.--Pursuant to section 1703E of title 38, United
States Code, the Secretary of Veterans Affairs, acting through the
Center for Innovation for Care and Payment established under such
section, shall carry out a pilot program to seek to develop and
implement a plan--
(1) to provide monetary and non-monetary incentives to a
covered health care provider--
(A) to allow the Secretary to see the scheduling system of
the provider, to assess the availability of, and to assist in
scheduling appointments for, veterans under the Veterans
Community Care Program under section 1703 of such title,
including through synchronous, asynchronous, and asynchronous
assisted digital scheduling;
(B) to complete continuing professional educational
training available through the VHA TRAIN program (or any
successor program or initiative) regarding veteran cultural
competency, the opioid safety initiative (or any successor
program or initiative), and other subjects determined
appropriate by the Secretary;
(C) to improve methods of accounting for non-Department
training that is equivalent or substantially similar to the
continuing professional educational training described in
subparagraph (B);
(D) to improve the rate of the timely return to the
Secretary of medical record documentation for care or services
provided under the Veterans Community Care Program;
(E) to improve the timeliness and quality of the delivery
of care and services to veterans under such program; and
(F) to achieve other objectives determined appropriate by
the Secretary; and
(2) to decrease the rate of no-show appointments under such
program.
(b) Report.--Not later than one year after the date of the
establishment of the pilot program under this section, and annually
thereafter during the term of the pilot program, the Secretary of
Veterans Affairs shall submit to the Committees on Veterans' Affairs of
the House of Representatives and the Senate a report on the pilot
program that includes, with respect to the period covered by the
report--
(1) an assessment of the extent to which--
(A) the system of the Department of Veterans Affairs for
scheduling appointments for veterans under the Veterans
Community Care Program has improved;
(B) the rate of timely return to the Secretary of medical
record documentation described in subparagraph (D) of
subsection (a)(1) has improved;
(C) the timeliness and quality of the delivery of care and
services described in subparagraph (E) of such subsection has
improved; and
(D) the frequency of no-show appointments described in
paragraph (2) of such subsection decreased;
(2) a list of the continuing professional educational training
courses under subparagraph (B) of such subsection available to
covered health care providers;
(3) the rate of participation in such continuing professional
education training courses; and
(4) any other matter the Secretary determines appropriate.
(c) Definitions.--In this section:
(1) The term ``covered health care provider'' means a health
care provider--
(A) described in subsection (c) of section 1703 of title
38, United States Code, that furnishes care or services under
the Veterans Community Care Program pursuant to a contract or
agreement with a Third Party Administrator; or
(B) that otherwise furnishes care or services outside of
Department facilities pursuant to a contract or agreement with
the Secretary of Veterans Affairs.
(2) The term ``opioid safety initiative'' means the programs,
processes, and guidelines of the Veterans Health Administration of
the Department of Veterans Affairs relating to the management of
opioid therapy and chronic pain.
(3) The term ``Third Party Administrator'' means an entity that
manages a network of health care providers and performs
administrative services related to such network under section 1703
of such title.
(4) The term ``VHA TRAIN program'' means the free program of
the Veterans Health Administration that offers veteran-specific
continuing medical education courses.
SEC. 106. PILOT PROGRAM ON CONSOLIDATING APPROVAL PROCESS OF
DEPARTMENT OF VETERANS AFFAIRS FOR COVERED DENTAL CARE.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs, acting
through the Center for Innovation for Care and Payment established
under section 1703E of title 38, United States Code, shall carry out a
pilot program under which the Secretary shall hire--
(1) general dentists at medical facilities of the Department of
Veterans Affairs to manage approval by the Department of treatment
plans requested by dental providers in providing covered dental
care; and
(2) dental specialists at Veterans Integrated Service Networks
of the Department to manage approval by the Department of treatment
plans for specialty dental care requested by dental providers in
providing covered dental care.
(b) Locations.--The Secretary shall carry out the pilot program in
not fewer than two Veterans Integrated Service Networks of the
Department.
(c) Reports.--
(1) Initial report.--Not later than one year after the date of
the commencement of such pilot program, the Secretary shall submit
to the Committees on Veterans' Affairs of the Senate and the House
of Representatives a report on the pilot program, that includes--
(A) an identification of the Veterans Integrated Service
Networks participating in such pilot program;
(B) a description of the implementation of such pilot
program;
(C) an identification of any barriers or challenges to
implementing such pilot program;
(D) an assessment of the efficacy of hiring general
dentists and dental specialists pursuant to such pilot program;
(E) aggregated feedback with respect to such pilot program
from dentists of the Department in Veterans Integrated Service
Networks participating in such pilot program; and
(F) aggregated feedback from dental providers providing
covered dental care within such Veterans Integrated Service
Networks regarding any changes in the timeliness of treatment
plan approvals by the Department.
(2) Final report.--Not later than 90 days before the date of
the completion of such pilot program, the Secretary shall submit to
the Committees on Veterans' Affairs of the Senate and the House of
Representatives a report on the pilot program that--
(A) includes, with respect to the period covered by the
report, each element of the report required under paragraph (1)
described in subparagraphs (A) through (F) of such paragraph;
(B) includes recommendations of the Secretary on whether
the pilot program should be--
(i) extended;
(ii) expanded; or
(iii) adopted throughout the Department; and
(C) indicates whether the Secretary requests action by
Congress to make the pilot program permanent.
(d) Sunset.--The authority to carry out the pilot program under
this section shall terminate on the date that is two years after the
date of the enactment of this Act.
(e) Covered Dental Care Defined.--In this section, the term
``covered dental care'' means dental care provided--
(1) under section 1703 of title 38, United States Code; or
(2) pursuant to a Veterans Care Agreement under section 1703A
of such title.
SEC. 107. STRATEGIC PLAN ON VALUE-BASED HEALTH CARE SYSTEM FOR
VETERANS HEALTH ADMINISTRATION; PILOT PROGRAM.
(a) Establishment of Working Group.--
(1) In general.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall--
(A) establish a working group on value-based care; and
(B) submit to the Committees on Veterans' Affairs of the
House of Representatives and the Senate the strategic plan
developed by the working group pursuant to subsection (b).
(2) Membership.--
(A) Required members.--The working group shall include, at
a minimum, the following members:
(i) The Under Secretary for Health of the Department of
Veterans Affairs.
(ii) The Director of the Office of Mental Health and
Suicide Prevention of the Department of Veterans Affairs
(or any successor office).
(iii) The Director of the Office of Integrated Veteran
Care of the Department (or any successor office).
(iv) The Director of the Office of Rural Health of the
Department (or any successor office).
(v) The Director of the Office of Connected Care of the
Department (or any successor office).
(vi) The Assistant Secretary for the Office of
Information Technology (or any successor office).
(vii) The Chief Officer of the Office of Healthcare
Innovation and Learning of the Office of Discovery,
Education, and Affiliate Networks of the Veterans Health
Administration (or any successor office).
(viii) An individual designated by the Secretary from
the Center for Innovation for Care and Payment of the
Department under section 1703E of title 38, United States
Code.
(ix) An individual designated by the Administrator of
the Centers for Medicare & Medicaid Services from the
Center for Medicare and Medicaid Innovation.
(x) An individual designated by the Secretary of Health
and Human Services from the Federal Office of Rural Health
Policy of the Health Resources and Services Administration.
(xi) The Chief of Human Capital Management for the
Veterans Health Administration.
(xii) An individual designated by the Secretary of
Defense that is a representative of the Defense Health
Agency.
(xiii) An individual selected by the Secretary of
Veterans Affairs from the special medical advisory group
established under section 7312 of title 38, United States
Code.
(B) Optional members.--The Secretary of Veterans Affairs
may appoint any of the following individuals as members of the
working group:
(i) An individual representing the Health and Medicine
Division of the National Academies of Sciences,
Engineering, and Medicine.
(ii) Three individuals representing a private health
care system that has made the transition to value-based
care.
(iii) Three individuals representing an organization
recognized by the Secretary of Veterans Affairs under
section 5902 of title 38, United States Code.
(3) Public availability.--All meetings deliberations, and
products of the working group shall be made publicly available
throughout the duration of the working group, including to
individuals representing organizations recognized by the Secretary
of Veterans Affairs under section 5902 of title 38, United States
Code.
(4) Exemption from faca.--Chapter 10 of title 5, United States
Code, shall not apply to the working group established under
paragraph (1).
(b) Development of Strategic Plan.--The working group shall develop
a strategic plan to implement value-based care into the Veterans Health
Administration that includes the following:
(1) An identification of the state of the Veterans Health
Administration as of the date of the enactment of this Act,
including an assessment of the current model of health care
delivery used by the Veterans Health Administration in medical
facilities of the Department of Veterans Affairs.
(2) An assessment of the capacity needs of the Veterans Health
Administration during the five-year period beginning on the date of
the enactment of this Act.
(3) An analysis of the leadership of the Veterans Health
Administration, including an assessment of leadership acumen and
ability to implement a clear, shared vision and effective change
management and care coordination.
(4) An identification of goals for the future of the Veterans
Health Administration.
(5) An identification and classification of the current
capabilities, capacity, and gaps in access and quality of the
health care system of the Department of Veterans Affairs.
(6) An analysis of value-based care models, including--
(A) a selection of potential models that would best work
for the Veterans Health Administration;
(B) the capacity and capabilities of each such model; and
(C) a thorough justification of the selection of each
selected model, including a summary of the ability of such
model to improve the metrics described under paragraph (9).
(7) A definition of what quality means with respect to--
(A) access to health care under the laws administered by
the Secretary of Veterans Affairs; and
(B) delivery of such health care.
(8) A definition of what value means with respect to care
furnished by the Veterans Health Administration,
(9) A system for measuring value within the Veterans Health
Administration that includes metrics for--
(A) outcomes;
(B) safety;
(C) service;
(D) access;
(E) productivity;
(F) capacity; and
(G) total cost of patient care.
(10) With respect to the system described in subparagraph (H),
an analysis of variable value with respect to patient outcomes
across different health care types and specialties.
(11) An assessment of--
(A) previous or ongoing assessments of the current
information technology infrastructure of the Veterans Health
Administration, including--
(i) such assessments conducted pursuant to the
Electronic Health Record Modernization program of the
Department of Veterans Affairs; and
(ii) any other ongoing information technology
modernization programs of such Department and any
unimplemented relevant recommendations from such
assessments;
(B) the information technology infrastructure of the
Veterans Health Administration in effect as of the date of the
enactment of this Act;
(C) the value-driven framework of the Department, in effect
as of the date of the enactment of this Act, for evaluating
health care innovations, and how improvements in such framework
could be used to encourage innovation; and
(D) workforce challenges and needs of the Veterans Health
Administration based on--
(i) reviews of workforce assessment data available as
of the date of the enactment of this Act; and
(ii) the findings of--
(I) the report required by section 301(d) of the
Veterans Access, Choice, and Accountability Act of 2014
(Public Law 113-146);
(II) the reports required by section 505 of the
John S. McCain III, Daniel K. Akaka and Samuel R.
Johnson VA Maintaining Internal Systems and
Strengthening Integrated Outside Networks Act of 2018
(Public Law 115-182);
(III) the report required by section 301 of the VA
Choice and Quality Employment Act of 2017 (Public Law
115-46); and
(IV) any comprehensive health care inspection
conducted by the Inspector General of the Department of
Veterans Affairs as of the date of the enactment of
this Act.
(12) Any recommendations of the working group with respect to
improving the information technology infrastructure described in
clause (i) of subparagraph (J).
(13) An analysis of how the value-driven framework described in
clause (iii) of such subparagraph could be used to improve the
model of care delivery by the Department.
(14) A description of how a value-based care system would apply
to primary care, inpatient and outpatient mental health care, and
inpatient and outpatient substance use treatment, spinal cord
injury disorder care, and polytrauma care furnished by the Veterans
Health Administration.
(15) With respect to legislative or administrative action
necessary to incorporate value-based care models into the Veterans
Health Administration, a description of the estimated timelines,
effect on workforce, and costs.
(c) Pilot Program.--
(1) In general.--Not later than 180 days after the submission
of the strategic plan pursuant to subsection (b), the Secretary of
Veterans Affairs, acting through the Center for Innovation for Care
and Payment established under section 1703E of title 38, United
States Code, shall commence a three-year pilot program under which
the Secretary shall implement the elements of such strategic plan
relating to the delivery, by the Veterans Health Administration, of
primary care, inpatient and outpatient mental health treatment,
inpatient and outpatient substance abuse treatment, spinal cord
injury disorder care, and polytrauma care.
(2) Locations.--The Secretary shall carry out such pilot
program in four Veterans Integrated Service Networks that are
geographically dispersed and shall include the following:
(A) A Veterans Integrated Service Network that
predominately serves veterans in rural and highly rural areas.
(B) A Veterans Integrated Service Network that
predominately serves veterans in urban areas.
(C) A Veterans Integrated Service Network that has a high
rate of suicide among veterans.
(D) A Veterans Integrated Service Network that has a high
rate of substance use disorder among veterans.
(E) A Veterans Integrated Service Network that has access
or productivity challenges.
(3) Reports to congress.--
(A) Annual report.--Not later than one year after the
commencement of the pilot program, and annually thereafter
during the duration of the pilot program, the Secretary shall
submit to Congress a report on the pilot program.
(B) Final report.--Not later than 90 days before the
conclusion of the pilot program, the Secretary shall submit to
Congress a final report on the pilot program that includes--
(i) lessons learned during the administration of such
pilot program; and
(ii) specific health outcomes in veteran patient care
compared to the Veterans Health Administration system of
care in effect as of the date of the enactment of this Act.
SEC. 108. PLAN ON ADOPTION OF CERTAIN HEALTH INFORMATION STANDARDS
FOR DEPARTMENT OF VETERANS AFFAIRS AND CERTAIN HEALTH CARE
PROVIDERS.
(a) Plan for Certain Health Information Standards.--
(1) In general.--The Secretary of Veterans Affairs, in
consultation with the Secretary of Health and Human Services, the
Administrator of the Centers for Medicare & Medicaid Services, and
the National Coordinator for Health Information Technology of the
Department of Health and Human Services, shall create and implement
a plan to adopt, as rapidly and to the most comprehensive extent
feasible, national health information interoperability standards
for the Department of Veterans Affairs and community care providers
with respect to--
(A) coordination of--
(i) care; and
(ii) benefits;
(B) patient identity matching;
(C) measurement and reporting of quality;
(D) population health; and
(E) public health.
(2) Consideration.--In developing the plan under paragraph (1),
the Secretary of Veterans Affairs shall consider challenges faced
by--
(A) small community care providers; and
(B) community care providers located in rural areas.
(b) Plan on Electronic Health Record Exchange.--
(1) In general.--Not later than one year after the date of
enactment of this Act, the Secretary shall submit to the Committees
on Veterans' Affairs of the Senate and the House of Representatives
a plan to provide, at no cost, to community care providers of the
Department, through Third Party Administrators, a capability to
facilitate the electronic direct exchange, between such providers
and the Department, of--
(A) the health records of veterans; and
(B) documents relating to health care of veterans, clinical
notes, and any other information the Secretary determines
necessary.
(2) Prioritization.--In developing the plan required under
paragraph (1), the Secretary shall prioritize providing the
capability described in such paragraph to community care providers
that--
(A) provide care under the laws administered by the
Secretary to--
(i) a lower volume of veterans; and
(ii) veterans who are located in rural areas; and
(B) are unable or unwilling to exchange the records and
documents described in subparagraphs (A) and (B) of such
paragraph with the Department through standards-based or direct
exchange mechanisms in effect as of the date of the enactment
of this Act.
(c) Reports on Plan for Interoperability Standards.--
(1) Initial report.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs shall
submit to the Committees on Veterans' Affairs of the Senate and the
House of Representatives--
(A) the plan required by subsection (a); and
(B) a report that includes--
(i) an analysis of gaps, if any, between the use, by
the Department and other agencies, health information
exchanges, and technology companies, of national health
information interoperability standards and the potential,
or optimal, use of such national health information
interoperability standards;
(ii) an analysis and description of the participation
by the Department, community care providers, and other
relevant entities in the Trusted Exchange Framework and
Common Agreement program of the Department of Health and
Human Services as of the date of the enactment of this Act;
(iii) recommendations of the Secretary with respect to
development of health information interoperability
standards;
(iv) timelines or schedules to implement the plan
required by subsection (a); and
(v) an identification of any legislative authorities or
resources the Secretary requires to implement such plan.
(2) Recurring report requirement.--
(A) In general.--Not later than 18 months after the date of
the enactment of this Act, and every 180 days thereafter for
four years, the Secretary of Veterans Affairs shall submit to
Committees on Veterans' Affairs of the Senate and the House of
Representatives a report on the status of implementation of the
plan required under subsection (a).
(B) Elements of subsequent reports.--Each report under
subparagraph (A) submitted after the date on which the first
report required by such subparagraph is submitted shall include
a description of any revisions to--
(i) the plan required by subsection (a) made during the
period covered by the report; and
(ii) the analysis, recommendations, timelines, and
legislative authorities reported pursuant to paragraph (1).
(d) Definitions.--In this section:
(1) The term ``community care provider'' means a non-Department
health care provider providing care (including dental care)--
(A) under section 1703 of title 38, United States Code;
(B) pursuant to a Veterans Care Agreement under section
1703A of such title; or
(C) under any other law administered by the Secretary of
Veterans Affairs.
(2) The term ``Third Party Administrator'' means an entity that
manages a provider network and performs administrative services
related to such network under section 1703 of title 38, United
States Code.
SEC. 109. REPORT ON USE OF VALUE-BASED REIMBURSEMENT MODELS UNDER
VETERANS COMMUNITY CARE PROGRAM.
(a) Report on Value-based Reimbursement Models.--Not later than one
year after the date of the enactment of this Act, the Secretary of
Veterans Affairs, in consultation with the Center for Innovation for
Care and Payment of the Department of Veterans Affairs under section
1703E of title 38 United States Code, the Office of Integrated Veteran
Care of the Department, or successor office, and Third Party
Administrators, shall submit to the Committees on Veterans' Affairs of
the House of Representatives and the Senate a report containing--
(1) an assessment of the efforts of the Department pursuant to
section 1703(i)(5) of such title, to incorporate value-based
reimbursement models under the Veterans Community Care Program to
promote the provision of high-quality care to veterans; and
(2) such recommendations for legislative or administrative
action as the Secretary considers appropriate regarding the use of
value-based reimbursement models throughout the Veterans Community
Care Program under section 1703 of such title.
(b) Rule of Construction.--This section shall not be construed to
be a pilot program subject to the requirements of section 1703E of
title 38, United States Code.
(c) Third Party Administrator Defined.--In this section, the term
``Third Party Administrator'' means an entity that manages a provider
network and performs administrative services related to such network
under section 1703 of title 38, United States Code.
SEC. 110. INSPECTOR GENERAL ASSESSMENT OF IMPLEMENTATION OF
VETERANS COMMUNITY CARE PROGRAM.
(a) In General.--Not later than 18 months after the date of the
enactment of this Act, and periodically thereafter, the Inspector
General shall assess the performance of the Department of Veterans
Affairs in--
(1) appropriately identifying veterans eligible for care and
services under section 1703 of title 38, United States Code;
(2) informing veterans of their eligibility for such care and
services; and
(3) delivering such care and services in a timely manner.
(b) Briefing on Assessments.--Upon the submission of the assessment
required by subsection (a), the Inspector General of the Department of
Veterans Affairs shall provide to the Committees on Veterans Affairs of
the House of Representatives and the Senate a briefing on the results
of such assessment.
SEC. 111. COMPTROLLER GENERAL REPORT ON DENTISTRY UNDER VETERANS
COMMUNITY CARE PROGRAM.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to the Committees on Veterans' Affairs of the Senate and
the House of Representatives a report on dental care furnished by the
Secretary of Veterans Affairs under the Veterans Community Care Program
under section 1703 of title 38, United States Code, that includes a
review of--
(1) the impact current reimbursement rates provided by the
Department of Veterans Affairs to dental providers under such
program have on--
(A) the availability of dental care for veterans; and
(B) the ability of Third Party Administrators to meet their
contractual obligations for network adequacy;
(2) the satisfaction of dental providers providing dental care
under such program with the processes of the Department for
approving dental care under such program; and
(3) the current processes of the Department for approving
emergent dental care under such program.
(b) Third Party Administrator Defined.--In this section, the term
``Third Party Administrator'' means an entity that manages a provider
network and performs administrative services related to such network
under section 1703 of title 38, United States Code.
Subtitle B--Matters Relating to Nursing Home and Other Long Term Care
and Family Caregivers
SEC. 120. INCREASE OF EXPENDITURE CAP FOR NONINSTITUTIONAL CARE
ALTERNATIVES TO NURSING HOME CARE.
(a) Increase of Expenditure Cap.--Section 1720C(d) of title 38,
United States Code, is amended--
(1) by striking ``The total cost'' and inserting ``(1) Except
as provided in paragraph (2), the total cost'';
(2) by striking ``65 percent'' and inserting ``100 percent'';
and
(3) by adding at the end the following new paragraph:
``(2)(A) The total cost of providing services or in-kind assistance
in the case of any veteran described in subparagraph (B) for any fiscal
year under the program may exceed 100 percent of the cost that would
otherwise have been incurred as specified in paragraph (1) if the
Secretary determines, based on a consideration of clinical need,
geographic market factors, and such other matters as the Secretary may
prescribe through regulation, that such higher total cost is in the
best interest of the veteran.
``(B) A veteran described in this subparagraph is a veteran with
amyotrophic lateral sclerosis, a spinal cord injury, or a condition the
Secretary determines to be similar to such conditions.''.
(b) Applicability.--The amendments made by subsection (a) shall
apply with respect to fiscal years beginning on or after the date of
the enactment of this Act.
SEC. 121. COORDINATION WITH PROGRAM OF ALL-INCLUSIVE CARE FOR THE
ELDERLY.
Section 1720C of title 38, United States Code, as amended by
section 120, is further amended by adding at the end the following new
subsection:
``(f) In furnishing services to a veteran under the program
conducted pursuant to subsection (a), if a medical center of the
Department through which such program is administered is located in a
geographic area in which services are available to the veteran under a
PACE program (as such term is defined in sections 1894(a)(2) and
1934(a)(2) of the Social Security Act (42 U.S.C. 1395eee(a)(2); 1396u-
4(a)(2))), the Secretary shall seek to enter into an agreement with the
PACE program operating in that area for the furnishing of such
services.''.
SEC. 122. AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO AWARD
GRANTS OR CONTRACTS TO ENTITIES TO IMPROVE PROVISION OF MENTAL
HEALTH SUPPORT TO FAMILY CAREGIVERS OF VETERANS.
Subchapter II of chapter 17 of title 38, United States Code, is
amended by adding at the end the following new section (and conforming
the table of sections at the beginning of such chapter accordingly):
``Sec. 1720K. Grants or contracts to provide mental health support to
family caregivers of veterans
``(a) Authority.--The Secretary may award grants or contracts to
carry out, coordinate, improve, or otherwise enhance mental health
counseling, treatment, or support to the family caregivers of veterans
participating in the family caregiver program.
``(b) Application.--(1) To be eligible for a grant or contract
under this section, an entity shall submit to the Secretary an
application therefor at such time, in such manner, and containing such
information as the Secretary may require.
``(2) Each application submitted under paragraph (1) shall include
the following:
``(A) A detailed plan for the use of the grant or contract.
``(B) A description of the programs or efforts through which
the entity will meet the outcome measures developed by the
Secretary under subsection (f).
``(C) A description of how the entity will distribute grant or
contract amounts equitably among areas with varying levels of
urbanization.
``(D) A plan for how the grant or contract will be used to meet
the unique needs of veterans residing in rural areas, Native
American, Native Hawaiian, or Alaska Native veterans, elderly
veterans, women veterans, and veterans from other underserved
communities.
``(c) Distribution.--The Secretary shall seek to ensure that grants
and contracts awarded under this section are equitably distributed
among entities located in States with varying levels of urbanization.
``(d) Priority.--The Secretary shall prioritize awarding grants or
contracts under this section that will serve the following areas:
``(1) Areas with high rates of veterans enrolled in the family
caregiver program.
``(2) Areas with high rates of--
``(A) suicide among veterans; or
``(B) referrals to the Veterans Crisis Line.
``(e) Required Activities.--Any grant or contract awarded under
this section shall be used--
``(1) to expand existing programs, activities, and services;
``(2) to establish new or additional programs, activities, and
services; or
``(3) for travel and transportation to facilitate carrying out
paragraph (1) or (2).
``(f) Outcome Measures.--(1) The Secretary shall develop and
provide to each entity that receives a grant or contract under this
section written guidance on the following:
``(A) Outcome measures.
``(B) Policies of the Department.
``(2) In developing outcome measures under paragraph (1), the
Secretary shall consider the following goals:
``(A) Increasing the utilization of mental health services
among family caregivers of veterans participating in the family
caregiver program.
``(B) Reducing barriers to mental health services among family
caregivers of veterans participating in such program.
``(g) Tracking Requirements.--(1) The Secretary shall establish
appropriate tracking requirements with respect to the entities
receiving a grant or contract under this section.
``(2) Not less frequently than annually, the Secretary shall submit
to Congress a report on such tracking requirements.
``(h) Performance Review.--The Secretary shall--
``(1) review the performance of each entity that receives a
grant or contract under this section; and
``(2) make information regarding such performance publicly
available.
``(i) Remediation Plan.--(1) In the case of an entity that receives
a grant or contract under this section and does not meet the outcome
measures developed by the Secretary under subsection (f), the Secretary
shall require the entity to submit to the Secretary a remediation plan
under which the entity shall describe how and when it plans to meet
such outcome measures.
``(2) The Secretary may not award a subsequent grant or contract
under this section to an entity described in paragraph (1) unless the
Secretary approves the remediation plan submitted by the entity under
such paragraph.
``(j) Maximum Amount.--The amount of a grant or contract awarded
under this section may not exceed 10 percent of amounts made available
for grants or contracts under this section for the fiscal year in which
the grant or contract is awarded.
``(k) Supplement, Not Supplant.--Any grant or contract awarded
under this section shall be used to supplement and not supplant funding
that is otherwise available through the Department to provide mental
health support among family caregivers of veterans participating in the
family caregiver program.
``(l) Outreach to Family Caregivers.--The Secretary shall include,
in the outreach materials regularly provided to a family caregiver who
participates in the family caregiver program, notice of mental health
support provided by recipients of grants or contracts under this
section that are located in the relevant Veterans Integrated Service
Network.
``(m) Funding.--(1) Amounts for the activities of the Department
under this section shall be budgeted and appropriated through a
separate appropriation account.
``(2) In the budget justification materials submitted to Congress
in support of the budget of the Department for any fiscal year (as
submitted with the budget of the President under section 1105(a) of
title 31), the Secretary shall include a separate statement of the
amount requested to be appropriated for that fiscal year for the
account specified in paragraph (1).
``(n) Authorization of Appropriations.--There is authorized to be
appropriated to the Secretary, for each of fiscal years 2025 and 2026,
$10,000,000 to carry out this section.
``(o) Definitions.--In this section:
``(1) The terms `caregiver' and `family caregiver' have the
meanings given those terms in section 1720G of this title.
``(2) The term `family caregiver program' means the program of
comprehensive assistance for family caregivers under section 1720G
of this title.
``(3) The term `Veterans Crisis Line' means the toll-free
hotline for veterans established under section 1720F of this
title.''.
SEC. 123. HOME- AND COMMUNITY-BASED SERVICES: PROGRAMS.
(a) Programs.--Such subchapter is further amended by inserting
after section 1720K (as added by section 122) the following new section
(and conforming the table of sections at the beginning of such chapter
accordingly):
``Sec. 1720L. Home- and community-based services: programs
``(a) In General.--In furnishing noninstitutional alternatives to
nursing home care pursuant to the authority of section 1720C of this
title (or any other authority under this chapter or other provision of
law administered by the Secretary of Veterans Affairs), the Secretary
shall carry out each of the programs specified in this section in
accordance with such relevant authorities except as otherwise provided
in this section.
``(b) Veteran-Directed Care Program.--(1) The Secretary of Veterans
Affairs, in collaboration with the Secretary of Health and Human
Services, shall carry out a program to be known as the `Veteran-
Directed Care program'. Under such program, the Secretary of Veterans
Affairs may enter into agreements with the providers described in
paragraph (2) to provide to eligible veterans funds, to the extent
practicable, to obtain such in-home care services and related items
that support clinical need and improve quality of life, as may be
determined appropriate by the Secretary of Veterans Affairs and
selected by the veteran, including through the veteran hiring
individuals to provide such services and items or directly purchasing
such services and items.
``(2) The providers described in this paragraph are the following:
``(A) An Aging and Disability Resource Center, an area agency
on aging, or a State agency.
``(B) A center for independent living.
``(C) An Indian tribe or tribal organization receiving
assistance under title VI of the Older Americans Act of 1965 (42
U.S.C. 3057 et seq.).
``(D) Any other entity that the Secretary, in consultation with
the Secretary of Health and Human Services, determines appropriate.
``(3) In carrying out the Veteran-Directed Care program, the
Secretary of Veterans Affairs shall--
``(A) administer such program through each medical center of
the Department of Veterans Affairs;
``(B) seek to ensure the availability of such program in
American Samoa, Guam, the Commonwealth of the Northern Mariana
Islands, the Commonwealth of Puerto Rico, the Virgin Islands of the
United States, and any other territory or possession of the United
States, to the extent practicable; and
``(C) seek to ensure the availability of such program for
eligible veterans who are Native American veterans receiving care
and services furnished by the Indian Health Service, a tribal
health program, an Urban Indian organization, or (in the case of a
Native Hawaiian veteran) a Native Hawaiian health care system, to
the extent practicable.
``(4) If a veteran participating in the Veteran-Directed Care
program is hospitalized, the veteran may continue to use funds under
the program during a period of hospitalization in the same manner that
the veteran would be authorized to use such funds under the program if
the veteran were not hospitalized.
``(c) Homemaker and Home Health Aide Program.--(1) The Secretary
shall carry out a program to be known as the `Homemaker and Home Health
Aide program' under which the Secretary may enter into agreements with
home health agencies to provide to eligible veterans such home health
aide services as may be determined appropriate by the Secretary.
``(2) In carrying out the Homemaker and Home Health Aide program,
the Secretary shall--
``(A) administer such program in the locations specified in
subparagraph (A) of subsection (b)(3);
``(B) seek to ensure the availability of such program in the
locations specified in subparagraph (B) of subsection (b)(3); and
``(C) seek to ensure the availability of such program for the
veteran populations specified in subparagraph (C) of subsection
(b)(3).
``(d) Home-Based Primary Care Program.--The Secretary shall carry
out a program to be known as the `Home-Based Primary Care program'
under which the Secretary may furnish to eligible veterans in-home
health care, the provision of which is overseen by a provider of the
Department.
``(e) Purchased Skilled Home Care Program.--The Secretary shall
carry out a program to be known as the `Purchased Skilled Home Care
program' under which the Secretary may furnish to eligible veterans
such in-home care services as may be determined appropriate and
selected by the Secretary for the veteran.
``(f) Caregiver Support.--(1) With respect to a resident eligible
caregiver of a veteran participating in a program under this section,
the Secretary shall--
``(A) if the veteran meets the requirements of a covered
veteran under section 1720G(b) of this title, provide to such
caregiver the option of enrolling in the program of general
caregiver support services under such section;
``(B) provide to such caregiver covered respite care of not
less than 30 days annually; and
``(C) conduct on an annual basis (and, to the extent
practicable, in connection with in-person services provided under
the program in which the veteran is participating), a wellness
contact of such caregiver.
``(2) Covered respite care provided to a resident eligible
caregiver of a veteran under paragraph (1) may exceed 30 days annually
if such extension is requested by the resident eligible caregiver or
veteran and determined medically appropriate by the Secretary.
``(g) Rule of Construction.--Nothing in this section shall be
construed to limit the authority of the Secretary to carry out programs
providing home- and community-based services under any other provision
of law.
``(h) Definitions.--In this section:
``(1) The terms `Aging and Disability Resource Center', `area
agency on aging', and `State agency' have the meanings given those
terms in section 102 of the Older Americans Act of 1965 (42 U.S.C.
3002).
``(2) The terms `caregiver' and `family caregiver', with
respect to a veteran, have the meanings given those terms,
respectively, under subsection (e) of section 1720G of this title
with respect to an eligible veteran under subsection (a) of such
section or a covered veteran under subsection (b) of such section,
as the case may be.
``(3) The term `center for independent living' has the meaning
given that term in section 702 of the Rehabilitation Act of 1973
(29 U.S.C. 796a).
``(4) The term `covered respite care' has the meaning given
such term in section 1720G(d) of this title.
``(5) The term `eligible veteran' means any veteran--
``(A) for whom the Secretary determines participation in a
specific program under this section is medically necessary to
promote, preserve, or restore the health of the veteran; and
``(B) who absent such participation would be at increased
risk for hospitalization, placement in a nursing home, or
emergency room care.
``(6) The term `home health aide' means an individual employed
by a home health agency to provide in-home care services.
``(7) The term `in-home care service' means any service,
including a personal care service, provided to enable the recipient
of such service to live at home.
``(8) The terms `Indian tribe' and `tribal organization' have
the meanings given those terms in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 5304).
``(9) The terms `Native American' and `Native American veteran'
have the meanings given those terms in section 3765 of this title.
``(10) The terms `Native Hawaiian' and `Native Hawaiian health
care system' have the meanings given those terms in section 12 of
the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11711).
``(11) The terms `tribal health programs' and `Urban Indian
organizations' have the meanings given those terms in section 4 of
the Indian Health Care Improvement Act (25 U.S.C. 1603).
``(12) The term `resident eligible caregiver' means an
individual who--
``(A) is a caregiver, or a family caregiver, of a veteran
and resides with that veteran; and
``(B) has not entered into a contract, agreement, or other
arrangement for such individual to act as a caregiver for that
veteran unless such individual is a family member of the
veteran or is furnishing caregiver services through a medical
foster home.''.
(b) Deadline for Improved Administration.--The Secretary of
Veterans Affairs shall ensure that the Veteran-Directed Care program
and the Homemaker and Home Health Aide program are administered through
each medical center of the Department of Veterans Affairs in accordance
with section 1720L of title 38, United States Code (as added by
subsection (a)), by not later than two years after the date of the
enactment of this Act.
(c) Administration of Veteran-Directed Care Program.--
(1) Procedures.--
(A) The Secretary shall establish procedures to--
(i) identify the staffing needs for the Veteran-
Directed Care program of the Department of Veterans Affairs
under such section (as added by subsection (a)); and
(ii) define the roles and responsibilities for
personnel of the Department responsible for the
administration of such program, including such personnel
employed at the national, Veterans Integrated Service
Network, or medical facility level.
(B) The responsibilities described in clause (ii) of
subparagraph (A) shall include responsibilities for engagement
with--
(i) veterans participating in such program;
(ii) veterans interested in participating in such
program; and
(iii) providers described in section 1720L(b)(2) (as
added by subsection (a)).
(2) Staffing model; report.--Not later than two years after
enactment of this Act, the Secretary of Veterans Affairs shall--
(A) establish a staffing model for the administration of
such program at each medical facility of the Department of
Veterans Affairs; and
(B) submit to the Committees on Veterans' Affairs of the
House of Representatives and the Senate a report containing the
following:
(i) A description of--
(I) the staffing model described in subparagraph
(A); and
(II) the rationale for such staffing model.
(ii) An identification of the ratio of staff required
to administer such program to the number of veterans served
by such program, disaggregated by each medical facility of
the Department of Veterans Affairs.
(iii) A description of budgetary resources or other
support, if any, required to accommodate an increase in
staffing at medical facilities of the Department of
Veterans Affairs pursuant to the requirements of the
staffing model described in subparagraph (A).
(iv) Such other matters as the Secretary of Veterans
Affairs determines appropriate.
SEC. 124. COORDINATION WITH ASSISTANCE AND SUPPORT SERVICES FOR
CAREGIVERS.
(a) Coordination With Program of Comprehensive Assistance for
Family Caregivers.--
(1) Coordination.--Section 1720G(a) of title 38, United States
Code, is amended by adding at the end the following new paragraph:
``(14)(A) In the case of a veteran or caregiver who seeks services
under this subsection and is denied such services, or a veteran or the
family caregiver of a veteran who is discharged from the program under
this subsection, the Secretary shall--
``(i) if the veteran meets the requirements of a covered
veteran under subsection (b), provide to such caregiver the option
of enrolling in the program of general caregiver support services
under such subsection;
``(ii) assess the veteran or caregiver for participation in any
other available program of the Department for home- and community-
based services (including the programs specified in section 1720L
of this title) for which the veteran or caregiver may be eligible
and, with respect to the veteran, store (and make accessible to the
veteran) the results of such assessment in the electronic medical
record of the veteran; and
``(iii) provide to the veteran or caregiver written information
on any such program identified pursuant to the assessment under
clause (ii), including information about facilities, eligibility
requirements, and relevant contact information for each such
program.
``(B) The Secretary shall, to the extent practicable, provide to a
veteran or family caregiver the option of obtaining clinically
appropriate services under any other available program of the
Department for home- and community-based services (including the
programs specified in section 1720L of this title) for which the
veteran or family caregiver may be eligible prior to discharging the
veteran or family caregiver from the program under this subsection.
``(C) For each veteran or family caregiver who is discharged from
the program under this subsection, a caregiver support coordinator
shall provide for a smooth and personalized transition from such
program to an appropriate program of the Department for home- and
community-based services (including the programs specified in section
1720L of this title), including by integrating caregiver support across
programs.''.
(2) Applicability.--The amendments made by paragraph (1) shall
apply with respect to denials and discharges occurring on or after
the date that is 180 days after the date of the enactment of this
Act.
(3) Technical and conforming amendments.--Section 1720G(d) of
such title is amended--
(A) by striking ``or a covered veteran'' each place it
appears and inserting ``, a veteran denied or discharged as
specified in paragraph (14) of such subsection, or a covered
veteran''; and
(B) by striking ``under subsection (a), means'' each place
it appears and inserting ``under subsection (a) or a veteran
denied or discharged as specified in paragraph (14) of such
subsection, means''.
(b) Conformity of Respite Care Across Programs.--Section 1720G of
title 38, United States Code, as amended by subsection (a)(3), is
further amended--
(1) in subsection (a)(3)--
(A) by amending subparagraph (A)(ii)(III) to read as
follows:
``(III) covered respite care of not less than 30 days
annually;''; and
(B) by striking subparagraph (B) and redesignating
subparagraphs (C) and (D) as subparagraphs (B) through (C),
respectively; and
(2) by amending subsection (b)(3)(A)(iii) to read as follows:
``(iii) Covered respite care of not less than 30 days
annually.''; and
(3) in subsection (d)--
(A) by redesignating paragraphs (2) through (4) as
paragraphs (3) through (5), respectively; and
(B) by inserting after paragraph (1) the following new
paragraph:
``(2) The term `covered respite care' means, with respect to a
caregiver of a veteran, respite care under section 1720B of this
title that--
``(A) is medically and age appropriate for the veteran
(including 24-hour per day care of the veteran commensurate
with the care provided by the caregiver); and
``(B) includes in-home care.''.
(c) Review Relating to Caregiver Contact.--The Secretary shall
conduct a review of the capacity of the Department to establish a
streamlined system for contacting all caregivers enrolled in the
program of general caregiver support services under section 1720G(b) of
title 38, United States Code, to provide to such caregivers program
updates and alerts relating to emerging services for which such
caregivers or the veterans for which they provide care may be eligible.
SEC. 125. IMPROVEMENTS TO PROGRAM OF COMPREHENSIVE ASSISTANCE FOR
FAMILY CAREGIVERS.
Section 1720G(a) of title 38, United States Code, as amended by
section 124, is further amended--
(1) in paragraph (12)--
(A) in subparagraph (A), by inserting ``, which shall
include all criteria used to determine eligibility for such
assistance and, in the case of a completed evaluation, how such
criteria were used to evaluate information provided in
assessments to determine such eligibility'' before the period
at the end; and
(B) in subparagraph (C)(i), by striking ``who submits'' and
all that follows through the end of the clause and inserting
the following: ``who--
``(I) submits an application for the program established
under paragraph (1); or
``(II) is being reassessed for eligibility to continue in
such program.''; and
(2) by adding at the end the following new paragraph:
``(15)(A) Not less frequently than annually, the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate and the
House of Representatives a comprehensive report on the program required
by paragraph (1) that includes, with respect to the one-year period
preceding the date of the submission of such report, the following:
``(i) The number of applications received for such program.
``(ii) The number, disaggregated by race, sex, and era and
branch of service in the Armed Forces of the applicant, of--
``(I) approvals of such applications; and
``(II) denials of such applications.
``(iii) The number of reassessments conducted for such program.
``(iv) An identification of each decision made with respect to
a reassessment conducted for such program, disaggregated by
decisions resulting in--
``(I) disenrollment, including removal, discharge, or
voluntary withdrawal;
``(II) tier reduction; and
``(III) tier continuation.
``(v) The number of appeals of decisions made with respect to
such program, disaggregated by type of appeal.
``(vi) With respect to each appeal described in clause (v), the
decision rendered, if any.
``(vii) A description of all tools used in assessments
conducted for such program, including an explanation of how and by
whom such tools are administered.
``(viii) A description of procedures used under such program
for reviewing and integrating clinical records from health care
providers that includes an explanation of how such records are used
in determinations of eligibility for such program.
``(ix) A description of procedures available under such program
for health care providers to communicate medical opinions to the
teams conducting assessments to determine eligibility for such
program, including health care providers in the private sector and
health care providers specified in subsection (c) of section 1703
of this title.
``(x) A description of information technology systems and
processes used under such program to upload and integrate all
clinical records from all non-Department providers, including
providers in the private sector and providers under the Veterans
Community Care Program established under such section.
``(B) The Secretary shall ensure that all data included in a report
under subparagraph (A)--
``(i) relating to a decision made under the program required by
paragraph (1), are disaggregated by the specific reason for the
decision;
``(ii) relating to a veteran, include comprehensive demographic
information of the veteran, including the time period of the
injuries, if any, of the veteran and the Veterans Integrated
Service Network in which the veteran is located; and
``(iii) with respect to eligibility determinations relating to
a serious injury of a veteran, specify--
``(I) how many such determinations relate to the ability of
the veteran to perform activities of daily living; and
``(II) how many such determinations relate to the need of a
veteran for supervision and protection.
``(C) The Secretary shall provide the data under paragraph (B)
pursuant to Federal laws and in a manner that is wholly consistent with
applicable Federal privacy and confidentiality laws, including the
Privacy Act (5 U.S.C. 552a), the Health Insurance Portability and
Accountability Act (Public Law 104-191; 42 U.S.C. 201 note) and
regulations (title 45, Code of Federal Regulations, parts 160 and 164,
or successor regulations), and sections 5701, 5705, and 7332 of this
title to ensure that the provided data, or some portion of the data,
will not undermine the anonymity of a veteran.''.
SEC. 126. IMPROVEMENTS RELATING TO HOMEMAKER AND HOME HEALTH AIDE
PROGRAM.
(a) Pilot Program for Communities With Shortage of Home Health
Aides.--
(1) Program.--Beginning not later than 18 months after the date
of the enactment of this Act, the Secretary shall carry out a
three-year pilot program under which the Secretary shall provide
homemaker and home health aide services to veterans who reside in
communities with a shortage of home health aides.
(2) Locations.--The Secretary shall select not fewer than five
geographic locations in which the Secretary determines there is a
shortage of home health aides at which to carry out the pilot
program under paragraph (1).
(3) Nursing assistants.--
(A) In general.--In carrying out the pilot program under
paragraph (1), the Secretary may hire nursing assistants as new
employees of the Department of Veterans Affairs, or reassign
nursing assistants who are existing employees of the
Department, to provide to veterans in-home care services
(including basic tasks authorized by the State certification of
the nursing assistant) under the pilot program, in lieu of or
in addition to the provision of such services through non-
Department home health aides.
(B) Relationship to home-based primary care program.--
Nursing assistants hired or reassigned under subparagraph (A)
may provide services to a veteran under the pilot program under
paragraph (1) while serving as part of a health care team for
the veteran under the Home-Based Primary Care program.
(4) Report to congress.--Not later than one year before the
date of the termination of the pilot program under paragraph (1),
the Secretary shall submit to the Committees on Veterans' Affairs
of the House of Representatives and the Senate a report that
includes--
(A) a statement of the results of such pilot program; and
(B) an assessment of the feasibility and advisability of--
(i) extending such pilot program; or
(ii) making such pilot program a permanent program of
the Department of Veterans Affairs.
(b) Report on Use of Funds.--Not later than one year after the date
of the enactment of this Act, the Secretary of Veterans Affairs shall
submit to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a report containing, with respect to the
period beginning in fiscal year 2012 and ending in fiscal year 2024,
the following:
(1) An identification of the amount of funds that were included
in a budget of the Department of Veterans Affairs during such
period for the provision of in-home care to veterans under the
Homemaker and Home Health Aide program but were not expended for
such provision, disaggregated by medical center of the Department
for which such unexpended funds were budgeted (if such
disaggregation is possible).
(2) To the extent practicable, an identification of the number
of veterans for whom, during such period, the hours during which a
home health aide was authorized to provide services to the veteran
under the Homemaker and Home Health Aide program were reduced for a
reason other than a change in the health care needs of the veteran,
and a detailed description of the reasons why any such reductions
may have occurred.
(c) Updated Guidance on Program.--Not later than one year after the
date of the enactment of this Act, the Secretary shall issue updated
guidance for the Homemaker and Home Health Aide program. Such updated
guidance shall include the following:
(1) A process for the transition of veterans from the Homemaker
and Home Health Aide program to other covered programs.
(2) A requirement for the directors of the medical facilities
of the Department to complete such process whenever a veteran with
care needs has been denied services from home health agencies under
the Homemaker and Home Health Aide program as a result of the
clinical needs or behavioral issues of the veteran.
SEC. 127. PILOT PROGRAM TO FURNISH ASSISTED LIVING SERVICES TO
CERTAIN VETERANS.
(a) Establishment.--Beginning not later than two years after the
date of the enactment of this Act, the Secretary of Veterans Affairs
shall carry out a pilot program to assess--
(1) the effectiveness of providing assisted living services to
eligible veterans, at the election of such veterans; and
(2) the satisfaction with the pilot program of veterans
participating in such pilot program.
(b) Program Locations.--
(1) Veterans integrated service networks.--The Secretary shall
select two Veterans Integrated Service Networks of the Department
of Veterans Affairs at which to carry out the pilot program under
subsection (a).
(2) Facilities.--
(A) In general.--Within the Veterans Integrated Service
Networks selected under paragraph (1), the Secretary shall
select facilities at which to carry out the pilot program under
subsection (a)(1).
(B) Selection criteria.--In selecting facilities under
subparagraph (A) at which to carry out the pilot program under
subsection (a)(1), the Secretary shall ensure that--
(i) the locations of such facilities are in
geographically diverse areas;
(ii) not fewer than one such facility serves veterans
in rural or highly rural areas (as determined through the
use of the Rural-Urban Commuting Areas coding system of the
Department of Agriculture);
(iii) not fewer than one such facility is located in
each Veterans Integrated Service Network selected under
paragraph (1); and
(iv) not fewer than one such facility is a State home.
(c) Program Participants.--Not more than 60 eligible veterans may
participate in the pilot program under subsection (a)(1) in each
Veterans Integrated Service Network selected under subsection (b)(1).
(d) Provision of Assisted Living Services.--
(1) Agreements.--In carrying out the pilot program under
subsection (a)(1), the Secretary may enter into agreements for the
provision of assisted living services on behalf of eligible
veterans with--
(A) a provider participating under a State plan or waiver
under title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.); or
(B) a State home recognized and certified under subpart B
of part 51 of title 38, Code of Federal Regulations, or
successor regulations.
(2) Standards.--The Secretary may not place, transfer, or admit
a veteran to any facility for assisted living services under the
pilot program under subsection (a)(1) unless the Secretary
determines that--
(A) the facility meets the standards for community
residential care established under sections 17.61 through 17.72
of title 38, Code of Federal Regulations, or successor
regulations, and any additional standards of care as the
Secretary may specify; or
(B) in the case of a facility that is a State home, the
State home meets such standards of care as the Secretary may
specify.
(3) Inspection.--The Secretary shall inspect facilities at
which veterans are placed under the pilot program under subsection
(a)(1)--
(A) with respect to a facility that is a State home, not
less frequently than annually and in the same manner as the
Secretary conducts inspection of State homes under section 1742
of title 38, United States Code; and
(B) with respect to any other facility, not less frequently
than annually and in the same manner as the Secretary conducts
inspection of facilities under section 1730 of such title.
(4) Payment to certain facilities.--
(A) State homes.--In the case of a facility participating
in the pilot program under subsection (a)(1) that is a State
home, the Secretary shall pay to the State home a per diem for
each veteran participating in the pilot program at a rate
agreed to by the Secretary and the State home.
(B) Community assisted living facilities.--In the case of a
facility participating in the pilot program under subsection
(a)(1) that is a community assisted living facility, the
Secretary shall--
(i) pay to the facility an amount that is less than the
average rate paid by the Department for placement in a
community nursing home in the same Veterans Integrated
Service Network; and
(ii) re-evaluate payment rates annually to account for
current economic conditions and current costs of assisted
living services.
(e) Continuity of Care.--Upon the termination of the pilot program
under subsection (a)(1), the Secretary shall--
(1) provide to all veterans participating in the pilot program
at the time of such termination the option to continue to receive
assisted living services at the site they were assigned to under
the pilot program, at the expense of the Department; and
(2) for such veterans who do not opt to continue to receive
such services--
(A) ensure such veterans do not experience lapses in care;
and
(B) provide such veterans with information on, and furnish
such veterans with, other extended care services based on their
preferences and best medical interest.
(f) Determination of Quality.--The Secretary shall determine a
method for assessment of quality of care provided to veterans
participating in the pilot program under subsection (a)(1) and shall
communicate that method to providers of services under the pilot
program.
(g) Annual Report.--Not later than one year after the initiation of
the pilot program under subsection (a)(1), and annually thereafter for
the duration of such pilot program, the Secretary shall submit to the
Committees on Veterans' Affairs of the House of Representatives and the
Senate a report on the pilot program that includes--
(1) an identification of Veterans Integrated Services Networks
and facilities of the Department participating in the pilot program
and assisted living facilities and State homes at which veterans
are placed under the pilot program;
(2) the number of participants in the pilot program,
disaggregated by facility;
(3) general demographic information of participants in the
pilot program, including average age, sex, and race or ethnicity;
(4) disability status of participants in the pilot program;
(5) an identification of any barriers or challenges to
furnishing care to veterans under the pilot program, conducting
oversight of the pilot program, or any other barriers or
challenges;
(6) the cost of care at each assisted living facility and State
home participating in the pilot program, including an analysis of
any cost savings by the Department when comparing that cost to the
cost of nursing home care;
(7) aggregated feedback from participants in the pilot program,
including from veteran resident surveys and interviews; and
(8) such other matters the Secretary considers appropriate.
(h) Final Report.--Not later than one year after the pilot program
terminates under subsection (j), the Secretary shall submit to the
Committees on Veterans' Affairs of the House of Representatives and the
Senate a report on the pilot program that--
(1) includes the matters required under paragraphs (1) through
(8) of subsection (g);
(2) includes recommendations on whether the model studied in
the pilot program should be continued or adopted throughout the
Department; and
(3) indicates whether the Secretary requests action by Congress
to make the pilot program permanent.
(i) Inspector General Report.--
(1) In general.--Not later than three years after the
initiation of the pilot program under subsection (a)(1), the
Inspector General of the Department of Veterans Affairs shall
submit to the Secretary of Veterans Affairs and the Committees on
Veterans' Affairs of House of Representatives and the Senate a
report on the pilot program.
(2) Elements.--The report required by paragraph (1) shall
include an assessment of--
(A) the quality of care provided to veterans at facilities
participating in the pilot program, measured pursuant to the
method determined under subsection (f);
(B) the oversight of such facilities, as conducted by the
Department, the Centers for Medicare & Medicaid Services, State
agencies, and other relevant entities; and
(C) such other matters as the Inspector General considers
appropriate.
(3) Plan required.--Not later than 90 days after the submission
of the report under paragraph (1), the Secretary shall submit to
the Committees on Veterans' Affairs of the House of Representatives
and the Senate a plan to address the deficiencies identified in the
report, if any.
(j) Termination.--
(1) In general.--Subject to paragraph (2), the pilot program
under subsection (a)(1) shall terminate on September 30, 2028.
(2) Extension.--The Secretary may extend the duration of the
pilot program for an additional two-year period if the Secretary,
based on the results of the reports submitted under subsection (g),
determines such an extension is appropriate.
(k) Definitions.--In this section:
(1) The term ``assisted living services'' means services of a
facility in providing room, board, and personal care for and
supervision of residents for their health, safety, and welfare.
(2) The term ``eligible veteran'' means a veteran who is--
(A) receiving nursing home care paid for by the Department
of Veterans Affairs, eligible to receive such care pursuant to
section 1710A of title 38, United States Code, or requires a
higher level of care than the domiciliary care provided by the
Department of Veterans Affairs, but does not meet the
requirements for nursing home level care provided by the
Department pursuant to such section; and
(B) eligible for assisted living services, as determined by
the Secretary or meets such additional criteria for eligibility
for the pilot program under subsection (a)(1) as the Secretary
may establish.
(3) The term ``State home'' has the meaning given that term in
section 101 of title 38, United States Code.
SEC. 128. PROVISION OF MEDICINE, EQUIPMENT, AND SUPPLIES AVAILABLE
TO DEPARTMENT OF VETERANS AFFAIRS TO STATE HOMES.
(a) Provision Authorized.--The Secretary of Veterans Affairs may
provide to State homes medicine, personal protective equipment, medical
supplies, and any other equipment, supplies, and assistance available
to the Department of Veterans Affairs.
(b) Definition.--In this section:
(1) The term ``personal protective equipment'' means any
protective equipment required to prevent the wearer from
contracting an infectious disease, including gloves, N-95
respirator masks, gowns, goggles, face shields, or other equipment
required for safety.
(2) The term ``State home'' has the meaning given such term in
section 101 of title 38, United States Code.
SEC. 129. RECOGNITION OF ORGANIZATIONS AND INDIVIDUALS TO ASSIST
VETERANS, FAMILY MEMBERS, AND CAREGIVERS NAVIGATING PROGRAMS AND
SERVICES OF VETERANS HEALTH ADMINISTRATION.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
establish a process through which the Department of Veterans Affairs
may recognize organizations and individuals to assist a veteran, a
family member of a veteran, or a caregiver of a veteran (as defined in
section 1720G(d) of title 38, United States Code) in navigating the
programs and services of the Veterans Health Administration.
(b) Solicitation of Feedback.--The Secretary shall solicit feedback
and recommendations in the creation of the process under subsection (a)
from such organizations as the Secretary may consider relevant.
(c) Limitation.--The Secretary may not recognize an organization or
individual pursuant to the process established under subsection (a)
unless the organization or individual has certified to the Secretary
that no fee or compensation of any nature will be charged to any
individual for services rendered in providing assistance pursuant to
such subsection.
SEC. 130. REVIEWS AND OTHER IMPROVEMENTS RELATING TO HOME- AND
COMMUNITY-BASED SERVICES.
(a) Office of Geriatric and Extended Care.--
(1) Review of programs.--The Under Secretary for Health of the
Department of Veterans Affairs shall conduct a review of each
program administered through the Office of Geriatric and Extended
Care of the Department and the Caregiver Support Program Office of
the Department, or any successor offices, to--
(A) eliminate service gaps at the medical center level; and
(B) ensure--
(i) the clinical needs of veterans are met;
(ii) consistency in program management;
(iii) the availability of, and the access by veterans
to, home- and community-based services, including for
veterans living in rural areas; and
(iv) proper coordination between covered programs.
(2) Assessment of staffing needs.--The Secretary of Veterans
Affairs shall conduct an assessment of the staffing needs of the
Office of Geriatric and Extended Care of the Department and the
Caregiver Support Program Office of the Department, or any
successor offices.
(3) Goals for geographic alignment of care.--
(A) Establishment of goals.--The Director of the Office of
Geriatric and Extended Care, or successor office, shall
establish quantitative goals to enable aging or disabled
veterans who are not located near medical centers of the
Department to access extended care services (including by
improving access to home- and community-based services for such
veterans).
(B) Implementation timeline.--Each goal established under
subparagraph (A) shall include a timeline for the
implementation of the goal at each medical center of the
Department.
(4) Goals for in-home specialty care.--The Director of the
Office of Geriatric and Extended Care, or successor office, shall
establish quantitative goals to address the specialty care needs of
veterans through in-home care, including by ensuring the education
of home health aides and caregivers of veterans in the following
areas:
(A) Dementia care.
(B) Care for spinal cord injuries and diseases.
(C) Ventilator care.
(D) Other speciality care areas as determined by the
Secretary.
(5) Input on goals.--To the extent practicable, the head of the
Caregiver Support Program Office, or successor office, shall
provide to the Director of the Office of Geriatric and Extended
Care, or successor office, input with respect to the establishment
of the goals under paragraphs (3) and (4).
(6) Report to congress.--Not later than one year after the date
of the enactment of this Act, the Secretary shall submit to the
Committees on Veterans' Affairs of the House of Representatives and
the Senate a report containing the findings of the review under
paragraph (1), the results of the assessment under paragraph (2),
and the goals established under paragraphs (3) and (4).
(b) Review of Incentives and Efforts Relating to Home- and
Community-based Services.--
(1) Review.--The Secretary of Veterans Affairs shall conduct a
review of the following:
(A) The financial and organizational incentives or
disincentives for the directors of medical centers of the
Department to establish or expand covered programs at such
medical centers.
(B) Any incentives or disincentives for such directors to
provide to veterans home- and community-based services in lieu
of institutional care.
(C) The efforts taken by the Secretary to enhance spending
of the Department for extended care by balancing spending
between institutional care and home- and community-based
services consistent with the demand for such services.
(D) The plan of the Under Secretary for Health of the
Department to accelerate efforts to enhance spending as
specified in subparagraph (C), to match the progress of similar
efforts taken by the Administrator of the Centers for Medicare
& Medicaid Services with respect to spending of the Centers for
Medicare & Medicaid Services for extended care.
(2) Report to congress.--Not later than one year after the date
of the enactment of this Act, the Secretary shall submit to the
Committees on Veterans' Affairs of the House of Representatives and
the Senate a report on the findings of the review under paragraph
(1).
(c) Review of Respite Care Services.--Not later than two years
after the date of the enactment of this Act, the Secretary of Veterans
Affairs shall conduct a review of the use, availability, cost, and
effectiveness, of the respite care services furnished by the Secretary
under chapter 17 of title 38, United States Code, including--
(1) the frequency at which the Department of Veterans Affairs
is unable to meet demand for such services;
(2) a detailed description of--
(A) the reasons the Department of Veterans Affairs is
unable to meet the demand for such services; and
(B) any actions, or planned actions, of the Secretary of
Veterans Affairs to ensure such demand is met.
(d) Collaboration to Improve Home- and Community-based Services.--
(1) Recommendations.--
(A) Development.--The Secretary of Veterans Affairs shall
develop recommendations as follows:
(i) With respect to home- and community-based services
for veterans, the Secretary of Veterans Affairs shall
develop recommendations regarding new services (in addition
to those furnished as of the date of enactment of this Act)
in collaboration with the Secretary of Health and Human
Services.
(ii) With respect to the national shortage of home
health aides, the Secretary of Veterans Affairs shall
develop recommendations regarding methods to address such
shortage in collaboration with the Secretary of Health and
Human Services and the Secretary of Labor.
(B) Submission to congress.--The Secretary of Veterans
Affairs shall submit to the Committees on Veterans' Affairs of
the House of Representatives and the Senate a report containing
the recommendations developed under subparagraph (A) and an
identification of any changes in existing law or new statutory
authority necessary to implement the recommendations, as
determined by the Secretary.
(C) Consultation with secretary of labor.--In carrying out
this paragraph, the Secretary of Veterans Affairs shall consult
with the Secretary of Labor.
(2) Feedback and recommendations on caregiver support.--
(A) Feedback and recommendations.--The Secretary of
Veterans Affairs shall solicit from the entities described in
subparagraph (B) feedback and recommendations regarding
opportunities for the Secretary to enhance home- and community-
based services for veterans and the caregivers of veterans,
including through the potential provision by the entity of care
and respite services to veterans and caregivers who may not be
eligible for any program under section 1720G of title 38,
United States Code, or section 1720L of such title (as added by
section 123), but have a need for assistance.
(B) Covered entities.--The entities described in this
subparagraph are veterans service organizations and nonprofit
organizations with a focus on caregiver support or long term
care (as determined by the Secretary).
(3) Collaboration for certain veterans.--The Secretary of
Veterans Affairs shall collaborate with the Director of the Indian
Health Service and representatives from tribal health programs and
Urban Indian organizations to ensure the availability of home- and
community-based services for--
(A) Native American veterans, including Native American
veterans receiving health care and medical services under
multiple health care systems; and
(B) Native Hawaiian veterans, including Native Hawaiian
veterans receiving health care and medical services under the
Native Hawaiian health care system.
SEC. 131. GAO REPORT ON MENTAL HEALTH SUPPORT FOR CAREGIVERS.
(a) Report Required.--Not later than one year 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 provision of mental health support to caregivers of
veterans.
(b) Contents.--The report submitted under subsection (a) shall
include the following:
(1) An assessment of the need for mental health support among
caregivers participating in the caregiver programs.
(2) An assessment of options for mental health support in
facilities of the Department of Veterans Affairs and in the
community for caregivers participating in the caregiver programs.
(3) An assessment of the availability and accessibility of
mental health support in facilities of the Department and in the
community for caregivers participating in the caregiver programs.
(4) An assessment of the awareness among caregivers of the
availability of mental health support in facilities of the
Department and in the community for caregivers participating in the
caregiver programs.
(5) An assessment of barriers to mental health support in
facilities of the Department and in the community for caregivers
participating in the caregiver programs.
(c) Definitions.--In this section:
(1) The term ``caregiver'' has the meaning given that term in
section 1720G of title 38, United States Code.
(2) The term ``caregiver programs'' means--
(A) the program of comprehensive assistance for family
caregivers under subsection (a) of section 1720G of title 38,
United States Code; and
(B) the program of support services for caregivers under
subsection (b) of such section.
SEC. 132. DEVELOPMENT OF CENTRALIZED WEBSITE FOR PROGRAM
INFORMATION.
(a) Centralized Website.--The Secretary shall develop and maintain
a centralized and publically accessible internet website of the
Department as a clearinghouse for information and resources relating to
covered programs.
(b) Contents.--The website under subsection (a) shall contain the
following:
(1) A description of each covered program.
(2) An informational assessment tool that--
(A) explains the administrative eligibility, if applicable,
of a veteran, or a caregiver of a veteran, for any covered
program; and
(B) provides information, as a result of such explanation,
on any covered program for which the veteran or caregiver (as
the case may be) may be eligible.
(3) A list of required procedures for the directors of the
medical facilities of the Department to follow in determining the
eligibility and suitability of veterans for participation in a
covered program, including procedures applicable to instances in
which the resource constraints of a facility (or of a community in
which a facility is located) may result in the inability to address
the health needs of a veteran under a covered program in a timely
manner.
(c) Updates.--The Secretary shall ensure the website under
subsection (a) is updated on a periodic basis.
SEC. 133. DEFINITIONS.
In this subtitle:
(1) The terms ``caregiver'' and ``family caregiver'' have the
meanings given those terms under section 1720L(h) of title 38,
United States Code (as added by section 123).
(2) The term ``covered program''--
(A) means any program of the Department of Veterans Affairs
for home- and community-based services; and
(B) includes the programs specified in section 1720L of
title 38, United States Code (as added by section 123).
(3) The term ``home- and community-based services''--
(A) means the services referred to in section 1701(6)(E) of
title 38, United States Code; and
(B) includes services furnished under a program specified
in section 1720L of such title (as added by section 123).
(4) The terms ``Home-Based Primary Care program'', ``Homemaker
and Home Health Aide program'', and ``Veteran-Directed Care
program'' mean the programs of the Department of Veterans Affairs
specified in subsection (d), (c), and (b) of such section 1720L,
respectively.
(5) The terms ``home health aide'', ``Native American'',
``Native American veteran'', ``tribal health programs'', and
``Urban Indian organizations'' have the meanings given those terms
in subsection (h) of such section 1720L.
(6) The term ``veterans service organization'' means any
organization recognized by the Secretary under section 5902 of such
title.
Subtitle C--Medical Treatment and Other Matters
SEC. 140. QUARTERLY REPORT ON REFERRALS FOR NON-DEPARTMENT OF
VETERANS AFFAIRS HEALTH CARE.
(a) In General.--Subchapter I of chapter 17 of title 38, United
States Code, is amended by inserting after section 1703F the following
new section (and amending the table of sections at the beginning of
such chapter accordingly):
``Sec. 1703G. Quarterly report on referrals for non-Department health
care
``The Secretary shall submit to the Committees on Veterans' Affairs
of the Senate and the House of Representatives a quarterly report
containing, with respect to referrals for non-Department health care
originating from a medical facility of the Department during the
quarter preceding the date of the submission of the report, a
measurement of, for each such medical facility--
``(1) the period of time between--
``(A) the date on which a clinician employed by the
Department determines that a veteran requires care, or a
veteran presents to the Department requesting care, and the
date on which the referral for care is sent to a non-Department
health care provider;
``(B) the date on which such referral is sent to a non-
Department health care provider and the date on which such non-
Department health care provider accepts such referral;
``(C) the date on which such non-Department health care
provider accepts such referral and the date on which such
referral is completed;
``(D) the date on which such referral is completed and the
date on which an appointment with a non-Department health care
provider is made; and
``(E) the date on which such an appointment is made and the
date on which such appointment occurs; and
``(2) any other period of time that the Secretary determines
necessary.''.
(b) Effective Date.--The first report under section 1703G, as added
by this section, shall be due not later than 180 days after the date of
the enactment of this section.
SEC. 141. ELIMINATION OF CERTAIN REQUIREMENTS FOR CERTAIN
DEPARTMENT OF VETERANS AFFAIRS ASSISTANT UNDER SECRETARIES.
Section 7306 of title 38, United States Code, is amended--
(1) by striking subsection (b);
(2) by redesignating subsections (c) through (g) as subsections
(b) through (f), respectively; and
(3) in subsection (c) (as so redesignated), by striking
``subsection (e)'' and inserting ``subsection (d)''.
SEC. 142. MODIFICATION OF PAY LIMITATION FOR PHYSICIANS,
PODIATRISTS, OPTOMETRISTS, AND DENTISTS OF DEPARTMENT OF VETERANS
AFFAIRS.
(a) Pay.--
(1) In general.--Section 7431 of title 38, United States Code,
is amended--
(A) by inserting ``optometrists,'' after ``podiatrists,''
each place it appears;
(B) by inserting ``optometrist'' after ``podiatrist,'' each
place it appears;
(C) in subsection (c)--
(i) in paragraph (5), by adding at the end the
following new sentence: ``Such a notice shall include a
statement of whether the market pay will increase,
decrease, or remain unchanged following such evaluation.'';
and
(ii) by adding at the end the following new paragraphs:
``(7) The Secretary shall ensure that each physician,
podiatrist, optometrist, and dentist in the Veterans Health
Administration is--
``(A) advised, on an annual basis, of the criteria
described in subparagraph (F) of paragraph (4);
``(B) evaluated in accordance with such criteria; and
``(C) compensated in accordance with--
``(i) applicable assignment and pay levels, subject to
relevant pay limitations; and
``(ii) the extent to which such criteria are met.
``(8) Not later than 120 days after the end of each fiscal
year, the Secretary shall submit to the Committees on Veterans'
Affairs of the Senate and the House of Representatives a report
that includes the following:
``(A) A list of each facility and specialty that conducted
an evaluation of pay during the period covered by the report.
``(B) For each evaluation described in subparagraph (A)--
``(i) a list of occupations for which pay was
evaluated, disaggregated by medical specialty, number of
authorized full-time employees, and onsite full-time
employees as of the date of the evaluation;
``(ii) the date such evaluation was completed;
``(iii) whether a market pay adjustment was made
following the evaluation per each occupation and specialty
evaluated;
``(iv) whether applicable employees were notified of
such evaluation;
``(v) whether local labor partners were notified of
such evaluation; and
``(vi) in the case of an evaluation that resulted in an
adjustment of pay--
``(I) the date such adjustment--
``(aa) was implemented; and
``(bb) became effective; and
``(II) the percentage of employees of each
occupation and specialty for which pay was adjusted
pursuant to such evaluation.
``(C) A list of facilities of the Department that have not
conducted an evaluation of market pay, pursuant to paragraph
(5), during the 18-month-period that precedes the date of the
submission of such report.''; and
(D) in subsection (e), by adding at the end the following
new paragraphs:
``(5) Notwithstanding any compensation or pay limitations under
this title or title 5, the Secretary may authorize the Under
Secretary for Health to pay physicians, podiatrists, optometrists,
and dentists--
``(A) awards authorized under this title;
``(B) advance payments, recruitment or relocation bonuses,
and retention allowances authorized under section 7410(a) of
this title or as otherwise provided by law;
``(C) incentives or bonuses under section 706 of this title
or as otherwise provided by law; and
``(D) earnings from fee-basis appointments under section
7405(a)(2) of this title.
``(6)(A) The Secretary may waive any pay limitation described
in this section (including tier limitations) that the Secretary
determines necessary for the recruitment or retention of critical
health care personnel whom the Secretary determines would provide
direct patient care.
``(B) Priority for such waivers shall be given for positions,
locations, and care provided through agreements that are costly to
the Department.
``(C) The Chief Human Capital Officer of the Department, the
Chief Financial Officer of the Department, and the Office of the
General Counsel of the Department shall review any waiver issued
under subparagraph (A).
``(D) During the period the authority under subparagraph (A) is
effective, the Secretary may not issue more than 300 waivers under
such subparagraph.
``(E) The Secretary may prescribe requirements, limitations,
and other considerations for waivers under such subparagraph.
``(F) Not later than 180 days after the date of the enactment
of the Senator Elizabeth Dole 21st Century Veterans Healthcare and
Benefits Improvement Act, and annually thereafter, the Secretary
shall submit to the Committees on Veterans' Affairs of the Senate
and the House of Representatives a report that includes--
``(i) any updates to the requirements, limitations, and
considerations prescribed under subparagraph (B) during the
period covered by the report;
``(ii) a description of the findings of each review, if
any, conducted pursuant to subparagraph (C);
``(iii) a description of each waiver under subparagraph (A)
in effect as of the date of the submission of the report,
including the--
``(I) duty location, position, specialty, market and
performance considerations for the waiver; and
``(II) impact, if any, of the waiver on care furnished
by the Department pursuant to an agreement regarding the
geographic area; and
``(iv) a list of any separation actions during the period
covered by the report with respect to a position for which a
waiver under subparagraph (A) is in effect.
``(G) The authority of the Secretary under subparagraph (A)
shall terminate on the last day of the third full fiscal year
following the date of the enactment of the Senator Elizabeth Dole
21st Century Veterans Healthcare and Benefits Improvement Act.''.
(2) Report on waiver authority.--Not later than 180 days after
the date of the enactment of this Act, the Secretary of Veterans
Affairs shall submit to the Committees on Veterans' Affairs of the
Senate and the House of Representatives a report that includes a
description of the requirements, limitations, and other
considerations prescribed under section 7431(b)(6)(D) of title 38,
United States Code, as added by paragraph (1).
(3) Conforming amendments.--
(A) Pay of under secretary for health.--Section 7432(b)(1)
of such title is amended by inserting ``, podiatrist,
optometrist,'' after ``physician''.
(B) Administrative matters.--Section 7433 of such title is
amended by inserting ``optometrists,'' after ``physicians,''
each place it appears.
(C) Competitive pay.--Section 7451(a)(2)(C) of such title
is amended by inserting ``optometrist,'' after ``physician,''.
(4) Clerical amendments.--
(A) Subchapter heading.--Subchapter III of chapter 74 of
such title is amended in the heading by inserting
``Optometrists,'' after ``PODIATRISTS,''.
(B) Table of sections.--The table of sections for such
chapter is amended by striking the item relating to subchapter
III and inserting the following:
``subchapter iii--pay for physicians and other health-care personnel''.
(5) Applicability dates.--The amendments made by this
subsection shall apply to any pay period of the Department of
Veterans Affairs beginning on or after the date that is 180 days
after the date of the enactment of this Act.
(b) Modification and Clarification of Pay Grade for Optometrists.--
Section 7404 of title 38, United States Code, is amended--
(1) in subsection (a)(2)(A), by striking ``podiatrists, and
dentists'' and inserting ``podiatrists, optometrists, and
dentists''; and
(2) in subsection (b)--
(A) by striking ``podiatrist (dpm), and dentist'' and
inserting ``podiatrist (dpm), optometrist (od), and dentist'';
(B) by striking ``clinical chiropractor and optometrist
schedule,'' and inserting ``clinical chiropractor schedule'';
and
(C) by inserting ``optometrist grade'' after ``Podiatrist
grade''.
(c) Retroactive Authority for Compensation.--
(1) In general.--The Secretary of Veterans Affairs may pay
retroactive compensation to a covered employee in an amount that
equals the amount of compensation that was authorized to be paid to
such covered employee during the period specified in paragraph (2),
but was deferred and paid to such employee in the calendar year
following the calender year in which such compensation was
authorized because the payment such compensation would have
exceeded an applicable cap on annual compensation.
(2) Period specified.--The period specified in this paragraph
is the period beginning on January 8, 2006, and ending on December
31, 2017.
(3) Exclusion.--Compensation authorized under this subsection
shall not be included in the calculation of any aggregate limit on
compensation for a covered employee for the year in which it is
paid.
(4) Charging of compensation.--Compensation authorized under
this subsection shall be charged to the appropriate medical care
appropriation account of the Department of Veterans Affairs for the
fiscal year in which the work was performed except as follows:
(A) In the case of an account that has closed pursuant to
section 1552 of title 31, United States Code, the compensation
shall be charged to a current appropriation account in
accordance with section 1553 of such title.
(B) In the case of an expired account that has not closed,
if charging the compensation to the expired account would cause
such account to have a negative unliquidated or unexpended
balance, the compensation may be charged to a current
appropriation account available for the same purpose.
(5) Definitions.--In this subsection:
(A) The term ``compensation'' means any pay, including
salary, awards, and incentives.
(B) The term ``covered employee'' means a physician,
podiatrist, or dentist subject to market pay under section 7431
of title 38, United States Code.
SEC. 143. REIMBURSEMENT OF AMBULANCE COST FOR CARE FOR CERTAIN
RURAL VETERANS.
(a) In General.--The Secretary of Veterans Affairs shall pay, or
reimburse a covered veteran for, the cost of transporting the veteran
by ambulance, including air ambulance, from a covered location to a
provider of the Department of Veterans Affairs, a non-Department
provider, or the nearest hospital that can meet the needs of the
veteran (including a hospital that compacts with the Indian Health
Service) for covered care.
(b) Amount Covered.--The maximum cumulative amount covered under
this section for a covered veteran is $46,000.
(c) Sunset.--This section shall cease to be effective on September
30, 2026.
(d) Definitions.--In this section:
(1) The term ``covered care'' means care for a veteran eligible
for care provided by the Department of Veterans Affairs under title
38, United States Code, or any other law administered by the
Secretary of Veterans Affairs, even if the care associated with the
transport described in subsection (a) is not authorized by the
Department.
(2) The term ``covered location'' means a location that is--
(A) in a State that is 100 miles or more from the nearest
medical center of the Department of Veterans Affairs; and
(B) in an area rated as a 10 or higher under the rural-
urban commuting areas coding system of the Department of
Agriculture.
(3) The term ``covered veteran'' means a veteran who--
(A) has a service-connected disability rated by the
Secretary as between 0 and 30 percent disabling;
(B) is not eligible for payments or reimbursements for
beneficiary travel or other transportation under the laws
administered by the Secretary of Veterans Affairs, other than
under this section; and
(C) is not entitled to care or services under a non-
Department of Veterans Affairs health-plan contract.
(4) The term ``health-plan contract'' has the meaning given
that term in section 1725 of title 38, United States Code.
(5) The term ``service-connected'' has the meaning given that
term in section 101 of such title.
SEC. 144. PILOT PROGRAM TO FURNISH DENTAL CARE FROM THE DEPARTMENT
OF VETERANS AFFAIRS TO CERTAIN VETERANS DIAGNOSED WITH ISCHEMIC
HEART DISEASE.
(a) In General.--Beginning not later than one year after the date
of the enactment of this Act, the Secretary of Veterans Affairs shall
carry out a two-year pilot program (in this section referred to as the
``pilot program'') under which the Secretary shall furnish covered care
to covered veterans through means that include the use of community
care.
(b) Locations.--
(1) In general.--The Secretary shall select not more than four
States in which to carry out the pilot program.
(2) Selection criteria.--In selecting States under paragraph
(1), the Secretary shall prioritize States in which--
(A) the Department of Veterans Affairs serves a high
proportion, as determined by the Secretary, of veterans
residing in rural or highly rural areas (as determined through
the use of the Rural-Urban Commuting Areas coding system of the
Department of Agriculture);
(B) dental clinics operated by the Department of Veterans
Affairs currently utilize teledentistry;
(C) the Department of Veterans Affairs does not currently
operate a dental clinic; or
(D) the Secretary determines a large percentage of veterans
enrolled in the system of annual patient enrollment of the
Department of Veterans Affairs established and operated under
paragraphs (1) or (2) of section 1705(a) of title 38, United
States Code, visit emergency rooms for dental emergencies at
high rates.
(c) Participation Limitation.--Participation in a pilot program
established pursuant to this section shall be limited to a covered
veteran who receives health care in a facility of the Department
located in a State selected under subsection (b).
(d) Use of Certain Methods to Provide Care.--
(1) Mobile dental clinics.--In carrying out the pilot program,
the Secretary shall test the efficacy of mobile dental clinics to
service rural areas that do not have a population base to warrant a
full-time clinic but where there are covered veterans in need of
dental care.
(2) Home-based dental care.--In carrying out the pilot program,
the Secretary shall test the efficacy of portable dental care units
to service rural veterans in their homes, as the Secretary
considers medically appropriate.
(e) Administration.--
(1) Community care network review.--
(A) In general.--Before commencing the pilot program, the
Secretary shall work with third party administrators to conduct
a review of dental providers who are part of the community care
network of the Department in each State selected under
subsection (b)(1) to ensure--
(i) dental providers who are no longer accepting
patients from the Department--
(I) are not still listed as providers accepting
referrals from the Department; and
(II) are not sent referrals from the Department;
and
(ii) dental providers participating in each such
network are capable of receiving an influx of patients from
the Department under the pilot program.
(B) Expansion of network.--If, pursuant to a review under
subparagraph (A), the Secretary determines the community care
network in a State selected under subsection (b)(1) is not
capable of receiving an influx of patients under the pilot
program, the Secretary shall coordinate with the Third Party
Administrator for such State to ensure the dental provider
network of such community care network is sufficiently expanded
before the initiation of the pilot program.
(2) Notice to covered veterans.--In carrying out the pilot
program, the Secretary shall inform all covered veterans in States
selected under subsection (b)(1) of the covered care available
under the pilot program.
(3) Loss of eligibility.--Any veteran participating in the
pilot program who ceases to be a covered veteran shall be removed
from the pilot program on the date that is 90 days after the
Secretary determines the participant is no longer a covered
veteran.
(4) Continuity of care.--
(A) In general.--Upon the termination of the pilot program,
the Secretary shall provide to all veterans participating in
the pilot program at the time of such termination--
(i) information on how to enroll in the dental
insurance plan of the Department of Veterans Affairs under
section 1712C of title 38, United States Code;
(ii) if appropriate, information on the VETSmile
program of the Department of Veterans Affairs, or any
successor program; and
(iii) contact information for dental providers in the
surrounding community who provide low- or no-cost dental
care and whom the Secretary has confirmed are available to
take on new patients.
(B) Continuation of treatment plan.--Any veteran
participating in the pilot program may continue to receive
services under the pilot program after the termination of the
pilot program to complete a treatment plan commenced under the
pilot program, as determined necessary by the Secretary.
(f) Reports.--
(1) Annual report.--Not later than one year after the
commencement of the pilot program, and annually thereafter for the
duration of the pilot program, the Secretary of Veterans Affairs
shall submit to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a report on the pilot program that
includes--
(A) an identification of the States participating in the
pilot program;
(B) a description of the implementation and operation of
the pilot program;
(C) the number of participants in the pilot program,
disaggregated by--
(i) State; and
(ii) disability rating;
(D) an identification of any barriers or challenges to
implementing the pilot program;
(E) aggregated feedback from participants in the pilot
program, including from interviews and surveys;
(F) the average annual cost of providing covered care to a
participant in the pilot program, disaggregated by--
(i) State;
(ii) disability rating; and
(iii) whether the care was provided through the
community care network or through a provider of the
Department;
(G) an analysis of the communication and collaboration of
the Department with Third Party Administrators and community
care dental providers, disaggregated by State;
(H) an analysis of any cost savings by the Department with
respect to the treatment of ischemic heart disease;
(I) an assessment of the impact of the pilot program on
appointments for care, prescriptions, hospitalizations,
emergency room visits, wellness, employability, satisfaction,
and perceived quality of life of covered veterans related to
their diagnosis of ischemic heart disease;
(J) an analysis and assessment of the efficacy of mobile
clinics and portable dental care units, to the extent such
modalities are used, to service the needs of covered veterans
under the pilot program;
(K) an analysis and assessment of the usage of
teledentistry to service the needs of covered veterans under
the pilot program, to include a cost benefit analysis of such
services; and
(L) such other matters as the Secretary considers
appropriate.
(2) Final report.--Not later than 90 days before the completion
of the pilot program, the Secretary shall submit to the Committees
on Veterans' Affairs of the House of Representatives and the Senate
a report on the pilot program that--
(A) includes the matters required under paragraph (1);
(B) includes recommendations on whether the pilot program
should be continued, expanded, or adopted throughout the
Department; and
(C) indicates whether the Secretary requests action by
Congress to make the pilot program permanent.
(g) Impact on Community Care.--Participants in the pilot program
shall be able to access covered care in the community under section
1703 of title 38, United States Code.
(h) Definitions.--In this section:
(1) The term ``covered care'' means dental care that is
consistent with the dental services and treatment furnished by the
Secretary of Veterans Affairs to veterans pursuant to section
1712(a)(1)(G) of title 38, United States Code.
(2) The term ``covered veteran'' means a veteran who--
(A) is enrolled in the system of annual patient enrollment
of the Department established and operated under paragraphs (1)
or (2) of section 1705(a) of title 38, United States Code;
(B) is not eligible for dental services and treatment and
related dental appliances under the laws administered by the
Secretary as of the date of the enactment of this Act; and
(C) has a diagnosis of ischemic heart disease.
(3) The term ``Third Party Administrator'' has the meaning
given such term in section 1703F of such title.
SEC. 145. DOCUMENTATION OF PREFERENCES OF VETERANS FOR SCHEDULING
OF APPOINTMENTS FOR HEALTH CARE UNDER LAWS ADMINISTERED BY
SECRETARY OF VETERANS AFFAIRS.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall develop
a mechanism to solicit information regarding the preference of veterans
enrolled in the system of annual patient enrollment of the Department
of Veterans Affairs established and operated under section 1705(a) of
title 38, United States Code, for scheduling of appointments for health
care and related services under the laws administered by the Secretary,
including through non-Department providers.
(b) Documentation of Preference.--Preferences provided voluntarily
by a veteran pursuant to subsection (a) shall be documented on My
HealtheVet or another system designated by the Secretary that allows
the veteran to view and change such preferences at any time.
(c) Inclusion in Preference.--Preferences solicited under
subsection (a) shall include the following:
(1) How and when the veteran prefers to be contacted about an
appointment for health care.
(2) Whether the veteran prefers to schedule appointments
without the assistance of the Department, if able.
(3) Whether the veteran prefers to select a provider without
the assistance of the Department, if able.
(4) Whether the veteran prefers appointments to be scheduled
during certain days or times.
(d) Use of Preference.--The Secretary shall make the preferences
provided under subsection (a) easily accessible to medical support
assistants and other staff of the Department, or non-Department staff,
as the Secretary determines appropriate, who assist in the appointment
scheduling process.
(e) Deployment of Mechanism.--
(1) In general.--Beginning after the date on which the
Secretary develops the mechanism required under subsection (a), the
Secretary shall--
(A) test the mechanism in not fewer than three
geographically diverse Veterans Integrated Service Networks;
and
(B) gather feedback about the effectiveness of such
mechanism from veterans, medical support assistants, staff and
other stakeholders as the Secretary determines appropriate.
(2) Limitation.--The Secretary may not implement such mechanism
across the Veterans Health Administration of the Department before
the Secretary addresses the feedback described in paragraph (1)(B).
SEC. 146. STAFFING MODEL AND PERFORMANCE METRICS FOR CERTAIN
EMPLOYEES OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Staffing Model.--
(1) In general.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall--
(A) develop, validate, and implement a staffing model for
the Office of Integrated Veteran Care of the Department of
Veterans Affairs, or successor office, Veterans Integrated
Services Networks, and medical centers of the Department that
includes appropriate target staffing levels nationally,
regionally, and locally to ensure timely access to care and
effectively oversee the provision of care by the Department,
whether at a facility of the Department or through a non-
Department provider; and
(B) provide to Congress a briefing on such staffing model,
which shall include--
(i) the metrics and measures used by the Secretary in
developing such staffing model;
(ii) an analysis of how such staffing model compares to
the staffing models of other relevant Government-owned and
private sector health care systems; and
(iii) an estimate of the portion of the roles in such
staffing model that will be filled by contracted staff at
any given time.
(2) Report on implementation of staffing model.--Not later than
one year after the date on which the Secretary implements the
staffing model required under paragraph (1), the Secretary shall
submit to Congress and the Comptroller General of the United States
a report containing--
(A) an update on such implementation; and
(B) information on the outcomes yielded by such staffing
model in terms of improved access to care for veterans and
improved compliance with relevant laws, regulations, policy
directives, and guidance governing access to care.
(b) Performance Metrics.--
(1) In general.--Not later than one year after the date of the
enactment of this Act, the Secretary shall develop and implement a
plan, with an appropriate tracking system, to incorporate
appropriate standardized performance metrics and oversight measures
within the performance appraisal systems for employees of the
Department specified in paragraph (2).
(2) Employees of the department specified.--Employees of the
Department specified in this paragraph are employees who are
responsible for ensuring timely access to care from the Department,
compliance with relevant statutes and regulations relating to the
provision of care, including section 1703 of title 38, United
States Code, and overseeing the provision of care, whether at a
facility of the Department or through a non-Department provider,
including employees within the Office of Integrated Veteran Care of
the Department, or successor office, employees of a Veterans
Integrated Service Network, and employees of a medical center of
the Department.
(3) Report on implementation of performance metrics.--Not later
than one year after implementing the performance metrics required
under paragraph (1), the Secretary shall submit to Congress and the
Comptroller General of the United States a report containing--
(A) an update on such implementation; and
(B) information on the outcomes yielded by such performance
metrics in terms of improved access to care for veterans and
improved compliance with relevant laws, policy directives, and
guidance governing access to care.
(c) GAO Report.--Not later than two years after the later of the
date on which the Comptroller General receives the report under
subsection (a)(2) or the report under subsection (b)(3), the
Comptroller General shall submit to Congress a report that includes--
(1) an assessment of the performance of the Office of
Integrated Veteran Care of the Department, or successor office, in
improving access to care for veterans in facilities of the
Department and pursuant to section 1703 of title 38, United States
Code; and
(2) such recommendations as the Comptroller General considers
appropriate with respect to improving access to the care described
in paragraph (1) for veterans.
SEC. 147. ONLINE HEALTH EDUCATION PORTAL FOR VETERANS ENROLLED IN
PATIENT ENROLLMENT SYSTEM OF DEPARTMENT OF VETERANS AFFAIRS.
Not later than one year after the date of the enactment of this
Act, the Secretary of Veterans Affairs shall establish, on an Internet
website of the Department, a health education portal that includes
interactive educational modules to ensure veterans enrolled in the
patient enrollment system of the Department of Veterans Affairs
established and operated under section 1705(a) of title 38, United
States Code, understand the basic health care eligibilities and
entitlements of veterans under the laws administered by the Secretary,
including under the Veterans Community Care Program under section 1703
of such title.
SEC. 148. LIMITATION ON DETAIL OF DIRECTORS OF MEDICAL CENTERS OF
DEPARTMENT OF VETERANS AFFAIRS TO DIFFERENT POSITIONS.
(a) Notification.--
(1) In general.--Not later than 90 days after detailing a
director of a medical center of the Department of Veterans Affairs
to a different position within the Department, the Secretary of
Veterans Affairs shall notify the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the House of
Representatives of such detail.
(2) Matters to be included.--The notification required by
paragraph (1) shall include, with respect to a director of a
medical center who is detailed to a different position within the
Department, the following information:
(A) The location at which the director is detailed.
(B) The position title of the detail.
(C) The estimated time the director is expected to be
absent from their duties at the medical center.
(D) Such other information as the Secretary may determine
appropriate.
(b) Appointment of Acting Director.--Not later than 120 days after
detailing a director of a medical center of the Department to a
different position within the Department, the Secretary shall appoint
an individual as acting director of such medical center with all of the
authority and responsibilities of the detailed director.
(c) Update on Detail.--Not later than 120 days after detailing a
director of a medical center of the Department to a different position
within the Department, and not less frequently than every 30 days
thereafter while the detail is in effect or while the director position
at the medical center is vacant, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives an update regarding
the status of the detail.
(d) Return to Position or Reassignment.--
(1) In general.--Except as provided in paragraph (2), not later
than 180 days after detailing a director of a medical center of the
Department to a different position within the Department, for a
reason other than an ongoing investigation or administrative action
with respect to the director, the Secretary shall--
(A) return the individual to the position as director of
the medical center; or
(B) reassign the individual from the position as director
of the medical center and begin the process of hiring a new
director for such position.
(2) Waiver.--
(A) In general.--The Secretary may waive the requirement
under paragraph (1) with respect to an individual for
successive 90-day increments for a total period of not more
than 540 days from the original date the individual was
detailed away from their position as director of a medical
center.
(B) Notification.--Not later than 30 days after exercising
a waiver under subparagraph (A), the Secretary shall notify
Congress of the waiver and provide to Congress information as
to why the waiver is necessary.
SEC. 149. NATIONAL VETERAN SUICIDE PREVENTION ANNUAL REPORT.
(a) National Veteran Suicide Prevention Annual Report.--
(1) In general.--Not later than 18 months after the date of the
enactment of this Act, and not later than September 30 of each year
thereafter, the Secretary of Veterans Affairs shall submit to the
appropriate congressional committees and publish on a publicly
available website of the Department of Veterans Affairs a report to
be known as the ``National Veteran Suicide Prevention Annual
Report''.
(2) Extension.--
(A) In general.--If the Secretary requires an extension of
the deadline for a report under subsection (a), the Secretary
shall submit to the appropriate congressional committees a
written request for such an extension.
(B) Elements.--Each written request under paragraph (1) for
an extension for a report shall include the following:
(i) The rationale for the delay in the submission of
the report.
(ii) An explanation of the need for an extension.
(iii) A proposed amended date for the submission and
publication of the report.
(3) Briefing.--With respect to each report required under
paragraph (1), the Secretary shall, before the date on which the
Secretary submits such report, provide to the appropriate
congressional committees a briefing on such report.
(4) Elements.--
(A) In general.--Each report required under paragraph (1)
shall include--
(i) the findings of the national analysis of veteran
suicide rates for the latest year for which data is
available;
(ii) an identification of trends, if any, demonstrated
by such data; and
(iii) a comparison of such data to data on veteran
suicide rates during preceding years.
(B) Additional elements.--Each report under paragraph (1)
shall include, for the year covered by the report, the
following:
(i) Suicide rates of veterans disaggregated by age,
gender, and race or ethnicity.
(ii) Trends in suicide rates of veterans compared to
engagement of those veterans with health care from the
Veterans Health Administration, including an examination of
trends in suicide rates or deaths among--
(I) veterans who have recently received health care
from the Veterans Health Administration as compared to
veterans who have never received health care from the
Veterans Health Administration;
(II) veterans who are enrolled in the patient
enrollment system of the Department of Veterans Affairs
under section 1705(a) of title 38, United States Code,
as compared to veterans who have never enrolled in such
system;
(III) veterans who have recently used services from
a Vet Center as compared to veterans who have never
used such services;
(IV) to the extent practicable, veterans who have a
diagnosis of substance use disorder; and
(V) other groups of veterans relating to engagement
with health care from the Veterans Health
Administration, as the Secretary considers practicable.
(iii) To the extent practicable, trends in suicide
rates of veterans compared to engagement of those veterans
with benefits from the Veterans Benefits Administration,
including an examination of trends in suicide rates or
deaths among--
(I) veterans who are currently using, have
previously used, or have never used educational
assistance under the laws administered by the
Secretary;
(II) veterans who are currently receiving, have
previously received, or have never received services or
assistance under chapter 31 of title 38, United States
Code;
(III) with respect to compensation under chapter 11
of such title--
(aa) veterans who were recipients of such
compensation as compared to veterans who never
applied for such compensation prior to death;
(bb) veterans who had a claim denied for such
compensation prior to death;
(cc) veterans who had a pending claim for such
compensation at time of death; and
(dd) veterans who had an entitlement for such
compensation reduced prior to death;
(IV) veterans who are currently receiving or have
never received pension under chapter 15 of title 38,
United States Code;
(V) veterans who are currently using, have recently
used, or have never used programs or services provided
by the Homeless Programs Office of the Department,
including an examination of trends in suicide rates or
deaths among veterans who made contact with such office
but were denied or deemed ineligible for any such
program or service;
(VI) with respect to housing loans guaranteed by
the Secretary under chapter 37 of title 38, United
States Code, veterans who are current recipients of,
were recent recipients of, or have never received such
a loan;
(VII) veterans owing debts to the Department;
(VIII) veterans who were involved in a veterans
treatment court program, whether they graduated
successfully or not; and
(IX) veterans who were successfully contacted,
unsuccessfully contacted, or never contacted by the
Department through the Solid Start program under
section 6320 of title 38, United States Code.
(C) Strategy and recommendations.--
(i) Initial report.--The initial report under paragraph
(1) shall include a strategy and recommendations developed
by the Secretary of Veterans Affairs, in collaboration with
the Director of the Centers for Disease Control and
Prevention, for--
(I) improving data collection at the State and
local levels to accurately capture suicide deaths of
veterans;
(II) improving the timeliness, efficacy, and
standardization of data reporting on suicide deaths of
veterans at the Federal level, including by the Centers
for Disease Control and Prevention and the Department
of Veterans Affairs;
(III) improving the timeliness of identification
and analysis of suicide deaths of veterans by Federal
agencies, including the Centers for Disease Control and
Prevention, and the Department of Veterans Affairs; and
(IV) any other necessary process improvements for
improving the timeliness, efficacy, and standardization
of reporting of data relating to suicide deaths of
veterans, particularly with respect to the annual
report under this section.
(ii) Subsequent reports.--Each report after the initial
report under paragraph (1) shall include updates on actions
taken to meet the strategy and recommendations developed
under subparagraph (A).
(5) Definitions.--In this subsection:
(A) The term ``appropriate congressional committees'' means
the Committees on Veterans' Affairs of the Senate and the House
of Representatives.
(B) The term ``Vet Center'' means a center for readjustment
counseling and related mental health services for veterans
under section 1712A of title 38, United States Code.
(b) Independent Assessment of National Veteran Suicide Prevention
Annual Report.--
(1) In general.--Not later than 90 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
enter into one or more contracts with a private sector entity
described in paragraph (5) to conduct an independent assessment of
the National Veteran Suicide Prevention Annual Report required
under subsection (a).
(2) Frequency.--The private sector entity or entities carrying
out the assessment required under paragraph (1) shall complete such
assessment not later than 240 days after entering into the contract
described in such subsection and not less frequently than every
five years thereafter.
(3) Elements.--Each assessment required under paragraph (1)
shall analyze the following:
(A) The methodology used by the Department to track,
analyze, categorize, and report suicide deaths and suicide
rates among veterans.
(B) Whether data sources used by the Department to compile
data on suicide deaths and suicide rates among veterans are
accurately reflecting such data.
(C) Vulnerabilities in the methodology used by the
Department that could lead to inaccurate counting of suicide
deaths and suicide rates among veterans.
(D) The ability of the Department to cross reference
suicide deaths and suicide rates among veterans with trends in
usage of programs of the Veterans Health Administration or the
Veterans Benefits Administration or other programs that could
serve as widespread protective factors against suicide.
(E) Improvements that could be made to ensure the National
Veteran Suicide Prevention Annual Report required under
subsection (a) is accurate and comprehensive and provides
insights for making improvements to the suicide prevention
efforts of the Department.
(4) Report on assessment.--
(A) Report on findings and recommendations.--Not later than
60 days after completing an assessment required by paragraph
(1), the private sector entity or entities carrying out the
assessment shall submit to the Secretary of Veterans Affairs
and the Committees on Veterans' Affairs of the Senate and the
House of Representatives a report on the findings and
recommendations of the private sector entity or entities with
respect to such assessment.
(B) Report on planned improvements.--Not later than 60 days
after receiving a report under paragraph (1) with respect to an
assessment required by paragraph (1), the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate and
the House of Representatives a report on how the Department
plans to improve the National Veteran Suicide Prevention Annual
Report required under subsection (a) based on such assessment.
(5) Private sector entity described.--A private sector entity
described in this paragraph is a private entity that--
(A) specializes in analyzing large-scale organizational
data collection and analysis efforts, especially with respect
to the health care sector; and
(B) has experience and proven outcomes in optimizing the
accuracy and comprehensiveness of data collection and analysis
related to suicide.
(c) Report on Additional Benefits and Services From Department of
Veterans Affairs to Prevent Veteran Suicide.--
(1) In general.--Not later than three years after the date of
the enactment of this Act, the Secretary of Veterans Affairs shall
submit to the Committees on Veterans' Affairs of the Senate and the
House of Representatives and publish on a publicly available
website of the Department of Veterans Affairs a report that
analyzes which benefits and services under the laws administered by
such Secretary, including such benefits and services furnished by
the Veterans Benefits Administration, have the greatest impact on
the prevention of suicide among veterans, including recommendations
for potential expansion of services and benefits to reduce the
number of veteran suicides.
(2) Assessment of solid start program.--The report required by
paragraph (1) shall include an analysis of the effectiveness of the
Solid Start program under section 6320 of title 38, United States
Code, on prevention of suicide among veterans.
(d) Toolkit for State and Local Coroners and Medical Examiners on
Best Practices for Identifying and Reporting on Suicide Deaths of
Veterans.--
(1) In general.--The Secretary of Veterans Affairs, in
collaboration with the Director of the Centers for Disease Control
and Prevention, shall develop a toolkit for State and local
coroners and medical examiners that contains best practices for--
(A) accurately identifying and reporting suicide deaths of
veterans, including how to identify veteran status; and
(B) reporting such deaths to the Centers for Disease
Control and Prevention and other applicable entities.
(2) Availability.--Not later than two years after the date of
the enactment of this Act, the Secretary shall make the toolkit
developed under paragraph (1) available on a publicly available
website of the Department of Veterans Affairs.
(3) Outreach.--The Secretary, in collaboration with the
Director of the Centers for Disease Control and Prevention, shall
conduct outreach to appropriate State and local agencies to promote
the availability and use of the toolkit developed under paragraph
(1).
SEC. 150. REPORT ON PHYSICAL INFRASTRUCTURE REQUIRED BY MEDICAL
FACILITIES OF DEPARTMENT OF VETERANS AFFAIRS TO PROVIDE DENTAL
CARE SERVICES.
Not later than one year after the date of the enactment of this
Act, the Secretary of Veterans Affairs shall submit to the Committees
on Veterans' Affairs of the Senate and the House of Representatives a
report, for each medical center or other relevant health care facility
of the Department of Veterans Affairs, that includes--
(1) an identification of the physical infrastructure, including
new facilities, renovations, remodels, leases, or other
infrastructure, such medical center or health care facility
requires to provide dental care services to veterans eligible for
such services under the laws administered by the Secretary; and
(2) an analysis of the physical infrastructure such medical
center or health care facility would require if a greater number of
veterans became eligible for such dental care services pursuant to
a modification of the laws administered by the Secretary.
SEC. 151. COMPTROLLER GENERAL REPORT ON CERTAIN ORAL HEALTH CARE
PROGRAMS UNDER LAWS ADMINISTERED BY SECRETARY OF VETERANS
AFFAIRS.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to the Committees on Veterans' Affairs of the Senate and
the House of Representatives a report on the status of the oral health
care programs of the Department of Veterans Affairs, that includes an
assessment of--
(1) any issues with information technology programs, including
Dental Record Manager Plus, that affect dental care staff of the
Department;
(2) the implementation of the dental insurance plan of the
Department under section 1712C of title 38, United States Code;
(3) the implementation and expansion of the VETSmile program of
the Department;
(4) barriers preventing the Department from expanding dental
care eligibility to all veterans with ischemic heart disease,
including such barriers relating to physical infrastructure,
workforce, and cost of such dental care;
(5) barriers preventing dental clinics of the Department, if
any, from adopting teledentistry;
(6) the demographic makeup of veterans eligible for dental care
paid for by the Department as of the commencement of the pilot
program under section 144 of this Act, including information on--
(A) age;
(B) gender;
(C) race or ethnicity, disaggregated by--
(i) membership in an Indian Tribe; and
(ii) the major race groups used in the decennial
census;
(D) employment status; and
(E) location of residence, disaggregated by rural, highly
rural, and urban locations; and
(7) changes to such demographic makeup if any, that would
result from an expansion of eligibility for dental care under the
laws administered by the Secretary to all veterans with ischemic
heart disease including changes to demographics specified in
paragraph (6).
(b) Third Party Administrator Defined.--In this section, the term
``Third Party Administrator'' means an entity that manages a provider
network and performs administrative services related to such network
under section 1703 of title 38, United States Code.
SEC. 152. REVIEW OF WORKFLOWS ASSOCIATED WITH PROCESSING REFERRALS
BETWEEN FACILITIES OF THE VETERANS HEALTH ADMINISTRATION.
(a) In General.--The Secretary of Veterans Affairs shall conduct a
review of the workflows directly associated with processing referrals
of patients between facilities of the Veterans Health Administration of
the Department of Veterans Affairs to identify specific delays or
bottlenecks in such referrals.
(b) Elements of Review.--The review required under subsection (a)
shall include a review of--
(1) the interfacility consult management guidance of the
Veterans Health Administration that assists facilities described in
subsection (a) in constructing a workflow for consults between such
facilities; and
(2) the roles and responsibilities of the individuals involved
in the consult management process in managing such consults,
including the role of the referral coordination team.
(c) Report.--Not later than 180 days after the date of the
enactment of this Act, the Secretary shall submit to Congress a report
on the results of the review required under subsection (a).
SEC. 153. PLAN FOR TIMELY SCHEDULING OF APPOINTMENTS AT MEDICAL
FACILITIES OF DEPARTMENT OF VETERANS AFFAIRS.
(a) Plan Required.--To improve responsiveness in the provision of
hospital care and medical services at medical facilities of the
Department of Veterans Affairs, the Secretary of Veterans Affairs shall
develop a plan to--
(1) ensure that whenever a covered veteran contacts the
Department by telephone to request the scheduling of an appointment
for care or services for the covered veteran at such a facility,
the scheduling for the appointment occurs during that telephone
call (regardless of the prospective date of the appointment being
scheduled); and
(2) provide timely and, where applicable, same-day scheduling
for an appointment described in paragraph (1).
(b) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary shall submit to the Committees on
Veterans' Affairs of the House of Representatives and the Senate a
report on the plan under subsection (a).
(c) Covered Veteran Defined.--In this section, the term ``covered
veteran'' means a veteran who is enrolled in the system of patient
enrollment of the Department under section 1705(a) of title 38, United
States Code.
SEC. 154. AUTHORIZATION OF APPROPRIATIONS TO SUPPORT INITIATIVES
FOR MOBILE MAMMOGRAPHY SERVICES FOR VETERANS.
There is authorized to be appropriated to the Secretary of Veterans
Affairs $5,000,000 for fiscal year 2025 for the Office of Women's
Health of the Department of Veterans Affairs under section 7310 of
title 38, United States Code, to be used by the Secretary to expand
access of women veterans to--
(1) mobile mammography initiatives;
(2) advanced mammography equipment; and
(3) outreach activities to publicize those initiatives and
equipment.
TITLE II--ECONOMIC OPPORTUNITY MATTERS
Subtitle A--Educational Assistance
SEC. 201. TEMPORARY EXPANSION OF ELIGIBILITY FOR MARINE GUNNERY
SERGEANT JOHN DAVID FRY SCHOLARSHIP.
(a) In General.--The Secretary of Veterans Affairs shall treat an
individual described in subsection (b) as a covered individual
described in section 3311(b) of title 38, United States Code.
(b) Covered Individual Described.--An individual described in this
subsection is an individual who is the child or spouse of a person--
(1) who dies from a service-connected disability during the
120-day period immediately following the day on which the person
was discharged or released from duty as a member of the Armed
Forces (without regard to whether such duty was active duty); and
(2)(A) who received an honorable discharge; or
(B) whose service in the Armed Forces is characterized by the
Secretary concerned as honorable service.
(c) Applicability.--This section shall apply with respect to--
(1) deaths that occur before, on, or after the date of the
enactment of this Act; and
(2) a quarter, semester, or term, as applicable, commencing--
(A) on or after August 1, 2025; and
(B) before October 1, 2027.
SEC. 202. REMOVAL OF EXPIRATION ON ENTITLEMENT TO MARINE GUNNERY
SERGEANT JOHN DAVID FRY SCHOLARSHIP FOR SURVIVING SPOUSES.
Section 3311(f) of title 38, United States Code, is amended--
(1) by striking paragraph (2);
(2) by redesignating paragraphs (3) through (5) as paragraphs
(2) through (4), respectively;
(3) in paragraph (2), as redesignated by paragraph (2) of this
section, by striking ``in paragraph (4)'' and inserting ``in
paragraph (3)''; and
(4) in paragraph (3)(A), as redesignated by paragraph (2) of
this section, by striking ``under paragraph (3)'' and inserting
``under paragraph (2)''.
SEC. 203. SOLE LIABILITY FOR TRANSFERRED EDUCATIONAL ASSISTANCE BY
AN INDIVIDUAL WHO FAILS TO COMPLETE A SERVICE AGREEMENT.
Subsection (i) of section 3319 of title 38, United States Code, is
amended--
(1) in paragraph (1)--
(A) by striking ``In the event'' and inserting ``Subject to
paragraph (2), in the event''; and
(B) by inserting ``of this title'' after ``section 3685'';
(2) in subparagraph (A) of paragraph (2)--
(A) in the heading, by striking ``In general'' and
inserting ``Sole liability''; and
(B) by striking ``under paragraph (1)'' and inserting ``for
which the individual shall be solely liable to the United
States for the amount of the overpayment for purposes of
section 3685 of this title''; and
(3) in subparagraph (B) of paragraph (2)--
(A) in the matter preceding clause (i), by striking
``Subparagraph (A) shall not apply'' and inserting ``Neither
the individual nor the dependent shall be liable to the United
States for the amount of the overpayment for purposes of
section 3685 of this title''; and
(B) in clause (ii), by inserting ``of this title'' after
``section 3311(c)(4)''.
SEC. 204. NOTICE TO EDUCATIONAL INSTITUTIONS OF RISK-BASED SURVEYS.
Section 3673A(d) of title 38, United States Code, is amended by
striking ``one business day'' and inserting ``two business days''.
SEC. 205. RELATIONSHIP OF PARTICIPATION BY AN EDUCATIONAL
INSTITUTION IN CERTAIN FEDERAL STUDENT FINANCIAL AID PROGRAMS TO
APPROVAL OF SUCH INSTITUTION FOR PURPOSES OF DEPARTMENT OF
VETERANS AFFAIRS EDUCATIONAL ASSISTANCE PROGRAMS.
Paragraph (4) of section 3675(b) of title 38, United States Code,
is amended to read as follows:
``(4) The educational institution--
``(A) is approved and participates in a program under title
IV of the Higher Education Act of 1965 (20 U.S.C. 1070 et
seq.); or
``(B) does not participate in such a program and the
Secretary has waived the requirement under this paragraph with
respect to the educational institution, and submits to the
Committee on Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives notice of
such waiver, because the Secretary determines that the
educational institution--
``(i) elects not to participate in such a program;
``(ii) cannot participate in such a program; or
``(iii) is in the process of making a good-faith effort
to submit an initial application for approval to
participate in such a program, except that a waiver under
this clause may not be provided for a period of longer than
36 months.''.
SEC. 206. EXPANSION OF DEPARTMENT OF VETERANS AFFAIRS OVERSIGHT OF
CERTAIN EDUCATIONAL INSTITUTIONS.
(a) Additional Requirement for Approval.--Section 3675(b) of title
38, United States Code, as amended by section 205, is further amended
by adding at the end the following new paragraph:
``(5) The educational institution agrees to, not later than 30
days after any date on which such educational institution becomes
subject to an action or event described in section 3673(e)(3) of
this title, submit to the State approving agency, or the Secretary
when acting in the role of a State approving agency, a notification
of such action or event in such form and containing such
information as the Secretary determines appropriate.''.
(b) Additional Requirement for Approval of Nonaccredited Courses.--
(1) In general.--Section 3676(c) of such title is amended--
(A) by redesignating paragraphs (14) through (16) as
paragraphs (15) through (17), respectively; and
(B) by inserting after paragraph (13) the following new
paragraph:
``(14) The institution agrees to, not later than 30 days after
any date on which such institution becomes subject to an action or
event described in section 3673(e)(3) of this title, submit to the
State approving agency, or the Secretary when acting in the role of
a State approving agency, a notification of such action or event in
such form and containing such information as the Secretary
determines appropriate.''.
(2) Conforming amendments.--Such title is further amended--
(A) in section 3672(b)(2)(C), by striking ``paragraph (14)
or (15)'' and inserting ``paragraph (15) or (16)'';
(B) in section 3675(b)(3), by striking ``(14), (15), and
(16)'' and inserting ``(15), (16), and (17)'';
(C) in section 3679(d), by striking ``described in
paragraph (14) or (15)'' and inserting ``described in paragraph
(15) or (16)''; and
(D) in section 3680A(a)(4)(C)(iii), by striking ``section
3676(c)(14) and (15)'' and inserting ``section 3676(c)(15) and
(16)''.
(c) Additional Grounds for Suspension of Approval.--Section
3679(f)(1) of such title is amended by adding at the end the following
new subparagraph:
``(I) Comply with the notification requirements under sections
3675(b)(5) and 3676(c)(14) of this title, when applicable.''.
(d) Deadline for Risk-based Surveys Database.--The Secretary of
Veterans Affairs shall establish the database required under section
3673A(c) of title 38, United States Code, by not later than 180 days
after the date of the enactment of this Act.
SEC. 207. REQUIREMENT THAT EDUCATIONAL INSTITUTIONS APPROVED FOR
PURPOSES OF DEPARTMENT OF VETERANS AFFAIRS EDUCATIONAL ASSISTANCE
PROGRAMS PROVIDE DIGITAL OFFICIAL TRANSCRIPTS.
(a) Requirement.--Section 3675(b) of title 38, United States Code,
as amended by sections 205 and 206, is further amended by adding at the
end the following new paragraph:
``(6) The educational institution makes available to each
eligible person or veteran a copy of the person or veteran's
official transcript in a digital format.''.
(b) Conforming Amendments.--
(1) Approval of courses.--Section 3672(b)(2)(A) of such title
is amended by striking ``(b)(1) and (b)(2)'' and inserting
``paragraphs (1), (2), and (6) of section 3675(b)''.
(2) Approval of nonaccredited courses.--Section 3676(c) of such
title is amended--
(A) by redesignating paragraph (17) as paragraph (18); and
(B) by inserting after paragraph (16) the following new
paragraph (17):
``(17) In the case of a course that leads to a standard college
degree, the educational institution satisfies the requirements of
section 3675(b)(6) of this title.''.
(3) Conforming amendments.--Section 3675(b)(3) of such title is
amended by striking ``(15), (16), and (17)'' and inserting ``(15),
(16), and (18)''.
(c) Effective Date.--The amendments made by this section shall take
effect on August 1, 2025, and apply with respect to a quarter,
semester, or term, as applicable, commencing on or after such date.
SEC. 208. PAYMENT OF FULL MONTHLY HOUSING STIPEND FOR VETERANS
ENROLLED IN FINAL SEMESTER USING EDUCATIONAL ASSISTANCE UNDER
POST-9/11 EDUCATIONAL ASSISTANCE PROGRAM.
(a) Housing Allowance.--Section 3680(a)(3) of title 38, United
States Code, is amended--
(1) by redesignating subparagraphs (A) and (B) as clauses (i)
and (ii), respectively (and by redesignating each subordinate
provision and the margins thereof accordingly);
(2) by striking ``Notwithstanding paragraph (1)'' and inserting
``(A) Notwithstanding paragraph (1)'';
(3) by striking ``, including a monthly housing stipend
described in section 3313(c) of this title,''; and
(4) by adding at the end the following new subparagraph (B):
``(B) For purposes of providing a monthly housing stipend described
in section 3313(c) to an eligible veteran or eligible person for whom
the Secretary is providing educational assistance under chapter 33 of
this title during a period that is the last semester, term, or academic
period pursuant to subparagraph (A), the Secretary shall treat the
veteran or person as pursuing a program of education on a full-time
basis.''.
(b) Application.--The amendments made by subsection (a) shall take
effect on the date of the enactment of this Act and apply with respect
to a quarter, semester, or term, as applicable, commencing on or after
January 1, 2025.
SEC. 209. MODIFICATION OF RULES FOR APPROVAL OF COMMERCIAL DRIVER
EDUCATION PROGRAMS FOR PURPOSES OF EDUCATIONAL ASSISTANCE
PROGRAMS OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Subsection (a)(4) of section 2 of the Veteran
Improvement Commercial Driver License Act of 2023 (Public Law 118-95)
is amended, in the matter to be inserted as the new paragraph (2) of
section 3680A(e) of title 38, United States Code--
(1) in subparagraph (A)--
(A) in the matter preceding clause (i), by striking ``the
commercial driver education program offered at the branch by
the educational institution--'' and inserting and em dash; and
(B) by striking clauses (i) and (ii) and inserting the
following:
``(i) the commercial driver education program offered at the
branch by the educational institution is approved for purposes of
this chapter by a State approving agency (or the Secretary when
acting in the role of a State approving agency); and
``(ii)(I) such branch is located in a State in which such
educational institution offers such commercial driver education
program at another branch of such educational institution; or
``(II) such branch--
``(aa) has been operating for at least one year; and
``(bb) offers such commercial driver education program,
using the same curriculum as another branch of such
educational institution.''; and
(2) by adding at the end the following new subparagraph:
``(D) The Secretary shall submit to the Committees on Veterans'
Affairs of the Senate and House of Representatives a notification not
later than 30 days after the Secretary grants an exemption under
subparagraph (A). Such notification shall identify the educational
institution, and the branch thereof, granted such exemption.''.
(b) Implementation.--Section 2(b) of such Act is amended--
(1) in paragraph (2), by striking ``180 days'' and inserting
``365 days''; and
(2) by adding at the end the following new paragraphs:
``(3) Regulations.--In prescribing any regulation to carry out
the amendments made by subsection (a), the Secretary of Veterans
Affairs shall consult with State approving agencies designated
under section 3671 of such title.
``(4) GAO study.--Not later than 365 days after the
applicability date under paragraph (2), the Comptroller General of
the United States shall--
``(A) conduct a study to--
``(i) determine the effects of the amendments made by
subsection (a); and
``(ii) the feasibility and advisability of similarly
amending the rules for approval of programs of education
for other vocational programs of education; and
``(B) submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a report on the findings of
the Comptroller General with respect to such study.''.
(c) Effective Date.--The amendments made by this section shall take
effect as if included in such Act on the date of the enactment of such
Act.
SEC. 210. PROVISION OF CERTIFICATES OF ELIGIBILITY AND AWARD
LETTERS USING ELECTRONIC MEANS.
(a) In General.--Chapter 36 of title 38, United States Code, is
amended by inserting after section 3698 the following new section (and
conforming the table of sections at the beginning of such chapter
accordingly):
``Sec. 3698A. Provision of certificates of eligibility and award
letters using electronic means
``(a) Requirement.--Except as provided by subsection (b), the
Secretary shall provide to an individual the following documents using
electronic means:
``(1) A certificate of eligibility for the entitlement of the
individual to covered educational assistance.
``(2) An award letter regarding the authorization of the
individual to receive covered educational assistance.
``(b) Election to Opt Out.--An individual may elect to receive the
documents specified in subsection (a) by mail rather than through
electronic means under subsection (a). An individual may revoke such an
election at any time, by means prescribed by the Secretary.
``(c) Covered Educational Assistance.--In this section, the term
`covered educational assistance' means educational assistance under
chapter 30, 33, or 35 of this title, or section 3699C of this title.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
3698 the following new item:
``3698A. Provision of certificates of eligibility and award letters
using electronic means.''.
SEC. 211. RETROACTIVE EFFECTIVE DATE OF LAW REGARDING CHARGE TO
ENTITLEMENT TO EDUCATIONAL ASSISTANCE FOR INDIVIDUALS WHO DO NOT
TRANSFER CREDITS FROM CERTAIN CLOSED OR DISAPPROVED PROGRAMS OF
EDUCATION.
Section 3699(c)(2) of title 38, United States Code, is amended by
striking subparagraph (C) and inserting the following new subparagraph
(C):
``(C) This paragraph, including clauses (ii) and (iii) of
subparagraph (A), shall apply with respect to the closure or
discontinuation of a course or program of education, as described in
subsection (b)(1), that occurs during the period beginning on August 1,
2021, and ending on September 30, 2025.''.
SEC. 212. DEPARTMENT OF VETERANS AFFAIRS HIGH TECHNOLOGY PROGRAM.
(a) High Technology Program.--
(1) In general.--Chapter 36 of title 38, United States Code, as
amended by section 210, is amended by adding at the end the
following new section:
``Sec. 3699C. High technology program
``(a) Establishment.--(1) The Secretary shall carry out a program
under which the Secretary provides covered individuals with the
opportunity to enroll in high technology programs of education that the
Secretary determines provide training or skills sought by employers in
a relevant field or industry.
``(2) Not more than 4,000 covered individuals may participate in
the program under this section in any fiscal year.
``(b) Amount of Assistance.--(1) The Secretary shall provide, to
each covered individual who pursues a high technology program of
education under this section, educational assistance in amounts equal
to the amounts provided under section 3313(c)(1) of this title,
including, except as provided in paragraph (3), with respect to the
housing stipend described in that section and in accordance with the
treatment of programs that are distance learning and programs that are
less than half-time.
``(2) Under paragraph (1), the Secretary shall provide such amounts
of educational assistance to a covered individual for each of the
following:
``(A) A high technology program of education.
``(B) A second such program if--
``(i) the second such program begins at least 18 months
after the covered individual graduates from the first such
program; and
``(ii) the covered individual uses educational assistance
under chapter 33 of this title to pursue the second such
program.
``(3) No covered individual may receive a housing stipend under
this subsection for any month if such individual is in receipt of a
housing stipend under chapter 33 of this title for that month.
``(c) Contracts.--(1) For purposes of carrying out subsection (a),
the Secretary shall seek to enter into contracts with any number of
qualified providers of high technology programs of education for the
provision of such programs to covered individuals. Each such contract
shall provide for the conditions under which the Secretary may
terminate the contract with the provider and the procedures for
providing for the graduation of students who were enrolled in a program
provided by such provider in the case of such a termination.
``(2) A contract under this subsection shall provide that the
Secretary shall pay to a provider--
``(A) upon the enrollment of a covered individual in the
program, 25 percent of the cost of the tuition and other fees for
the program of education for the individual;
``(B) upon graduation of the individual from the program, 25
percent of such cost; and
``(C) 50 percent of such cost upon--
``(i) the successful employment of the covered individual
for a period--
``(I) of 180 days in the field of study of the program;
and
``(II) that begins not later than 180 days following
graduation of the covered individual from the program;
``(ii) the employment of the individual by the provider for
a period of one year; or
``(iii) the enrollment of the individual in a program of
education to continue education in such field of study.
``(3) For purposes of this section, a provider of a high technology
program of education is qualified if--
``(A) the provider employs instructors whom the Secretary
determines are experts in their respective fields in accordance
with paragraph (5);
``(B) the provider has successfully provided the high
technology program for at least one year;
``(C) the provider does not charge tuition and fees to a
covered individual who receives assistance under this section to
pursue such program that are higher than the tuition and fees
charged by such provider to another individual; and
``(D) the provider meets the approval criteria developed by the
Secretary under paragraph (4).
``(4)(A) The Secretary shall prescribe criteria for approving
providers of a high technology program of education under this section.
``(B) In developing such criteria, the Secretary may consult with
State approving agencies.
``(C) Such criteria are not required to meet the requirements of
section 3672 of this title.
``(D) Such criteria shall include the job placement rate, in the
field of study of a program of education, of covered individuals who
complete such program of education.
``(5) The Secretary shall determine whether instructors are experts
under paragraph (3)(A) based on evidence furnished to the Secretary by
the provider regarding the ability of the instructors to--
``(A) identify professions in need of new employees to hire,
tailor the programs to meet market needs, and identify the
employers likely to hire graduates;
``(B) effectively teach the skills offered to covered
individuals;
``(C) provide relevant industry experience in the fields of
programs offered to incoming covered individuals; and
``(D) demonstrate relevant industry experience in such fields
of programs.
``(6) In entering into contracts under this subsection, the
Secretary shall give preference to a provider of a high technology
program of education--
``(A) from which at least 70 percent of graduates find full-
time employment in the field of study of the program during the
180-day period beginning on the date the student graduates from the
program; or
``(B) that offers tuition reimbursement for any student who
graduates from such a program and does not find employment
described in subparagraph (A).
``(d) Effect on Other Entitlement.--(1) If a covered individual
enrolled in a high technology program of education under this section
has remaining entitlement to educational assistance under chapter 30,
32, 33, 34, or 35 of this title, such entitlement shall be charged at
the rate of one month of such entitlement for each month of educational
assistance provided under this section.
``(2) If a covered individual enrolled in a high technology program
of education under this section does not have remaining entitlement to
educational assistance under chapter 30, 32, 33, 34, or 35 of this
title, any educational assistance provided to such individual under
this section shall be provided in addition to the entitlement that the
individual has used.
``(3) The Secretary may not consider enrollment in a high
technology program of education under this section to be assistance
under a provision of law referred to in section 3695 of this title.
``(4)(A) An application for enrollment in a high technology program
of education under this section shall include notice of the
requirements relating to use of entitlement under paragraphs (1) and
(2), including--
``(i) in the case of the enrollment of an individual referred
to under paragraph (1), the amount of entitlement that is typically
charged for such enrollment;
``(ii) an identification of any methods that may be available
for minimizing the amount of entitlement required for such
enrollment; and
``(iii) an element requiring applicants to acknowledge receipt
of the notice under this subparagraph.
``(B) If the Secretary approves the enrollment of a covered
individual in a high technology program of education under this
section, the Secretary shall deliver electronically to the individual
an award letter that provides notice of such approval and includes
specific information describing how paragraphs (1) and (2) will be
applied to the individual if the individual chooses to enroll in the
program.
``(e) Requirements for Educational Institutions.--(1) The Secretary
shall not approve the enrollment of any covered individual, not already
enrolled, in any high technology programs of education under this
section for any period during which the Secretary finds that more than
85 percent of the students enrolled in the program are having all or
part of their tuition, fees, or other charges paid to or for them by
the educational institution or by the Department of Veterans Affairs
under this title or under chapter 1606 or 1607 of title 10, except with
respect to tuition, fees, or other charges that are paid under a
payment plan at an educational institution that the Secretary
determines has a history of offering payment plans that are completed
not later than 180 days after the end of the applicable term, quarter,
or semester.
``(2) The Secretary may waive a requirement of paragraph (1) if the
Secretary determines, pursuant to regulations which the Secretary shall
prescribe, such waiver to be in the interest of the covered individual
and the Federal Government. Not later than 30 days after the Secretary
waives such a requirement, the Secretary shall submit to the Committees
on Veterans' Affairs of the Senate and House of Representatives a
report regarding such waiver.
``(3)(A)(i) The Secretary shall establish and maintain a process by
which an educational institution may request a review of a
determination that the educational institution does not meet the
requirements of paragraph (1).
``(ii) The Secretary may consult with a State approving agency
regarding such process or such a review.
``(iii) Not later than 180 days after the Secretary establishes or
revises a process under this subparagraph, the Secretary shall submit
to the Committees on Veterans' Affairs of the Senate and House of
Representatives a report regarding such process.
``(B) An educational institution that requests a review under
subparagraph (A)--
``(i) shall request the review not later than 30 days after the
start of the term, quarter, or semester for which the determination
described in subparagraph (A) applies; and
``(ii) may include any information that the educational
institution believes the Department should have taken into account
when making the determination, including with respect to any
mitigating circumstances.
``(f) Annual Reports.--Not later than one year after the date of
the enactment of this section, and annually thereafter until the
termination date specified in subsection (i), the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate and House
of Representatives a report on the operation of program under this
section during the year covered by the report. Each such report shall
include each of the following:
``(1) The number of covered individuals enrolled in the
program, disaggregated by type of educational institution, during
the year covered by the report.
``(2) The number of covered individuals who completed a high
technology program of education under the program during the year
covered by the report.
``(3) The average employment rate of covered individuals who
completed such a program of education during such year, as of 180
days after the date of completion.
``(4) The average length of time between the completion of such
a program of education and employment.
``(5) The total number of covered individuals who completed a
program of education under the program and who, as of the date of
the submission of the report, are employed in a position related to
technology.
``(6) The average salary of a covered individual who completed
a program of education under the program and who is employed in a
position related to technology, in various geographic areas
determined by the Secretary.
``(7) The average salary of all individuals employed in
positions related to technology in the geographic areas determined
under subparagraph (F), and the difference, if any, between such
average salary and the average salary of a covered individual who
completed a program of education under the program and who is
employed in a position related to technology.
``(8) The number of covered individuals who completed a program
of education under the program and who subsequently enrolled in a
second program of education under the program.
``(g) Collection of Information; Consultation.--(1) The Secretary
shall develop practices to use to collect information about covered
individuals and providers of high technology programs of education.
``(2) For the purpose of carrying out program under this section,
the Secretary may consult with providers of high technology programs of
education and may establish an advisory group made up of
representatives of such providers, private employers in the technology
field, and other relevant groups or entities, as the Secretary
determines necessary.
``(h) Definitions.--In this section:
``(1) The term `covered individual' means any of the following:
``(A) A veteran whom the Secretary determines--
``(i) served an aggregate of at least 36 months on
active duty in the Armed Forces (including service on
active duty in entry level and skill training) and was
discharged or released therefrom under conditions other
than dishonorable; and
``(ii) has not attained the age of 62.
``(B) A member of the Armed Forces that the Secretary
determines will become a veteran described in subparagraph (A)
fewer than 180 days after the date of such determination.
``(2) The term `high technology program of education' means a
program of education--
``(A) offered by a public or private educational
institution;
``(B) if offered by an institution of higher learning, that
is provided directly by such institution rather than by an
entity other than such institution under a contract or other
agreement;
``(C) that does not lead to a degree;
``(D) that has a term of not less than six and not more
than 28 weeks; and
``(E) that provides instruction in computer programming,
computer software, media application, data processing, or
information sciences.
``(i) Termination.--The Secretary may not provide educational
assistance under this section for a high technology program of
education that begins after September 30, 2027.''.
(2) Clerical amendment.--The table of sections at the beginning
of such chapter is amended by inserting after the item relating to
section 3699B the following new item:
``3699C. High technology program.''.
(b) Effect on High Technology Pilot Program.--Section 116 of the
Harry W. Colmery Veterans Educational Assistance Act of 2017 (Public
Law 115-48; 38 U.S.C. 3001 note) is amended--
(1) by amending subsection (d) to read as follows:
``(d) Housing Stipend.--
``(1) In general.--Except as provided under paragraph (2), the
Secretary shall pay to each eligible veteran (not including an
individual described in the second sentence of subsection (b)) who
is enrolled in a high technology program of education under the
pilot program on a full-time or part-time basis a monthly housing
stipend equal to the product--
``(A) of--
``(i) in the case of a veteran pursuing resident
training, the monthly amount of the basic allowance for
housing payable under section 403 of title 37, United
States Code, for a member with dependents in pay grade E-5
residing in the military housing area that encompasses all
or the majority portion of the ZIP code area in which is
located the campus of the institution where the individual
physically participates in a majority of classes; or
``(ii) in the case of a veteran pursuing a program of
education through distance learning, a monthly amount equal
to 50 percent of the national average of the monthly amount
of the basic allowance for housing payable under section
403 of title 37, United States Code, for a member with
dependents in pay grade E-5, multiplied by
``(B) the lesser of--
``(i) 1.0; or
``(ii) the number of course hours borne by the
individual in pursuit of the program of education involved,
divided by the minimum number of course hours required for
full-time pursuit of such program of education, rounded to
the nearest multiple of 10.
``(2) Bar to dual eligibility.--No covered individual may
receive a housing stipend under this subsection for any month if
such individual is in receipt of a housing stipend under chapter 33
of title 38, United States Code, for that month.'';
(2) in subsection (g), by striking paragraph (6); and
(3) by striking subsection (h) and inserting the following new
subsection (h):
``(h) Termination.--The Secretary may not, under this section, pay
a provider for a high technology program of education that begins after
September 30, 2024.''.
(c) Approval of Certain High Technology Programs.--Section 3680A of
title 38, United States Code, is amended--
(1) in subsection (a), by striking paragraph (4) and inserting
the following:
``(4) Any independent study program except--
``(A) an independent study program (including such a
program taken over open circuit television) that--
``(i) 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);
``(ii) leads to--
``(I) a standard college degree;
``(II) a certificate that reflects educational
attainment offered by an institution of higher
learning; or
``(III) a certificate that reflects graduation from
a course of study offered by--
``(aa) an area career and technical education
school (as defined in subparagraphs (C) and (D) of
section 3(3) of the Carl D. Perkins Career and
Technical Education Act of 2006 (20 U.S.C.
2302(3))) that provides education at the
postsecondary level; or
``(bb) a postsecondary vocational institution
(as defined in section 102(c) of the Higher
Education Act of 1965 (20 U.S.C. 1002(c))) that
provides education at the postsecondary level; and
``(iii) in the case of a program described in clause
(ii)(III)--
``(I) provides training aligned with the
requirements of employers in the State or local area
where the program is located, which may include in-
demand industry sectors or occupations;
``(II) provides a student, upon graduation from the
program, with a recognized postsecondary credential
that is recognized by employers in the relevant
industry, which may include a credential recognized by
industry or sector partnerships in the State or local
area where the industry is located; and
``(III) meets such content and instructional
standards as may be required to comply with the
criteria under section 3676(c)(14) and (15) of this
title; or
``(B) an online high technology program of education (as
defined in subsection (h)(2) of section 3699C of this title)--
``(i) the provider of which has entered into a contract
with the Secretary under subsection (c) of such section;
``(ii) that has been provided to covered individuals
(as defined in subsection (h)(1) of such section) under
such contract for a period of at least five years;
``(iii) regarding which the Secretary has determined
that the average employment rate of covered individuals who
graduated from such program of education is 65 percent or
higher for the year preceding such determination; and
``(iv) that satisfies the requirements of subsection
(e) of such section.''; and
(2) in subsection (d), by adding at the end the following:
``(8) Paragraph (1) shall not apply to the enrollment of a veteran
in an online high technology program described in subsection
(a)(4)(B).''.
SEC. 213. NOTICE OF CHANGES TO DEPARTMENT OF VETERANS AFFAIRS
POLICIES AND GUIDANCE AFFECTING THE EDUCATIONAL ASSISTANCE
PROGRAMS OF THE DEPARTMENT.
(a) In General.--Subchapter III of chapter 36 of title 38, United
States Code, as amended by sections 210 and 212, is further amended by
adding at the end the following new section:
``Sec. 3699D. Notice of changes to policies and guidance relating to
educational assistance programs
``In the case of any change to any policy or guidance provided by
the Secretary that relates to any educational assistance program of the
Department, the Secretary may not implement the change before the date
that is 90 days after the date on which the Secretary makes available
to students, educational institutions, and the Committees on Veterans'
Affairs of the Senate and House of Representatives notice of, and
justification for, the change.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
3699B the following new item:
``3699D. Notice of changes to policies and guidance relating to
educational assistance programs.''.
SEC. 214. PAYMENT OF VA EDUCATIONAL ASSISTANCE VIA ELECTRONIC FUND
TRANSFER TO A FOREIGN INSTITUTION OF HIGHER EDUCATION.
Not later than 90 days after the date of the enactment of this Act,
the Secretary of Veterans Affairs shall update the payment system of
the Department of Veterans Affairs to allow for electronic fund
transfer of educational assistance, administered by the Secretary, to a
foreign institution of higher education that--
(1) provides an approved course of education to an eligible
recipient of such assistance; and
(2) does not have--
(A) an employer identification number; or
(B) an account with a domestic bank.
SEC. 215. IMPROVING TRANSPARENCY AND ACCOUNTABILITY OF EDUCATIONAL
INSTITUTIONS FOR PURPOSES OF VETERANS EDUCATIONAL ASSISTANCE.
(a) Requirement Relating to G.I. Bill Comparison Tool.--
(1) Requirement to maintain tool.--The Secretary of Veterans
Affairs shall maintain the G.I. Bill Comparison Tool that was
established pursuant to Executive Order 13607 (77 Fed. Reg. 25861;
relating to establishing principles of excellence for educational
institutions serving service members, veterans, spouses, and other
family members) and in effect on the day before the date of
enactment of this Act, or a successor tool, to provide relevant and
timely information about programs of education approved under
chapter 36 of title 38, United States Code, and the educational
institutions that offer such programs.
(2) Data retention.--The Secretary shall ensure that historical
data that is reported via the tool maintained under paragraph (1)
remains easily and prominently accessible on the benefits.va.gov
website, or a successor website, for a period of not less than six
years from the date of initial publication.
(b) Providing Timely and Relevant Education Information to
Veterans, Members of the Armed Forces, and Other Individuals.--
(1) In general.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs, in
consultation with the Secretary of Education, the Secretary of the
Treasury, and the heads of other relevant Federal agencies, shall
make such changes to the tool maintained under subsection (a) as
the Secretary of Veterans Affairs determines appropriate to ensure
that such tool is an effective and efficient method for providing
information pursuant to section 3698(b)(5) of title 38, United
States Code.
(2) Memorandum of understanding required.--Not later than two
years after the date of the enactment of this Act, the Secretary of
Veterans Affairs shall seek to enter into a memorandum of
understanding with the Secretary of Education and the heads other
relevant Federal agencies, as the Secretary of Veterans Affairs
determines appropriate, to obtain information on outcomes with
respect to individuals who are entitled to educational assistance
under the laws administered by the Secretary of Veterans Affairs
and who are attending educational institutions. Such memorandum of
understanding may include data sharing or computer matching
agreements.
(3) Modification of scope of comprehensive policy on providing
education information.--Section 3698 of title 38, United States
Code, is amended--
(A) in subsection (a), by striking ``veterans and members
of the Armed Forces'' and inserting ``individuals entitled to
educational assistance under laws administered by the Secretary
of Veterans Affairs''; and
(B) in subsection (b)(5)--
(i) by striking ``veterans and members of the Armed
Forces'' and inserting ``individuals described in
subsection (a)''; and
(ii) by striking ``the veteran or member'' and
inserting ``the individual''.
(4) G.I. bill comparison tool required disclosures.--Paragraph
(1) of subsection (c) of such section is amended--
(A) by striking subparagraph (B) and inserting the
following:
``(B) for each individual described in subsection (a) seeking
information provided under subsection (b)(5), the name of each
Federal student aid program, and a description of each such
program, from which the individual may receive educational
assistance; and'';
(B) in subparagraph (C)--
(i) in clause (i), by inserting ``and a definition of
each type of institution'' before the semicolon;
(ii) in clause (iv), by inserting ``and if so, which
programs'' before the semicolon;
(iii) by striking clause (v) and inserting the
following:
``(v) the average annual cost and the total cost to earn an
associate's degree and a bachelor's degree, with available cost
information on any other degree or credential the institution
awards;'';
(iv) in clause (vi), by inserting before the semicolon
the following: ``disaggregated by--
``(I) the type of beneficiary of educational
assistance;
``(II) individuals who received a credential and
individuals who did not; and
``(III) individuals using educational assistance under
laws administered by the Secretary and individuals who are
not;'';
(v) in clause (xiv), by striking ``and'' at the end;
(vi) in clause (xv), by striking the period at the end
and inserting a semicolon; and
(vii) by adding at the end the following new clauses:
``(xvi) the number of veterans or members who completed
covered education at the institution leading to--
``(I) a degree, disaggregated by type of program,
including--
``(aa) an associate degree;
``(bb) a bachelor's degree; and
``(cc) a postbaccalaureate degree; and
``(II) a certificate or professional license,
disaggregated by type of certificate or professional
license;
``(xvii) programs available and the average time for
completion of each program;
``(xviii) employment rate and median income of graduates of
the institution in general two and five years after graduation,
disaggregated by--
``(I) specific program; and
``(II) individuals using educational assistance under
laws administered by the Secretary and individuals who are
not; and
``(xix) the number of individuals using educational
assistance under laws administered by the Secretary who are
enrolled in the both the institution and specific program per
year.''.
(5) Clarity and anonymity of information provided.--Paragraph
(2) of such subsection is amended--
(A) by inserting ``(A)'' before ``To the extent''; and
(B) by adding at the end the following new subparagraph:
``(B) The Secretary shall ensure that information provided pursuant
to subsection (b)(5) is provided in a manner that is easy for, and
accessible to, individuals described in subsection (a).
``(C) In providing information pursuant to subsection (b)(5), the
Secretary shall maintain the anonymity of individuals described in
subsection (a) and, to the extent that a portion of any data would
undermine such anonymity, ensure that such data is not made available
pursuant to such subsection.''.
(c) Improvements for Student Feedback.--
(1) In general.--Subsection (b)(2) of such section is amended--
(A) by amending subparagraph (A) to read as follows:
``(A) provides institutions of higher learning--
``(i) up to 30 days to review and respond to feedback
from individuals described in subsection (a) and address
issues regarding the feedback before the feedback is
published; and
``(ii) if an institution of higher learning contests
the accuracy of the feedback, the opportunity to challenge
the inclusion of such data with an official appointed by
the Secretary;'';
(B) in subparagraph (B), by striking ``and'' at the end;
(C) in subparagraph (C), by striking ``that conforms with
criteria for relevancy that the Secretary shall determine.''
and inserting ``, and responses from institutions of higher
learning to such feedback, that conform with criteria for
relevancy that the Secretary shall determine;''; and
(D) by adding at the end the following new subparagraphs:
``(D) for each institution of higher learning that is
approved under this chapter, retains, maintains, and publishes
all of such feedback for not less than six years; and
``(E) is easily accessible to individuals described in
subsection (a) and to the general public.''.
(2) Accessibility from g.i. bill comparison tool.--The
Secretary shall ensure that--
(A) the feedback tracked and published under subsection
(b)(2) of such section, as amended by paragraph (1), is
prominently displayed in the tool maintained under subsection
(a) of this section; and
(B) when such tool displays information for an institution
of higher learning, the applicable feedback is also displayed
for such institution of higher learning.
(d) Training for Provision of Education Counseling Services.--
(1) In general.--Not less than one year after the date of the
enactment of this Act, the Secretary shall ensure that personnel
employed by the Department of Veteran Affairs, or a contractor of
the Department, to provide education benefits counseling,
vocational or transition assistance, or similar functions,
including employees or contractors of the Department who provide
such counseling or assistance as part of the Transition Assistance
Program, are trained on how--
(A) to use properly the tool maintained under subsection
(a); and
(B) to provide appropriate educational counseling services
to individuals described in section 3698(a) of such title, as
amended by subsection (b)(3)(A).
(2) Transition assistance program defined.--In this subsection,
the term ``Transition Assistance Program'' means the program of
counseling, information, and services under section 1142 of title
10, United States Code.
Subtitle B--Employment and Training
SEC. 221. IMPROVEMENTS TO REEMPLOYMENT RIGHTS OF MEMBERS OF THE
ARMED FORCES.
(a) USERRA Purposes.--Section 4301(a)(1) of title 38, United States
Code, is amended by striking ``encourage noncareer service in the
uniformed services'' and inserting ``encourage service in the uniformed
services''.
(b) Prohibition of Retaliation.--Subsection (b) of section 4311 of
title 38, United States Code, is amended by inserting ``or other
retaliatory action'' after ``employment action''.
(c) Expansion of Injunctive Relief.--Subsection (e) of section 4323
of such title is amended--
(1) by striking ``The court shall use'' and inserting ``(1) The
court shall use''; and
(2) by adding at the end the following new paragraphs:
``(2) A person bringing an action to enforce a provision of this
chapter pursuant to subsection (a) shall be entitled to an injunction
under paragraph (1) if such person demonstrates--
``(A) a violation--
``(i) of the provisions of this chapter; or
``(ii) of the provisions of this chapter is threatened or
is imminent;
``(B) the harm to the person outweighs the injury to the
employer;
``(C) a likelihood of success on the merits of such action; and
``(D) awarding such relief is in the public interest.
``(3) The court may not deny a motion for injunctive relief on the
basis that a party bringing an action to enforce a provision of this
chapter may be awarded wages unearned due to an unlawful termination or
denial of employment at the conclusion of such action.''.
(d) Damages Against a State or Private Employer.--Section 4323 of
such title is further amended, in paragraph (1) of subsection (d), by
striking subparagraph (C) and inserting the following new
subparagraphs:
``(C) The court may require the employer to pay the person the
amount referred to in subparagraph (B) and interest on such amount,
calculated at a rate of 3 percent per year.
``(D) The court may require the employer to pay the person the
greater of $50,000 or the amount equal to the amounts referred to
in subparagraphs (B) and (C) as liquidated damages, if the court
determines that the employer knowingly failed to comply with the
provisions of this chapter.''.
(e) Mandatory Attorney Fees Award in Successful Actions for
Reemployment.--
(1) MSPB actions.--Paragraph (4) of subsection (c) of section
4324 of such title is amended--
(A) by striking ``may, in its discretion,'' and inserting
``shall''; and
(B) by adding at the end the following new sentence: ``The
Board may, in its discretion, award reasonable attorney fees in
a case settled before the issuance of an order if the person
can demonstrate that significant attorney fees were incurred
and that justice requires such an award.''.
(2) Federal circuit actions.--Subsection (d) of such section is
amended by adding at the end the following new paragraph:
``(3) In such Federal Circuit proceeding, the court shall award
such person reasonable attorney fees, expert witness fees, and other
litigation expenses if such person--
``(A) prevails in such Federal Circuit proceeding; and
``(B) is not represented by the Special Counsel in such Federal
Circuit proceeding.''.
(3) Actions against a state or private employer.--Paragraph (2)
of section 4323(h) of such title is amended--
(A) by striking ``subsection (a)(2)'' and inserting
``subsection (a)(3)''; and
(B) by striking ``the court may award any such person who
prevails in such action or proceeding reasonable attorney
fees'' and inserting ``the court shall award any such person
who prevails in such action or proceeding reasonable attorney
fees''.
(f) GAO Review and Report on USERRA.--
(1) Review.--The Comptroller General of the United States shall
review the methods through which the Secretary of Labor, acting
through the Veterans' Employment and Training Service, processes
actions for relief under chapter 43 of title 38, United States
Code.
(2) Elements.--Not later than one year after the date of the
enactment of this Act, the Comptroller General shall submit to the
Committees on Veterans' Affairs of the House of Representatives and
the Senate a report that includes--
(A) the findings of the review required under paragraph
(1);
(B) an identification of the number of actions for relief
under chapter 43 of title 38, United States Code, initiated
during the period covered by the report, disaggregated by size
of employer and geographic region;
(C) an identification of the number of such actions for
relief that were erroneously dismissed, as determined by the
Comptroller General;
(D) an identification of the number of such actions for
relief that were referred to the Department of Justice; and
(E) an assessment of trends, if any, in such actions for
relief initiated during such period.
(g) GAO Review of Protections for Members of the Uniformed Services
by Federal Intelligence Agencies.--
(1) In general.--Not later than one year after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to the appropriate congressional committees a report
on the processes and procedures adopted and used by the
intelligence community to provide the protections for members of
the uniformed services otherwise established under chapter 43 of
title 38, United States Code.
(2) Definitions.--In this subsection:
(A) The term ``appropriate congressional committees'' means
the Committees on Veterans' Affairs of the House of
Representatives and Senate, the Permanent Select Committee on
Intelligence of the House of Representatives, and the Select
Committee on Intelligence of the Senate.
(B) The term ``intelligence community'' has the meaning
given such term in section 3(4) of the National Security Act of
1947 (50 U.S.C. 3003(4)).
SEC. 222. REVIEW OF INVESTIGATIONS MANUAL OF VETERANS' EMPLOYMENT
AND TRAINING SERVICE.
(a) In General.--Not later than one year after the date of the
enactment of this Act, and once every two years thereafter for the
period of five years beginning on such date, the Secretary of Labor,
shall review the manual of the Department of Labor titled ``Veterans'
Employment and Training Service Investigations Manual: USERRA, VEOA,
and VP'' (or a successor manual) and make such revisions to such manual
as the Secretary determines appropriate.
(b) Report.--Not later than 90 days after any date on which the
Secretary completes a review required under subsection (a), the
Secretary shall submit to the Committees on Veterans' Affairs of the
House of Representatives and the Senate--
(1) a report that includes a description of any revision to
such manual made pursuant to such review; and
(2) a copy of the entire such manual which--
(A) shall be provided to the Chairman and Ranking Member of
each such committee; and
(B) may contain a separate addendum for portions of the
manual that contain law enforcement sensitive materials.
SEC. 223. WARRIOR TRAINING ADVANCEMENT COURSE.
(a) Reports Required.--
(1) Initial report.--Not later than six months after the date
of the enactment of this Act, the Secretary of Veterans Affairs
shall submit to the Committees on Veterans' Affairs of the Senate
and House of Representatives a report on WARTAC.
(2) Annual report.--One year after the submission of the report
required under paragraph (1) and annually thereafter, the Secretary
shall submit to such Committees a report that contains the elements
under paragraphs (1) and (3) of subsection (b) with regards to the
preceding year.
(3) Elements.--Except as provided in subsection (a)(2), the
reports under this subsection shall include the following elements:
(A) Best practices.--With regards to best practices of
WARTAC--
(i) how many covered members have applied to
participate in WARTAC;
(ii) how many covered members have participated in
WARTAC;
(iii) how the Secretary provides training to covered
members during TAP;
(iv) how many covered members have completed WARTAC;
and
(v) any other information the Secretary determines
appropriate.
(B) Cost savings.--With regards to cost savings of WARTAC--
(i) how much money the Secretary determines WARTAC
saves the United States each fiscal year;
(ii) how much money the Secretary determines WARTAC has
saved the United States since its establishment; and
(iii) the determination of the Secretary whether other
Federal agencies may save money by establishing a program
similar to WARTAC.
(C) Hiring.--With regards to hiring covered members who
complete WARTAC--
(i) how the Secretary identifies positions in the
Department of Veterans Affairs for which such covered
members may qualify;
(ii) the grades of such positions on the General
Schedule under section 5332 of title 5, United States Code;
and
(iii) how many such covered members the Secretary has
hired to such positions.
(4) Distribution.--Not later than 30 days after submitting the
report under paragraph (1), the Secretary of Veterans Affairs shall
transmit a copy of such report to the head of each Federal agency.
(5) Definitions.--In this subsection:
(A) The term ``covered member'' means members of the Armed
Forces participating in TAP.
(B) The term ``TAP'' means the Transition Assistance
Program under sections 1142 and 1144 of title 10, United States
Code.
(C) The term ``WARTAC'' means the Warrior Training
Advancement Course of the Veterans Benefit Administration, in
which the Secretary provides training to covered members so
such covered members may qualify for certain employment in the
Veterans Benefit Administration.
(b) Best Practices for Other Departments.--The Assistant Secretary
of Labor for Veterans' Employment and Training shall, in consultation
with the Secretary of Veterans Affairs, establish guidelines containing
best practices for departments and agencies of the Federal Government
that carry out programs to employ veterans who are transitioning from
service in the Armed Forces. Such guidelines shall include the findings
of the initial report required under subsection (a)(1).
(c) Pilot Program.--
(1) Establishment.--The Secretary of the Interior shall, in
consultation with the Secretary of Labor and the Secretary of
Veterans Affairs, establish a pilot program to proactively inform
veterans of available employment positions that relate to the
conservation and resource management activities of the Department
of the Interior.
(2) Positions.--The Secretary of the Interior shall--
(A) identify vacant positions in the Department of the
Interior that are appropriate to fill using the pilot program;
and
(B) to the maximum extent practicable, provide assistance
to veterans in selecting one or more vacant positions to apply
to, for which that veteran may be best qualified.
(3) Reports.--
(A) Implementation report.--Not later than one year after
the date on which the pilot program under paragraph (1)
commences, the Secretary of the Interior, the Secretary of
Veterans Affairs, and the Secretary of Labor shall jointly
provide to the appropriate congressional committees a report on
the implementation of the pilot program.
(B) Final report.--Not later than 30 days after the date on
which the pilot program under paragraph (1) terminates under
paragraph (4), the Secretary of the Interior, the Secretary of
Veterans Affairs, and the Secretary of Labor shall jointly
submit to the appropriate congressional committees a report on
the pilot program that includes the following:
(i) The number of veterans who applied to participate
in the pilot program.
(ii) The number of such veterans employed under the
pilot program.
(iii) The number of veterans identified in clause (ii)
who transitioned to full-time positions with the Federal
Government after participating in the pilot program.
(iv) Any other information the Secretary of the
Interior, the Secretary of Veterans Affairs, and the
Secretary of Labor determine appropriate with respect to
measuring the effectiveness of the pilot program.
(4) Termination.--The authority to carry out the pilot program
under this subsection shall terminate on the date that is two years
after the date on which the pilot program commences.
(5) Appropriate congressional committees defined.--In this
subsection, the term ``appropriate congressional committees''
means--
(A) the Committee on Veterans' Affairs and the Committee on
Energy and Natural Resources of the Senate; and
(B) the Committee on Veterans' Affairs and the Committee on
Natural Resources of the House of Representatives.
(d) Outdoor Recreation Program Attendance.--The Secretary of the
Interior and the Secretary of Agriculture are encouraged to work with
the Secretary of Defense and the Secretary of Veterans Affairs to
ensure members of the Armed Forces and veterans have access to outdoor
recreation and outdoor-related volunteer and wellness programs as part
of the basic services provided to such members and veterans.
Subtitle C--Home Loans
SEC. 231. IMPROVEMENTS TO PROGRAM FOR DIRECT HOUSING LOANS MADE TO
NATIVE AMERICAN VETERANS BY THE SECRETARY OF VETERANS AFFAIRS.
(a) General Authorities and Requirements.--
(1) Direct housing loans to native american veterans.--Section
3762(a) of title 38, United States Code, is amended to read as
follows:
``(a) The Secretary may make a direct housing loan to a Native
American veteran under this subchapter if the Secretary ensures the
following:
``(1) That each Native American veteran to whom the Secretary
makes a direct housing loan under this subchapter--
``(A) holds, possesses, or purchases using the proceeds of
the loan a meaningful interest in a lot or dwelling (or both)
that is located on trust land; and
``(B) will purchase, construct, or improve (as the case may
be) a dwelling on the lot using the proceeds of the loan.
``(2) That each such Native American veteran will convey to the
Secretary by an appropriate instrument the interest referred to in
paragraph (1)(A) as security for a direct housing loan under this
subchapter.
``(3) That the Secretary, including the Secretary's employees
or agents, may enter upon the trust land for the purposes of
carrying out such actions as the Secretary determines are
necessary, including--
``(A) to evaluate the advisability of the loan;
``(B) to monitor any purchase, construction, or
improvements carried out using the proceeds of the loan; and
``(C) to manage any servicing or post-foreclosure
activities, including acquisition, property inspections, and
property management.
``(4) That there are established standards and procedures that
apply to the foreclosure of the interest conveyed by a Native
American veteran pursuant to paragraph (2), including--
``(A) procedures for foreclosing the interest; and
``(B) procedures for the resale of the lot or dwelling (or
both) purchased, constructed, or improved using the proceeds of
the loan.
``(5) That the loan is made in a responsible and prudent
manner, subject to standards and procedures as are necessary for
the reasonable protection of the financial interests of the United
States.''.
(2) Memorandums of understanding, agreements, and
determinations.--Section 3762(b) of such title is amended to read
as follows:
``(b)(1) To carry out the purpose of subsection (a), the Secretary
may--
``(A) enter into a memorandum of understanding with a tribal
organization, other entity, or individual;
``(B) rely on agreements or determinations of other Federal
agencies to guarantee, insure, or make loans on trust land; and
``(C) enter into other agreements or take such other actions as
the Secretary determines necessary.
``(2) If the Secretary determines that the requirements under
subsection (a) are not being enforced by a tribal organization, other
entity, or individual that is a party to any memorandum of
understanding, agreement, or determination described in paragraph (1),
the Secretary may cease making new direct housing loans to Native
American veterans under this subchapter within the area of the
authority of the tribal organization, other entity, or individual (as
the case may be).''.
(b) Direct Loans to Native American Veterans To Refinance Existing
Mortgage Loans.--Section 3762(h) of such title is amended to read as
follows:
``(h) The Secretary may make direct loans to Native American
veterans in order to enable such veterans to refinance existing
mortgage loans for any of the following purposes:
``(1) To refinance an existing loan made under this section, if
the loan--
``(A) meets the requirements set forth in subparagraphs
(B), (C), and (E) of paragraph (1) of section 3710(e) of this
title;
``(B) will bear an interest rate at least one percentage
point less than the interest rate borne by the loan being
refinanced; and
``(C) complies with paragraphs (2) and (3) of section
3710(e) of this title, except that for the purposes of this
subsection the reference to subsection (a)(8) of section 3710
of this title in such paragraphs (2) and (3) shall be deemed to
be a reference to this subsection.
``(2) To refinance an existing mortgage loan not made under
this section on a dwelling owned and occupied by the veteran as the
veteran's home, if all of the following requirements are met:
``(A) The loan will be secured by the same dwelling as was
the loan being refinanced.
``(B) The loan will provide the veteran with a net tangible
benefit.
``(C) The nature and condition of the property is such as
to be suitable for dwelling purposes.
``(D) The amount of the loan does not exceed either of the
following:
``(i) 100 percent of the reasonable value of the
dwelling, with such reasonable value determined under the
procedures established by the Secretary under subsection
(d)(2).
``(ii) An amount equal to the sum of the balance of the
loan being refinanced and such closing costs (including any
discount points) as may be authorized by the Secretary to
be included in the loan.
``(E) Notwithstanding subparagraph (D), if a loan is made
for both the purpose of this paragraph and to make energy
efficiency improvements, the loan must not exceed either of the
following:
``(i) 100 percent of the reasonable value of the
dwelling as improved for energy efficiency, with such
reasonable value determined under the procedures
established by the Secretary under subsection (d)(2).
``(ii) The amount referred to under subparagraph
(D)(ii), plus the applicable amount specified under section
3710(d)(2) of this title.
``(F) The loan meets all other requirements the Secretary
may establish under this subchapter.
``(G) The existing mortgage being refinanced is a first
lien on the property and secured of record.
``(3) To refinance an existing mortgage loan to repair, alter,
or improve a dwelling owned by the veteran and occupied by the
veteran as the veteran's home, if all of the following requirements
are met:
``(A) The loan will be secured by the same dwelling as was
the loan being refinanced.
``(B) The nature and condition of the property is such as
to be suitable for dwelling purposes, and the repair,
alteration, or improvement substantially protects or improves
the basic livability or utility of such property.
``(C) The amount of the loan, including the costs of
repairs, alterations, and improvements, does not exceed either
of the following:
``(i) 100 percent of the reasonable value of the
dwelling as repaired, altered, or improved, with such
reasonable value determined under the procedures
established by the Secretary under subsection (d)(2).
``(ii) An amount equal to the sum of--
``(I) the balance of the loan being refinanced;
``(II) the actual cost of repairs, alterations, or
improvements; and
``(III) such closing costs (including any discount
points) as may be authorized by the Secretary to be
included in the loan.
``(D) The loan meets all other requirements the Secretary
may establish under this subchapter.
``(E) The existing mortgage loan being refinanced is a
first lien on the property and secured of record.''.
(c) Expansion of Outreach Program on Availability of Direct Housing
Loans for Native American Veterans.--Section 3762(i)(2) of such title
is amended by adding at the end the following new subparagraph:
``(G) Pursuant to subsection (g)(4), assisting Native American
veterans in qualifying for mortgage financing by--
``(i) partnering with local service providers, such as
tribal organizations, tribally designated housing entities,
Native community development financial institutions, and
nonprofit organizations, for conducting outreach, homebuyer
education, housing counseling, and post-purchase education; and
``(ii) providing other technical assistance as needed.
``(H) Attending conferences and conventions conducted by the
network of Native community development financial institutions and
other Native American homeownership organizations to provide
information and training to Native community development financial
institutions about the availability of the relending program under
section 3762A of this title.''.
(d) Adequate Personnel.--Section 3762 of such title is amended by
adding at the end the following new subsection:
``(k) The Secretary shall assign a sufficient number of personnel
of the Department dedicated to carrying out the authority of the
Secretary under this subchapter, including construction and valuation
specialists to assist with issues unique to new construction and
renovations on trust land.''.
(e) Definitions.--Section 3765 of such title is amended--
(1) in paragraph (1)--
(A) by amending subparagraph (C) to read as follows:
``(C) is located in the State of Alaska within a region
established under section 7(a) of the Alaska Native Claims
Settlement Act (43 U.S.C. 1606(a));'';
(B) in subparagraph (D), by striking the period at the end
and inserting a semicolon; and
(C) by adding at the end the following new subparagraphs:
``(E) is defined by the Secretary of the Interior and
recognized by the United States as land over which an Indian
Tribe has governmental dominion; or
``(F) is on any land that the Secretary determines is
provided to Native American veterans because of their status as
Native Americans.''; and
(2) by adding at the end the following new paragraphs:
``(6) The term `community development financial institution'
has the meaning given that term in section 103 of the Community
Development Banking and Financial Institutions Act of 1994 (12
U.S.C. 4702).
``(7) The term `Indian Tribe' means any Indian tribe, band,
nation, or other organized group or community, including any Alaska
Native village or regional or village corporation as defined in or
established pursuant to the Alaska Native Claims Settlement Act (43
U.S.C. 1601 et seq.), which is recognized as eligible for the
special programs and services provided by the United States to
Indians because of their status as Indians.
``(8) The term `Native community development financial
institution' means any entity--
``(A) that has been certified as a community development
financial institution by the Secretary of the Treasury;
``(B) that is not less than 51 percent owned or controlled
by Native Americans; and
``(C) for which not less than 51 percent of the activities
of the entity serve Native Americans.
``(9) The term `net tangible benefit' shall have such meaning
as the Secretary determines appropriate, but shall include the
refinance of an interim construction loan.
``(10) The term `other technical assistance' means services to
assist a Native American veteran to navigate the steps necessary
for securing a mortgage loan on trust land, including pre-
development activities related to utilities, identifying
appropriate residential construction services, and obtaining lease
clearances and title status reports from the applicable tribal
organization or the Bureau of Indian Affairs.
``(11) The term `tribally designated housing entity' has the
meaning given that term in section 4 of the Native American Housing
Assistance and Self-Determination Act of 1996 (25 U.S.C. 4103).''.
(f) Interest Rate Reduction Financing Loan.--Section 3729(b)(4)(F)
of such title is amended by striking ``3762(h)'' and inserting
``3762(h)(1)''.
(g) Regulations.--Section 3761 of such title is amended by adding
at the end the following new subsection:
``(c) The Secretary shall prescribe such regulations as may be
necessary to carry out this subchapter.''.
SEC. 232. NATIVE COMMUNITY DEVELOPMENT FINANCIAL INSTITUTION
RELENDING PROGRAM.
(a) In General.--Subchapter V of chapter 37 of title 38, United
States Code, is amended by inserting after section 3762 the following
new section:
``Sec. 3762A. Native community development financial institution
relending program
``(a) Purpose.--The Secretary may make a loan to a Native community
development financial institution for the purpose of allowing the
institution to relend loan amounts to qualified Native American
veterans, subject to the requirements of this section.
``(b) Standards.--(1) The Secretary shall establish standards to be
used in evaluating whether to make a loan to a Native community
development financial institution under this section.
``(2) In establishing standards under paragraph (1), the Secretary
shall ensure that a Native community development financial
institution--
``(A) is able to originate and service loans for single-family
homes;
``(B) is able to operate the relending program in a manner
consistent with the mission of the Department to serve veterans;
and
``(C) uses loan amounts received under this section only for
the purpose of relending, as described in subsection (c), to Native
American veterans.
``(c) Relending Requirements.--(1) A Native community development
financial institution that receives a loan under this section shall use
the loan amounts to make loans to Native American veterans residing on
trust land.
``(2) A loan to a Native American veteran made by a Native
community development financial institution under paragraph (1) shall--
``(A) be limited either to the purpose of purchase,
construction, or improvement of a dwelling located on trust land or
to the refinance of an existing mortgage loan for a dwelling on
trust land, consistent with the requirements of section 3762(h) of
this title; and
``(B) comply with such terms and conditions as the Secretary
determines are necessary to protect against predatory lending,
including the interest rate charged on a loan to a Native American
veteran.
``(d) Repayment.--A loan made to a Native community development
financial institution under this section shall--
``(1) be payable to the Secretary upon such terms and
conditions as are prescribed in regulations pursuant to this
subchapter; and
``(2) bear interest at a rate of one percent.
``(e) Oversight.--Subject to notice and opportunity for a hearing,
whenever the Secretary finds with respect to loans made under
subsection (a) or (c) that any Native community development financial
institution has failed to maintain adequate loan accounting records, to
demonstrate proper ability to service loans adequately, or to exercise
proper credit judgment, or that such Native community development
financial institution has willfully or negligently engaged in practices
otherwise detrimental to the interest of veterans or of the Government,
the Secretary may take such actions as the Secretary determines
necessary to protect veterans or the Government, such as requiring
immediate repayment of any loans made under subsection (a) and the
assignment to the Secretary of loans made under subsection (c).
``(f) Sunset.--The Secretary may not make a loan under this section
after September 30, 2027.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 37 of such title is amended by inserting after the item
relating to section 3762 the following new item:
``3762A. Native community development financial institution relending
program.''.
(c) Native American Veteran Housing Loan Program Account.--Section
3763 of such title is amended by adding at the end the following new
subsection:
``(c) Of amounts available in the Account, the Secretary may use
for loans made under section 3762A of this title--
``(1) in fiscal year 2025, not more than $5,000,000; and
``(2) in any fiscal year after fiscal year 2025, an amount
determined necessary by the Secretary to meet the demand for such
loans.''.
TITLE III--DISABILITY AND MEMORIAL AFFAIRS MATTERS
SEC. 301. BURIAL ALLOWANCE FOR CERTAIN VETERANS WHO DIE AT HOME
WHILE IN RECEIPT OF HOSPICE CARE FURNISHED BY DEPARTMENT OF
VETERANS AFFAIRS.
(a) In General.--The Secretary of Veterans Affairs shall treat a
veteran described in subsection (b) as a veteran described in
subparagraph (A) of section 2303(a)(2) of title 38, United States Code.
(b) Veteran Described.--A veteran described in this subsection is a
veteran who dies in a home or other setting at which the deceased
veteran was, at the time of death, receiving hospice care pursuant to
section 1717(a) of such title if such care was directly preceded by the
Secretary furnishing to the veteran hospital care or nursing home care
described in clause (ii) of such subparagraph.
(c) Effective Date; Applicability.--This section shall apply with
respect to deaths that occur--
(1) on or after the date that is 180 days after the date of the
enactment of this Act; and
(2) before October 1, 2026.
SEC. 302. AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO AWARD
GRANTS TO STATES AND INDIAN TRIBES TO IMPROVE OUTREACH TO
VETERANS.
(a) In General.--Chapter 63 of title 38, United States Code, is
amended--
(1) by redesignating sections 6307 and 6308 as sections 6308
and 6309, respectively; and
(2) by inserting after section 6306 the following new section
6307:
``Sec. 6307. Grants to States and Indian Tribes to improve outreach to
veterans
``(a) Purpose.--It is the purpose of this section to provide for
assistance by the Secretary to States and Indian Tribes to carry out
programs that improve covered outreach and assistance to veterans and
the spouses, children, and parents of veterans, to ensure that such
individuals are fully informed about, and assisted in applying for, any
veterans and veterans-related benefits and programs (including veterans
programs of a State or Indian Tribe) for which they may be eligible and
facilitate opportunities for such individuals to receive competent,
qualified services in the preparation, presentation and prosecution of
veterans benefits claims.
``(b) Authority.--The Secretary may award grants to States and
Indian Tribes--
``(1) to carry out, coordinate, improve, or otherwise enhance--
``(A) covered outreach activities; or
``(B) activities to assist in the development and submittal
of claims for veterans and veterans-related benefits; or
``(2) to increase the number of county or Tribal veterans
service officers serving in the State by hiring new, additional
such officers.
``(c) Application.--(1) To be eligible for a grant under this
section, a State or Indian Tribe shall submit to the Secretary an
application therefor at such time, in such manner, and containing such
information as the Secretary may require.
``(2) Each application submitted under paragraph (1) shall include
the following:
``(A) A detailed plan for the use of the grant.
``(B) A description of the programs through which the State or
Indian Tribe will meet the outcome measures developed by the
Secretary under subsection (j).
``(C) A description of how the State or Indian Tribe will
distribute grant amounts equitably among counties or Tribal lands
with varying levels of urbanization.
``(D) A plan for how the grant will be used to meet the unique
needs of American Indian veterans, Alaska Native veterans, or
Native Hawaiian veterans, elderly veterans, and veterans from other
underserved communities.
``(d) Distribution.--The Secretary shall seek to ensure that grants
awarded under this section are equitably distributed among States and
Indian Tribes with varying levels of urbanization.
``(e) Set-aside.--Of the amounts authorized to be appropriated or
otherwise made available for grants under this section for any fiscal
year, the Secretary shall ensure that not less than five percent is
used to make grants to Indian Tribes.
``(f) Priority.--The Secretary shall prioritize awarding grants
under this section that will serve the following areas:
``(1) Areas with a critical shortage of county or Tribal
veterans service officers.
``(2) Areas with high rates of--
``(A) suicide among veterans; or
``(B) referrals to the Veterans Crisis Line.
``(g) Use of County or Tribal Veterans Service Officers.--A State
or Indian Tribe that receives a grant under this section to carry out
an activity described in subsection (b)(1) shall carry out the activity
through--
``(1) a county or Tribal veterans service officer of the State;
or
``(2) if the State or Indian Tribe does not have a county or
Tribal veterans service officer, or if the county or Tribal
veterans service officers of the State or Indian Tribe cover only a
portion of that State or Indian Tribe, an appropriate entity of a
State, local, or Tribal government, as determined by the Secretary.
``(h) Required Activities.--Any grant awarded under this section
shall be used--
``(1) to expand existing programs, activities, and services;
``(2) to hire new, additional county or Tribal veterans service
officers; or
``(3) for travel and transportation to facilitate carrying out
paragraph (1) or (2).
``(i) Authorized Activities.--A grant under this section may be
used to provide education and training, including on-the-job training,
for State, county, local, and Tribal government employees who provide
(or when trained will provide) covered outreach services in order for
those employees to obtain accreditation in accordance with procedures
approved by the Secretary.
``(j) Outcome Measures.--(1) The Secretary shall develop and
provide to each State or Indian Tribe that receives a grant under this
section written guidance on the following:
``(A) Outcome measures.
``(B) Policies of the Department.
``(2) In developing outcome measures under paragraph (1), the
Secretary shall consider the following goals:
``(A) Increasing the use of veterans and veterans-related
benefits, particularly among vulnerable populations.
``(B) Increasing the number of county and Tribal veterans
service officers recognized by the Secretary for the representation
of veterans under chapter 59 of this title.
``(k) Tracking Requirements.--(1) With respect to each grant
awarded under this section, the Secretary shall track the use of
veterans and veterans-related benefits among the population served by
the grant, including the average period of time between the date on
which a veteran applies for such a benefit and the date on which the
veteran receives the benefit, disaggregated by type of benefit.
``(2) Not less frequently than annually during the life of the
grant program established under this section, the Secretary shall
submit to Congress a report on--
``(A) the information tracked under paragraph (1);
``(B) how the grants awarded under this section serve the
unique needs of American Indian veterans, Alaska Native veterans,
or Native Hawaiian veterans, elderly veterans, and veterans from
other underserved communities; and
``(C) other information provided by States and Indian Tribes
pursuant to the grant reporting requirements.
``(l) Performance Review.--The Secretary shall--
``(1) review the performance of each State or Indian Tribe that
receives a grant under this section; and
``(2) make information regarding such performance publicly
available.
``(m) Remediation Plan.--(1) In the case of a State or Indian Tribe
that receives a grant under this section and does not meet the outcome
measures developed by the Secretary under subsection (j), the Secretary
shall require the State or Indian Tribe to submit a remediation plan
under which the State shall describe how and when it plans to meet such
outcome measures.
``(2) The Secretary may not award a subsequent grant under this
section to a State or Indian Tribe described in paragraph (1) unless
the Secretary approves the remediation plan submitted by the State or
Indian Tribe.
``(n) Definitions.--In this section:
``(1) The term `county or Tribal veterans service officer'
includes a local equivalent veterans service officer.
``(2) The term `covered outreach' means outreach with respect
to--
``(A) benefits administered by the Under Secretary for
Benefits; or
``(B) similar benefits administered by a State or Indian
Tribe.
``(3) The term `Indian Tribe' has the meaning given such term
in section 4 of the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 5304).
``(4) The term `State' includes the District of Columbia, the
Commonwealth of Puerto Rico, the Commonwealth of the Northern
Mariana Islands, and any territory or possession of the United
States.
``(5) The term `Veterans Crisis Line' means the toll-free
hotline for veterans established under section 1720F(h) of this
title.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 63 of such title is amended by striking the items relating to
sections 6307 and 6308 and inserting the following new items:
``6307. Grants to States and Indian Tribes to improve outreach to
veterans.
``6308. Outreach for eligible dependents.
``6309. Biennial report to Congress.''.
(c) Authorization of Appropriations.--There is authorized to be
appropriated to the Secretary of Veterans Affairs for each of fiscal
years 2026 and 2027, $10,000,000 to carry out section 6307 of title 38,
United States Code, as added by subsection (a).
SEC. 303. DEFINITION OF SURVIVING SPOUSE.
Paragraph (3) of section 101 of title 38, United States Code, is
amended to read as follows:
``(3) The term `surviving spouse' means (except for purposes of
chapter 19 of this title) a person who was the spouse of a veteran
at the time of the veteran's death, and who lived with the veteran
continuously from the date of marriage to the date of the veteran's
death (except where there was a separation which was due to the
misconduct of, or procured by, the veteran without the fault of the
spouse) and who has not remarried.''.
SEC. 304. ENSURING ONLY LICENSED HEALTH CARE PROFESSIONALS PERFORM
MEDICAL DISABILITY EXAMINATIONS UNDER CERTAIN DEPARTMENT OF
VETERANS AFFAIRS PILOT PROGRAM.
(a) Prohibition on Use of Certain Health Care Professionals.--
Section 504(c)(1) of the Veterans' Benefits Improvements Act of 1996
(Public Law 104-275; 38 U.S.C. 5101 note) is amended by inserting
``only'' before ``a health care professional''.
(b) Remedies.--The Secretary of Veterans Affairs shall take such
actions as the Secretary considers appropriate to ensure compliance
with section 504(c) of the Veterans' Benefits Improvements Act of 1996
(Public Law 104-275; 38 U.S.C. 5101 note), as amended by subsection
(a).
(c) Annual Report.--Not later than one year after the date of the
enactment of this Act and not less frequently than once each year
thereafter, the Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs of the
House of Representatives a report on--
(1) the conduct of the pilot program established under section
504 of the Veterans' Benefits Improvements Act of 1996 (Public Law
104-275; 38 U.S.C. 5101 note); and
(2) the actions of the Secretary under subsection (b).
(d) Technical Corrections.--Section 504 of the Veterans' Benefits
Improvements Act of 1996 (Public Law 104-275; 38 U.S.C. 5101 note) is
amended, in the section heading, by striking ``physicians'' and
inserting ``health care professionals''.
SEC. 305. PROVISION OF INFORMATION REGARDING AN AGENT OR ATTORNEY
TO A LICENSED HEALTH CARE PROFESSIONAL WHO PERFORMS A MEDICAL
DISABILITY EXAMINATION UNDER CERTAIN DEPARTMENT OF VETERANS
AFFAIRS PILOT PROGRAM.
(a) In General.--Section 504 of the Veterans' Benefits Improvements
Act of 1996 (Public Law 104-275; 38 U.S.C. 5101 note), as amended by
section 304, is further amended by adding at the end the following new
subsection:
``(f) Certain Information Provided to Health Care Professional.--
The Secretary shall provide to a health care professional who performs
an examination under subsection (a), or a contractor performing a
contract under such subsection, the contact information of any agent or
attorney recognized by the Secretary under chapter 59 of title 38,
United States Code, with regards to a claim for benefits that gives
rise to such examination.''.
(b) Applicability.--The amendment made by this section shall apply
to an examination described in subsection (a) of such section that is
performed on or after the date of the enactment of this Act.
SEC. 306. MODERNIZATION OF DEPARTMENT OF VETERANS AFFAIRS
DISABILITY BENEFIT QUESTIONNAIRES.
(a) Requirement for Transmission of Certain Information in Machine-
readable Format.--
(1) Requirement.--Not later than 180 days after enactment of
this Act, the Secretary of Veterans Affairs shall require all
disability benefit questionnaire data collected in the course of
medical disability examinations made by covered non-Department
providers to be transmitted to the Department in a machine-readable
format.
(2) Issuance of standards.--Not later than 90 days after the
date of the enactment of this Act, the Secretary shall issue
standards for the transmission of disability benefit questionnaire
data in a machine-readable format as required under paragraph (1).
(3) Updates.--In making updates to disability benefit
questionnaires after the date specified in paragraph (1), the
Secretary shall--
(A) ensure that the updates are made in a manner that
allows for the data collected under the questionnaires to be in
a machine-readable format as of the date on which the update
goes into effect; and
(B) not later than 30 days before an update goes into
effect, notify the covered non-Department providers (or the
contractor performing a contract under section 504 of the
Veterans Benefits Improvement Act of 1996 (Public Law 104-275;
38 U.S.C. 5101 note)) described in such paragraph of such
updates.
(b) Plan for Information Technology System Modification.--Not later
than 180 days after the date of the enactment of this Act, the
Secretary shall submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a plan to modify the information
technology systems and processes of the Department to enable a non-
Department health care professional, assigned to or selected by a
claimant, to transmit to the Department, in a machine-readable format,
disability benefit questionnaire data, including complete disability
benefit questionnaires rather than partial questionnaires or elements
of medical evidence.
(c) Public Availability of Information.--The Secretary shall make
publicly available on the internet website of the Department referred
to in section 5101(d) of title 38, United States Code--
(1) a description of the standards issued under subsection
(a)(2); and
(2) the plan required under subsection (b).
(d) Definitions.--In this section:
(1) The term ``claimant'' has the meaning given such term in
section 5100 of title 38, United States Code.
(2) The term ``covered non-Department provider'' means a health
care provider who--
(A) is not an employee of the Department of Veterans
Affairs; and
(B) pursuant to a contract under section 504 of the
Veterans Benefits Improvement Act of 1996 (Public Law 104-275;
38 U.S.C. 5101 note), as amended by sections 304 and 305,
examines a claimant for a medical disability.
SEC. 307. DEPARTMENT OF VETERANS AFFAIRS AUTOMATIC PROCESSING OF
CERTAIN CLAIMS FOR TEMPORARY DISABILITY RATINGS.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall modify
the information technology systems of the Department of Veterans
Affairs to use automation technology for claims for temporary
disability ratings for veterans described in section 1156(a)(1)(C) of
title 38, United States Code.
(b) Additional Requirements.--In carrying out subsection (a), the
Secretary shall ensure that--
(1) medical evidence is obtained from the corporate data
warehouse of the Department or other sources of data, the Secretary
determines appropriate;
(2) employees of the Department continue to determine whether a
veteran is entitled to a temporary disability rating under section
1156(a)(1)(C) of title 38, United States Code; and
(3) claims may be processed manually if the evidence of record
is not sufficient to decide the claim or if the medical evidence is
provided in a format that is not compatible with the system
developed under subsection (a).
TITLE IV--HOMELESSNESS MATTERS
SEC. 401. SHORT TITLE.
This title may be cited as the ``Housing our Military Veterans
Effectively Act of 2024'' or the ``HOME Act of 2024''.
SEC. 402. PER DIEM PAYMENTS PROVIDED BY THE SECRETARY OF VETERANS
AFFAIRS FOR SERVICES FURNISHED TO HOMELESS VETERANS.
(a) In General.--Section 2012 of title 38, United States Code, is
amended--
(1) in subsection (a)--
(A) in paragraph (2)(B)--
(i) in clause (i)(II)(aa)(BB), by striking ``115
percent'' and inserting ``115 percent (or, during the
period beginning on the date of the enactment of the
Housing our Military Veterans Effectively Act of 2024 and
ending on September 30, 2027, 133 percent)''; and
(ii) by adding at the end the following:
``(iii) For each of fiscal years 2025 through 2027, the Secretary
may waive the maximum rate for per diem payments under clause
(i)(II)(aa)(BB) or (ii) and, subject to the availability of
appropriations, provide such payments at a rate that does not exceed
200 percent of 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, if the Secretary notifies Congress of such waiver.
``(iv) The Secretary may not, pursuant to clause (iii), waive the
maximum rate described in such clause for more than 50 percent of all
grant recipients and eligible entities for a fiscal year.''; and
(B) by adding at the end the following new paragraph:
``(4) The Secretary may not provide more than 12,000 per diem
payments under this section for a fiscal year.''; and
(2) by adding at the end the following new subsection:
``(f) Reports Required.--Not later than 90 days after the date of
the enactment of the HOME Act of 2024, and not less frequently than
twice each year 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 on the rate for per
diem payments under this section that includes, for each Veterans
Integrated Service Network of the Department, the following data:
``(1) The average rate for such a payment.
``(2) A list of locations where the rate for such a payment is
within 10 percent of the maximum rate for such a payment authorized
under this section.
``(3) The average length of stay by a veteran participating in
a program described in section 2012(a) of this title.''.
(b) Regulatory Authority.--The Secretary of Veterans Affairs may
carry out the amendments made by subsection (a) through interim
guidance in advance of the issuance of regulations for such purpose.
(c) Strategic Plan.--
(1) In general.--Not later than September 30, 2025, 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 strategic plan for the
provision of grants and per diem payments for services furnished to
homeless veterans under sections 2011 and 2012 of title 38, United
States Code.
(2) Elements.--The plan required by paragraph (1) shall include
the following:
(A) A method for administering grant funding equitably
without using the rate authorized for State homes for
domiciliary care under subsection (a)(1)(A) of section 1741 of
title 38, United States Code, as the Secretary may increase
from time to time under subsection (c) of that section, that
takes into account--
(i) the wide variety of services furnished by grant
recipients and eligible entities under sections 2011 and
2012 of title 38, United States Code;
(ii) varying costs of living across different
geographic locations;
(iii) varying availability of affordable housing in
different geographic locations;
(iv) circumstances of housing insecurity in rural and
Tribal communities;
(v) veterans with significant medical care needs; and
(vi) the changing dynamic of the veteran population
nationwide.
(B) A plan and timeline for implementation of the method
included under subparagraph (A).
(C) An estimate of increased costs or savings per year
under the plan.
(D) An overview of the different grants that will be
available once the plan is implemented.
SEC. 403. AUTHORIZATION FOR SECRETARY OF VETERANS AFFAIRS TO USE
CERTAIN FUNDS FOR IMPROVED FLEXIBILITY IN ASSISTANCE TO HOMELESS
VETERANS.
(a) Use of Funds.--During the period beginning on the date of the
enactment of this Act and ending on the termination date specified in
subsection (d), the Secretary of Veterans Affairs may provide to a
covered veteran, as the Secretary determines necessary--
(1) food, shelter, clothing, blankets, and hygiene items
required for the safety and survival of the veteran;
(2) transportation required to support the stability and health
of the veteran for appointments with service providers, the conduct
of housing and employment searches, and the obtainment of food and
supplies; and
(3) tablets, smartphones, disposable phones and other
technology, and related service plans required to support the
stability and health of the veteran through the maintenance of
contact with service providers, prospective landlords, and family
members.
(b) Homeless Veterans on Department of Veterans Affairs Land.--
(1) In general.--The Secretary may collaborate, to the extent
practicable, with one or more organizations to manage the use of
land of the Department of Veterans Affairs for homeless veterans
for living and sleeping.
(2) Forms of collaboration.--Collaboration under paragraph (1)
may include the provision by either the Secretary or the head of
the organization concerned of food services and security for
property, buildings, and other facilities owned or controlled by
the Department of Veterans Affairs.
(c) Report Required.--Not later than six months after the date of
the enactment of this Act, and annually thereafter until the date
specified in subsection (d), the Secretary shall submit to Congress a
report that includes, with respect to the period covered by such
report--
(1) a statement, disaggregated by each medical center of the
Department of Veterans Affairs, of the amount of funds under this
section--
(A) each such medical center requested from the Secretary;
and
(B) to which the Secretary provided each such medical
center;
(2) data, disaggregated by each such medical center, relating
to how each such medical center used amounts provided by the
Secretary under this section;
(3) the number of covered veterans to which the Secretary
provided assistance under this section;
(4) the total amount of assistance the Secretary provided to
covered veterans pursuant to subsection (a)(3) for communications
equipment, broken down by the type of equipment provided;
(5) the total amount of assistance the Secretary provided
covered veterans pursuant to subsection (a)(2) for ridesharing;
(6) the number of covered veterans who received such
assistance; and
(7) a description, for each rideshare used by a covered veteran
with such assistance, of the reasons such covered veteran used such
rideshare.
(8) the number of covered veterans who lived or slept on
Department land;
(9) the amount of funds used to make available Department land
for covered veterans to live and sleep;
(10) the number of Department employees whose primary
responsibilities involved providing services for covered veterans
living or sleeping on Department land;
(11) the average length of time a covered veteran lived or
slept on Department land, and
(12) the period of time the Secretary expects Department land
will be made available for covered veterans to live and sleep.
(d) Termination Date.--The termination date specified in this
subsection is September 30, 2027.
(e) Definitions.--In this section, the term ``covered veteran''
means--
(1) a homeless veteran, as such term is defined in section 2002
of title 38, United States Code; and
(2) a veteran participating in the program carried out under
section 8(o)(19) of the United States Housing Act of 1937 (42
U.S.C. 1437f(o)(19)).
SEC. 404. ACCESS TO DEPARTMENT OF VETERANS AFFAIRS TELEHEALTH
SERVICES.
(a) In General.--Subtitle VII of chapter 20 of title 38, United
States Code is amended by adding at the end the following new section:
``Sec. 2069. Access to telehealth services
``To the extent practicable, the Secretary shall ensure that
veterans participating in or receiving services from a program under
this chapter have access to telehealth services to which such veterans
are eligible under the laws administered by the Secretary, including by
ensuring that telehealth capabilities are available to--
``(1) such veterans;
``(2) case managers of the Department of programs for homeless
veterans authorized under this chapter; and
``(3) community-based service providers for homeless veterans
receiving funds from the Department through grants or contracts.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 20 of title 38, United States Code, is amended by adding at the
end the following new item:
``2069. Access to telehealth services.''.
TITLE V--OVERSIGHT AND INVESTIGATIONS MATTERS
SEC. 501. DEPARTMENT OF VETERANS AFFAIRS EMPLOYEE TRAINING
REGARDING OFFICE OF INSPECTOR GENERAL.
(a) Training.--The Secretary of Veterans Affairs shall require each
employee of the Department of Veterans Affairs who begins employment
with the Department on or after the date of the enactment of this Act
to receive training that the Inspector General of the Department shall
develop on the reporting of wrongdoing to, responding to requests from,
and the duty of cooperating with the Office of Inspector General of the
Department.
(b) Timing of Training.--In carrying out subsection (a), the
Secretary shall require each employee of the Department covered under
such subsection to undergo the training required by such subsection not
later than one year after the date on which the employee begins
employment with the Department.
(c) Elements.--Training developed and required under subsection (a)
shall include the following:
(1) Definition of the role, responsibilities, and legal
authority of the Inspector General of the Department and the duties
of employees of the Department for engaging with the Office of
Inspector General.
(2) Identification of Federal whistleblower protection rights,
including the right to report fraud, waste, abuse, and other
wrongdoing to Congress.
(3) Identification of the circumstances and mechanisms for
reporting fraud, waste, abuse, and other wrongdoing to the
Inspector General, including making confidential complaints to the
Inspector General.
(4) Identification of the prohibitions and remedies that help
to protect employees of the Department from retaliation when
reporting wrongdoing to the Inspector General.
(5) Recognition of opportunities to engage with staff of the
Office of Inspector General to improve programs, operations, and
services of the Department.
(6) Notification of the authority of the Inspector General to
subpoena the attendance and testimony of witnesses, including
former employees of the Department, as necessary to carry out the
duties of the Office of Inspector General under section 312 of
title 38, United States Code.
(d) Design and Update.--The Inspector General of the Department
shall design, and update as the Inspector General considers
appropriate, the training developed and required by subsection (a).
(e) System.--The Secretary shall provide, via the talent management
system of the Department, or successor system, the training developed
and required under subsection (a).
(f) Relation to Certain Training.--The Secretary shall ensure that
training developed and required under subsection (a) is separate and
distinct from training provided under section 733 of title 38, United
States Code.
(g) Notice to Employees.--The Secretary shall ensure that the
Inspector General is afforded the opportunity, not less frequently than
twice each year and more frequently if the Inspector General considers
appropriate under extraordinary circumstances, to use the electronic
mail system of the Department to notify all authorized users of such
system of the following:
(1) The roles and responsibilities of the employees of the
Department when engaging with the Office of Inspector General.
(2) The availability of training provided under subsection (a).
(3) How to access training provided under subsection (a).
(4) Information about how to contact the Office of Inspector
General, including a link to any website-based reporting form of
the Office.
SEC. 502. ANNUAL REVIEW OF SECURITY AT COVERED FACILITIES OF THE
DEPARTMENT OF VETERANS AFFAIRS.
(a) Annual Survey.--Not later than one year after the date of the
enactment of this Act, and annually thereafter for each of the
following five fiscal years, the Secretary of Veterans Affairs, in
coordination with the Director of the Office of Security and Law
Enforcement of the Department of Veterans Affairs, shall conduct a
survey of the covered employees at each covered facility to collect
information regarding security. Each annual survey shall include
questions about--
(1) the type and frequency of criminal activity experienced at
the covered facility during the fiscal year which most recently
concluded including whether or not the criminal activity was
related to residents at the facility or campus such as those in a
residential rehabilitation treatment program or enhanced-use lease
facility;
(2) the number of vacancies and number of days vacant for
Department police officers at the covered facility at the time of
the survey delineated by recruitment status and stage;
(3) the availability and adequacy of covered equipment;
(4) the availability and adequacy of resources, classes, or
other time set aside for training Department police officers who
work at each covered facility about any skill or tactic related to
law enforcement, including the proper use of force, firearms
qualifications and training, procedures for responding to an active
threat, and any other training required for Department police
officers;
(5) any security weakness at covered facilities;
(6) the relationship between the covered facility (including
the Department police officers who work at the covered facility)
and local, state, and federal law enforcement agencies including
what agreements or memorandums of understanding exist between each
covered facility and external law enforcement agencies;
(7) efforts by the personnel of the covered facility to address
and reduce criminal activity at, or in close proximity to, the
covered facility; and
(8) recommendations for the Secretary to better address and
reduce criminal activity at, or in close proximity to, covered
facilities so as to improve the safety of veterans, employees,
visitors, other authorized personnel, and the surrounding
community.
(b) Report.--Not later than 30 days after the end of the next full
Fiscal Year after the enactment of this Act and for each of the
following five fiscal years, the Secretary shall submit to each of the
Committees on Veterans' Affairs of the Senate and the House of
Representatives a report regarding the results of the surveys conducted
under subsection (a) during the previous fiscal year. The report shall
include--
(1) the results of the annual survey described under subsection
(a) for the year covered by the report;
(2) an analysis, made in coordination with the Director of the
Office of Security and Law Enforcement of such Department, each
director and police chief of a Veterans Integrated Service Network,
and the directors and police chiefs of the medical centers within
the Veterans Integrated Service Network of the results of the
triannual security inspections conducted in prior fiscal year, to
include a plan of action that describes how the Secretary plans to
address any security weakness identified in the results of the
triannual security inspections and includes clearly-stated goals
with measurable benchmarks for each goal and deadlines for each
benchmark; and
(3) a list of all vacant positions for police chief or deputy
police chief at each covered facility during the prior fiscal year,
the number of individuals who filled those positions over the two
years prior to the date of the survey, the number of days the
positions were vacant without someone serving in an acting
capacity, and the number of days the positions were filled by
individuals serving in an acting capacity.
(c) Definitions.--In this section:
(1) The term ``covered equipment'' means any item issued by the
Secretary of Veterans Affairs to a Department police officer
(including firearms, weapons detecting technology, ballistic vests,
body-worn cameras, and radios) for use in the provision of services
under section 902 of title 38, United States Code.
(2) The term ``covered employee'' means an employee of the
Department of Veterans Affairs who is employed and responsible for
security operations at a covered facility including a covered
facility's police chief, facility emergency management leader,
facility director, or person carrying out the responsibilities of
one of these positions in an acting capacity.
(3) The term ``covered facility'' means any facility of the
Department of Veterans Affairs where Department police officers
have jurisdiction.
(4) The term ``Department police officer'' is used as such term
as used in section 902 of title 38, United States Code.
(5) The term ``security weakness'' means a deficiency in the
facilities, staffing, or covered equipment at a covered facility
that a covered employee of the covered facility determines presents
a risk to the safety of visitors or staff, including an unsecured
door, inoperable security camera, unsecured police operations room,
a lack of security presence at an entrance to the covered facility,
and a lack of security presence in an area of the covered facility
or the grounds of the covered facility that the director of the
covered facility determines requires an increased security
presence.
SEC. 503. MODIFICATION OF CERTAIN HOUSING LOAN FEES.
The loan fee table in section 3729(b)(2) of title 38, United States
Code, is amended by striking ``November 29, 2031'' each place it
appears and inserting ``June 9, 2034''.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.