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113th Congress  }                                            {   Report
  2d Session    }        HOUSE OF REPRESENTATIVES            {  113-564

=======================================================================
 
        VETERANS ACCESS, CHOICE, AND ACCOUNTABILITY ACT OF 2014 

                                _______
                                

                 July 28, 2014.--Ordered to be printed

                                _______
                                

Mr. Miller of Florida, from the committee of conference, submitted the 
                               following

                           CONFERENCE REPORT

                        [To accompany H.R. 3230]

      The committee of conference on the disagreeing votes of 
the two Houses on the amendment of the House to the amendment 
of the Senate to the bill (H.R. 3230), making continuing 
appropriations during a Government shutdown to provide pay and 
allowances to members of the reserve components of the Armed 
Forces who perform inactive-duty training during such period, 
having met, after full and free conference, have agreed to 
recommend and do recommend to their respective Houses as 
follows:
      That the Senate recede from its disagreement to the 
amendment of the House and agree to the same with an amendment 
as follows:
      In lieu of the matter proposed to be inserted by the 
House amendment, insert the following:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Veterans 
Access, Choice, and Accountability Act of 2014''.
    (b) Table of Contents.--The table of contents for this Act 
is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Definitions.

 TITLE I--IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT OF VETERANS 
                            AFFAIRS PROVIDERS

Sec. 101. Expanded availability of hospital care and medical services 
          for veterans through the use of agreements with non-Department 
          of Veterans Affairs entities.
Sec. 102. Enhancement of collaboration between Department of Veterans 
          Affairs and Indian Health Service.
Sec. 103. Enhancement of collaboration between Department of Veterans 
          Affairs and Native Hawaiian health care systems.
Sec. 104. Reauthorization and modification of pilot program of enhanced 
          contract care authority for health care needs of veterans.
Sec. 105. Prompt payment by Department of Veterans Affairs.
Sec. 106. Transfer of authority for payments for hospital care, medical 
          services, and other health care from non-Department of 
          Veterans Affairs providers to the chief business office of the 
          Veterans Health Administration.

              TITLE II--HEALTH CARE ADMINISTRATIVE MATTERS

Sec. 201. Independent assessment of the health care delivery systems and 
          management processes of the Department of Veterans Affairs.
Sec. 202. Commission on Care.
Sec. 203. Technology task force on review of scheduling system and 
          software of the Department of Veterans Affairs.
Sec. 204. Improvement of access of veterans to mobile vet centers and 
          mobile medical centers of the Department of Veterans Affairs.
Sec. 205. Improved performance metrics for health care provided by 
          Department of Veterans Affairs.
Sec. 206. Improved transparency concerning health care provided by 
          Department of Veterans Affairs.
Sec. 207. Information for veterans on the credentials of Department of 
          Veterans Affairs physicians.
Sec. 208. Information in annual budget of the President on hospital care 
          and medical services furnished through expanded use of 
          contracts for such care.
Sec. 209. Prohibition on falsification of data concerning wait times and 
          quality measures at Department of Veterans Affairs.

   TITLE III--HEALTH CARE STAFFING, RECRUITMENT, AND TRAINING MATTERS

Sec. 301. Treatment of staffing shortage and biennial report on staffing 
          of medical facilities of the Department of Veterans Affairs.
Sec. 302. Extension and modification of certain programs within the 
          Department of Veterans Affairs Health Professionals 
          Educational Assistance Program.
Sec. 303. Clinic management training for employees at medical facilities 
          of the Department of Veterans Affairs.

             TITLE IV--HEALTH CARE RELATED TO SEXUAL TRAUMA

Sec. 401. Expansion of eligibility for sexual trauma counseling and 
          treatment to veterans on inactive duty training.
Sec. 402. Provision of counseling and treatment for sexual trauma by the 
          Department of Veterans Affairs to members of the Armed Forces.
Sec. 403. Reports on military sexual trauma.

                   TITLE V--OTHER HEALTH CARE MATTERS

Sec. 501. Extension of pilot program on assisted living services for 
          veterans with traumatic brain injury.

                 TITLE VI--MAJOR MEDICAL FACILITY LEASES

Sec. 601. Authorization of major medical facility leases.
Sec. 602. Budgetary treatment of Department of Veterans Affairs major 
          medical facilities leases.

                    TITLE VII--OTHER VETERANS MATTERS

Sec. 701. Expansion of Marine Gunnery Sergeant John David Fry 
          Scholarship.
Sec. 702. Approval of courses of education provided by public 
          institutions of higher learning for purposes of All-Volunteer 
          Force Educational Assistance Program and Post-9/11 Educational 
          Assistance conditional on in-State tuition rate for veterans.
Sec. 703. Extension of reduction in amount of pension furnished by 
          Department of Veterans Affairs for certain veterans covered by 
          Medicaid plans for services furnished by nursing facilities.
Sec. 704. Extension of requirement for collection of fees for housing 
          loans guaranteed by Secretary of Veterans Affairs.
Sec. 705. Limitation on awards and bonuses paid to employees of 
          Department of Veterans Affairs.
Sec. 706. Extension of authority to use income information.
Sec. 707. Removal of senior executives of the Department of Veterans 
          Affairs for performance or misconduct.

                        TITLE VIII--OTHER MATTERS

Sec. 801. Appropriation of amounts.
Sec. 802. Veterans Choice Fund.
Sec. 803. Emergency designations.

SEC. 2. DEFINITIONS.

    In this Act:
            (1) The term ``facility of the Department'' has the 
        meaning given the term ``facilities of the Department'' 
        in section 1701 of title 38, United States Code.
            (2) The terms ``hospital care'' and ``medical 
        services'' have the meanings given such terms in 
        section 1701 of title 38, United States Code.

TITLE I--IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT OF VETERANS 
                           AFFAIRS PROVIDERS

SEC. 101. EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL SERVICES 
                    FOR VETERANS THROUGH THE USE OF AGREEMENTS WITH 
                    NON-DEPARTMENT OF VETERANS AFFAIRS ENTITIES.

    (a) Expansion of Available Care and Services.--
            (1) Furnishing of care.--
                    (A) In general.--Hospital care and medical 
                services under chapter 17 of title 38, United 
                States Code, shall be furnished to an eligible 
                veteran described in subsection (b), at the 
                election of such veteran, through agreements 
                authorized under subsection (d), or any other 
                law administered by the Secretary of Veterans 
                Affairs, with entities specified in 
                subparagraph (B) for the furnishing of such 
                care and services to veterans.
                    (B) Entities specified.--The entities 
                specified in this subparagraph are the 
                following:
                            (i) Any health care provider that 
                        is participating in the Medicare 
                        program under title XVIII of the Social 
                        Security Act (42 U.S.C. 1395 et seq.).
                            (ii) Any Federally-qualified health 
                        center (as defined in section 
                        1905(l)(2)(B) of the Social Security 
                        Act (42 U.S.C. 1396d(l)(2)(B))).
                            (iii) The Department of Defense.
                            (iv) The Indian Health Service.
            (2) Choice of provider.--An eligible veteran who 
        makes an election under subsection (c) to receive 
        hospital care or medical services under this section 
        may select a provider of such care or services from 
        among the entities specified in paragraph (1)(B) that 
        are accessible to the veteran.
            (3) Coordination of care and services.--The 
        Secretary shall coordinate, through the Non-VA Care 
        Coordination Program of the Department of Veterans 
        Affairs, the furnishing of care and services under this 
        section to eligible veterans, including by ensuring 
        that an eligible veteran receives an appointment for 
        such care and services within the wait-time goals of 
        the Veterans Health Administration for the furnishing 
        of hospital care and medical services.
    (b) Eligible Veterans.--A veteran is an eligible veteran 
for purposes of this section if--
            (1)(A) as of August 1, 2014, the veteran is 
        enrolled in the patient enrollment system of the 
        Department of Veterans Affairs established and operated 
        under section 1705 of title 38, United States Code, 
        including any such veteran who has not received 
        hospital care or medical services from the Department 
        and has contacted the Department seeking an initial 
        appointment from the Department for the receipt of such 
        care or services; or
            (B) the veteran is eligible for hospital care and 
        medical services under section 1710(e)(1)(D) of such 
        title and is a veteran described in section 1710(e)(3) 
        of such title; and
            (2) the veteran--
                    (A) attempts, or has attempted, to schedule 
                an appointment for the receipt of hospital care 
                or medical services under chapter 17 of title 
                38, United States Code, but is unable to 
                schedule an appointment within the wait-time 
                goals of the Veterans Health Administration for 
                the furnishing of such care or services;
                    (B) resides more than 40 miles from the 
                medical facility of the Department, including a 
                community-based outpatient clinic, that is 
                closest to the residence of the veteran;
                    (C) resides--
                            (i) in a State without a medical 
                        facility of the Department that 
                        provides--
                                    (I) hospital care;
                                    (II) emergency medical 
                                services; and
                                    (III) surgical care rated 
                                by the Secretary as having a 
                                surgical complexity of 
                                standard; and
                            (ii) more than 20 miles from a 
                        medical facility of the Department 
                        described in clause (i); or
                    (D)(i) resides in a location, other than a 
                location in Guam, American Samoa, or the 
                Republic of the Philippines, that is 40 miles 
                or less from a medical facility of the 
                Department, including a community-based 
                outpatient clinic; and
                    (ii)(I) is required to travel by air, boat, 
                or ferry to reach each medical facility 
                described in clause (i) that is 40 miles or 
                less from the residence of the veteran; or
                    (II) faces an unusual or excessive burden 
                in accessing each medical facility described in 
                clause (i) that is 40 miles or less from the 
                residence of the veteran due to geographical 
                challenges, as determined by the Secretary.
    (c) Election and Authorization.--
            (1) In general.--In the case of an eligible veteran 
        described in subsection (b)(2)(A), the Secretary shall, 
        at the election of the eligible veteran--
                    (A) place such eligible veteran on an 
                electronic waiting list described in paragraph 
                (2) for an appointment for hospital care or 
                medical services the veteran has elected to 
                receive under this section; or
                    (B)(i) authorize that such care or services 
                be furnished to the eligible veteran under this 
                section for a period of time specified by the 
                Secretary; and
                    (ii) notify the eligible veteran by the 
                most effective means available, including 
                electronic communication or notification in 
                writing, describing the care or services the 
                eligible veteran is eligible to receive under 
                this section.
            (2) Electronic waiting list.--The electronic 
        waiting list described in this paragraph shall be 
        maintained by the Department and allow access by each 
        eligible veteran via www.myhealth.va.gov or any 
        successor website for the following purposes:
                    (A) To determine the place of such eligible 
                veteran on the waiting list.
                    (B) To determine the average length of time 
                an individual spends on the waiting list, 
                disaggregated by medical facility of the 
                Department and type of care or service needed, 
                for purposes of allowing such eligible veteran 
                to make an informed election under paragraph 
                (1).
    (d) Care and Services Through Agreements.--
            (1) Agreements.--
                    (A) In general.--The Secretary shall enter 
                into agreements for furnishing care and 
                services to eligible veterans under this 
                section with entities specified in subsection 
                (a)(1)(B).
                    (B) Agreement defined.--In this paragraph, 
                the term ``agreement'' includes contracts, 
                intergovernmental agreements, and provider 
                agreements, as appropriate.
            (2) Rates and reimbursement.--
                    (A) In general.--In entering into an 
                agreement under paragraph (1) with an entity 
                specified in subsection (a)(1)(B), the 
                Secretary shall--
                            (i) negotiate rates for the 
                        furnishing of care and services under 
                        this section; and
                            (ii) reimburse the entity for such 
                        care and services at the rates 
                        negotiated pursuant to clause (i) as 
                        provided in such agreement.
                    (B) Limit on rates.--
                            (i) In general.--Except as provided 
                        in clause (ii), rates negotiated under 
                        subparagraph (A)(i) shall not be more 
                        than the rates paid by the United 
                        States to a provider of services (as 
                        defined in section 1861(u) of the 
                        Social Security Act (42 U.S.C. 
                        1395x(u))) or a supplier (as defined in 
                        section 1861(d) of such Act (42 U.S.C. 
                        1395x(d))) under the Medicare program 
                        under title XVIII of the Social 
                        Security Act (42 U.S.C. 1395 et seq.) 
                        for the same care or services.
                            (ii) Exception.--
                                    (I) In general.--The 
                                Secretary may negotiate a rate 
                                that is more than the rate paid 
                                by the United States as 
                                described in clause (i) with 
                                respect to the furnishing of 
                                care or services under this 
                                section to an eligible veteran 
                                who resides in a highly rural 
                                area.
                                    (II) Highly rural area 
                                defined.--In this clause, the 
                                term ``highly rural area'' 
                                means an area located in a 
                                county that has fewer than 
                                seven individuals residing in 
                                that county per square mile.
                    (C) Limit on collection.--For the 
                furnishing of care or services pursuant to an 
                agreement under paragraph (1), an entity 
                specified in subsection (a)(1)(B) may not 
                collect any amount that is greater than the 
                rate negotiated pursuant to subparagraph 
                (A)(i).
            (3) Certain procedures.--
                    (A) In general.--In entering into an 
                agreement under paragraph (1) with an entity 
                described in subparagraph (B), the Secretary 
                may use the procedures, including those 
                procedures relating to reimbursement, available 
                for entering into provider agreements under 
                section 1866(a) of the Social Security Act (42 
                U.S.C. 1395cc(a)). During the period in which 
                such entity furnishes care or services pursuant 
                to this section, such entity may not be treated 
                as a Federal contractor or subcontractor by the 
                Office of Federal Contract Compliance Programs 
                of the Department of Labor by virtue of 
                furnishing such care or services.
                    (B) Entities described.--The entities 
                described in this subparagraph are the 
                following:
                            (i) In the case of the Medicare 
                        program, any provider of service that 
                        has entered into a provider agreement 
                        under section 1866(a) of the Social 
                        Security Act (42 U.S.C. 1395cc(a)); and
                            (ii) In the case of the Medicaid 
                        program, any provider participating 
                        under a State plan under title XIX of 
                        such Act (42 U.S.C. 1396 et seq.).
            (4) Information on policies and procedures.--The 
        Secretary shall provide to any entity with which the 
        Secretary has entered into an agreement under paragraph 
        (1) the following:
                    (A) Information on applicable policies and 
                procedures for submitting bills or claims for 
                authorized care or services furnished to 
                eligible veterans under this section.
                    (B) Access to a telephone hotline 
                maintained by the Department that such entity 
                may call for information on the following:
                            (i) Procedures for furnishing care 
                        and services under this section.
                            (ii) Procedures for submitting 
                        bills or claims for authorized care and 
                        services furnished to eligible veterans 
                        under this section and being reimbursed 
                        for furnishing such care and services.
                            (iii) Whether particular care or 
                        services under this section are 
                        authorized, and the procedures for 
                        authorization of such care or services.
    (e) Other Health-care Plan.--
            (1) Submittal of information to secretary.--Before 
        receiving hospital care or medical services under this 
        section, an eligible veteran shall provide to the 
        Secretary information on any health-care plan described 
        in paragraph (4) under which the eligible veteran is 
        covered.
            (2) Disclosure of information to non-department 
        entity.--Notwithstanding section 5701 of title 38, 
        United States Code, for purposes of furnishing hospital 
        care or medical services to an eligible veteran under 
        this section, the Secretary shall disclose to the 
        entity specified in paragraph (1)(B) of subsection (a) 
        with which the Secretary has entered into an agreement 
        described in such subsection--
                    (A) whether the eligible veteran is covered 
                under a health-care plan described in paragraph 
                (4); and
                    (B) whether the hospital care or medical 
                services sought by the eligible veteran is for 
                a medical condition that is related to a non-
                service-connected disability described in 
                paragraph (3)(C).
            (3) Care for which the department is secondarily 
        responsible.--
                    (A) In general.--If an eligible veteran is 
                covered under a health-care plan described in 
                paragraph (4) and receives hospital care or 
                medical services for a non-service-connected 
                disability described in subparagraph (C), such 
                health-care plan shall be primarily responsible 
                for paying for such care or services, to the 
                extent such care or services is covered by such 
                health-care plan, and the Secretary shall be 
                secondarily responsible for paying for such 
                care or services in accordance with 
                subparagraph (B)(ii).
                    (B) Responsibility for costs of care.--In a 
                case in which the Secretary is secondarily 
                responsible for paying for hospital care or 
                medical services as described in subparagraph 
                (A)--
                            (i) the health care provider that 
                        furnishes such care or services 
                        pursuant to an agreement described in 
                        subsection (a) shall be responsible for 
                        seeking reimbursement for the cost of 
                        such care or services from the health-
                        care plan described in paragraph (4) 
                        under which the eligible veteran is 
                        covered; and
                            (ii) the Secretary shall be 
                        responsible for promptly paying only 
                        the amount that is not covered by such 
                        health-care plan, except that such 
                        responsibility for payment may not 
                        exceed the rate determined for such 
                        care or services pursuant to subsection 
                        (d)(2).
                    (C) Non-service-connected disability 
                described.--A non-service-connected disability 
                described in this subsection is a non-service-
                connected disability (as defined in section 101 
                of title 38, United States Code)--
                            (i) that is incurred incident to a 
                        veteran's employment and that is 
                        covered under a workers' compensation 
                        law or plan that provides for payment 
                        for the cost of health care and 
                        services provided to the veteran by 
                        reason of the disability;
                            (ii) that is incurred as the result 
                        of a motor vehicle accident to which 
                        applies a State law that requires the 
                        owners or operators of motor vehicles 
                        registered in that State to have in 
                        force automobile accident reparations 
                        insurance;
                            (iii) that is incurred as the 
                        result of a crime of personal violence 
                        that occurred in a State, or a 
                        political subdivision of a State, in 
                        which a person injured as the result of 
                        such a crime is entitled to receive 
                        health care and services at such 
                        State's or subdivision's expense for 
                        personal injuries suffered as the 
                        result of such crime;
                            (iv) that is incurred by a 
                        veteran--
                                    (I) who does not have a 
                                service-connected disability; 
                                and
                                    (II) who is entitled to 
                                care (or payment of the 
                                expenses of care) under a 
                                health-care plan; or
                            (v) for which care and services are 
                        furnished under this section to a 
                        veteran who--
                                    (I) has a service-connected 
                                disability; and
                                    (II) is entitled to care 
                                (or payment of the expenses of 
                                care) under a health-care plan.
            (4) Health-care plan.--A health-care plan described 
        in this paragraph--
                    (A) is an insurance policy or contract, 
                medical or hospital service agreement, 
                membership or subscription contract, or similar 
                arrangement not administered by the Secretary 
                of Veterans Affairs, under which health 
                services for individuals are provided or the 
                expenses of such services are paid; and
                    (B) does not include any such policy, 
                contract, agreement, or similar arrangement 
                pursuant to title XVIII or XIX of the Social 
                Security Act (42 U.S.C. 1395 et seq.) or 
                chapter 55 of title 10, United States Code.
    (f) Veterans Choice Card.--
            (1) In general.--For purposes of receiving care and 
        services under this section, the Secretary shall, not 
        later than 90 days after the date of the enactment of 
        this Act, issue to each veteran described in subsection 
        (b)(1) a card that may be presented to a health care 
        provider to facilitate the receipt of care or services 
        under this section.
            (2) Name of card.--Each card issued under paragraph 
        (1) shall be known as a ``Veterans Choice Card''.
            (3) Details of card.--Each Veterans Choice Card 
        issued to a veteran under paragraph (1) shall include 
        the following:
                    (A) The name of the veteran.
                    (B) An identification number for the 
                veteran that is not the social security number 
                of the veteran.
                    (C) The contact information of an 
                appropriate office of the Department for health 
                care providers to confirm that care or services 
                under this section are authorized for the 
                veteran.
                    (D) Contact information and other relevant 
                information for the submittal of claims or 
                bills for the furnishing of care or services 
                under this section.
                    (E) The following statement: ``This card is 
                for qualifying medical care outside the 
                Department of Veterans Affairs. Please call the 
                Department of Veterans Affairs phone number 
                specified on this card to ensure that treatment 
                has been authorized.''.
            (4) Information on use of card.--Upon issuing a 
        Veterans Choice Card to a veteran, the Secretary shall 
        provide the veteran with information clearly stating 
        the circumstances under which the veteran may be 
        eligible for care or services under this section.
    (g) Information on Availability of Care.--The Secretary 
shall provide information to a veteran about the availability 
of care and services under this section in the following 
circumstances:
            (1) In the case of a veteran described in 
        subsection (b)(1)(B), when the veteran enrolls in the 
        patient enrollment system of the Department under 
        section 1705 of title 38, United States Code.
            (2) When the veteran attempts to schedule an 
        appointment for the receipt of hospital care or medical 
        services from the Department but is unable to schedule 
        an appointment within the wait-time goals of the 
        Veterans Health Administration for the furnishing of 
        such care or services.
            (3) When the veteran becomes eligible for hospital 
        care or medical services under this section under 
        subparagraph (B), (C), or (D) of subsection (b)(2).
    (h) Follow-Up Care.--In carrying out this section, the 
Secretary shall ensure that, at the election of an eligible 
veteran who receives hospital care or medical services from a 
health care provider in an episode of care under this section, 
the veteran receives such hospital care and medical services 
from such health care provider through the completion of the 
episode of care (but for a period not exceeding 60 days), 
including all specialty and ancillary services deemed necessary 
as part of the treatment recommended in the course of such 
hospital care or medical services.
    (i) Providers.--To be eligible to furnish care or services 
under this section, a health care provider must--
            (1) maintain at least the same or similar 
        credentials and licenses as those credentials and 
        licenses that are required of health care providers of 
        the Department, as determined by the Secretary for 
        purposes of this section; and
            (2) submit, not less frequently than once each year 
        during the period in which the Secretary is authorized 
        to carry out this section pursuant to subsection (p), 
        verification of such licenses and credentials 
        maintained by such health care provider.
    (j) Cost-sharing.--
            (1) In general.--The Secretary shall require an 
        eligible veteran to pay a copayment for the receipt of 
        care or services under this section only if such 
        eligible veteran would be required to pay a copayment 
        for the receipt of such care or services at a medical 
        facility of the Department or from a health care 
        provider of the Department pursuant to chapter 17 of 
        title 38, United States Code.
            (2) Limitation.--The amount of a copayment charged 
        under paragraph (1) may not exceed the amount of the 
        copayment that would be payable by such eligible 
        veteran for the receipt of such care or services at a 
        medical facility of the Department or from a health 
        care provider of the Department pursuant to chapter 17 
        of title 38, United States Code.
            (3) Collection of copayment.--A health care 
        provider that furnishes care or services to an eligible 
        veteran under this section shall collect the copayment 
        required under paragraph (1) from such eligible veteran 
        at the time of furnishing such care or services.
    (k) Claims Processing System.--
            (1) In general.--The Secretary shall provide for an 
        efficient nationwide system for processing and paying 
        bills or claims for authorized care and services 
        furnished to eligible veterans under this section.
            (2) Regulations.--Not later than 90 days after the 
        date of the enactment of this Act, the Secretary of 
        Veterans Affairs shall prescribe regulations for the 
        implementation of such system.
            (3) Oversight.--The Chief Business Office of the 
        Veterans Health Administration shall oversee the 
        implementation and maintenance of such system.
            (4) Accuracy of payment.--
                    (A) In general.--The Secretary shall ensure 
                that such system meets such goals for accuracy 
                of payment as the Secretary shall specify for 
                purposes of this section.
                    (B) Quarterly report.--
                            (i) In general.--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 quarterly 
                        report on the accuracy of such system.
                            (ii) Elements.--Each report 
                        required by clause (i) shall include 
                        the following:
                                    (I) A description of the 
                                goals for accuracy for such 
                                system specified by the 
                                Secretary under subparagraph 
                                (A).
                                    (II) An assessment of the 
                                success of the Department in 
                                meeting such goals during the 
                                quarter covered by the report.
                            (iii) Deadline.--The Secretary 
                        shall submit each report required by 
                        clause (i) not later than 20 days after 
                        the end of the quarter covered by the 
                        report.
    (l) Medical Records.--
            (1) In general.--The Secretary shall ensure that 
        any health care provider that furnishes care or 
        services under this section to an eligible veteran 
        submits to the Department any medical record related to 
        the care or services provided to such eligible veteran 
        by such health care provider for inclusion in the 
        electronic medical record of such eligible veteran 
        maintained by the Department upon the completion of the 
        provision of such care or services to such eligible 
        veteran.
            (2) Electronic format.--Any medical record 
        submitted to the Department under paragraph (1) shall, 
        to the extent possible, be in an electronic format.
    (m) Tracking of Missed Appointments.--The Secretary shall 
implement a mechanism to track any missed appointments for care 
or services under this section by eligible veterans to ensure 
that the Department does not pay for such care or services that 
were not furnished to an eligible veteran.
    (n) Implementation.--Not later than 90 days after the date 
of the enactment of this Act, the Secretary shall prescribe 
interim final regulations on the implementation of this section 
and publish such regulations in the Federal Register.
    (o) Inspector General Report.--Not later than 30 days after 
the date on which the Secretary determines that 75 percent of 
the amounts deposited in the Veterans Choice Fund established 
by section 802 have been exhausted, the Inspector General of 
the Department shall submit to the Secretary a report on the 
results of an audit of the care and services furnished under 
this section to ensure the accuracy and timeliness of payments 
by the Department for the cost of such care and services, 
including any findings and recommendations of the Inspector 
General.
    (p) Authority to Furnish Care and Services.--
            (1) In general.--The Secretary may not use the 
        authority under this section to furnish care and 
        services after the date specified in paragraph (2).
            (2) Date specified.--The date specified in this 
        paragraph is the date on which the Secretary has 
        exhausted all amounts deposited in the Veterans Choice 
        Fund established by section 802, or the date that is 
        three years after the date of the enactment of this 
        Act, whichever occurs first.
            (3) Publication.--The Secretary shall publish such 
        date in the Federal Register and on an Internet website 
        of the Department available to the public not later 
        than 30 days before such date.
    (q) Reports.--
            (1) Initial report.--Not later than 90 days after 
        the publication of the interim final regulations under 
        subsection (n), 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 furnishing of care and 
        services under this section that includes the 
        following:
                    (A) The number of eligible veterans who 
                have received care or services under this 
                section.
                    (B) A description of the types of care and 
                services furnished to eligible veterans under 
                this section.
            (2) Final report.--Not later than 30 days after the 
        date on which the Secretary determines that 75 percent 
        of the amounts deposited in the Veterans Choice Fund 
        established by section 802 have been exhausted, 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 
        furnishing of care and services under this section that 
        includes the following:
                    (A) The total number of eligible veterans 
                who have received care or services under this 
                section, disaggregated by--
                            (i) eligible veterans described in 
                        subsection (b)(2)(A);
                            (ii) eligible veterans described in 
                        subsection (b)(2)(B);
                            (iii) eligible veterans described 
                        in subsection (b)(2)(C); and
                            (iv) eligible veterans described in 
                        subsection (b)(2)(D).
                    (B) A description of the types of care and 
                services furnished to eligible veterans under 
                this section.
                    (C) An accounting of the total cost of 
                furnishing care and services to eligible 
                veterans under this section.
                    (D) The results of a survey of eligible 
                veterans who have received care or services 
                under this section on the satisfaction of such 
                eligible veterans with the care or services 
                received by such eligible veterans under this 
                section.
                    (E) An assessment of the effect of 
                furnishing care and services under this section 
                on wait times for appointments for the receipt 
                of hospital care and medical services from the 
                Department.
                    (F) An assessment of the feasibility and 
                advisability of continuing furnishing care and 
                services under this section after the 
                termination date specified in subsection (p).
    (r) Rule of Construction.--Nothing in this section shall be 
construed to alter the process of the Department for filling 
and paying for prescription medications.
    (s) Wait-time Goals of the Veterans Health 
Administration.--
            (1) In general.--Except as provided in paragraph 
        (2), in this section, the term ``wait-time goals of the 
        Veterans Health Administration'' means not more than 30 
        days from the date on which a veteran requests an 
        appointment for hospital care or medical services from 
        the Department.
            (2) Alternate goals.--If the Secretary submits to 
        Congress, not later than 60 days after the date of the 
        enactment of this Act, a report stating that the actual 
        wait-time goals of the Veterans Health Administration 
        are different from the wait-time goals specified in 
        paragraph (1)--
                    (A) for purposes of this section, the wait-
                time goals of the Veterans Health 
                Administration shall be the wait-time goals 
                submitted by the Secretary under this 
                paragraph; and
                    (B) the Secretary shall publish such wait-
                time goals in the Federal Register and on an 
                Internet website of the Department available to 
                the public.

SEC. 102. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF VETERANS 
                    AFFAIRS AND INDIAN HEALTH SERVICE.

    (a) Outreach to Tribal-Run Medical Facilities.--The 
Secretary of Veterans Affairs shall, in consultation with the 
Director of the Indian Health Service, conduct outreach to each 
medical facility operated by an Indian tribe or tribal 
organization through a contract or compact with the Indian 
Health Service under the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et seq.) to raise 
awareness of the ability of such facilities, Indian tribes, and 
tribal organizations to enter into agreements with the 
Department of Veterans Affairs under which the Secretary 
reimburses such facilities, Indian tribes, or tribal 
organizations, as the case may be, for health care provided to 
veterans who are--
            (1) eligible for health care at such facilities; 
        and
            (2)(A) enrolled in the patient enrollment system of 
        the Department established and operated under section 
        1705 of title 38, United States Code; or
            (B) eligible for hospital care and medical services 
        pursuant to subsection (c)(2) of such section.
    (b) Performance Metrics for Memorandum of Understanding.--
The Secretary of Veterans Affairs shall establish performance 
metrics for assessing the performance by the Department of 
Veterans Affairs and the Indian Health Service under the 
memorandum of understanding entitled ``Memorandum of 
Understanding between the Department of Veterans Affairs (VA) 
and the Indian Health Service (IHS)'' in increasing access to 
health care, improving quality and coordination of health care, 
promoting effective patient-centered collaboration and 
partnerships between the Department and the Service, and 
ensuring health-promotion and disease-prevention services are 
appropriately funded and available for beneficiaries under both 
health care systems.
    (c) Report.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs and 
the Director of the Indian Health Service shall jointly submit 
to Congress a report on the feasibility and advisability of the 
following:
            (1) Entering into agreements for the reimbursement 
        by the Secretary of the costs of direct care services 
        provided through organizations receiving amounts 
        pursuant to grants made or contracts entered into under 
        section 503 of the Indian Health Care Improvement Act 
        (25 U.S.C. 1653) to veterans who are otherwise eligible 
        to receive health care from such organizations.
            (2) Including the reimbursement of the costs of 
        direct care services provided to veterans who are not 
        Indians in agreements between the Department and the 
        following:
                    (A) The Indian Health Service.
                    (B) An Indian tribe or tribal organization 
                operating a medical facility through a contract 
                or compact with the Indian Health Service under 
                the Indian Self-Determination and Education 
                Assistance Act (25 U.S.C. 450 et seq.).
                    (C) A medical facility of the Indian Health 
                Service.
    (d) Definitions.--In this section:
            (1) Indian.--The terms ``Indian'' and ``Indian 
        tribe'' have the meanings given those terms in section 
        4 of the Indian Health Care Improvement Act (25 U.S.C. 
        1603).
            (2) Medical facility of the indian health 
        service.--The term ``medical facility of the Indian 
        Health Service'' includes a facility operated by an 
        Indian tribe or tribal organization through a contract 
        or compact with the Indian Health Service under the 
        Indian Self-Determination and Education Assistance Act 
        (25 U.S.C. 450 et seq.).
            (3) Tribal organization.--The term ``tribal 
        organization'' has the meaning given the term in 
        section 4 of the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450b).

SEC. 103. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF VETERANS 
                    AFFAIRS AND NATIVE HAWAIIAN HEALTH CARE SYSTEMS.

    (a) In General.--The Secretary of Veterans Affairs shall, 
in consultation with Papa Ola Lokahi and such other 
organizations involved in the delivery of health care to Native 
Hawaiians as the Secretary considers appropriate, enter into 
contracts or agreements with Native Hawaiian health care 
systems that are in receipt of funds from the Secretary of 
Health and Human Services pursuant to grants awarded or 
contracts entered into under section 6(a) of the Native 
Hawaiian Health Care Improvement Act (42 U.S.C. 11705(a)) for 
the reimbursement of direct care services provided to eligible 
veterans as specified in such contracts or agreements.
    (b) Definitions.--In this section, the terms ``Native 
Hawaiian'', ``Native Hawaiian health care system'', and ``Papa 
Ola Lokahi'' have the meanings given those terms in section 12 
of the Native Hawaiian Health Care Improvement Act (42 U.S.C. 
11711).

SEC. 104. REAUTHORIZATION AND MODIFICATION OF PILOT PROGRAM OF ENHANCED 
                    CONTRACT CARE AUTHORITY FOR HEALTH CARE NEEDS OF 
                    VETERANS.

    Section 403 of the Veterans' Mental Health and Other Care 
Improvements Act of 2008 (Public Law 110-387; 38 U.S.C. 1703 
note) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (3), by striking ``only 
                during the'' and all that follows through the 
                period at the end and inserting ``only during 
                the period beginning on the date of the 
                commencement of the pilot program under 
                paragraph (2) and ending on the date that is 
                two years after the date of the enactment of 
                the Veterans Access, Choice, and Accountability 
                Act of 2014.''; and
                    (B) by amending paragraph (4) to read as 
                follows:
            ``(4) Program locations.--The Secretary shall carry 
        out the pilot program at locations in the following 
        Veterans Integrated Service Networks (and such other 
        locations as the Secretary considers appropriate):
                    ``(A) Veterans Integrated Service Network 
                1.
                    ``(B) Veterans Integrated Service Network 
                6.
                    ``(C) Veterans Integrated Service Network 
                15.
                    ``(D) Veterans Integrated Service Network 
                18.
                    ``(E) Veterans Integrated Service Network 
                19.'';
            (2) in subsection (b)(1)(A), by striking ``as of 
        the date of the commencement of the pilot program under 
        subsection (a)(2)'' and inserting ``as of August 1, 
        2014'';
            (3) by redesignating subsection (h) as subsection 
        (k);
            (4) by inserting after subsection (g) the following 
        new subsections:
    ``(h) Appointments.--In carrying out the pilot program 
under this section, the Secretary shall ensure that medical 
appointments for covered veterans--
            ``(1) are scheduled not later than 5 days after the 
        date on which the appointment is requested; and
            ``(2) occur not later than 30 days after such date.
    ``(i) Outreach.--The Secretary shall ensure that covered 
veterans are informed about the pilot program under this 
section.
    ``(j) Use of Existing Contracts.--In carrying out the pilot 
program under this section after the date of the enactment of 
the Veterans Access, Choice, and Accountability Act of 2014, 
the Secretary shall make use of contracts entered into before 
such date or may enter into new contracts.''; and
            (5) in paragraph (2)(B) of subsection (k), as 
        redesignated by paragraph (3) of this section, by 
        striking the semicolon at the end and inserting ``; 
        and''.

SEC. 105. PROMPT PAYMENT BY DEPARTMENT OF VETERANS AFFAIRS.

    (a) Sense of Congress on Prompt Payment by Department.--It 
is the sense of Congress that the Secretary of Veterans Affairs 
shall comply with section 1315 of title 5, Code of Federal 
Regulations (commonly known as the ``prompt payment rule''), or 
any corresponding similar regulation or ruling, in paying for 
health care pursuant to contracts entered into with non-
Department of Veterans Affairs providers to provide health care 
under the laws administered by the Secretary.
    (b) Establishment of Claims Processing System.--
            (1) Claims processing system.--The Secretary of 
        Veterans Affairs shall establish and implement a system 
        to process and pay claims for payment for hospital 
        care, medical services, and other health care furnished 
        by non-Department of Veterans Affairs health care 
        providers under the laws administered by the Secretary.
            (2) Compliance with prompt payment act.--The system 
        established and implemented under paragraph (1) shall 
        comply with all requirements of chapter 39, United 
        States Code (commonly referred to as the ``Prompt 
        Payment Act'').
    (c) Report.--Not later than one year after the date of the 
enactment of this Act, the Comptroller General of the United 
States shall submit to Congress a report on the timeliness of 
payments by the Secretary for hospital care, medical services, 
and other health care furnished by non-Department of Veterans 
Affairs health care providers under the laws administered by 
the Secretary.
    (d) Elements.--The report required by subsection (b) shall 
include the following:
            (1) The results of a survey of non-Department 
        health care providers who have submitted claims to the 
        Department for hospital care, medical services, or 
        other health care furnished to veterans for which 
        payment is authorized under the laws administered by 
        the Secretary during the one-year period preceding the 
        submittal of the report, which survey shall include the 
        following:
                    (A) The amount of time it took for such 
                health care providers, after submitting such 
                claims, to receive payment from the Department 
                for such care or services.
                    (B) A comparison of the amount of time 
                under subparagraph (A) and the amount of time 
                it takes such health care providers to receive 
                payments from the United States for similar 
                care or services provided to the following, if 
                applicable:
                            (i) Beneficiaries under the 
                        Medicare program under title XVIII of 
                        the Social Security Act (42 U.S.C. 1395 
                        et seq.).
                            (ii) Covered beneficiaries under 
                        the TRICARE program under chapter 55 of 
                        title 10, United States Code.
            (2) Such recommendations for legislative or 
        administrative action as the Comptroller General 
        considers appropriate.
    (e) Survey Elements.--In carrying out the survey, the 
Comptroller General shall seek responses from non-Department 
health care providers in a manner that ensures that the survey 
reflects the responses of such providers that--
            (1) are located in different geographic areas;
            (2) furnish a variety of different hospital care, 
        medical services, and other health care; and
            (3) furnish such care and services in a variety of 
        different types of medical facilities.

SEC. 106. TRANSFER OF AUTHORITY FOR PAYMENTS FOR HOSPITAL CARE, MEDICAL 
                    SERVICES, AND OTHER HEALTH CARE FROM NON-DEPARTMENT 
                    OF VETERANS AFFAIRS PROVIDERS TO THE CHIEF BUSINESS 
                    OFFICE OF THE VETERANS HEALTH ADMINISTRATION.

    (a) Transfer of Authority.--
            (1) In general.--Effective as of October 1, 2014, 
        the Secretary of Veterans Affairs shall transfer the 
        authority to pay for hospital care, medical services, 
        and other health care furnished through non-Department 
        of Veterans Affairs providers from--
                    (A) the Veterans Integrated Service 
                Networks and medical centers of the Department 
                of Veterans Affairs, to
                    (B) the Chief Business Office of the 
                Veterans Health Administration of the 
                Department of Veterans Affairs.
            (2) Manner of care.--The Chief Business Office 
        shall work in consultation with the Office of Clinical 
        Operations and Management of the Department to ensure 
        that care and services described in paragraph (1) are 
        provided in a manner that is clinically appropriate and 
        in the best interest of the veterans receiving such 
        care and services.
            (3) No delay in payment.--The transfer of authority 
        under paragraph (1) shall be carried out in a manner 
        that does not delay or impede any payment by the 
        Department for hospital care, medical services, or 
        other health care furnished through a non-Department 
        provider under the laws administered by the Secretary.
    (b) Budget Matters.--The budget of the Department of 
Veterans Affairs for any fiscal year beginning after the date 
of the enactment of this Act (as submitted to Congress pursuant 
to section 1105(a) of title 31, United States Code) shall 
specify funds for the payment for hospital care, medical 
services, and other health care furnished through non-
Department of Veterans Affairs providers, including any 
administrative costs associated with such payment, as funds for 
the Chief Business Office of the Veterans Health Administration 
rather than as funds for the Veterans Integrated Service 
Networks or medical centers of the Department.

              TITLE II--HEALTH CARE ADMINISTRATIVE MATTERS

SEC. 201. INDEPENDENT ASSESSMENT OF THE HEALTH CARE DELIVERY SYSTEMS 
                    AND MANAGEMENT PROCESSES OF THE DEPARTMENT OF 
                    VETERANS AFFAIRS.

    (a) Independent Assessment.--
            (1) Assessment.--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 or entities described in 
        subsection (b) to conduct an independent assessment of 
        the hospital care, medical services, and other health 
        care furnished in medical facilities of the Department. 
        Such assessment shall address each of the following:
                    (A) Current and projected demographics and 
                unique health care needs of the patient 
                population served by the Department.
                    (B) Current and projected health care 
                capabilities and resources of the Department, 
                including hospital care, medical services, and 
                other health care furnished by non-Department 
                facilities under contract with the Department, 
                to provide timely and accessible care to 
                veterans.
                    (C) The authorities and mechanisms under 
                which the Secretary may furnish hospital care, 
                medical services, and other health care at non-
                Department facilities, including whether the 
                Secretary should have the authority to furnish 
                such care and services at such facilities 
                through the completion of episodes of care.
                    (D) The appropriate system-wide access 
                standard applicable to hospital care, medical 
                services, and other health care furnished by 
                and through the Department, including an 
                identification of appropriate access standards 
                for each individual specialty and post-care 
                rehabilitation.
                    (E) The workflow process at each medical 
                facility of the Department for scheduling 
                appointments for veterans to receive hospital 
                care, medical services, or other health care 
                from the Department.
                    (F) The organization, workflow processes, 
                and tools used by the Department to support 
                clinical staffing, access to care, effective 
                length-of-stay management and care transitions, 
                positive patient experience, accurate 
                documentation, and subsequent coding of 
                inpatient services.
                    (G) The staffing level at each medical 
                facility of the Department and the productivity 
                of each health care provider at such medical 
                facility, compared with health care industry 
                performance metrics, which may include an 
                assessment of any of the following:
                            (i) The case load of, and number of 
                        patients treated by, each health care 
                        provider at such medical facility 
                        during an average week.
                            (ii) The time spent by such health 
                        care provider on matters other than the 
                        case load of such health care provider, 
                        including time spent by such health 
                        care provider as follows:
                                    (I) At a medical facility 
                                that is affiliated with the 
                                Department.
                                    (II) Conducting research.
                                    (III) Training or 
                                supervising other health care 
                                professionals of the 
                                Department.
                    (H) The information technology strategies 
                of the Department with respect to furnishing 
                and managing health care, including an 
                identification of any weaknesses and 
                opportunities with respect to the technology 
                used by the Department, especially those 
                strategies with respect to clinical 
                documentation of episodes of hospital care, 
                medical services, and other health care, 
                including any clinical images and associated 
                textual reports, furnished by the Department in 
                Department or non-Department facilities.
                    (I) Business processes of the Veterans 
                Health Administration, including processes 
                relating to furnishing non-Department health 
                care, insurance identification, third-party 
                revenue collection, and vendor reimbursement, 
                including an identification of mechanisms as 
                follows:
                            (i) To avoid the payment of 
                        penalties to vendors.
                            (ii) To increase the collection of 
                        amounts owed to the Department for 
                        hospital care, medical services, or 
                        other health care provided by the 
                        Department for which reimbursement from 
                        a third party is authorized and to 
                        ensure that such amounts collected are 
                        accurate.
                            (iii) To increase the collection of 
                        any other amounts owed to the 
                        Department with respect to hospital 
                        care, medical services, and other 
                        health care and to ensure that such 
                        amounts collected are accurate.
                            (iv) To increase the accuracy and 
                        timeliness of Department payments to 
                        vendors and providers.
                    (J) The purchasing, distribution, and use 
                of pharmaceuticals, medical and surgical 
                supplies, medical devices, and health care 
                related services by the Department, including 
                the following:
                            (i) The prices paid for, 
                        standardization of, and use by the 
                        Department of the following:
                                    (I) Pharmaceuticals.
                                    (II) Medical and surgical 
                                supplies.
                                    (III) Medical devices.
                            (ii) The use by the Department of 
                        group purchasing arrangements to 
                        purchase pharmaceuticals, medical and 
                        surgical supplies, medical devices, and 
                        health care related services.
                            (iii) The strategy and systems used 
                        by the Department to distribute 
                        pharmaceuticals, medical and surgical 
                        supplies, medical devices, and health 
                        care related services to Veterans 
                        Integrated Service Networks and medical 
                        facilities of the Department.
                    (K) The process of the Department for 
                carrying out construction and maintenance 
                projects at medical facilities of the 
                Department and the medical facility leasing 
                program of the Department.
                    (L) The competency of leadership with 
                respect to culture, accountability, reform 
                readiness, leadership development, physician 
                alignment, employee engagement, succession 
                planning, and performance management.
            (2) Particular elements of certain assessments.--
                    (A) Scheduling assessment.--In carrying out 
                the assessment required by paragraph (1)(E), 
                the private sector entity or entities shall do 
                the following:
                            (i) Review all training materials 
                        pertaining to scheduling of 
                        appointments at each medical facility 
                        of the Department.
                            (ii) Assess whether all employees 
                        of the Department conducting tasks 
                        related to scheduling are properly 
                        trained for conducting such tasks.
                            (iii) Assess whether changes in the 
                        technology or system used in scheduling 
                        appointments are necessary to limit 
                        access to the system to only those 
                        employees that have been properly 
                        trained in conducting such tasks.
                            (iv) Assess whether health care 
                        providers of the Department are making 
                        changes to their schedules that hinder 
                        the ability of employees conducting 
                        such tasks to perform such tasks.
                            (v) Assess whether the 
                        establishment of a centralized call 
                        center throughout the Department for 
                        scheduling appointments at medical 
                        facilities of the Department would 
                        improve the process of scheduling such 
                        appointments.
                            (vi) Assess whether booking 
                        templates for each medical facility or 
                        clinic of the Department would improve 
                        the process of scheduling such 
                        appointments.
                            (vii) Assess any interim technology 
                        changes or attempts by Department to 
                        internally develop a long-term 
                        scheduling solutions with respect to 
                        the feasibility and cost effectiveness 
                        of such internally developed solutions 
                        compared to commercially available 
                        solutions.
                            (viii) Recommend actions, if any, 
                        to be taken by the Department to 
                        improve the process for scheduling such 
                        appointments, including the following:
                                    (I) Changes in training 
                                materials provided to employees 
                                of the Department with respect 
                                to conducting tasks related to 
                                scheduling such appointments.
                                    (II) Changes in monitoring 
                                and assessment conducted by the 
                                Department of wait times of 
                                veterans for such appointments.
                                    (III) Changes in the system 
                                used to schedule such 
                                appointments, including changes 
                                to improve how the Department--
                                            (aa) measures wait 
                                        times of veterans for 
                                        such appointments;
                                            (bb) monitors the 
                                        availability of health 
                                        care providers of the 
                                        Department; and
                                            (cc) provides 
                                        veterans the ability to 
                                        schedule such 
                                        appointments.
                                    (IV) Such other actions as 
                                the private sector entity or 
                                entities considers appropriate.
                    (B) Medical construction and maintenance 
                project and leasing program assessment.--In 
                carrying out the assessment required by 
                paragraph (1)(K), the private sector entity or 
                entities shall do the following:
                            (i) Review the process of the 
                        Department for identifying and 
                        designing proposals for construction 
                        and maintenance projects at medical 
                        facilities of the Department and leases 
                        for medical facilities of the 
                        Department.
                            (ii) Assess the process through 
                        which the Department determines the 
                        following:
                                    (I) That a construction or 
                                maintenance project or lease is 
                                necessary with respect to a 
                                medical facility or proposed 
                                medical facility of the 
                                Department.
                                    (II) The proper size of 
                                such medical facility or 
                                proposed medical facility with 
                                respect to treating veterans in 
                                the catchment area of such 
                                medical facility or proposed 
                                medical facility.
                            (iii) Assess the management 
                        processes of the Department with 
                        respect to the capital management 
                        programs of the Department, including 
                        processes relating to the methodology 
                        for construction and design of medical 
                        facilities of the Department, the 
                        management of projects relating to the 
                        construction and design of such 
                        facilities, and the activation of such 
                        facilities.
                            (iv) Assess the medical facility 
                        leasing program of the Department.
            (3) Timing.--The private sector entity or entities 
        carrying out the assessment required by paragraph (1) 
        shall complete such assessment not later than 240 days 
        after entering into the contract described in such 
        paragraph.
    (b) Private Sector Entities Described.--A private entity 
described in this subsection is a private entity that--
            (1) has experience and proven outcomes in 
        optimizing the performance of the health care delivery 
        systems of the Veterans Health Administration and the 
        private sector and in health care management; and
            (2) specializes in implementing large-scale 
        organizational and cultural transformations, especially 
        with respect to health care delivery systems.
    (c) Program Integrator.--
            (1) In general.--If the Secretary enters into 
        contracts with more than one private sector entity 
        under subsection (a), the Secretary shall designate one 
        such entity that is predominately a health care 
        organization as the program integrator.
            (2) Responsibilities.--The program integrator 
        designated pursuant to paragraph (1) shall be 
        responsible for coordinating the outcomes of the 
        assessments conducted by the private entities pursuant 
        to such contracts.
    (d) Report on Assessment.--
            (1) In general.--Not later than 60 days after 
        completing the assessment required by subsection (a), 
        the private sector entity or entities carrying out such 
        assessment shall submit to the Secretary of Veterans 
        Affairs, the Committee on Veterans' Affairs of the 
        Senate, the Committee on Veterans' Affairs of the House 
        of Representatives, and the Commission on Care 
        established under section 202 a report on the findings 
        and recommendations of the private sector entity or 
        entities with respect to such assessment.
            (2) Publication.--Not later than 30 days after 
        receiving the report under paragraph (1), the Secretary 
        shall publish such report in the Federal Register and 
        on an Internet website of the Department of Veterans 
        Affairs that is accessible to the public.
    (e) Non-department Facilities Defined.--In this section, 
the term ``non-Department facilities'' has the meaning given 
that term in section 1701 of title 38, United States Code.

SEC. 202. COMMISSION ON CARE.

    (a) Establishment of Commission.--
            (1) In general.--There is established a commission, 
        to be known as the ``Commission on Care'' (in this 
        section referred to as the ``Commission''), to examine 
        the access of veterans to health care from the 
        Department of Veterans Affairs and strategically 
        examine how best to organize the Veterans Health 
        Administration, locate health care resources, and 
        deliver health care to veterans during the 20-year 
        period beginning on the date of the enactment of this 
        Act.
            (2) Membership.--
                    (A) Voting members.--The Commission shall 
                be composed of 15 voting members who are 
                appointed as follows:
                            (i) Three members appointed by the 
                        Speaker of the House of 
                        Representatives, at least one of whom 
                        shall be a veteran.
                            (ii) Three members appointed by the 
                        Minority Leader of the House of 
                        Representatives, at least one of whom 
                        shall be a veteran.
                            (iii) Three members appointed by 
                        the Majority Leader of the Senate, at 
                        least one of whom shall be a veteran.
                            (iv) Three members appointed by the 
                        Minority Leader of the Senate, at least 
                        one of whom shall be a veteran.
                            (v) Three members appointed by the 
                        President, at least two of whom shall 
                        be veterans.
                    (B) Qualifications.--Of the members 
                appointed under subparagraph (A)--
                            (i) at least one member shall 
                        represent an organization recognized by 
                        the Secretary of Veterans Affairs for 
                        the representation of veterans under 
                        section 5902 of title 38, United States 
                        Code;
                            (ii) at least one member shall have 
                        experience as senior management for a 
                        private integrated health care system 
                        with an annual gross revenue of more 
                        than $50,000,000;
                            (iii) at least one member shall be 
                        familiar with government health care 
                        systems, including those systems of the 
                        Department of Defense, the Indian 
                        Health Service, and Federally-qualified 
                        health centers (as defined in section 
                        1905(l)(2)(B) of the Social Security 
                        Act (42 U.S.C. 1396d(l)(2)(B)));
                            (iv) at least one member shall be 
                        familiar with the Veterans Health 
                        Administration but shall not be 
                        currently employed by the Veterans 
                        Health Administration; and
                            (v) at least one member shall be 
                        familiar with medical facility 
                        construction and leasing projects 
                        carried out by government entities and 
                        have experience in the building trades, 
                        including construction, engineering, 
                        and architecture.
                    (C) Date.--The appointments of members of 
                the Commission shall be made not later than one 
                year after the date of the enactment of this 
                Act.
            (3) Period of appointment.--
                    (A) In general.--Members shall be appointed 
                for the life of the Commission.
                    (B) Vacancies.--Any vacancy in the 
                Commission shall not affect its powers, but 
                shall be filled in the same manner as the 
                original appointment.
            (4) Initial meeting.--Not later than 15 days after 
        the date on which eight voting members of the 
        Commission have been appointed, the Commission shall 
        hold its first meeting.
            (5) Meetings.--The Commission shall meet at the 
        call of the Chairperson.
            (6) Quorum.--A majority of the members of the 
        Commission shall constitute a quorum, but a lesser 
        number of members may hold hearings.
            (7) Chairperson and vice chairperson.--The 
        President shall designate a member of the commission to 
        serve as Chairperson of the Commission. The Commission 
        shall select a Vice Chairperson from among its members.
    (b) Duties of Commission.--
            (1) Evaluation and assessment.--The Commission 
        shall undertake a comprehensive evaluation and 
        assessment of access to health care at the Department 
        of Veterans Affairs.
            (2) Matters evaluated and assessed.--In undertaking 
        the comprehensive evaluation and assessment required by 
        paragraph (1), the Commission shall evaluate and assess 
        the results of the assessment conducted by the private 
        sector entity or entities under section 201, including 
        any findings, data, or recommendations included in such 
        assessment.
            (3) Reports.--The Commission shall submit to the 
        President, through the Secretary of Veterans Affairs, 
        reports as follows:
                    (A) Not later than 90 days after the date 
                of the initial meeting of the Commission, an 
                interim report on--
                            (i) the findings of the Commission 
                        with respect to the evaluation and 
                        assessment required by this subsection; 
                        and
                            (ii) such recommendations as the 
                        Commission may have for legislative or 
                        administrative action to improve access 
                        to health care through the Veterans 
                        Health Administration.
                    (B) Not later than 180 days after the date 
                of the initial meeting of the Commission, a 
                final report on--
                            (i) the findings of the Commission 
                        with respect to the evaluation and 
                        assessment required by this subsection; 
                        and
                            (ii) such recommendations as the 
                        Commission may have for legislative or 
                        administrative action to improve access 
                        to health care through the Veterans 
                        Health Administration.
    (c) Powers of the Commission.--
            (1) Hearings.--The Commission may hold such 
        hearings, sit and act at such times and places, take 
        such testimony, and receive such evidence as the 
        Commission considers advisable to carry out this 
        section.
            (2) Information from federal agencies.--The 
        Commission may secure directly from any Federal agency 
        such information as the Commission considers necessary 
        to carry out this section. Upon request of the 
        Chairperson of the Commission, the head of such agency 
        shall furnish such information to the Commission.
    (d) Commission Personnel Matters.--
            (1) Compensation of members.--
                    (A) In general.--Each member of the 
                Commission who is not an officer or employee of 
                the Federal Government shall be compensated at 
                a rate equal to the daily equivalent of the 
                annual rate of basic pay prescribed for level 
                IV of the Executive Schedule under section 5315 
                of title 5, United States Code, for each day 
                (including travel time) during which such 
                member is engaged in the performance of the 
                duties of the Commission.
                    (B) Officers or employees of the united 
                states.--All members of the Commission who are 
                officers or employees of the United States 
                shall serve without compensation in addition to 
                that received for their services as officers or 
                employees of the United States.
            (2) Travel expenses.--The members of the Commission 
        shall be allowed travel expenses, including per diem in 
        lieu of subsistence, at rates authorized for employees 
        of agencies under subchapter I of chapter 57 of title 
        5, United States Code, while away from their homes or 
        regular places of business in the performance of 
        services for the Commission.
            (3) Staff.--
                    (A) In general.--The Chairperson of the 
                Commission may, without regard to the civil 
                service laws and regulations, appoint and 
                terminate an executive director and such other 
                additional personnel as may be necessary to 
                enable the Commission to perform its duties. 
                The employment of an executive director shall 
                be subject to confirmation by the Commission.
                    (B) Compensation.--The Chairperson of the 
                Commission may fix the compensation of the 
                executive director and other personnel without 
                regard to chapter 51 and subchapter III of 
                chapter 53 of title 5, United States Code, 
                relating to classification of positions and 
                General Schedule pay rates, except that the 
                rate of pay for the executive director and 
                other personnel may not exceed the rate payable 
                for level V of the Executive Schedule under 
                section 5316 of such title.
            (4) Detail of government employees.--Any Federal 
        Government employee may be detailed to the Commission 
        without reimbursement, and such detail shall be without 
        interruption or loss of civil service status or 
        privilege.
            (5) Procurement of temporary and intermittent 
        services.--The Chairperson of the Commission may 
        procure temporary and intermittent services under 
        section 3109(b) of title 5, United States Code, at 
        rates for individuals that do not exceed the daily 
        equivalent of the annual rate of basic pay prescribed 
        for level V of the Executive Schedule under section 
        5316 of such title.
    (e) Termination of the Commission.--The Commission shall 
terminate 30 days after the date on which the Commission 
submits the report under subsection (b)(3)(B).
    (f) Funding.--The Secretary of Veterans Affairs shall make 
available to the Commission from amounts appropriated or 
otherwise made available to the Secretary such amounts as the 
Secretary and the Chairperson of the Commission jointly 
consider appropriate for the Commission to perform its duties 
under this section.
    (g) Executive Action.--
            (1) Action on recommendations.--The President shall 
        require the Secretary of Veterans Affairs and such 
        other heads of relevant Federal departments and 
        agencies to implement each recommendation set forth in 
        a report submitted under subsection (b)(3) that the 
        President--
                    (A) considers feasible and advisable; and
                    (B) determines can be implemented without 
                further legislative action.
            (2) Reports.--Not later than 60 days after the date 
        on which the President receives a report under 
        subsection (b)(3), the President shall submit to the 
        Committee on Veterans' Affairs of the Senate and the 
        Committee on Veterans' Affairs of the House of 
        Representatives and such other committees of Congress 
        as the President considers appropriate a report setting 
        forth the following:
                    (A) An assessment of the feasibility and 
                advisability of each recommendation contained 
                in the report received by the President.
                    (B) For each recommendation assessed as 
                feasible and advisable under subparagraph (A) 
                the following:
                            (i) Whether such recommendation 
                        requires legislative action.
                            (ii) If such recommendation 
                        requires legislative action, a 
                        recommendation concerning such 
                        legislative action.
                            (iii) A description of any 
                        administrative action already taken to 
                        carry out such recommendation.
                            (iv) A description of any 
                        administrative action the President 
                        intends to be taken to carry out such 
                        recommendation and by whom.

SEC. 203. TECHNOLOGY TASK FORCE ON REVIEW OF SCHEDULING SYSTEM AND 
                    SOFTWARE OF THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) Task Force Review.--
            (1) In general.--The Secretary of Veterans Affairs 
        shall, through the use of a technology task force, 
        conduct a review of the needs of the Department of 
        Veterans Affairs with respect to the scheduling system 
        and scheduling software of the Department of Veterans 
        Affairs that is used by the Department to schedule 
        appointments for veterans for hospital care, medical 
        services, and other health care from the Department.
            (2) Agreement.--
                    (A) In general.--The Secretary shall seek 
                to enter into an agreement with a technology 
                organization or technology organizations to 
                carry out the review required by paragraph (1).
                    (B) Prohibition on use of funds.--
                Notwithstanding any other provision of law, no 
                Federal funds may be used to assist the 
                technology organization or technology 
                organizations under subparagraph (A) in 
                carrying out the review required by paragraph 
                (1).
    (b) Report.--
            (1) In general.--Not later than 45 days after the 
        date of the enactment of this Act, the technology task 
        force required under subsection (a)(1) 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 setting forth the 
        findings and recommendations of the technology task 
        force regarding the needs of the Department with 
        respect to the scheduling system and scheduling 
        software of the Department described in such 
        subsection.
            (2) Elements.--The report required by paragraph (1) 
        shall include the following:
                    (A) Proposals for specific actions to be 
                taken by the Department to improve the 
                scheduling system and scheduling software of 
                the Department described in subsection (a)(1).
                    (B) A determination as to whether one or 
                more existing off-the-shelf systems would--
                            (i) meet the needs of the 
                        Department to schedule appointments for 
                        veterans for hospital care, medical 
                        services, and other health care from 
                        the Department; and
                            (ii) improve the access of veterans 
                        to such care and services.
            (3) Publication.--Not later than 30 days after the 
        receipt of the report required by paragraph (1), the 
        Secretary shall publish such report in the Federal 
        Register and on an Internet website of the Department 
        accessible to the public.
    (c) Implementation of Task Force Recommendations.--Not 
later than one year after the receipt of the report required by 
subsection (b)(1), the Secretary shall implement the 
recommendations set forth in such report that the Secretary 
considers are feasible, advisable, and cost effective.

SEC. 204. IMPROVEMENT OF ACCESS OF VETERANS TO MOBILE VET CENTERS AND 
                    MOBILE MEDICAL CENTERS OF THE DEPARTMENT OF 
                    VETERANS AFFAIRS.

    (a) Improvement of Access.--
            (1) In general.--The Secretary of Veterans Affairs 
        shall improve the access of veterans to telemedicine 
        and other health care through the use of mobile vet 
        centers and mobile medical centers of the Department of 
        Veterans Affairs by providing standardized requirements 
        for the operation of such centers.
            (2) Requirements.--The standardized requirements 
        required by paragraph (1) shall include the following:
                    (A) The number of days each mobile vet 
                center and mobile medical center of the 
                Department is expected to travel per year.
                    (B) The number of locations each center is 
                expected to visit per year.
                    (C) The number of appointments each center 
                is expected to conduct per year.
                    (D) The method and timing of notifications 
                given by each center to individuals in the area 
                to which the center is traveling, including 
                notifications informing veterans of the 
                availability to schedule appointments at the 
                center.
            (3) Use of telemedicine.--The Secretary shall 
        ensure that each mobile vet center and mobile medical 
        center of the Department has the capability to provide 
        telemedicine services.
    (b) Reports.--
            (1) In general.--Not later than one year after the 
        date of the enactment of this Act, and not later than 
        September 30 each year thereafter, the Secretary of 
        Veterans Affairs shall submit to the Committee on 
        Veterans' Affairs of the Senate and the Committee on 
        Veterans' Affairs of the House of Representatives a 
        report on access to health care through the use of 
        mobile vet centers and mobile medical centers of the 
        Department that includes statistics on each of the 
        requirements set forth in subsection (a)(2) for the 
        year covered by the report.
            (2) Elements.--Each report required by paragraph 
        (1) shall include the following:
                    (A) A description of the use of mobile vet 
                centers and mobile medical centers to provide 
                telemedicine services to veterans during the 
                year preceding the submittal of the report, 
                including the following:
                            (i) The number of days each mobile 
                        vet center and mobile medical center 
                        was open to provide such services.
                            (ii) The number of days each center 
                        traveled to a location other than the 
                        headquarters of the center to provide 
                        such services.
                            (iii) The number of appointments 
                        each center conducted to provide such 
                        services on average per month and in 
                        total during such year.
                    (B) An analysis of the effectiveness of 
                using mobile vet centers and mobile medical 
                centers to provide health care services to 
                veterans through the use of telemedicine.
                    (C) Any recommendations for an increase in 
                the number of mobile vet centers and mobile 
                medical centers of the Department.
                    (D) Any recommendations for an increase in 
                the telemedicine capabilities of each mobile 
                vet center and mobile medical center.
                    (E) The feasibility and advisability of 
                using temporary health care providers, 
                including locum tenens, to provide direct 
                health care services to veterans at mobile vet 
                centers and mobile medical centers.
                    (F) Such other recommendations on 
                improvement of the use of mobile vet centers 
                and mobile medical centers by the Department as 
                the Secretary considers appropriate.

SEC. 205. IMPROVED PERFORMANCE METRICS FOR HEALTH CARE PROVIDED BY 
                    DEPARTMENT OF VETERANS AFFAIRS.

    (a) Prohibition on Use of Scheduling and Wait-time Metrics 
in Determination of Performance Awards.--The Secretary of 
Veterans Affairs shall ensure that scheduling and wait-time 
metrics or goals are not used as factors in determining the 
performance of the following employees for purposes of 
determining whether to pay performance awards to such 
employees:
            (1) Directors, associate directors, assistant 
        directors, deputy directors, chiefs of staff, and 
        clinical leads of medical centers of the Department of 
        Veterans Affairs.
            (2) Directors, assistant directors, and quality 
        management officers of Veterans Integrated Service 
        Networks of the Department of Veterans Affairs.
    (b) Modification of Performance Plans.--
            (1) In general.--Not later than 30 days after the 
        date of the enactment of this Act, the Secretary shall 
        modify the performance plans of the directors of the 
        medical centers of the Department and the directors of 
        the Veterans Integrated Service Networks to ensure that 
        such plans are based on the quality of care received by 
        veterans at the health care facilities under the 
        jurisdictions of such directors.
            (2) Factors.--In modifying performance plans under 
        paragraph (1), the Secretary shall ensure that 
        assessment of the quality of care provided at health 
        care facilities under the jurisdiction of a director 
        described in paragraph (1) includes consideration of 
        the following:
                    (A) Recent reviews by the Joint Commission 
                (formerly known as the ``Joint Commission on 
                Accreditation of Healthcare Organizations'') of 
                such facilities.
                    (B) The number and nature of 
                recommendations concerning such facilities by 
                the Inspector General of the Department in 
                reviews conducted through the Combined 
                Assessment Program, in the reviews by the 
                Inspector General of community-based outpatient 
                clinics and primary care clinics, and in 
                reviews conducted through the Office of 
                Healthcare Inspections during the two most 
                recently completed fiscal years.
                    (C) The number of recommendations described 
                in subparagraph (B) that the Inspector General 
                of the Department determines have not been 
                carried out satisfactorily with respect to such 
                facilities.
                    (D) Reviews of such facilities by the 
                Commission on Accreditation of Rehabilitation 
                Facilities.
                    (E) The number and outcomes of 
                administrative investigation boards, root cause 
                analyses, and peer reviews conducted at such 
                facilities during the fiscal year for which the 
                assessment is being conducted.
                    (F) The effectiveness of any remedial 
                actions or plans resulting from any Inspector 
                General recommendations in the reviews and 
                analyses described in subparagraphs (A) through 
                (E).
            (3) Additional leadership positions.--To the degree 
        practicable, the Secretary shall assess the performance 
        of other employees of the Department in leadership 
        positions at Department medical centers, including 
        associate directors, assistant directors, deputy 
        directors, chiefs of staff, and clinical leads, and in 
        Veterans Integrated Service Networks, including 
        assistant directors and quality management officers, 
        using factors and criteria similar to those used in the 
        performance plans modified under paragraph (1).
    (c) Removal of Certain Performance Goals.--For each fiscal 
year that begins after the date of the enactment of this Act, 
the Secretary shall not include in the performance goals of any 
employee of a Veterans Integrated Service Network or medical 
center of the Department any performance goal that might 
disincentivize the payment of Department amounts to provide 
hospital care, medical services, or other health care through a 
non-Department provider.

SEC. 206. IMPROVED TRANSPARENCY CONCERNING HEALTH CARE PROVIDED BY 
                    DEPARTMENT OF VETERANS AFFAIRS.

    (a) Publication of Wait Times.--Not later than 90 days 
after the date of the enactment of this Act, the Secretary of 
Veterans Affairs shall publish in the Federal Register, and on 
a publicly accessible Internet website of each medical center 
of the Department of Veterans Affairs, the wait-times for the 
scheduling of an appointment in each Department facility by a 
veteran for the receipt of primary care, specialty care, and 
hospital care and medical services based on the general 
severity of the condition of the veteran. Whenever the wait-
times for the scheduling of such an appointment changes, the 
Secretary shall publish the revised wait-times--
            (1) on a publicly accessible Internet website of 
        each medical center of the Department by not later than 
        30 days after such change; and
            (2) in the Federal Register by not later than 90 
        days after such change.
    (b) Publicly Available Database of Patient Safety, Quality 
of Care, and Outcome Measures.--
            (1) In general.--Not later than 180 days after the 
        date of the enactment of this Act, the Secretary shall 
        develop and make available to the public a 
        comprehensive database containing all applicable 
        patient safety, quality of care, and outcome measures 
        for health care provided by the Department that are 
        tracked by the Secretary.
            (2) Update frequency.--The Secretary shall update 
        the database required by paragraph (1) not less 
        frequently than once each year.
            (3) Unavailable measures.--For all measures that 
        the Secretary would otherwise publish in the database 
        required by paragraph (1) but has not done so because 
        such measures are not available, the Secretary shall 
        publish notice in the database of the reason for such 
        unavailability and a timeline for making such measures 
        available in the database.
            (4) Accessibility.--The Secretary shall ensure that 
        the database required by paragraph (1) is accessible to 
        the public through the primary Internet website of the 
        Department and through each primary Internet website of 
        a Department medical center.
    (c) Hospital Compare Website of Department of Health and 
Human Services.--
            (1) Agreement required.--Not later than 180 days 
        after the date of the enactment of this Act, the 
        Secretary of Veterans Affairs shall enter into an 
        agreement with the Secretary of Health and Human 
        Services for the provision by the Secretary of Veterans 
        Affairs of such information as the Secretary of Health 
        and Human Services may require to report and make 
        publicly available patient quality and outcome 
        information concerning Department of Veterans Affairs 
        medical centers through the Hospital Compare Internet 
        website of the Department of Health and Human Services 
        or any successor Internet website.
            (2) Information provided.--The information provided 
        by the Secretary of Veterans Affairs to the Secretary 
        of Health and Human Services under paragraph (1) shall 
        include the following:
                    (A) Measures of timely and effective health 
                care.
                    (B) Measures of readmissions, complications 
                of death, including with respect to 30-day 
                mortality rates and 30-day readmission rates, 
                surgical complication measures, and health care 
                related infection measures.
                    (C) Survey data of patient experiences, 
                including the Hospital Consumer Assessment of 
                Healthcare Providers and Systems or any similar 
                successor survey developed by the Department of 
                Health and Human Services.
                    (D) Any other measures required of or 
                reported with respect to hospitals 
                participating in the Medicare program under 
                title XVIII of the Social Security Act (42 
                U.S.C. 1395 et seq.).
            (3) Unavailable information.--For any applicable 
        metric collected by the Department of Veterans Affairs 
        or required to be provided under paragraph (2) and 
        withheld from or unavailable in the Hospital Compare 
        Internet website or any successor Internet website, the 
        Secretary of Veterans Affairs shall publish a notice on 
        such Internet website stating the reason why such 
        metric was withheld from public disclosure and a 
        timeline for making such metric available, if 
        applicable.
    (d) Comptroller General Review of Publicly Available Safety 
and Quality Metrics.--Not later than three years after the date 
of the enactment of this Act, the Comptroller General of the 
United States shall conduct a review of the safety and quality 
metrics made publicly available by the Secretary of Veterans 
Affairs under this section to assess the degree to which the 
Secretary is complying with the provisions of this section.

SEC. 207. INFORMATION FOR VETERANS ON THE CREDENTIALS OF DEPARTMENT OF 
                    VETERANS AFFAIRS PHYSICIANS.

    (a) Improvement of ``Our Doctors'' Internet Website 
Links.--
            (1) Availability through department of veterans 
        affairs homepage.--A link to the ``Our Doctors'' health 
        care providers database of the Department of Veterans 
        Affairs, or any successor database, shall be available 
        on and through the homepage of the Internet website of 
        the Department that is accessible to the public.
            (2) Information on location of residency 
        training.--The Internet website of the Department that 
        is accessible to the public shall include under the 
        link to the ``Our Doctors'' health care providers 
        database of the Department, or any successor database, 
        the name of the facility at which each licensed 
        physician of the Department underwent residency 
        training.
            (3) Information on physicians at particular 
        facilities.--The ``Our Doctors'' health care providers 
        database of the Department, or any successor database, 
        shall identify whether each licensed physician of the 
        Department is a physician in residency.
    (b) Information on Credentials of Physicians for Veterans 
Undergoing Surgical Procedures.--
            (1) In general.--Each veteran who is undergoing a 
        surgical procedure by or through the Department shall 
        be provided information described in paragraph (2) with 
        respect to the surgeon to be performing such procedure 
        at such time in advance of the procedure as is 
        appropriate to permit such veteran to evaluate such 
        information.
            (2) Information described.--The information 
        described in this paragraph with respect to a surgeon 
        described in paragraph (1) is as follows:
                    (A) The education and training of the 
                surgeon.
                    (B) The licensure, registration, and 
                certification of the surgeon by the State or 
                national entity responsible for such licensure, 
                registration, or certification.
            (3) Other individuals.--If a veteran is unable to 
        evaluate the information provided under paragraph (1) 
        due to the health or mental competence of the veteran, 
        such information shall be provided to an individual 
        acting on behalf of the veteran.
    (c) Comptroller General Report and Plan.--
            (1) Report.--Not later than two years after the 
        date of the enactment of this Act, the Comptroller 
        General of the United States shall submit to the 
        Committee on Veterans' Affairs of the Senate and the 
        Committee on Veterans' Affairs of the House of 
        Representatives a report setting forth an assessment by 
        the Comptroller General of the following:
                    (A) The manner in which contractors under 
                the Patient-Centered Community Care initiative 
                of the Department perform oversight of the 
                credentials of physicians within the networks 
                of such contractors under the initiative.
                    (B) The oversight by the Department of the 
                contracts under the Patient-Centered Community 
                Care initiative.
                    (C) The verification by the Department of 
                the credentials and licenses of health care 
                providers furnishing hospital care and medical 
                services under section 101.
            (2) Plan.--
                    (A) In general.--Not later than 30 days 
                after the submittal of the report under 
                paragraph (1), the Secretary shall submit to 
                the Comptroller General, the Committee on 
                Veterans' Affairs of the Senate, and the 
                Committee on Veterans' Affairs of the House of 
                Representatives a plan to address any findings 
                and recommendations of the Comptroller General 
                included in such report.
                    (B) Implementation.--Not later than 90 days 
                after the submittal of the report under 
                paragraph (1), the Secretary shall carry out 
                such plan.

SEC. 208. INFORMATION IN ANNUAL BUDGET OF THE PRESIDENT ON HOSPITAL 
                    CARE AND MEDICAL SERVICES FURNISHED THROUGH 
                    EXPANDED USE OF CONTRACTS FOR SUCH CARE.

    The materials on the Department of Veterans Affairs in the 
budget of the President for a fiscal year, as submitted to 
Congress pursuant to section 1105(a) of title 31, United States 
Code, shall set forth the following:
            (1) The number of veterans who received hospital 
        care and medical services under section 101 during the 
        fiscal year preceding the fiscal year in which such 
        budget is submitted.
            (2) The amount expended by the Department on 
        furnishing care and services under such section during 
        the fiscal year preceding the fiscal year in which such 
        budget is submitted.
            (3) The amount requested in such budget for the 
        costs of furnishing care and services under such 
        section during the fiscal year covered by such budget, 
        set forth in aggregate and by amounts for each account 
        for which amounts are so requested.
            (4) The number of veterans that the Department 
        estimates will receive hospital care and medical 
        services under such section during the fiscal years 
        covered by the budget submission.
            (5) The number of employees of the Department on 
        paid administrative leave at any point during the 
        fiscal year preceding the fiscal year in which such 
        budget is submitted.

SEC. 209. PROHIBITION ON FALSIFICATION OF DATA CONCERNING WAIT TIMES 
                    AND QUALITY MEASURES AT DEPARTMENT OF VETERANS 
                    AFFAIRS.

    Not later than 60 days after the date of the enactment of 
this Act, and in accordance with title 5, United States Code, 
the Secretary of Veterans Affairs shall establish policies 
whereby any employee of the Department of Veterans Affairs who 
knowingly submits false data concerning wait times for health 
care or quality measures with respect to health care to another 
employee of the Department or knowingly requires another 
employee of the Department to submit false data concerning such 
wait times or quality measures to another employee of the 
Department is subject to a penalty the Secretary considers 
appropriate after notice and an opportunity for a hearing, 
including civil penalties, unpaid suspensions, or termination.

   TITLE III--HEALTH CARE STAFFING, RECRUITMENT, AND TRAINING MATTERS

SEC. 301. TREATMENT OF STAFFING SHORTAGE AND BIENNIAL REPORT ON 
                    STAFFING OF MEDICAL FACILITIES OF THE DEPARTMENT OF 
                    VETERANS AFFAIRS.

    (a) Staffing Shortages.--
            (1) In general.--Subchapter I of chapter 74 of 
        title 38, United States Code, is amended by adding at 
        the end the following new section:

``Sec. 7412. Annual determination of staffing shortages; recruitment 
                    and appointment for needed occupations

    ``(a) In General.--Not later than September 30 of each 
year, the Inspector General of the Department shall determine, 
and the Secretary shall publish in the Federal Register, the 
five occupations of personnel of this title of the Department 
covered under section 7401 of this title for which there are 
the largest staffing shortages throughout the Department as 
calculated over the five-year period preceding the 
determination.
    ``(b) Recruitment and Appointment.--Notwithstanding 
sections 3304 and 3309 through 3318 of title 5, the Secretary 
may, upon a determination by the Inspector General under 
paragraph (1) that there is a staffing shortage throughout the 
Department with respect to a particular occupation, recruit and 
directly appoint, during the fiscal year after the fiscal year 
during which such determination is made, qualified personnel to 
serve in that particular occupation for the Department.''.
            (2) Clerical amendment.--The table of sections at 
        the beginning of such chapter is amended by inserting 
        after the item relating to section 7411 the following 
        new item:

``7412. Annual determination of staffing shortages; recruitment and 
          appointment for needed occupations.''.

            (3) Deadline for first determination.--
        Notwithstanding the deadline under section 7412 of 
        title 38, United States Code, as added by paragraph 
        (1), for the annual determination of staffing shortages 
        in the Veterans Health Administration, the Inspector 
        General of the Department of Veterans Affairs shall 
        make the first determination required under such 
        section, and the Secretary of Veterans Affairs shall 
        publish in the Federal Register such determination, by 
        not later than the date that is 180 days after the date 
        of the enactment of this Act.
    (b) Increase of Graduate Medical Education Residency 
Positions.--
            (1) In general.--Section 7302 of title 38, United 
        States Code, is amended by adding at the end the 
        following new subsection:
    ``(e)(1) In carrying out this section, the Secretary shall 
establish medical residency programs, or ensure that already 
established medical residency programs have a sufficient number 
of residency positions, at any medical facility of the 
Department that the Secretary determines--
            ``(A) is experiencing a shortage of physicians; and
            ``(B) is located in a community that is designated 
        as a health professional shortage area (as defined in 
        section 332 of the Public Health Service Act (42 U.S.C. 
        254e)).
    ``(2) In carrying out paragraph (1), the Secretary shall--
            ``(A) allocate the residency positions under such 
        paragraph among occupations included in the most 
        current determination published in the Federal Register 
        pursuant to section 7412(a) of this title; and
            ``(B) give priority to residency positions and 
        programs in primary care, mental health, and any other 
        specialty the Secretary determines appropriate.''.
            (2) Five-year increase.--
                    (A) In general.--In carrying out section 
                7302(e) of title 38, United States Code, as 
                added by paragraph (1), during the five-year 
                period beginning on the day that is one year 
                after the date of the enactment of this Act, 
                the Secretary of Veterans Affairs shall 
                increase the number of graduate medical 
                education residency positions at medical 
                facilities of the Department by up to 1,500 
                positions.
                    (B) Priority.--In increasing the number of 
                graduate medical education residency positions 
                at medical facilities of the Department under 
                subparagraph (A), the Secretary shall give 
                priority to medical facilities that--
                            (i) as of the date of the enactment 
                        of this Act, do not have a medical 
                        residency program; and
                            (ii) are located in a community 
                        that has a high concentration of 
                        veterans.
            (3) Report.--
                    (A) In general.--Not later than 60 days 
                after the date of the enactment of this Act, 
                and not later than October 1 each year 
                thereafter until 2019, the Secretary shall 
                submit to the Committee on Veterans' Affairs of 
                the Senate and the Committee on Veterans' 
                Affairs of the House of Representatives a 
                report on graduate medical education residency 
                positions at medical facilities of the 
                Department.
                    (B) Elements.--Each report required by 
                subparagraph (A) shall include the following:
                            (i) For the year preceding the 
                        submittal of the report, the number of 
                        graduate medical education residency 
                        positions at medical facilities of the 
                        Department as follows:
                                    (I) That were filled.
                                    (II) That were not filled.
                                    (III) That the Department 
                                anticipated filling.
                            (ii) With respect to each graduate 
                        medical education residency position 
                        specified in clause (i)--
                                    (I) the geographic location 
                                of each such position; and
                                    (II) if such position was 
                                filled, the academic 
                                affiliation of the medical 
                                resident that filled such 
                                position.
                            (iii) The policy at each medical 
                        facility of the Department with respect 
                        to the ratio of medical residents to 
                        staff supervising medical residents.
                            (iv) During the one-year period 
                        preceding the submittal of the report, 
                        the number of individuals who declined 
                        an offer from the Department to serve 
                        as a medical resident at a medical 
                        facility of the Department and the 
                        reason why each such individual 
                        declined such offer.
                            (v) During the one-year period 
                        preceding the submittal of the report, 
                        a description of--
                                    (I) challenges, if any, 
                                faced by the Department in 
                                filling graduate medical 
                                education residency positions 
                                at medical facilities of the 
                                Department; and
                                    (II) actions, if any, taken 
                                by the Department to address 
                                such challenges.
                            (vi) A description of efforts of 
                        the Department, as of the date of the 
                        submittal of the report, to recruit and 
                        retain medical residents to work for 
                        the Veterans Health Administration as 
                        full-time employees.
    (c) Priority in Scholarship Program of Health Professionals 
Educational Assistance Program to Certain Providers.--Section 
7612(b)(5) of title 38, United States Code, is amended--
            (1) in subparagraph (A), by striking ``and'' at the 
        end;
            (2) by redesignating subparagraph (B) as 
        subparagraph (C); and
            (3) by inserting after subparagraph (A) the 
        following new subparagraph (B):
            ``(B) shall give priority to applicants pursuing a 
        course of education or training toward a career in an 
        occupation for which the Inspector General of the 
        Department has, in the most current determination 
        published in the Federal Register pursuant to section 
        7412(a) of this title, determined that there is one of 
        the largest staffing shortages throughout the 
        Department with respect to such occupation; and''.
    (d) Reports.--
            (1) In general.--Not later than 180 days after the 
        date of the enactment of this Act, and not later than 
        December 31 of each even-numbered year thereafter until 
        2024, the Secretary of Veterans Affairs shall submit to 
        the Committees on Veterans' Affairs of the Senate and 
        House of Representatives a report assessing the 
        staffing of each medical facility of the Department.
            (2) Elements.--Each report submitted under 
        paragraph (1) shall include the following:
                    (A) The results of a system-wide assessment 
                of all medical facilities of the Department to 
                ensure the following:
                            (i) Appropriate staffing levels for 
                        health care professionals to meet the 
                        goals of the Secretary for timely 
                        access to care for veterans.
                            (ii) Appropriate staffing levels 
                        for support personnel, including 
                        clerks.
                            (iii) Appropriate sizes for 
                        clinical panels.
                            (iv) Appropriate numbers of full-
                        time staff, or full-time equivalents, 
                        dedicated to direct care of patients.
                            (v) Appropriate physical plant 
                        space to meet the capacity needs of the 
                        Department in that area.
                            (vi) Such other factors as the 
                        Secretary considers necessary.
                    (B) A plan for addressing any issues 
                identified in the assessment described in 
                subparagraph (A), including a timeline for 
                addressing such issues.
                    (C) A list of the current wait times and 
                workload levels for the following clinics in 
                each medical facility:
                            (i) Mental health.
                            (ii) Primary care.
                            (iii) Gastroenterology.
                            (iv) Women's health.
                            (v) Such other clinics as the 
                        Secretary considers appropriate.
                    (D) A description of the results of the 
                most current determination of the Inspector 
                General under subsection (a) of section 7412 of 
                title 38, United States Code, as added by 
                subsection (a)(1) of this section, and a plan 
                to use direct appointment authority under 
                subsection (b) of such section 7412 to fill 
                staffing shortages, including recommendations 
                for improving the speed at which the 
                credentialing and privileging process can be 
                conducted.
                    (E) The current staffing models of the 
                Department for the following clinics, including 
                recommendations for changes to such models:
                            (i) Mental health.
                            (ii) Primary care.
                            (iii) Gastroenterology.
                            (iv) Women's health.
                            (v) Such other clinics as the 
                        Secretary considers appropriate.
                    (F) A detailed analysis of succession 
                planning at medical facilities of the 
                Department, including the following:
                            (i) The number of positions in 
                        medical facilities throughout the 
                        Department that are not filled by a 
                        permanent employee.
                            (ii) The length of time each 
                        position described in clause (i) 
                        remained vacant or filled by a 
                        temporary or acting employee.
                            (iii) A description of any barriers 
                        to filling the positions described in 
                        clause (i).
                            (iv) A plan for filling any 
                        positions that are vacant or filled by 
                        a temporary or acting employee for more 
                        than 180 days.
                            (v) A plan for handling emergency 
                        circumstances, such as administrative 
                        leave or sudden medical leave for 
                        senior officials.
                    (G) The number of health care providers of 
                the Department who have been removed from their 
                positions, have retired, or have left their 
                positions for another reason, disaggregated by 
                provider type, during the two-year period 
                preceding the submittal of the report.
                    (H) Of the health care providers specified 
                in subparagraph (G) who have been removed from 
                their positions, the following:
                            (i) The number of such health care 
                        providers who were reassigned to other 
                        positions in the Department.
                            (ii) The number of such health care 
                        providers who left the Department.
                            (iii) The number of such health 
                        care providers who left the Department 
                        and were subsequently rehired by the 
                        Department.

SEC. 302. EXTENSION AND MODIFICATION OF CERTAIN PROGRAMS WITHIN THE 
                    DEPARTMENT OF VETERANS AFFAIRS HEALTH PROFESSIONALS 
                    EDUCATIONAL ASSISTANCE PROGRAM.

    (a) Extension of Scholarship Program.--Section 7619 of 
title 38, United States Code, is amended by striking ``December 
31, 2014'' and inserting ``December 31, 2019''.
    (b) Modification of Education Debt Reduction Program.--
            (1) Modification of amount and duration of 
        eligibility.--Paragraph (1) of section 7683(d) of such 
        title is amended--
                    (A) by striking ``$60,000'' and inserting 
                ``$120,000''; and
                    (B) by striking ``$12,000 of such 
                payments'' and all that follows through the 
                period at the end and inserting ``$24,000 of 
                such payments may be made in each year of 
                participation in the Program''.
            (2) Elimination of limitation.--
                    (A) In general.--Such section is further 
                amended--
                            (i) by striking paragraph (2);
                            (ii) by redesignating paragraph (3) 
                        as paragraph (2); and
                            (iii) in paragraph (2), as 
                        redesignated by clause (ii), by 
                        striking ``paragraphs (1) and (2)'' and 
                        inserting ``paragraph (1)''.
                    (B) Conforming amendment.--Paragraph (1) of 
                such section, as amended by paragraph (1), is 
                further amended by striking ``Subject to 
                paragraph (2), the amount'' and inserting ``The 
                amount''.

SEC. 303. CLINIC MANAGEMENT TRAINING FOR EMPLOYEES AT MEDICAL 
                    FACILITIES OF THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) Clinic Management Training Program.--
            (1) In general.--Not later than 180 days after the 
        date of the enactment of this Act, the Secretary of 
        Veterans Affairs shall commence a role-specific clinic 
        management training program to provide in-person, 
        standardized education on systems and processes for 
        health care practice management and scheduling to all 
        appropriate employees, as determined by the Secretary, 
        at medical facilities of the Department.
            (2) Elements.--
                    (A) In general.--The clinic management 
                training program required by paragraph (1) 
                shall include the following:
                            (i) Training on how to manage the 
                        schedules of health care providers of 
                        the Department, including the 
                        following:
                                    (I) Maintaining such 
                                schedules in a manner that 
                                allows appointments to be 
                                booked at least eight weeks in 
                                advance.
                                    (II) Proper planning 
                                procedures for vacation, leave, 
                                and graduate medical education 
                                training schedules.
                            (ii) Training on the appropriate 
                        number of appointments that a health 
                        care provider should conduct on a daily 
                        basis, based on specialty.
                            (iii) Training on how to determine 
                        whether there are enough available 
                        appointment slots to manage demand for 
                        different appointment types and 
                        mechanisms for alerting management of 
                        insufficient slots.
                            (iv) Training on how to properly 
                        use the appointment scheduling system 
                        of the Department, including any new 
                        scheduling system implemented by the 
                        Department.
                            (v) Training on how to optimize the 
                        use of technology, including the 
                        following:
                                    (I) Telemedicine.
                                    (II) Electronic mail.
                                    (III) Text messaging.
                                    (IV) Such other 
                                technologies as specified by 
                                the Secretary.
                            (vi) Training on how to properly 
                        use physical plant space at medical 
                        facilities of the Department to ensure 
                        efficient flow and privacy for patients 
                        and staff.
                    (B) Role-specific.--The Secretary shall 
                ensure that each employee of the Department 
                included in the clinic management training 
                program required by paragraph (1) receives 
                education under such program that is relevant 
                to the responsibilities of such employee.
            (3) Sunset.--The clinic management training program 
        required by paragraph (1) shall terminate on the date 
        that is two years after the date on which the Secretary 
        commences such program.
    (b) Training Materials.--
            (1) In general.--After the termination of the 
        clinic management training program required by 
        subsection (a), the Secretary shall provide training 
        materials on health care management to each of the 
        following employees of the Department that are relevant 
        to the position and responsibilities of such employee 
        upon the commencement of employment of such employee:
                    (A) Any manager of a medical facility of 
                the Department.
                    (B) Any health care provider at a medical 
                facility of the Department.
                    (C) Such other employees of the Department 
                as the Secretary considers appropriate.
            (2) Update.--The Secretary shall regularly update 
        the training materials required under paragraph (1).

             TITLE IV--HEALTH CARE RELATED TO SEXUAL TRAUMA

SEC. 401. EXPANSION OF ELIGIBILITY FOR SEXUAL TRAUMA COUNSELING AND 
                    TREATMENT TO VETERANS ON INACTIVE DUTY TRAINING.

    Section 1720D(a)(1) of title 38, United States Code, is 
amended by striking ``or active duty for training'' and 
inserting ``, active duty for training, or inactive duty 
training''.

SEC. 402. PROVISION OF COUNSELING AND TREATMENT FOR SEXUAL TRAUMA BY 
                    THE DEPARTMENT OF VETERANS AFFAIRS TO MEMBERS OF 
                    THE ARMED FORCES.

    (a) Expansion of Coverage to Members of the Armed Forces.--
Subsection (a) of section 1720D of title 38, United States 
Code, is amended--
            (1) by redesignating paragraph (2) as paragraph 
        (3);
            (2) by inserting after paragraph (1) the following 
        new paragraph (2):
    ``(2)(A) In operating the program required by paragraph 
(1), the Secretary may, in consultation with the Secretary of 
Defense, provide counseling and care and services to members of 
the Armed Forces (including members of the National Guard and 
Reserves) on active duty to overcome psychological trauma 
described in that paragraph.
    ``(B) A member described in subparagraph (A) shall not be 
required to obtain a referral before receiving counseling and 
care and services under this paragraph.''; and
            (3) in paragraph (3), as redesignated by paragraph 
        (1)--
                    (A) by striking ``a veteran'' and inserting 
                ``an individual''; and
                    (B) by striking ``that veteran'' each place 
                it appears and inserting ``that individual''.
    (b) Information to Members on Availability of Counseling 
and Services.--Subsection (c) of such section is amended--
            (1) by striking ``to veterans'' each place it 
        appears; and
            (2) in paragraph (3), by inserting ``members of the 
        Armed Forces and'' before ``individuals''.
    (c) Inclusion of Members in Reports on Counseling and 
Services.--Subsection (e) of such section is amended--
            (1) in the matter preceding paragraph (1), by 
        striking ``to veterans'';
            (2) in paragraph (2)--
                    (A) by striking ``women veterans'' and 
                inserting ``individuals''; and
                    (B) by striking ``training under subsection 
                (d).'' and inserting ``training under 
                subsection (d), disaggregated by--
                    ``(A) veterans;
                    ``(B) members of the Armed Forces 
                (including members of the National Guard and 
                Reserves) on active duty; and
                    ``(C) for each of subparagraphs (A) and 
                (B)--
                            ``(i) men; and
                            ``(ii) women.'';
            (3) in paragraph (4), by striking ``veterans'' and 
        inserting ``individuals''; and
            (4) in paragraph (5)--
                    (A) by striking ``women veterans'' and 
                inserting ``individuals''; and
                    (B) by inserting ``, including specific 
                recommendations for individuals specified in 
                subparagraphs (A), (B), and (C) of paragraph 
                (2)'' before the period at the end.
    (d) Effective Date.--The amendments made by this section 
shall take effect on the date that is one year after the date 
of the enactment of this Act.

SEC. 403. REPORTS ON MILITARY SEXUAL TRAUMA.

    (a) Report on Services Available for Military Sexual Trauma 
in the Department of Veterans Affairs.--Not later than 630 days 
after the date of the enactment of this Act, the Secretary of 
Veterans Affairs shall submit to the Committee on Veterans' 
Affairs of the Senate and the Committee on Veterans' Affairs of 
the House of Representatives a report on the treatment and 
services available from the Department of Veterans Affairs for 
male veterans who experience military sexual trauma compared to 
such treatment and services available to female veterans who 
experience military sexual trauma.
    (b) Reports on Transition of Military Sexual Trauma 
Treatment From Department of Defense to Department of Veterans 
Affairs.--Not later than 630 days after the date of the 
enactment of this Act, and annually thereafter for five years, 
the Department of Veterans Affairs-Department of Defense Joint 
Executive Committee established by section 320(a) of title 38, 
United States Code, shall submit to the appropriate committees 
of Congress a report on military sexual trauma that includes 
the following:
            (1) The processes and procedures utilized by the 
        Department of Veterans Affairs and the Department of 
        Defense to facilitate transition of treatment of 
        individuals who have experienced military sexual trauma 
        from treatment provided by the Department of Defense to 
        treatment provided by the Department of Veterans 
        Affairs.
            (2) A description and assessment of the 
        collaboration between the Department of Veterans 
        Affairs and the Department of Defense in assisting 
        veterans in filing claims for disabilities related to 
        military sexual trauma, including permitting veterans 
        access to information and evidence necessary to develop 
        or support such claims.
    (c) Definitions.--In this section:
            (1) Appropriate committees of congress.--The term 
        ``appropriate committees of Congress'' means--
                    (A) the Committee on Veterans' Affairs and 
                the Committee on Armed Services of the Senate; 
                and
                    (B) the Committee on Veterans' Affairs and 
                the Committee on Armed Services of the House of 
                Representatives.
            (2) Military sexual trauma.--The term ``military 
        sexual trauma'' means psychological trauma, which in 
        the judgment of a mental health professional employed 
        by the Department, resulted from a physical assault of 
        a sexual nature, battery of a sexual nature, or sexual 
        harassment which occurred while the veteran was serving 
        on active duty, active duty for training, or inactive 
        duty training.
            (3) Sexual harassment.--The term ``sexual 
        harassment'' means repeated, unsolicited verbal or 
        physical contact of a sexual nature which is 
        threatening in character.
            (4) Sexual trauma.--The term ``sexual trauma'' 
        shall have the meaning given that term by the Secretary 
        of Veterans Affairs for purposes of this section.
    (d) Effective Date.--This section shall take effect on the 
date that is 270 days after the date of the enactment of this 
Act.

                   TITLE V--OTHER HEALTH CARE MATTERS

SEC. 501. EXTENSION OF PILOT PROGRAM ON ASSISTED LIVING SERVICES FOR 
                    VETERANS WITH TRAUMATIC BRAIN INJURY.

    (a) In General.--Section 1705 of the National Defense 
Authorization Act for Fiscal Year 2008 (Public Law 110-181; 38 
U.S.C. 1710C note) is amended by adding at the end the 
following:
    ``(g) Termination.--The pilot program shall terminate on 
October 6, 2017.''.
    (b) Conforming Amendment.--Subsection (a) of such section 
is amended by striking ``five-year''.

                TITLE VI--MAJOR MEDICAL FACILITY LEASES

SEC. 601. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.

    (a) In General.--The Secretary of Veterans Affairs may 
carry out the following major medical facility leases at the 
locations specified, and in an amount for each lease not to 
exceed the amount shown for such location (not including any 
estimated cancellation costs):
            (1) For a clinical research and pharmacy 
        coordinating center, Albuquerque, New Mexico, an amount 
        not to exceed $9,560,000.
            (2) For a community-based outpatient clinic, Brick, 
        New Jersey, an amount not to exceed $7,280,000.
            (3) For a new primary care and dental clinic annex, 
        Charleston, South Carolina, an amount not to exceed 
        $7,070,250.
            (4) For a community-based outpatient clinic, Cobb 
        County, Georgia, an amount not to exceed $6,409,000.
            (5) For the Leeward Outpatient Healthcare Access 
        Center, Honolulu, Hawaii, including a co-located clinic 
        with the Department of Defense and the co-location of 
        the Honolulu Regional Office of the Veterans Benefits 
        Administration and the Kapolei Vet Center of the 
        Department of Veterans Affairs, an amount not to exceed 
        $15,887,370.
            (6) For a community-based outpatient clinic, 
        Johnson County, Kansas, an amount not to exceed 
        $2,263,000.
            (7) For a replacement community-based outpatient 
        clinic, Lafayette, Louisiana, an amount not to exceed 
        $2,996,000.
            (8) For a community-based outpatient clinic, Lake 
        Charles, Louisiana, an amount not to exceed $2,626,000.
            (9) For outpatient clinic consolidation, New Port 
        Richey, Florida, an amount not to exceed $11,927,000.
            (10) For an outpatient clinic, Ponce, Puerto Rico, 
        an amount not to exceed $11,535,000.
            (11) For lease consolidation, San Antonio, Texas, 
        an amount not to exceed $19,426,000.
            (12) For a community-based outpatient clinic, San 
        Diego, California, an amount not to exceed $11,946,100.
            (13) For an outpatient clinic, Tyler, Texas, an 
        amount not to exceed $4,327,000.
            (14) For the Errera Community Care Center, West 
        Haven, Connecticut, an amount not to exceed $4,883,000.
            (15) For the Worcester Community-Based Outpatient 
        Clinic, Worcester, Massachusetts, an amount not to 
        exceed $4,855,000.
            (16) For the expansion of a community-based 
        outpatient clinic, Cape Girardeau, Missouri, an amount 
        not to exceed $4,232,060.
            (17) For a multispecialty clinic, Chattanooga, 
        Tennessee, an amount not to exceed $7,069,000.
            (18) For the expansion of a community-based 
        outpatient clinic, Chico, California, an amount not to 
        exceed $4,534,000.
            (19) For a community-based outpatient clinic, Chula 
        Vista, California, an amount not to exceed $3,714,000.
            (20) For a new research lease, Hines, Illinois, an 
        amount not to exceed $22,032,000.
            (21) For a replacement research lease, Houston, 
        Texas, an amount not to exceed $6,142,000.
            (22) For a community-based outpatient clinic, 
        Lincoln, Nebraska, an amount not to exceed $7,178,400.
            (23) For a community-based outpatient clinic, 
        Lubbock, Texas, an amount not to exceed $8,554,000.
            (24) For a community-based outpatient clinic 
        consolidation, Myrtle Beach, South Carolina, an amount 
        not to exceed $8,022,000.
            (25) For a community-based outpatient clinic, 
        Phoenix, Arizona, an amount not to exceed $20,757,000.
            (26) For the expansion of a community-based 
        outpatient clinic, Redding, California, an amount not 
        to exceed $8,154,000.
            (27) For the expansion of a community-based 
        outpatient clinic, Tulsa, Oklahoma, an amount not to 
        exceed $13,269,200.
    (b) Requirements for Clinic in Tulsa.--
            (1) In general.--In carrying out the expansion of 
        the community-based outpatient clinic in Tulsa, 
        Oklahoma, authorized by subsection (a)(27), the 
        Secretary of Veterans Affairs shall ensure that such 
        clinic satisfies the following requirements:
                    (A) Consist of not more than 140,000 gross 
                square feet.
                    (B) Have an annual cost per square foot of 
                not more than the average market rate in Tulsa, 
                Oklahoma, for an equivalent medical facility 
                plus 20 percent.
                    (C) Satisfy the mandate of the Department 
                of Veterans Affairs to provide veterans in 
                Oklahoma with access to quality and efficient 
                care.
                    (D) Expand clinical capacity in the region 
                in which the clinic is located in a cost 
                efficient manner based upon regional cost 
                comparisons, taking into account the needs of 
                current veterans and the potential demand by 
                veterans for care in the future.
                    (E) Be the most cost effective option for 
                the Department as predicted over a 30-year life 
                cycle for such clinic.
            (2) Cost effective determination.--
                    (A) In general.--If the Secretary 
                determines that the most cost effective option 
                over a 30-year life cycle would be to purchase 
                or construct a facility in Tulsa, Oklahoma, 
                instead of entering into a major medical 
                facility lease in such location as authorized 
                by subsection (a)(27), the Secretary shall not 
                enter into such lease.
                    (B) Major medical facility project.--If the 
                Secretary makes the determination described in 
                subparagraph (A), the Secretary may request 
                authority for a major medical facility project 
                in Tulsa, Oklahoma, from Congress pursuant to 
                section 8104(b) of title 38, United States 
                Code.
                    (C) Cost-benefit analysis.--If the 
                Secretary requests authority for the major 
                medical facility project described in 
                subparagraph (B), not later than 90 days after 
                making the determination described in 
                subparagraph (A), the Secretary shall submit to 
                Congress a detailed cost-benefit analysis of 
                such major medical facility project.

SEC. 602. BUDGETARY TREATMENT OF DEPARTMENT OF VETERANS AFFAIRS MAJOR 
                    MEDICAL FACILITIES LEASES.

    (a) Findings.--Congress finds the following:
            (1) Title 31, United States Code, requires the 
        Department of Veterans Affairs to record the full cost 
        of its contractual obligation against funds available 
        at the time a contract is executed.
            (2) Office of Management and Budget Circular A-11 
        provides guidance to agencies in meeting the statutory 
        requirements under title 31, United States Code, with 
        respect to leases.
            (3) For operating leases, Office of Management and 
        Budget Circular A-11 requires the Department of 
        Veterans Affairs to record up-front budget authority in 
        an ``amount equal to total payments under the full term 
        of the lease or [an] amount sufficient to cover first 
        year lease payments plus cancellation costs''.
    (b) Requirement for Obligation of Full Cost.--
            (1) In general.--Subject to the availability of 
        appropriations provided in advance, in exercising the 
        authority of the Secretary of Veterans Affairs to enter 
        into leases provided in this Act, the Secretary shall 
        record, pursuant to section 1501 of title 31, United 
        States Code, as the full cost of the contractual 
        obligation at the time a contract is executed either--
                    (A) an amount equal to total payments under 
                the full term of the lease; or
                    (B) if the lease specifies payments to be 
                made in the event the lease is terminated 
                before its full term, an amount sufficient to 
                cover the first year lease payments plus the 
                specified cancellation costs.
            (2) Self-insuring authority.--The requirements of 
        paragraph (1) may be satisfied through the use of the 
        self-insuring authority identified in title 40, United 
        States Code, consistent with Office of Management and 
        Budget Circular A-11.
    (c) Transparency.--
            (1) Compliance.--Subsection (b) of section 8104 of 
        title 38, United States Code, is amended by adding at 
        the end the following new paragraph:
            ``(7) In the case of a prospectus proposing funding 
        for a major medical facility lease, a detailed analysis 
        of how the lease is expected to comply with Office of 
        Management and Budget Circular A-11 and section 1341 of 
        title 31 (commonly referred to as the `Anti-Deficiency 
        Act'). Any such analysis shall include--
                    ``(A) an analysis of the classification of 
                the lease as a `lease-purchase', `capital 
                lease', or `operating lease' as those terms are 
                defined in Office of Management and Budget 
                Circular A-11;
                    ``(B) an analysis of the obligation of 
                budgetary resources associated with the lease; 
                and
                    ``(C) an analysis of the methodology used 
                in determining the asset cost, fair market 
                value, and cancellation costs of the lease.''.
            (2) Submittal to congress.--Such section 8104 is 
        further amended by adding at the end the following new 
        subsection:
    ``(h)(1) Not less than 30 days before entering into a major 
medical facility lease, the Secretary shall submit to the 
Committees on Veterans' Affairs of the Senate and the House of 
Representatives--
            ``(A) notice of the Secretary's intention to enter 
        into the lease;
            ``(B) a detailed summary of the proposed lease;
            ``(C) a description and analysis of any differences 
        between the prospectus submitted pursuant to subsection 
        (b) and the proposed lease; and
            ``(D) a scoring analysis demonstrating that the 
        proposed lease fully complies with Office of Management 
        and Budget Circular A-11.
    ``(2) Each committee described in paragraph (1) shall 
ensure that any information submitted to the committee under 
such paragraph is treated by the committee with the same level 
of confidentiality as is required by law of the Secretary and 
subject to the same statutory penalties for unauthorized 
disclosure or use as the Secretary.
    ``(3) Not more than 30 days after entering into a major 
medical facility lease, the Secretary shall submit to each 
committee described in paragraph (1) a report on any material 
differences between the lease that was entered into and the 
proposed lease described under such paragraph, including how 
the lease that was entered into changes the previously 
submitted scoring analysis described in subparagraph (D) of 
such paragraph.''.
    (d) Rule of Construction.--Nothing in this section, or the 
amendments made by this section, shall be construed to in any 
way relieve the Department of Veterans Affairs from any 
statutory or regulatory obligations or requirements existing 
prior to the enactment of this section and such amendments.

                   TITLE VII--OTHER VETERANS MATTERS

SEC. 701. EXPANSION OF MARINE GUNNERY SERGEANT JOHN DAVID FRY 
                    SCHOLARSHIP.

    (a) Expansion of Entitlement.--Subsection (b)(9) of section 
3311 of title 38, United States Code, is amended by inserting 
``or spouse'' after ``child''.
    (b) Limitation and Election on Certain Benefits.--
Subsection (f) of such section is amended--
            (1) by redesignating paragraph (2) as paragraph 
        (4); and
            (2) by inserting after paragraph (1) the following 
        new paragraphs:
            ``(2) Limitation.--The entitlement of an individual 
        to assistance under subsection (a) pursuant to 
        paragraph (9) of subsection (b) because the individual 
        was a spouse of a person described in such paragraph 
        shall expire on the earlier of--
                    ``(A) the date that is 15 years after the 
                date on which the person died; or
                    ``(B) the date on which the individual 
                remarries.
            ``(3) Election on receipt of certain benefits.--A 
        surviving spouse entitled to assistance under 
        subsection (a) pursuant to paragraph (9) of subsection 
        (b) who is also entitled to educational assistance 
        under chapter 35 of this title may not receive 
        assistance under both this section and such chapter, 
        but shall make an irrevocable election (in such form 
        and manner as the Secretary may prescribe) under which 
        section or chapter to receive educational 
        assistance.''.
    (c) Conforming Amendment.--Section 3321(b)(4) of such title 
is amended--
            (1) by striking ``an individual'' and inserting ``a 
        child''; and
            (2) by striking ``such individual's'' each time it 
        appears and inserting ``such child's''.
    (d) Effective Date.--The amendments made by this section 
shall apply with respect to a quarter, semester, or term, as 
applicable, commencing on or after January 1, 2015.

SEC. 702. APPROVAL OF COURSES OF EDUCATION PROVIDED BY PUBLIC 
                    INSTITUTIONS OF HIGHER LEARNING FOR PURPOSES OF 
                    ALL-VOLUNTEER FORCE EDUCATIONAL ASSISTANCE PROGRAM 
                    AND POST-9/11 EDUCATIONAL ASSISTANCE CONDITIONAL ON 
                    IN-STATE TUITION RATE FOR VETERANS.

    (a) In General.--Section 3679 of title 38, United States 
Code, is amended by adding at the end the following new 
subsection:
    ``(c)(1) Notwithstanding any other provision of this 
chapter and subject to paragraphs (3) through (6), the 
Secretary shall disapprove a course of education provided by a 
public institution of higher learning to a covered individual 
pursuing a course of education with educational assistance 
under chapter 30 or 33 of this title while living in the State 
in which the public institution of higher learning is located 
if the institution charges tuition and fees for that course for 
the covered individual at a rate that is higher than the rate 
the institution charges for tuition and fees for that course 
for residents of the State in which the institution is located, 
regardless of the covered individual's State of residence.
    ``(2) For purposes of this subsection, a covered individual 
is any individual as follows:
            ``(A) A veteran who was discharged or released from 
        a period of not fewer than 90 days of service in the 
        active military, naval, or air service less than three 
        years before the date of enrollment in the course 
        concerned.
            ``(B) An individual who is entitled to assistance 
        under section 3311(b)(9) or 3319 of this title by 
        virtue of such individual's relationship to a veteran 
        described in subparagraph (A).
    ``(3) If after enrollment in a course of education that is 
subject to disapproval under paragraph (1) by reason of 
paragraph (2)(A) or (2)(B) a covered individual pursues one or 
more courses of education at the same public institution of 
higher learning while remaining continuously enrolled (other 
than during regularly scheduled breaks between courses, 
semesters or terms) at that institution of higher learning, any 
course so pursued by the covered individual at that institution 
of higher learning while so continuously enrolled shall also be 
subject to disapproval under paragraph (1).
    ``(4) It shall not be grounds to disapprove a course of 
education under paragraph (1) if a public institution of higher 
learning requires a covered individual pursuing a course of 
education at the institution to demonstrate an intent, by means 
other than satisfying a physical presence requirement, to 
establish residency in the State in which the institution is 
located, or to satisfy other requirements not relating to the 
establishment of residency, in order to be charged tuition and 
fees for that course at a rate that is equal to or less than 
the rate the institution charges for tuition and fees for that 
course for residents of the State.
    ``(5) The Secretary may waive such requirements of 
paragraph (1) as the Secretary considers appropriate.
    ``(6) Disapproval under paragraph (1) shall apply only with 
respect to educational assistance under chapters 30 and 33 of 
this title.''.
    (b) Effective Date.--Subsection (c) of section 3679 of 
title 38, United States Code (as added by subsection (a) of 
this section), shall apply with respect to educational 
assistance provided for pursuit of a program of education 
during a quarter, semester, or term, as applicable, that begins 
after July 1, 2015.

SEC. 703. EXTENSION OF REDUCTION IN AMOUNT OF PENSION FURNISHED BY 
                    DEPARTMENT OF VETERANS AFFAIRS FOR CERTAIN VETERANS 
                    COVERED BY MEDICAID PLANS FOR SERVICES FURNISHED BY 
                    NURSING FACILITIES.

    Section 5503(d)(7) of title 38, United States Code, is 
amended by striking ``November 30, 2016'' and inserting 
``September 30, 2024''.

SEC. 704. EXTENSION OF REQUIREMENT FOR COLLECTION OF FEES FOR HOUSING 
                    LOANS GUARANTEED BY SECRETARY OF VETERANS AFFAIRS.

    Section 3729(b)(2) of title 38, United States Code, is 
amended--
            (1) in subparagraph (A)--
                    (A) in clause (iii), by striking ``October 
                1, 2017'' and inserting ``September 30, 2024''; 
                and
                    (B) in clause (iv), by striking ``October 
                1, 2017'' and inserting ``September 30, 2024'';
            (2) in subparagraph (B)--
                    (A) in clause (i), by striking ``October 1, 
                2017'' and inserting ``September 30, 2024''; 
                and
                    (B) in clause (ii), by striking ``October 
                1, 2017'' and inserting ``September 30, 2024'';
            (3) in subparagraph (C)--
                    (A) in clause (i), by striking ``October 1, 
                2017'' and inserting ``September 30, 2024''; 
                and
                    (B) in clause (ii), by striking ``October 
                1, 2017'' and inserting ``September 30, 2024''; 
                and
            (4) in subparagraph (D)--
                    (A) in clause (i), by striking ``October 1, 
                2017'' and inserting ``September 30, 2024''; 
                and
                    (B) in clause (ii), by striking ``October 
                1, 2017'' and inserting ``September 30, 2024''.

SEC. 705. LIMITATION ON AWARDS AND BONUSES PAID TO EMPLOYEES OF 
                    DEPARTMENT OF VETERANS AFFAIRS.

    In each of fiscal years 2015 through 2024, the Secretary of 
Veterans Affairs shall ensure that the aggregate amount of 
awards and bonuses paid by the Secretary in a fiscal year under 
chapter 45 or 53 of title 5, United States Code, or any other 
awards or bonuses authorized under such title does not exceed 
$360,000,000.

SEC. 706. EXTENSION OF AUTHORITY TO USE INCOME INFORMATION.

    Section 5317(g) of title 38, United States Code, is amended 
by striking ``September 30, 2016'' and inserting ``September 
30, 2024''.

SEC. 707. REMOVAL OF SENIOR EXECUTIVES OF THE DEPARTMENT OF VETERANS 
                    AFFAIRS FOR PERFORMANCE OR MISCONDUCT.

    (a) Removal or Transfer.--
            (1) In general.--Chapter 7 of title 38, United 
        States Code, is amended by adding at the end the 
        following new section:

``Sec. 713. Senior executives: removal based on performance or 
                    misconduct

    ``(a) In General.--(1) The Secretary may remove an 
individual employed in a senior executive position at the 
Department of Veterans Affairs from the senior executive 
position if the Secretary determines the performance or 
misconduct of the individual warrants such removal. If the 
Secretary so removes such an individual, the Secretary may--
            ``(A) remove the individual from the civil service 
        (as defined in section 2101 of title 5); or
            ``(B) in the case of an individual described in 
        paragraph (2), transfer the individual from the senior 
        executive position to a General Schedule position at 
        any grade of the General Schedule for which the 
        individual is qualified and that the Secretary 
        determines is appropriate.
    ``(2) An individual described in this paragraph is an 
individual who--
            ``(A) previously occupied a permanent position 
        within the competitive service (as that term is defined 
        in section 2102 of title 5);
            ``(B) previously occupied a permanent position 
        within the excepted service (as that term is defined in 
        section 2103 of title 5); or
            ``(C) prior to employment in a senior executive 
        position at the Department of Veterans Affairs, did not 
        occupy any position within the Federal Government.
    ``(b) Pay of Transferred Individual.--(1) Notwithstanding 
any other provision of law, including the requirements of 
section 3594 of title 5, any individual transferred to a 
General Schedule position under subsection (a)(2) shall, 
beginning on the date of such transfer, receive the annual rate 
of pay applicable to such position.
    ``(2) An individual so transferred may not be placed on 
administrative leave or any other category of paid leave during 
the period during which an appeal (if any) under this section 
is ongoing, and may only receive pay if the individual reports 
for duty. If an individual so transferred does not report for 
duty, such individual shall not receive pay or other benefits 
pursuant to subsection (e)(5).
    ``(c) Notice to Congress.--Not later than 30 days after 
removing or transferring an individual from a senior executive 
position under subsection (a), the Secretary shall submit to 
the Committees on Veterans' Affairs of the Senate and House of 
Representatives notice in writing of such removal or transfer 
and the reason for such removal or transfer.
    ``(d) Procedure.--(1) The procedures under section 7543(b) 
of title 5 shall not apply to a removal or transfer under this 
section.
    ``(2)(A) Subject to subparagraph (B) and subsection (e), 
any removal or transfer under subsection (a) may be appealed to 
the Merit Systems Protection Board under section 7701 of title 
5.
    ``(B) An appeal under subparagraph (A) of a removal or 
transfer may only be made if such appeal is made not later than 
seven days after the date of such removal or transfer.
    ``(e) Expedited Review by Administrative Judge.--(1) Upon 
receipt of an appeal under subsection (d)(2)(A), the Merit 
Systems Protection Board shall refer such appeal to an 
administrative judge pursuant to section 7701(b)(1) of title 5. 
The administrative judge shall expedite any such appeal under 
such section and, in any such case, shall issue a decision not 
later than 21 days after the date of the appeal.
    ``(2) Notwithstanding any other provision of law, including 
section 7703 of title 5, the decision of an administrative 
judge under paragraph (1) shall be final and shall not be 
subject to any further appeal.
    ``(3) In any case in which the administrative judge cannot 
issue a decision in accordance with the 21-day requirement 
under paragraph (1), the removal or transfer is final. In such 
a case, the Merit Systems Protection Board shall, within 14 
days after the date that such removal or transfer is final, 
submit to Congress and the Committees on Veterans' Affairs of 
the Senate and House of Representatives a report that explains 
the reasons why a decision was not issued in accordance with 
such requirement.
    ``(4) The Merit Systems Protection Board or administrative 
judge may not stay any removal or transfer under this section.
    ``(5) During the period beginning on the date on which an 
individual appeals a removal from the civil service under 
subsection (d) and ending on the date that the administrative 
judge issues a final decision on such appeal, such individual 
may not receive any pay, awards, bonuses, incentives, 
allowances, differentials, student loan repayments, special 
payments, or benefits.
    ``(6) To the maximum extent practicable, the Secretary 
shall provide to the Merit Systems Protection Board, and to any 
administrative judge to whom an appeal under this section is 
referred, such information and assistance as may be necessary 
to ensure an appeal under this subsection is expedited.
    ``(f) Relation to Title 5.--(1) The authority provided by 
this section is in addition to the authority provided by 
section 3592 or subchapter V of chapter 75 of title 5.
    ``(2) Section 3592(b)(1) of title 5 does not apply to an 
action to remove or transfer an individual under this section.
    ``(g) Definitions.--In this section:
            ``(1) The term `individual' means--
                    ``(A) a career appointee (as that term is 
                defined in section 3132(a)(4) of title 5); or
                    ``(B) any individual who occupies an 
                administrative or executive position and who 
                was appointed under section 7306(a) or section 
                7401(1) of this title.
            ``(2) The term `misconduct' includes neglect of 
        duty, malfeasance, or failure to accept a directed 
        reassignment or to accompany a position in a transfer 
        of function.
            ``(3) The term `senior executive position' means--
                    ``(A) with respect to a career appointee 
                (as that term is defined in section 3132(a)(4) 
                of title 5), a Senior Executive Service 
                position (as such term is defined in section 
                3132(a)(2) of title 5); and
                    ``(B) with respect to an individual 
                appointed under section 7306(a) or section 
                7401(1) of this title, an administrative or 
                executive position.''.
            (2) Clerical amendment.--The table of sections at 
        the beginning of such chapter is amended by adding at 
        the end the following new item:

``713. Senior executives: removal based on performance or misconduct.''.
    (b) Establishment of Expedited Review Process.--
            (1) In general.--Not later than 14 days after the 
        date of the enactment of this Act, the Merit Systems 
        Protection Board shall establish and put into effect a 
        process to conduct expedited reviews in accordance with 
        section 713(d) of title 38, United States Code.
            (2) Inapplicability of certain regulations.--
        Section 1201.22 of title 5, Code of Federal 
        Regulations, as in effect on the day before the date of 
        the enactment of this Act, shall not apply to expedited 
        reviews carried out under section 713(d) of title 38, 
        United States Code.
            (3) Waiver.--The Merit Systems Protection Board may 
        waive any other regulation in order to provide for the 
        expedited review required under section 713(d) of title 
        38, United States Code.
            (4) Report by merit systems protection board.--Not 
        later than 14 days after the date of the enactment of 
        this Act, the Merit Systems Protection Board shall 
        submit to the Committees on Veterans' Affairs of the 
        Senate and House of Representatives a report on the 
        actions the Board plans to take to conduct expedited 
        reviews under section 713(d) of title 38, United States 
        Code, as added by subsection (a). Such report shall 
        include a description of the resources the Board 
        determines will be necessary to conduct such reviews 
        and a description of whether any resources will be 
        necessary to conduct such reviews that were not 
        available to the Board on the day before the date of 
        the enactment of this Act.
    (c) Temporary Exemption From Certain Limitation on 
Initiation of Removal From Senior Executive Service.--During 
the 120-day period beginning on the date of the enactment of 
this Act, an action to remove an individual from the Senior 
Executive Service at the Department of Veterans Affairs 
pursuant to section 7543 of title 5, United States Code, may be 
initiated, notwithstanding section 3592(b) of such title, or 
any other provision of law.
    (d) Construction.--
            (1) In general.--Nothing in this section or section 
        713 of title 38, United States Code, as added by 
        subsection (a), shall be construed to apply to an 
        appeal of a removal, transfer, or other personnel 
        action that was pending before the date of the 
        enactment of this Act.
            (2) Relation to title 5.--With respect to the 
        removal or transfer of an individual (as that term is 
        defined in such section 713) employed at the Department 
        of Veterans Affairs, the authority provided by such 
        section 713 is in addition to the authority provided by 
        section 3592 or subchapter V of chapter 75 of title 5, 
        United States Code.

                       TITLE VIII--OTHER MATTERS

SEC. 801. APPROPRIATION OF AMOUNTS.

    (a) In General.--There is authorized to be appropriated, 
and is appropriated, to the Secretary of Veterans Affairs, out 
of any funds in the Treasury not otherwise appropriated 
$5,000,000,000 to carry out subsection (b). Such funds shall be 
available for obligation or expenditure without fiscal year 
limitation.
    (b) Use of Amounts.--The amount appropriated under 
subsection (a) shall be used by the Secretary as follows:
            (1) To increase the access of veterans to care as 
        follows:
                    (A) To hire primary care and specialty care 
                physicians for employment in the Department of 
                Veterans Affairs.
                    (B) To hire other medical staff, including 
                the following:
                            (i) Physicians.
                            (ii) Nurses.
                            (iii) Social workers.
                            (iv) Mental health professionals.
                            (v) Other health care professionals 
                        as the Secretary considers appropriate.
                    (C) To carry out sections 301 and 302, 
                including the amendments made by such sections.
                    (D) To pay for expenses, equipment, and 
                other costs associated with the hiring of 
                primary care, specialty care physicians, and 
                other medical staff under subparagraphs (A), 
                (B), and (C).
            (2) To improve the physical infrastructure of the 
        Department as follows:
                    (A) To maintain and operate hospitals, 
                nursing homes, domiciliary facilities, and 
                other facilities of the Veterans Health 
                Administration.
                    (B) To enter into contracts or hire 
                temporary employees to repair, alter, or 
                improve facilities under the jurisdiction of 
                the Department that are not otherwise provided 
                for under this paragraph.
                    (C) To carry out leases for facilities of 
                the Department.
                    (D) To carry out minor construction 
                projects of the Department.
    (c) Availability.--The amount appropriated under subsection 
(a) shall remain available until expended.
    (d) Report.--
            (1) In general.--Not later than one year after the 
        date of the enactment of this Act, the Secretary of 
        Veterans Affairs shall submit to the appropriate 
        committees of Congress a report on how the Secretary 
        has obligated the amounts appropriated under subsection 
        (a) as of the date of the submittal of the report.
            (2) Appropriate committees of congress defined.--In 
        this subsection, the term ``appropriate committees of 
        Congress'' means--
                    (A) the Committee on Veterans' Affairs and 
                the Committee on Appropriations of the Senate; 
                and
                    (B) the Committee on Veterans' Affairs and 
                the Committee on Appropriations of the House of 
                Representatives.
    (e) Funding Plan.--The Secretary shall submit to Congress a 
funding plan describing how the Secretary intends to use the 
amounts provided under subsection (a).

SEC. 802. VETERANS CHOICE FUND.

    (a) In General.--There is established in the Treasury of 
the United States a fund to be known as the Veterans Choice 
Fund.
    (b) Administration of Fund.--The Secretary of Veterans 
Affairs shall administer the Veterans Choice Fund established 
by subsection (a).
    (c) Use of Amounts.--
            (1) In general.--Any amounts deposited in the 
        Veteran Choice Fund shall be used by the Secretary of 
        Veterans Affairs to carry out section 101, including, 
        subject to paragraph (2), any administrative 
        requirements of such section.
            (2) Amount for administrative requirements.--
                    (A) Limitation.--Except as provided by 
                subparagraph (B), of the amounts deposited in 
                the Veterans Choice Fund, not more than 
                $300,000,000 may be used for administrative 
                requirements to carry out section 101.
                    (B) Increase.--The Secretary may increase 
                the amount set forth in subparagraph (A) with 
                respect to the amounts used for administrative 
                requirements if--
                            (i) the Secretary determines that 
                        the amount of such increase is 
                        necessary to carry out section 101;
                            (ii) the Secretary submits to the 
                        Committees on Veterans' Affairs and 
                        Appropriations of the House of 
                        Representatives and the Committees on 
                        Veterans' Affairs and Appropriations of 
                        the Senate a report described in 
                        subparagraph (C); and
                            (iii) a period of 60 days has 
                        elapsed following the date on which the 
                        Secretary submits the report under 
                        clause (ii).
                    (C) Report.--A report described in this 
                subparagraph is a report that contains the 
                following:
                            (i) A notification of the amount of 
                        the increase that the Secretary 
                        determines necessary under subparagraph 
                        (B)(i).
                            (ii) The justifications for such 
                        increased amount.
                            (iii) The administrative 
                        requirements that the Secretary will 
                        carry out using such increased amount.
    (d) Appropriation and Deposit of Amounts.--
            (1) In general.--There is authorized to be 
        appropriated, and is appropriated, to the Secretary of 
        Veterans Affairs, out of any funds in the Treasury not 
        otherwise appropriated $10,000,000,000 to be deposited 
        in the Veterans Choice Fund established by subsection 
        (a). Such funds shall be available for obligation or 
        expenditure without fiscal year limitation, and only 
        for the program created under section 101.
            (2) Availability.--The amount appropriated under 
        paragraph (1) shall remain available until expended.
    (e) Sense of Congress.--It is the sense of Congress that 
the Veterans Choice Fund is a supplement to but distinct from 
the Department of Veterans Affairs' current and expected level 
of non-Department care currently part of Department's medical 
care budget. Congress expects that the Department will maintain 
at least its existing obligations of non-Department care 
programs in addition to but distinct from the Veterans Choice 
Fund for each of fiscal years 2015 through 2017.

SEC. 803. EMERGENCY DESIGNATIONS.

    (a) In General.--This Act is designated as an emergency 
requirement pursuant to section 4(g) of the Statutory Pay-As-
You-Go Act of 2010 (2 U.S.C. 933(g)).
    (b) Designation in Senate.--In the Senate, this Act is 
designated as an emergency requirement pursuant to section 
403(a) of S. Con. Res. 13 (111th Congress), the concurrent 
resolution on the budget for fiscal year 2010.
      And the House agree to the same.
                For consideration of the House amendment and 
                the Senate amendment, and modifications 
                committed to conference:
                                   Jeff Miller of Florida,
                                   Doug Lamborn,
                                   David P. Roe of Tennessee,
                                   Bill Flores,
                                   Dan Benishek,
                                   Mike Coffman,
                                   Brad R. Wenstrup,
                                   Jackie Walorski,
                                   Michael H. Michaud,
                                   Corrine Brown of Florida,
                                   Mark Takano,
                                   Julia Brownley of California,
                                   Ann Kirkpatrick,
                                   Timothy J. Walz,
                                 Managers on the part of the House.

                                   Bernard Sanders,
                                   John D. Rockefeller IV,
                                   Patty Murray,
                                   Sherrod Brown,
                                   Jon Tester,
                                   Mark Begich,
                                   Richard Blumenthal,
                                   Mazie K. Hirono,
                                   Richard Burr,
                                   Johnny Isakson,
                                   Mike Johanns,
                                Managers on the part of the Senate.
       JOINT EXPLANATORY STATEMENT OF THE COMMITTEE OF CONFERENCE

      The managers on the part of the House and the Senate at 
the conference on the disagreeing votes of the two Houses on 
the amendment of the House to the amendment of the Senate to 
the bill (H.R. 3230), making continuing appropriations during a 
Government shutdown to provide pay and allowances to members of 
the reserve components of the Armed Forces who perform 
inactive-duty training during such period, submit the following 
joint statement to the House and the Senate in explanation of 
the effect of the action agreed upon by the managers and 
recommended in the accompanying conference report:
      The House amendment to the Senate amendment struck all of 
the House bill after the enacting clause and inserted a 
substitute text.
      The Senate recedes from its disagreement to the amendment 
of the House with an amendment that is a substitute for the 
House bill and the House amendment to the Senate amendment. The 
differences between the House amendment, the Senate amendment, 
and the substitute agreed to in conference are noted below, 
except for clerical corrections, conforming changes made 
necessary by agreements reached by the conferees, and minor 
drafting and clarifying changes.

                                OVERVIEW

      The House amendment to the Senate amendment to the 
Conference bill consists of provisions from the following House 
bills: H.R. 4810, the Veteran Access to Care Act of 2014, which 
passed the House on June 10, 2014, and H.R. 4031, the 
Department of Veterans Affairs Management Accountability Act of 
2014, which passed the House on May 21, 2014.
      The Senate amendment consists of provisions from the 
following Senate bill: S. 2450, the Veterans' Access to Care 
through Choice, Accountability, and Transparency Act of 2014, 
which was incorporated as a substitute amendment to H.R. 3230 
and passed the Senate on June 11, 2014.

Title I--Improvement of Access to Care From Non-Department of Veterans 
                           Affairs Providers

    EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL SERVICES FOR 
VETERANS THROUGH THE USE OF AGREEMENTS WITH NON-DEPARTMENT OF VETERANS 
                            AFFAIRS ENTITIES

Current Law
      Section 1710 of title 38, United States Code 
(hereinafter, ``U.S.C.''), requires the Department of Veterans 
Affairs (hereinafter, ``VA'') to provide hospital care and 
medical services to eligible veterans. Section 1703 of title 
38, U.S.C., authorizes VA to contract with non-Department 
facilities and providers to furnish hospital or medical 
services to eligible veterans when VA is not capable of 
providing economical care because of geographical 
inaccessibility or due to an inability to furnish such care or 
services required. Sections 1725 and 1728 of title 38, U.S.C., 
authorize VA to reimburse for certain types of care, such as 
emergency treatment, at non-Department facilities. Section 1786 
of title 38, U.S.C., authorizes VA to provide needed post-
delivery care and services. Section 8111 of title 38, U.S.C., 
authorizes VA to enter into sharing agreements at other 
government facilities. Section 8153 of title 38, U.S.C., 
authorizes a VA facility to enter into a contract or agreement 
with non-VA health care entities to secure healthcare services 
that are either unavailable or not cost-effective to provide at 
a VA facility.
Senate Amendment
      The Senate amendment would require VA to provide hospital 
and medical services to an eligible veteran, at the election of 
such veteran, through non-VA health care providers, who 
participate in the Medicare program, or at Federally Qualified 
Health Centers (hereinafter, ``FQHCs''), facilities funded by 
the Indian Health Service (hereinafter, ``IHS''), or Department 
of Defense (hereinafter, ``DOD''). It would also require the 
Secretary of Veterans Affairs (hereinafter, ``the Secretary'') 
to coordinate the delivery of such non-VA care and services 
through the Non-VA Care Coordination Program.
      For purposes of receiving non-VA care and services as a 
veteran enrolled in the VA health care system, the Senate 
amendment would define an eligible veteran as someone who is 
unable to schedule an appointment at a VA medical facility 
within VA's stated wait-time goals; resides more than 40 miles 
from the nearest VA medical facility; or, in the case of a 
veteran who resides in a State without a VA medical facility 
that provides hospital care, emergency medical services, and 
surgical care, resides 20 miles from such VA medical facility.
      It would also authorize VA to enter into negotiated 
contracts with eligible non-VA providers for the provision of 
care and services to an eligible veteran. Furthermore, it would 
authorize VA to establish contracts with non-VA providers at 
the Medicare rate or to negotiate a rate that is higher than 
the Medicare rate, only if VA is unable to find a health care 
provider that is able to provide such care and services at the 
Medicare rate.
House Amendment
      The House amendment would require VA, for two years after 
enactment, to offer non-VA care at the Department's expense to 
any enrolled veteran who resides more than 40 miles from a VA 
medical facility or has waited longer than the VA's wait-time 
goals--as of June 1, 2014--for a medical appointment or has 
been notified by VA that an appointment is not available within 
VA's wait-time goals--as of June 1, 2014--and who elects to 
receive care at a non-VA facility. In furnishing such care, the 
House amendment would require VA to utilize existing contracts 
to the greatest extent possible; to reimburse any non-VA care 
providers with which VA has not entered into an existing 
contract, at the greater of the rate set by VA, TRICARE, or 
Medicare, for care received by an eligible veteran; and, ensure 
that a non-VA care authorization encompasses the complete 
episode of care but does not exceed sixty days.
      It would also require VA to submit to Congress a 
quarterly report, which includes how many eligible veterans 
have received non-VA care or services.
Conference Agreement
      The Conference agreement adopts the Senate provision with 
amendments to eligibility, payment rates and VA's obligation 
for payments for non-service-connected care or services. The 
conference substitute defines an eligible veteran as a veteran 
who is enrolled in the patient enrollment system as of August 
1, 2014, or any veteran who enrolls after such date and who, at 
any time during the five-year period preceding such enrollment, 
served on active duty in a theater of combat operation. It also 
includes those veterans who live within 40 miles of a medical 
facility and are required to travel by air, boat, or ferry to 
access a VA medical facility or who face geographical 
challenges in accessing that medical facility. In calculating 
the distance from a nearest VA medical facility, it is the 
Conferees' expectation that VA will use geodesic distance, or 
the shortest distance between two points. The Conferees do not 
intend the 40-mile eligibility criteria included in this 
section to preclude veterans who reside closer than 40-miles 
from a VA facility from accessing care through non-VA 
providers, particularly if the VA facility the veteran resides 
near provides limited services.
      Should an appointment not be available for a veteran 
within the established wait time goals and the veteran chooses 
to be seen by non-VA entities, the veteran will be informed by 
electronic means, or by a letter if the veteran so chooses, as 
to the care or services they are authorized to receive.
      The rates for contracts established under this section 
shall be no more than the rates paid to a provider of services 
under Medicare with the exception VA may negotiate a higher 
rate for care provided to veterans residing in highly rural 
areas.
      A ``Veterans Choice Card'' will be issued to each 
enrolled veteran for presentation to health care providers for 
the delivery of authorized medical care and services. This card 
will contain identifying information as well as contact and 
relevant information for authorization and claims procedures. 
The Secretary will provide information to veterans about the 
availability of care and services through the use of this card. 
The Conferees do not intend for any delays that may occur in 
the production of the ``Veterans Choice Card'' to delay the 
implementation of the choice program.
      This election to receive care through a health care 
provider also includes what would be considered an episode of 
care up to a period of 60 days. The Conferees recognize that 
chronic conditions or illnesses may require episodes of care 
that extend beyond the 60 day limit. In such cases, the 
Conferees expect the Secretary to authorize additional episodes 
of care sufficient to complete the needed treatment or in the 
case of treatment needed to maintain a quality of life during a 
terminal illness.
      For those veterans receiving hospital care or medical 
services for non-service-connected conditions, the Department 
is secondarily responsible. The health care provider that 
furnishes care or services shall be responsible for seeking 
reimbursement from the health care plan contract under which 
the eligible veteran is covered. Eligible veterans will pay a 
copayment for the receipt of hospital care or medical services 
under this section only if such eligible veteran would be 
required to pay a copayment for the receipt of care and 
services at a VA medical facility. Nothing in this section 
amends health plans not administered by the Department, 
including with respect to the terms and conditions of such 
coverage, reimbursement, and cost-sharing.
      Numerous reports are required to document program 
implementation, establishment and success in meeting goals, 
utilization of and satisfaction in care and services delivered 
under this section, and Department expenditures.
      The Conferees expect VA will provide care and services 
under this section at the choice of an eligible veteran if the 
veteran experiences the time or distance delays described in 
this section. When coordinating care for eligible veterans 
through the Non-VA Care Coordination program, the Department 
should attempt to ensure when an appointment is authorized, the 
eligible veteran receives care within an appropriate time 
period, as defined by medical necessity as determined by the 
referring physician, or a mandatory time period established by 
the Secretary when the request for care is not initiated by a 
physician, that all medical fees are appropriately paid and 
health care records are returned to the Department within the 
prescribed time. The Conferees also expect that VA will utilize 
providers who have demonstrated success providing a variety of 
care, to veterans under an integrated model of care and a 
proven ability to partner with the Federal government.
      Congress has authorized a new program to provide care and 
choice to veterans, the funds made available for this program 
through section 802(d)(1) are available only to carry out this 
new program.

ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF VETERANS AFFAIRS AND 
                         INDIAN HEALTH SERVICE

Current Law
      Subsection 1645(c) of title 25, U.S.C., requires VA and 
DOD to reimburse IHS, an Indian tribe, or a tribal organization 
for providing eligible beneficiaries with health care services. 
In 2010, VA and IHS signed an updated Memorandum of 
Understanding (hereinafter, ``MOU'') in order to establish 
``mutual goals and objectives for ongoing collaboration between 
VA and IHS in support of their respective missions and to 
establish a common mission of serving our nation's American 
Indian and Alaska Native Veteran.'' This MOU set forth five 
goals, to be achieved through 12 areas of collaboration between 
VA and IHS. One of the areas of collaboration focused on 
increasing the availability of health care services through 
development of payment and reimbursement policies to support 
interagency care delivery.
      As a result, in December 2012, VA and IHS signed a 
national reimbursement agreement to create a mechanism by which 
VA can reimburse IHS for health services provided to eligible 
veterans. This MOU only covers direct care services provided by 
IHS. In addition to providing direct care, IHS also contracts 
with Urban Indian Health Centers and Tribal Health Programs 
(hereinafter, ``THP'') to provide additional points of care to 
eligible Native Americans. VA has worked with individual THPs 
to negotiate separate reimbursement agreements to care for 
veterans. While VA's agreement with IHS only covers dual 
eligible veterans, the Department's agreements with health 
providers through the Alaska Native Tribal Health Consortium 
include coverage for all veterans. VA has not yet entered into 
reimbursement agreements with any Urban IHS Centers to treat 
veterans.
      In April 2013 and June 2014, the Government 
Accountability Office (hereinafter, ``GAO'') issued two reports 
on the VA-IHS MOU. GAO's recommendations indicated that better 
definition of metrics and improved oversight and guidance would 
improve implementation of the MOU and its impact on access to 
care for veterans.
Senate Amendment
      The Senate amendment would require VA, in consultation 
with IHS, to conduct more outreach to IHS tribal health 
programs to ensure they are aware of the opportunity to 
negotiate a reimbursement agreement.
      It would require VA, in collaboration with IHS, to define 
metrics for implementing and overseeing existing partnership 
efforts under the current VA-IHS MOU.
      Finally, it would require VA and IHS to jointly report to 
Congress, within 180 days of enactment, on the feasibility and 
advisability of entering into reimbursement agreements with 
Urban IHS Centers and including treatment of non-Native 
veterans as a reimbursable expense under existing reimbursement 
structures.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate provision.

ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF VETERANS AFFAIRS AND 
                  NATIVE HAWAIIAN HEALTH CARE SYSTEMS

Current Law
      In October 2013, the VA Pacific Islands Health Care 
System (hereinafter, ``VAPIHCS'') entered into an MOU with Papa 
Ola Lokahi, the statutorily designated statewide coordinating 
body for the five Native Hawaiian Health Care Systems, in order 
to improve communication, collaboration, and cooperation 
regarding health care for Native Hawaiian veterans. The purpose 
statement of the MOU notes that both parties, ``hope to seek 
and develop greater means of achieving efficiency of care 
provided and to create future processes for VAPIHCS 
reimbursement for services provided to Native Hawaiian veterans 
referred to Papa Ola Lokahi by VAPIHCS.'' VA estimated the 
average waiting time for a new patient requesting a primary 
care appointment at VAPIHCS was nearly 130 days, the highest in 
the nation. Due to the rural nature of the state, VAPIHCS has 
received funding above and beyond its Veterans Equitable 
Resource Allocation in Fiscal Year (hereinafter, ``FY'') 2012 
and FY 2013, in order to account for the costs of beneficiary 
travel for eligible veterans to receive services on other 
islands. These numbers were $4.94 million and $4.65 million, 
respectively.
Senate Amendment
      The Senate amendment would require VA to enter into 
contracts or agreements with the Native Hawaiian health care 
systems for reimbursement of direct care services provided to 
eligible veterans.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate provision.

REAUTHORIZATION AND MODIFICATION OF PILOT PROGRAM OF ENHANCED CONTRACT 
            CARE AUTHORITY FOR HEALTH CARE NEEDS OF VETERANS

Current Law
      Section 403 of the Veterans' Mental Health and Other Care 
Improvements Act of 2008, Public Law 110-387, provided VA with 
authority to conduct a pilot program commonly known as Project 
ARCH (Access Received Closer to Home) in five Veterans 
Integrated Service Networks (hereinafter, ``VISNs''). The pilot 
program was to be carried out in at least five VISNs, 
restricted by various geographic and demographic factors. 
Locations included: Northern Maine; Farmville, Virginia; Pratt, 
Kansas; Flagstaff, Arizona; and, Billings, Montana. The aim of 
the pilot was to provide health care access to eligible 
veterans closer to home through a non-Department health care 
provider.
Senate Amendment
      The Senate amendment contained no similar provision.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Committee substitute would extend Project ARCH within 
specified VISNs for veterans in highly rural areas who are 
enrolled in VA health care for an additional 2 years. It would 
also require appointments to be scheduled within 5 days from 
the date the provider accepts a referral from VA and requires 
these veterans receive care within 30 days from the date the 
appointment was made.

          PROMPT PAYMENT BY THE DEPARTMENT OF VETERANS AFFAIRS

Current Law
      In general, the Prompt Payment Act, as amended, requires 
executive branch agencies, including VA, to pay late-payment 
penalties when the Department does not pay commercial payments 
on time.
      In March 2014, GAO reported that billing officials at one 
non-VA provider experienced ``lengthy delays'' in the 
processing of their claims, which in some cases took years. 
Additionally, GAO testified at a House Committee on Veterans' 
Affairs hearing on June 18, 2014, on claim processing 
discrepancies that delayed or denied payments for healthcare 
provided by non-VA providers.
      According to GAO, these delays or denials create an 
environment where non-VA entities are hesitant to provide care 
due to fears they will not be paid for services provided. This 
hinders access to care for veterans who need non-VA services.
Senate Amendment
      The Senate amendment would provide a Sense of Congress 
that VA comply with section 1315 of title 5, Code of Federal 
Regulations (hereinafter, ``CFR''), (commonly known as the 
``prompt payment rule'') in paying for health care pursuant to 
contracts with non-VA providers.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate provision 
with an amendment that adds a GAO report on the timeliness of 
payments by VA for non-VA care and services. The Committee is 
concerned that the Department is not paying claims for services 
provided to veterans by non-Department providers in a timely 
manner. The Committee urges the Secretary to establish and 
implement a system for the processing and paying of those 
claims.

TRANSFER OF AUTHORITY FOR PAYMENTS FOR HOSPITAL CARE, MEDICAL SERVICES, 
AND OTHER HEALTH CARE FROM NON-DEPARTMENT OF VETERANS AFFAIRS PROVIDERS 
   TO THE CHIEF BUSINESS OFFICE OF THE VETERANS HEALTH ADMINISTRATION

Current Law
      Under current law, section 1703 of title 38, U.S.C., VA 
may contract with non-Department facilities and providers to 
furnish hospital care or medical services to eligible veterans 
when VA is not capable of furnishing the care or services 
required or VA is not capable of providing economical care 
because of geographical inaccessibility. Further, VA has 
authority, under sections 1725 and 1728 of title 38, U.S.C., to 
reimburse for certain types of care, such as emergency 
treatment, at non-Department facilities.
      The criteria for determining whether a veteran is 
eligible for non-VA care is established by each VISN or VA 
medical center. Committee oversight has determined that a 
decentralized eligibility determination process ensures 
eligibility is appropriate for each medical center's capacity 
and the needs of the veterans it serves. However, such 
decentralization has caused disparity in eligibility criteria 
throughout the VA health care system and in some cases has led 
to the determination of eligibility as subject to facility 
budget considerations rather than to the determination of what 
is best for the veteran.
      The use of non-VA care has increased. In fact, non-VA 
care has been the subject of two recent reports by the GAO. 
Both reports highlighted vulnerabilities in VA's ability to 
manage and oversee utilization of and spending on non-VA care. 
In its May 2013 report, GAO noted VA's fee basis care spending 
had increased nearly $1.5 billion from FY 2008 through FY 2012 
and had witnessed an increase in utilization of 19% during that 
same time period.
      Without central oversight of non-VA care, VA has limited 
ability to collect and analyze data that could help to improve 
the program's management.
Senate Amendment
      The Senate amendment would require the Secretary to 
transfer the authority to pay for hospital care, medical 
services, and other health care through non-VA providers to the 
Chief Business Office from VA's VISNs and medical centers by 
October 1, 2014. It would also require the Chief Business 
Office to work with the Office of Clinical Operations and 
Management to ensure care and services are provided in a manner 
that is clinically appropriate and in the best interest of the 
veterans receiving such care and services.
      Finally, in each FY after the date of enactment, the 
Secretary would be required to include in the Chief Business 
Office budget funds to pay for hospital care, medical services, 
and other health care provided through non-VA providers.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate provision.

              Title II--Health Care Administrative Matters

    INDEPENDENT ASSESSMENT OF THE HEALTH CARE DELIVERY SYSTEMS AND 
       MANAGEMENT PROCESSES OF THE DEPARTMENT OF VETERANS AFFAIRS

Current Law
      VA operates the largest integrated health care system in 
the nation, comprised of 150 VA medical centers (hereinafter, 
``VAMCs''), 820 community-based outpatient clinics, 135 
community-living centers, 300 Vet Centers, 140 domiciliary 
treatment programs, and 70 mobile Vet Centers. These sites of 
care are divided amongst 21 VISNs. The VA health care system is 
overseen by the Veterans Health Administration (hereinafter, 
``VHA''), which operates under the leadership of the VA Under 
Secretary for Health. VHA employs a staff of approximately 
288,000 employees and oversees a medical care budget of 
approximately $55 billion. In addition to providing direct 
health care services to eligible veterans, caregivers, and 
dependents, VHA also conducts education and training programs 
for health care professionals and medical residents; operates 
an extensive medical research program; and, serves as the 
contingency back-up to the Department of Defense during 
national emergencies.
      VHA directive 2010-027, ``VHA Outpatient Scheduling 
Processes and Procedures'' (hereinafter, ``the directive''), 
established on June 9, 2010, outlines the policy for 
implementing processes and procedures for scheduling outpatient 
appointments using the Veterans Health Information Systems and 
Technology Architecture (hereinafter, ``VistA''). The directive 
also provides detail regarding how to ensure staff is competent 
in the scheduling process. This directive is set to expire on 
June 30, 2015.
      VA's Office of Inspector General (hereinafter, 
``VAOIG''), GAO and a recent VA audit have identified 
significant problems with VA's ability to provide timely access 
to health care.
Senate Amendment
      The Senate amendment would require VA to enter into a 
contract with an independent third party for a 180-day 
assessment of: the process for scheduling appointments at each 
VA medical facility; the staffing level at and productivity of 
each VA medical facility; the organization, processes, and 
tools used to support clinical documentation and coding of 
inpatient services; the purchasing, distribution, and use of 
pharmaceuticals; and the performance of the Department in 
paying amounts owed to third parties and collecting amounts 
owed to the Department. The independent third party conducting 
the assessment would be required to conduct a comprehensive 
review of the Department's scheduling process and recommend any 
actions to be taken by the Department to improve its process 
for scheduling medical appointments.
      The Senate amendment would also require VA to submit a 
report to the Committees on Veterans' Affairs of the Senate and 
the House of Representatives (hereinafter, ``the Committees''), 
no later than 90 days after the date on which the independent 
third party completes the assessment, on the results of such 
assessment.
House Amendment
      The House amendment would require an independent 
assessment of hospital care and medical services furnished in 
VA medical facilities. The independent assessment would 
address: the current and projected demographics and unique 
needs of the patient population served by VA; the Department's 
current and projected health care capabilities and resources; 
the authorities and mechanisms under which the Secretary may 
furnish hospital care and medical services at non-VA 
facilities; the appropriate system-wide access standard 
applicable to hospital care and medical services furnished by 
VA; the current organization, processes, and tools used to 
support clinical staffing; VA's staffing levels and 
productivity standards; information technology strategies; and, 
VHA' s business processes. Further, the independent assessment 
would include: an identification of improvement areas; 
recommendations for how to address such improvement areas; the 
business case associated with making such improvements; and 
findings and supporting analysis on how credible conclusions 
were established.
      It would also require the Secretary to designate a 
program integrator if VA enters into contracts with more than 
one private sector entity to conduct the independent 
assessment. The program integrator would be required to be 
responsible for coordinating the outcomes of the assessments 
conducted by the private entities.
      Finally, the House amendment would require VA to submit 
to the Committees a report, no later than 10 months after 
entering into a contract with a private entity, on the findings 
of the independent assessment and a subsequent report, no later 
than 120 days after the date of the submission of the first 
report, which would be required to include VA's action plan for 
fully implementing the recommendations of the independent 
assessment.
Conference Agreement
      The Conference substitute adopts the House provision with 
amendments to broaden the breadth of the assessment to include: 
VA leadership; access to care; length of stay management; 
patient experience; workflow; care transitions; mechanisms by 
which VA ensures timely payments to nonVA care providers; 
pharmaceutical; supply and device purchasing; distribution and 
use; scheduling; and medical construction, maintenance and 
leasing.
      The Conferees expect that the assessment will produce 
outcomes that identify improvement areas outlined both 
qualitatively and quantitatively, taking into consideration 
Department of Veterans Affairs' directives and industry 
benchmarks from outside the Federal Government. The assessment 
is also expected to provide supporting analysis on how credible 
conclusions were established. The business cases associated 
with and the recommendations for how to address these 
identified improvement areas relating to structure, 
accountability, process changes, technology, capabilities and 
usage, staff compliance, training effectiveness, and other 
relevant drivers of performance are expected to better inform 
the Commission on Care in its work.

                           COMMISSION ON CARE

Current Law
      Precedent exists for establishing an independent 
commission in response to concerns regarding the care provided 
to our nation's servicemembers and veterans. In 2007, ``the 
President's Commission on Care for America's Returning Wounded 
Warriors,'' known as the Dole-Shalala Commission, was 
established in response to reports of substandard conditions 
and mismanagement at Walter Reed Army Hospital. The subsequent 
report and recommendations issued by the Dole-Shalala 
Commission have been critical to improving the health care, 
benefits, and services available to our nation's veterans in 
recent years.
      Another independent, high-level commission, the Capital 
Asset Realignment for Enhanced Services (``CARES'') Commission 
has been utilized in recent history to examine and recommend 
improvements for addressing a host of challenges facing VHA, 
such as how best to align VA's health care system to deliver 
care to veterans.
      Physical infrastructure plays a significant role in VA's 
ability to provide high quality care to veterans. With more 
than 2 million new veterans enrolling into the VA health care 
system since 2009, and veterans experiencing extended wait 
times for appointments, it is essential that VA facility 
leasing programs and maintenance projects are completed on time 
and within budget.
Senate Amendment
      The Senate amendment would establish a Commission on 
Access to Care to examine the access of veterans to health care 
and strategically examine how best to organize VHA, locate 
health care resources, and deliver health care to veterans. The 
Commission would be required to report initial findings and 
recommendations within 90 days of its first meeting, and would 
be required to provide a final report within 180 days of such 
meeting.
      The Senate amendment would also establish an Independent 
Commission on Department of Veterans Affairs Construction 
Projects to review current construction and maintenance 
projects and the medical facility leasing program in order to 
identify any issues the Department may be experiencing as it 
carries out these projects. The Commission would be required to 
report to the Secretary and Congress not later than 120 days 
after enactment any recommendations for improving how VA 
carries out its construction and maintenance projects. 
Following submission of the Commission's report, the Secretary 
would have 60 days to submit to Congress a report on the 
feasibility and advisability of implementing the 
recommendations of the Commission, including a timeline for the 
implementation of such recommendations.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate provision on 
the Commission on Care with an amendment to include a 
representative with familiarity with medical facility 
construction and leasing projects. This amendment would allow 
the Commission on Care to examine how VA's physical 
infrastructure impacts VA's ability to provide high quality 
care to veterans and eliminate the need for a separate 
Independent Commission on Department of Veterans Affairs 
Construction Projects. Further, the Conference substitute 
increases the number of voting members to 15, eliminates non-
voting members, and allows for appointment by the Speaker and 
Minority Leader of the House of Representatives and Majority 
and Minority Leaders of the Senate. It is the expectation of 
the Conferees that the membership of the Commission on Care 
will represent and reflect a bipartisan, cross-section of VHA 
users.
      The Commission on Care may also consider looking at the 
relationship and communication structure between the VHA and 
the Veterans Benefits Administration. The Conferees are 
concerned the two administrations do not communicate and lack 
synergy to ensure that veterans' benefits and services are 
rendered in a timely, safe, and veteran focused manner.

 TECHNOLOGY TASK FORCE ON REVIEW OF SCHEDULING SYSTEM AND SOFTWARE OF 
                   THE DEPARTMENT OF VETERANS AFFAIRS

Current Law
      VHA presently relies on an outpatient scheduling system 
that is more than 25 years-old. In October 2001, due to an 
aging system with various limitations that hindered its 
effectiveness, VHA launched a scheduling replacement 
initiative. This process was wrought with setbacks, including 
failed information technology (hereinafter, ``IT'') management 
and acquisition practices. After expending $127 million on that 
effort, VA was only able to obtain defective software that 
could not be fixed and did not achieve the intended goal. 
Further, reports by GAO and VAOIG have repeatedly highlighted 
challenges with the use of the Electronic Wait List 
(hereinafter, ``EWL''), an inability to connect with the 
consult management system, and other change management 
challenges regarding training for medical appointment 
schedulers.
      Utilizing the America Competes Reauthorization Act of 
2011, VA started the 21st Century Medical Scheduling contest in 
order to encourage commercial vendors to develop solutions VA 
can use and to mitigate risks VA identified in previous 
attempts to replace the existing Medical Scheduling Package. 
The contest ended on September 30, 2013, and three winners were 
identified and awarded slightly over $3 million for their 
efforts. VA is currently pursuing modernization of VistA; thus, 
there has been renewed focus within the Department on how to 
improve its functionality and user experiences across the 
board. VA recently held Industry Days and one-on-one 
demonstrations with potential vendors in order to choose an 
off-the-shelf product as part of a long-term scheduling package 
replacement strategy.
Senate Amendment
      The Senate amendment would require VA to review, through 
the use of a technology task force, the needs of the Department 
with respect to the scheduling system and scheduling software. 
The task force would be required to issue a report to propose 
specific actions that VA can take to improve its scheduling 
software and determine whether an existing off-the-shelf system 
would meet the Department's needs within 45 days of enactment. 
VA would be required to publish the report in the Federal 
Register and on a publicly accessible website. VA would also be 
required to implement any feasible, advisable, and cost-
effective recommendations set forth in the report within one 
year of its receipt.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate provision. 
The Conferees expect VA to utilize the Northern Virginia 
Technology Task Force to implement this section. The Task Force 
previously provided a pro-bono review for Arlington National 
Cemetery.

  IMPROVEMENT OF ACCESS OF VETERANS TO MOBILE VET CENTERS AND MOBILE 
         MEDICAL CENTERS OF THE DEPARTMENT OF VETERANS AFFAIRS

Current Law
      In May 2014, VHA's Office of Rural Health published a 
fact sheet reporting that, of the Nation's 22 million veterans, 
5.3 million live in rural areas. Currently, there are 70 mobile 
vet centers operating around the country providing readjustment 
counseling and information resources to veterans in rural 
areas. Mobile vet centers in some areas also provide limited 
telemedicine services. VA, however, has not issued any standard 
procedures for the operation of mobile vet centers. Currently, 
regional managers determine how a mobile vet center is employed 
and utilized. As a result, mobile vet centers are vulnerable to 
inconsistencies.
      In addition to mobile vet centers, VA uses mobile medical 
units (hereinafter, ``MMUs'') to increase access to care for 
rural veterans. As of March 2013, VA operated eight MMUs. In 
May 2014, VAOIG issued an audit of VA MMUs, which found that VA 
lacked critical information regarding the number, locations, 
purpose, patient workloads, operation costs, and operations of 
MMUs. VAOIG recommended that VA improve oversight of MMUs.
Senate Amendment
      The Senate amendment would require VA to improve access 
to health care services, including telemedicine, by 
standardizing requirements for the operation of mobile vet 
centers. It would also require the Secretary to submit an 
annual report to Congress on the use of mobile vet centers as 
well as recommended improvements for access to telemedicine and 
health care via mobile vet centers.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate provision 
with an amendment to require VA to use MMUs as well as mobile 
vet centers to improve access to care for veterans, 
particularly those residing in rural areas.

IMPROVED PERFORMANCE METRICS FOR HEALTH CARE PROVIDED BY DEPARTMENT OF 
                            VETERANS AFFAIRS

Current Law
      Under current law, chapter 45, chapter 53, and other 
provisions of title 5, U.S.C., VA has the authority to provide 
awards to certain employees. For example, chapter 45 of title 
5, U.S.C., provides VA with authority to grant cash awards to 
employees in recognition of performance.
Senate Amendment
      The Senate amendment would require the Secretary to 
ensure that scheduling and wait-time metrics are not used as 
factors in determining the performance of certain employees for 
purposes of determining whether to pay performance awards to 
such employees. It would also require the Secretary to remove 
from the performance goals of any VISN or VA medical center 
employee, any performance goal that might disincentivize the 
payment of Department amounts to provide health care through 
non-VA providers.
      The Senate amendment would also require the Secretary to 
modify the performance plans of the directors of VISNs and VA 
medical centers to ensure that such plans are based on the 
quality of care received by veterans at VA medical facilities, 
including reviews and recommendations concerning such 
facilities by the VAOIG and the Joint Commission.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate provision.

IMPROVED TRANSPARENCY CONCERNING HEALTH CARE PROVIDED BY DEPARTMENT OF 
                            VETERANS AFFAIRS

Current Law
      VHA operates the largest integrated health care system in 
the nation, providing care to nearly 6.5 million veterans, 
survivors, and their dependents every year. According to GAO, 
between FY 2005 and FY 2012, the number of outpatient medical 
appointments at VA has increased by roughly 45 percent. VA' s 
own data on wait times for FY 2010 suggested it was seeing 
virtually all its primary and specialty care appointments 
within the 30 days of desired date requirement that had been 
established in 1995. As a result, in FY 2011, VHA shortened its 
goal of scheduling both primary and specialty care appointments 
to 14 days. While VA did not publicly publish data related to 
wait times, it did attempt to encourage accountability by 
incorporating the wait-time goal metric into the performance 
contracts of VISN and VAMC directors.
Senate Amendment
      The Senate amendment would require the Secretary to 
publish wait-times for scheduling an appointment at VA 
facilities in the Federal Register and on a public website of 
each medical center within 90 days of the date of enactment of 
this Act. It would also require VA to publish, on the Internet, 
current wait times for appointments in primary and specialty 
care at each VA medical center.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate provision.

 INFORMATION FOR VETERANS ON THE CREDENTIALS OF DEPARTMENT OF VETERANS 
                           AFFAIRS PHYSICIANS

Current Law
      In FY 2013, 18,342 physicians; 991 dentists; 50,862 
registered nurses; 23,729 licensed practical nurses, licensed 
vocational nurses, and nurse assistants; and 12,102 non-
physician providers delivered care to nearly 6.5 million 
veterans, survivors, and their dependents. VA makes information 
regarding its health care providers available to its patients 
and the public through the ``Our Doctors'' section on the 
website for each of VA's medical centers. Congressional 
oversight has determined that these websites contain limited 
information regarding the credentials for VA's physicians.
Senate Amendment
      The Senate amendment would require VA to improve the 
information available to veterans regarding residency training 
in the ``Our Doctors'' database located on each VA medical 
facility's website. It would also require VA to provide 
information regarding a physician's credentials to a veteran, 
or an individual acting on behalf of a veteran, prior to 
undergoing a surgical procedure by or through VA.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate provision.

  INFORMATION IN ANNUAL BUDGET OF THE PRESIDENT ON HOSPITAL CARE AND 
 MEDICAL SERVICES FURNISHED THROUGH EXPANDED USE OF CONTRACTS FOR SUCH 
                                  CARE

Current Law
      Under current law, section 1105 of title 31, U.S.C., the 
President submits a budget for the U.S. Government that 
includes a message, summary and supporting information.
Senate Amendment
      The Senate amendment would require the Secretary to 
include information in the Department's budget submission 
regarding hospital care and medical services furnished through 
expanded use of contracts.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate provision.

PROHIBITION ON FALSIFICATION OF DATA CONCERNING WAIT TIMES AND QUALITY 
               MEASURES AT DEPARTMENT OF VETERANS AFFAIRS

Current Law
      In May 2014, concerns about VA's scheduling practices, 
including excessive wait times, were identified in the VAOIG's 
interim report regarding the alleged patient deaths at the 
Phoenix Health Care System. The results indicated that 1,700 
veterans were waiting for a primary care appointment but had 
not been placed on the EWL. In its report, the VAOIG noted 
that, as a direct result of not properly placing veterans on 
the EWL, the leadership at the Phoenix Health Care System had 
radically understated the amount of time new patients waited 
for their primary care appointments.
Senate Amendment
      The Senate amendment would require VA to establish 
disciplinary procedures within 60 days of enactment of this Act 
for employees who knowingly submit false data pertaining to 
wait times and quality measures or knowingly require another 
employee of the Department to submit false data concerning such 
wait times or quality measures to another employee of the 
Department.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate provision.

   Title III--Health Care Staffing, Recruitment, and Training Matters

   TREATMENT OF STAFFING SHORTAGE AND BIENNIAL REPORT ON STAFFING OF 
        MEDICAL FACILITIES OF THE DEPARTMENT OF VETERANS AFFAIRS

Current Law
      Subsection 3304(a) of title 5, U.S.C., authorizes federal 
agencies to appoint, without regard to certain hiring 
preferences and competitive service selection requirements, 
candidates directly to positions for which a severe shortage of 
candidates or a critical hiring need has been identified.
      VA's own nation-wide access audit determined that VA 
faces staffing challenges and needs additional health care 
professionals, such as primary care physicians, specialty care 
physicians, and administrative and support staff, to improve 
access to high quality health care for veterans. These reviews 
and Congressional oversight have identified the federal 
government's long hiring process as a barrier to recruiting 
qualified health care professionals to the VA health care 
system.
      Furthermore, GAO and VAOIG have reported that inadequate 
staffing and gaps in hiring health care professionals at VA 
medical facilities throughout the country have adverse effects 
on patient care. These adverse effects include increased wait 
times and delays in scheduling appointments. Current law, 
however, is silent on requiring periodic assessments of VA's 
staffing and succession planning process.
Senate Amendment
      The Senate amendment would require VAOIG to annually 
identify the five occupations of health care providers with the 
largest staffing shortages and would authorize VA to utilize 
direct appointment authority to fill such openings in an 
expedited manner. It would also give priority for VA' s Health 
Professionals Educational Assistance Program to individuals 
pursuing a medical degree with the intent to specialize in 
occupations identified by the VAOIG.
      It would also require VA to submit a report to the 
Committees, not later than 180 days after the date of enactment 
of and not later than December 31, biennially, thereafter 
through 2024, on staffing at each VA medical facility. Such 
report would be required to include: the results of a system-
wide assessment of all VA medical facilities, including a plan 
for addressing any issues identified in such assessment; a list 
of the current wait times, workload levels, and staffing models 
for certain clinics; the results of the most current VAOIG 
findings regarding staffing shortages and VA's plan to use 
direct appointment authority to fill such staffing shortages; 
an analysis of succession planning at VA medical facilities; 
and the number of VA health care providers who have been 
removed, retired, or left their positions for other reasons.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate provision 
with an amendment that would require the Secretary to establish 
medical residency programs or ensure sufficient numbers of 
medical residency positions at facilities with existing 
programs in areas experiencing a shortage of physicians or 
located in a community that is designated as a health 
professional shortage area. It would also increase the number 
of graduate medical education residency positions by up to 
1,500 over five years with a priority for primary care, mental 
health, and other specialties as VA determines appropriate. 
Finally, it would require an annual report to Congress.
      The Conference encourages VA to explore options of 
partnering with private sector and affiliate hospitals who 
could potentially provide vacant space to VA for care.

EXTENSION AND MODIFICATION OF CERTAIN PROGRAMS WITHIN THE DEPARTMENT OF 
  VETERANS AFFAIRS HEALTH PROFESSIONALS EDUCATIONAL ASSISTANCE PROGRAM

Current Law
      Section 7601, et seq. of title 38, U.S.C., provides VA 
with authority to carry out the VA Health Professionals 
Education Assistance Program (hereinafter, ``HPEAP'') to 
provide scholarships, tuition assistance, debt reduction 
assistance, and other educational programs to VA health care 
professionals. HPEAP serves as a recruitment and retention tool 
for the Department. For example, the Education Debt Reduction 
Program (hereinafter, ``EDRP''), which provides educational 
assistance to VHA employees in an effort to maintain staffing 
levels, has assisted 10,055 individuals from FY 2002 through FY 
2013. However, VA has acknowledged EDRP has experienced lower 
than expected utilization rates because it requires 
participants to pay student loan expenses upfront which are 
reimbursed later by the Department. As a result, the number of 
participants defaulting on their loans and subsequently being 
removed from the program is higher than anticipated.
Senate Amendment
      The Senate amendment contained no similar provision.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute would extend VA's authority to 
operate HPEAP through December 31, 2019. It would also increase 
the cap on debt reduction payments to an individual participant 
from $60,000 to $120,000. These amendments would bring VA's 
Health Professionals Educational Assistance Program in line 
with other similar federal programs and ensure VA has the 
authority to provide appropriate incentives to attract health 
care professionals.

 CLINIC MANAGEMENT TRAINING FOR EMPLOYEES AT MEDICAL FACILITIES OF THE 
                     DEPARTMENT OF VETERANS AFFAIRS

Current Law
      Timely access to health care requires efficient clinic 
management. As early as 2005, GAO noted that VHA lacked 
standardized training programs for scheduling. Further, VHA has 
no leadership or management training in access to care 
management. GAO, VAOIG and VA's Office of Medical Inspector 
have identified standardization of clinic management training 
regarding availability of providers' schedules as a VA 
management challenge. Specific VA medical centers that have 
experienced difficulty with standardized scheduling processes 
are the VA San Diego Health Care System, the Cheyenne, Wyoming, 
VA Medical Center, and the Phoenix VA Healthcare System. 
Moreover, the tone of VHA's directive entitled Outpatient 
Scheduling Processes and Procedures is written in a manner that 
offers guidance rather than specific policy, seemingly allowing 
for discretion regarding its implementation.
Senate Amendment
      The Senate amendment would require VA to implement a 
clinic management training program to provide in-person, 
standardized education on health care management to all VA 
managers and health care providers. Such training program would 
be required to include training on: managing the schedules of 
VA health care providers; the appropriate number of 
appointments that a VA health care provider should conduct on a 
daily basis; managing appointments; the proper use of VA' s 
appointment scheduling system; optimizing the use of 
technology; and the proper use of physical plant space at VA 
medical facilities.
      It would also require VA to carry out the clinic 
management training program for two years and would require VA 
to update training materials on an ongoing basis and provide 
such training materials to relevant officials, as appropriate. 
Updating of training materials will need to account for new IT 
such as a new scheduling system or electronic access to care 
dash board.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate provision.

             Title IV--Health Care Related to Sexual Trauma

EXPANSION OF ELIGIBILITY FOR SEXUAL TRAUMA COUNSELING AND TREATMENT TO 
                   VETERANS ON INACTIVE DUTY TRAINING

Current Law
      Section 1720D of title 38, U.S.C., requires VA to provide 
counseling and appropriate care and services to veterans to 
overcome psychological trauma, which in the judgment of a VA 
mental health professional, resulted from a physical assault of 
a sexual nature, battery of a sexual nature, or sexual 
harassment which occurred while the veteran was serving on 
active duty or active duty for training (otherwise known as 
military sexual trauma) (hereinafter, ``MST''). Veterans who 
experienced MST while serving on active duty or active duty for 
training are included under this authority. However, veterans 
who experienced MST while on inactive duty for training--for 
example, those who were assaulted during weekend drill training 
for the National Guard and Reserve--are not included.
Senate Amendment
      The Senate amendment would amend section 1720D of title 
38, U.S.C., to provide VA with the authority to provide 
counseling, care and services to veterans, and certain other 
servicemembers who may not have veteran status, who experienced 
sexual trauma while serving on inactive duty for training.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate provision.

    PROVISION OF COUNSELING AND TREATMENT FOR SEXUAL TRAUMA BY THE 
     DEPARTMENT OF VETERANS AFFAIRS TO MEMBERS OF THE ARMED FORCES

Current Law
      Under current law, section 1720D of title 38, U.S.C., VA 
has the authority to provide counseling, care and services to 
veterans who experienced sexual trauma while serving on active 
duty or active duty for training.
Senate Amendment
      The Senate amendment would expand eligibility for care 
and services for MST at a VA facility to active duty 
servicemembers. Active duty servicemembers would not be 
required to initially be seen by DOD and receive a referral 
before seeking treatment at a VA facility for MST. It would 
take effect on the date that is one year after the date of 
enactment.
House Amendment
      The House amendment contains no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate position.

                   REPORTS ON MILITARY SEXUAL TRAUMA

Current Law
      Section 1720D of title 38, U.S.C., states that ``each 
year, the Secretary shall submit to Congress an annual report 
on the counseling, care, and services provided to veterans 
pursuant to this section.'' However, there is no language 
requiring an assessment.
Senate Amendment
      The Senate amendment would require the VA-DOD Joint 
Executive Committee to conduct an annual assessment for the 
next five years of the processes and procedures regarding the 
transition and continuum of care from the DOD to VA for 
individuals who have experienced MST. The assessment would also 
include the processes and collaboration by the agencies to 
assist individuals filing a claim for MST related disability. 
Additionally, VA would be required to submit a report to 
Congress no later than 630 days from the date of enactment of 
the Act on the treatment and services available for male 
veterans who experience MST compared to such treatment and 
services available to female veterans. It would take effect on 
the date that is 270 days after the date of enactment of the 
Act.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate provision.

                   Title V--Other Health Care Matters

  EXTENSION OF PILOT PROGRAM ON ASSISTED LIVING SERVICES FOR VETERANS 
                      WITH TRAUMATIC BRAIN INJURY

Current Law
      Section 1705 of Public Law 110-181, the ``National 
Defense Authorization Act for Fiscal Year 2008,'' requires: (1) 
VA, in collaboration with the Defense and Veterans Brain Injury 
Center, to carry out a five-year pilot program to assess the 
effectiveness of providing assisted living services to veterans 
with traumatic brain injury (hereinafter, ``TBI'') to enhance 
their rehabilitation, quality of life, and community 
integration; (2) at least one part of the pilot program to be 
carried out in a VISN that contains a VA polytrauma center; (3) 
special consideration to be given to veterans in rural areas; 
and, (4) VA to report to the Committees on the pilot program. 
To comply with this requirement, VA awarded a national contract 
to 20 contractors at more than 150 sites of care across the 
U.S. However, statutory authority for this pilot program 
expires on September 30, 2014.
Senate Amendment
      The Senate amendment contains no similar provision.
House Amendment
      The House amendment contains no similar provision.
Conference Agreement
      The Conference agreement extends the statutory authority 
for VA to operate the pilot program from September 30, 2014, to 
October 6, 2017.

                Title VI--Major Medical Facility Leases

             AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES

Current Law
      Under current law, section 8104 of title 38, U.S.C., 
Congressional authorization is required prior to entering into 
any VA major medical facility lease that has an average annual 
rent of $1,000,000 or above.
Senate Amendment
      The Senate amendment would authorize VA to enter into 26 
major medical facility leases in 17 states and Puerto Rico.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate provision 
with an amendment to include a lease authorization for a VA 
community-based outpatient clinic in Tulsa, Oklahoma, in an 
amount not to exceed $13.27 million. In enacting such leases, 
the Conferees would like the Secretary to consider any 
potential cost, energy and schedule savings that might be 
offered by standardized design elements and off-site 
construction methods, including prefabricated components and 
panelized structures.

  BUDGETARY TREATMENT OF DEPARTMENT OF VETERANS AFFAIRS MAJOR MEDICAL 
                           FACILITIES LEASES

Current Law
      Section 8104 of title 38, U.S.C., requires authorization 
of any major medical facility construction project or lease. 
Subsections (a)(1)(A) and (a)(1)(B) of section 1341 of title 
31, U.S.C., prohibit any government employee from entering into 
contracts, or making or authorizing expenditures and 
obligations that exceed the amount of appropriated funds for 
such expenditures.
      Appendix B of the Office of Management and Budget's 
(hereinafter, ``OMB'') Circular A-11 (hereinafter, 
``Circular'') describes the processes through which budgetary 
treatment of lease-purchase and leases of capital assets will 
be consistent with scorekeeping rules originally promulgated in 
connection with the Budget Enforcement Act of 1990 and the 
Anti-Deficiency Act. According to the Circular, at the time an 
Agency enters into a binding commitment, the Agency must 
obligate sufficient budget authority to cover associated legal 
obligations to the government, consistent with the requirements 
of the Anti-Deficiency Act. For lease-purchases or capital 
leases, this consists of the net present value of the total 
estimated legal obligations over the entire life of the 
contract. For operating leases, this can consist of either an 
amount sufficient to cover the lease payments for the first 
year plus a sufficient amount to cover any costs associated 
with cancellation of the contract, if the contract includes a 
cancellation clause, or an amount sufficient to cover the 
annual lease payment, if the lease is funded through a self-
insuring fund such as the General Services Administration's 
Federal Building Fund.
      After receiving information about how VA has exercised 
the authority provided in prior VA major medical facilities 
leasing authorizations, the Congressional Budget Office 
(hereinafter, ``CBO'') concluded in 2012 that VA has been 
entering into binding obligations for the full period of the 
lease, without regard to the scorekeeping rules contained in 
the Circular.
Senate Amendment
      The Senate amendment would require the funding prospectus 
of a proposed lease to include a detailed analysis of how the 
lease is expected to comply with OMB's Circular and the Anti-
Deficiency Act. It also directs VA, at least 30 days before 
entering into a lease, to submit to the Committees: (1) notice 
of the intention to enter into, and a detailed summary of, such 
lease; (2) a description and analysis of any differences 
between the lease prospectus submitted and the proposed lease; 
and (3) a scoring analysis demonstrating that the proposed 
lease fully complies with OMB's Circular. VA must also report 
any material differences between the proposed lease and the 
lease entered, no later than 30 days after entering into a 
lease.
House Amendment
      The House amendment contains no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate provision.

                   Title VII--Other Veterans Matters

    EXPANSION OF MARINE GUNNERY SERGEANT JOHN DAVID FRY SCHOLARSHIP

Current Law
      Public Law 111-32, the ``Supplemental Appropriations Act 
of 2009,'' amended the Post-9/11 GI Bill to establish the 
Marine Gunnery Sergeant John David Fry Scholarship for the 
children of servicemembers who died in the line of duty after 
September 10, 2001. Eligible children are entitled to 36 months 
of benefits at the 100 percent level and may use the benefit 
until their 33rd birthday.
      Currently, surviving spouses of servicemembers who died 
in the line of duty are only eligible to receive survivors' and 
dependents' educational assistance (hereinafter, ``Chapter 
35''). Chapter 35 benefits provide a spouse up to $1,003 per 
month as a full-time college student, which may require the 
spouse to find other sources of income or funding to offset the 
high cost of education. Additionally, recipients of Chapter 35 
do not receive a separate living allowance.
Senate Amendment
      The Senate amendment would expand the Marine Gunnery 
Sergeant John David Fry Scholarship to include surviving 
spouses of members of the Armed Forces who died or die in the 
line of duty after September 10, 2001. It would amend 
subsection (b)(9) of section 3311 of title 38, U.S.C., to 
expand the ability to receive the Marine Gunnery Sergeant John 
David Fry Scholarship to surviving spouses. It would limit the 
entitlement of the surviving spouse to the date that is 15 
years after the date of the servicemember's death or the date 
the surviving spouse remarries, whichever is earlier. Further, 
a surviving spouse, who is entitled both under amended section 
3311 and under Chapter 35, would be required to make an 
irrevocable election to receive educational assistance under 
either amended section 3311 or Chapter 35. Finally, this 
provision would make a necessary conforming amendment to 
subsection (b)(4) of section 3321 of title 38, U.S.C.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate position with 
an effective date of January 1, 2015.

  APPROVAL OF COURSES OF EDUCATION PROVIDED BY PUBLIC INSTITUTIONS OF 
    HIGHER LEARNING FOR PURPOSES OF ALL-VOLUNTEER FORCE EDUCATIONAL 
ASSISTANCE PROGRAM AND POST-9/11 EDUCATIONAL ASSISTANCE CONDITIONAL ON 
                   IN-STATE TUITION RATE FOR VETERANS

Current Law
      Section 3313 of title 38, U.S.C., authorizes VA to pay 
in-state tuition and fees for veterans attending a public 
educational institution using their Post-9/11 GI Bill 
educational benefits. However, a veteran may not always qualify 
for in-state tuition rates.
      Several states currently assist all or certain veterans 
by recognizing them as in-state students for purposes of 
attending a public educational institution, regardless of 
length of residency in the state where the veteran is attending 
college. Yet, many states require transitioning veterans to 
meet stringent residency requirements before they can be 
considered in-state residents. Federal law is silent on this 
matter.
      Recently-separated veterans may not be able to meet state 
residency requirements where they choose to attend school 
because they were stationed elsewhere during their military 
service, and once enrolled, they may not be able to legally 
establish residency because of their status as full-time 
students. The federal educational assistance provided to 
veterans by VA was designed, in part, to help them develop the 
skills and background necessary to make a successful transition 
from military service to a civilian life and career.
Senate Amendment
      The Senate amendment would amend section 3679 of title 
38, U.S.C., by adding a new subsection (c) to require VA to 
disapprove courses of education provided by public institutions 
of higher learning that charge tuition and fees at more than 
the in-state resident rate for veterans within three years from 
discharge from a period of at least 90 days service in the 
military, irrespective of the veteran's current state of 
residence, if the veteran is living in the state in which the 
institution is located while pursuing that course of education. 
Pursuant to subsection (c), this provision would apply to 
veterans using the educational assistance programs administered 
by VA under chapters 30 and 33 of title 38, U.S.C., and to 
dependent beneficiaries using Post-9/11 GI Bill benefits during 
the three years after the veteran's discharge. If the veteran 
or dependent enrolls within three years after the veteran's 
discharge, the requirement to charge no more than the in-state 
tuition rate would apply for the duration the individual 
remains continuously enrolled at the institution.
      Subsection (c)(4) would permit a public educational 
institution to require a covered individual to demonstrate an 
intent, by means other than satisfying a physical presence 
requirement, to eventually establish residency in that state or 
to meet requirements unrelated to residency in order to be 
eligible for the in-state tuition rate. This section would also 
provide VA discretion to waive the established requirements in 
a circumstance where it is deemed appropriate in regards to 
approval of a specific course of education. Any disapproval of 
courses pursuant to these new requirements would apply only 
with respect to benefits provided under chapters 30 and 33 of 
title 38. This provision would apply to programs of education 
that begin during academic terms after July 1, 2015.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate provision.

EXTENSION OF REDUCTION IN AMOUNT OF PENSION FURNISHED BY DEPARTMENT OF 
  VETERANS AFFAIRS FOR CERTAIN VETERANS COVERED BY MEDICAID PLANS FOR 
                SERVICES FURNISHED BY NURSING FACILITIES

Current Law
      Section 5503 of title 38, U.S.C., sets forth the criteria 
under which eligibility for income-based pension payments and 
aid and attendance allowances are affected by domiciliary or 
nursing home residence. In instances where a veteran, or 
surviving spouse, has neither a spouse nor a child, and is 
receiving Medicaid-covered nursing home care, the veteran or 
surviving spouse is eligible to receive no more than $90 per 
month in VA pension or death pension payments. Under current 
law, this authority shall expire on November 30, 2016. This 
authority has been extended several times, most recently 
pursuant to Public Law 112-260, the ``Dignified Burial and 
Other Veterans' Benefits Improvement Act of 2012.''
Senate Amendment
      The Senate amendment contains no similar provision.
House Amendment
      The House amendment contains no similar provision.
Conference Agreement
      The Committee substitute would amend section 5503( d)(7) 
to extend, through September 30, 2024, current eligibility 
restrictions for recipients of a VA pension who receive 
Medicaid-covered nursing home care. The VA pension program 
should not be used to subsidize other federal benefit programs. 
Further, pension recipients should have available funds for 
incidentals and personal expenses.

   EXTENSION OF REQUIREMENT FOR COLLECTION OF FEES FOR HOUSING LOANS 
              GUARANTEED BY SECRETARY OF VETERANS AFFAIRS

Current Law
      Under VA's home loan guaranty program, VA may guarantee a 
loan made to eligible servicemembers, veterans, reservists, and 
certain un-remarried surviving spouses for the purchase (or 
refinancing) of houses, condominiums, and manufactured homes. 
Section 3729(b)(2) of title 38, U.S.C., sets forth a loan fee 
table that lists funding fees, expressed as a percentage of the 
loan amount, for different types of loans.
Senate Amendment
      The Senate amendment contains no similar provision.
House Amendment
      The House amendment contains no similar provision.
Conference Agreement
      The Committee substitute would extend VA's authority to 
collect certain funding fees through September 30, 2024, by 
amending the fee schedule set forth in section 3729(b)(2) of 
title 38, U.S.C.

  LIMITATION ON AWARDS AND BONUSES PAID TO EMPLOYEES OF DEPARTMENT OF 
                            VETERANS AFFAIRS

Current Law
      Under current law, chapter 45, chapter 53, and other 
provisions of title 5, U.S.C., VA has the authority to provide 
awards to certain employees. For example, chapter 45 of title 5 
provides VA with authority to grant cash awards to employees in 
recognition of performance.
Senate Amendment
      The Senate amendment contained no similar provision.
House Amendment
      The House amendment would, for each of FYs 2014 through 
2016, prohibit the Secretary from paying awards or bonuses 
under chapters 45 or 53 of title 5, U.S.C., or any other awards 
or bonuses authorized under such title.
Conference Agreement
      The Conference substitute adopts the House provision with 
an amendment that would, for each of FYs 2014 through 2024, cap 
the amount of awards or bonuses payable under chapter 45 or 53 
of title 5, U.S.C., or any other awards or bonuses authorized 
under such title, at $360 million. It is the Conferees' 
expectation that this cap not disproportionately impact lower-
wage employees.

            EXTENSION OF AUTHORITY TO USE INCOME INFORMATION

Current Law
      Certain benefit programs administered by VA, including 
pension for wartime veterans and compensation for Individual 
Unemployability are available only to beneficiaries whose 
annual income is below a certain level. VA must have access to 
verifiable income information in order to ensure that those 
receiving benefits under its income-based programs are not 
earning a greater annual income than the law permits.
      Section 6103(1)(7)(D) of title 26, U.S.C., authorizes the 
release of certain income information by the Internal Revenue 
Service (hereinafter, ``IRS'') or the Social Security 
Administration (hereinafter, ``SSA'') to VA for the purposes of 
verifying income of applicants for VA needs-based benefits. 
Section 5317(g) of title 38, U.S.C., provides VA with temporary 
authority to obtain and use this information. Under current 
law, this authority expires on September 30, 2016.
Senate Amendment
      The Senate amendment contains no similar provision.
House Amendment
      The House amendment contains no similar provision.
Conference Agreement
      The Committee substitute would extend for eight years, 
until September 30, 2024, VA's authority to obtain information 
from the IRS or the SSA for income verification purposes for 
needs-based benefits.

 REMOVAL OF SENIOR EXECUTIVE OF THE DEPARTMENT OF VETERANS AFFAIRS FOR 
                       PERFORMANCE OR MISCONDUCT.

Current Law
      Under current law, section 7543 of title 5, U.S.C., 
career appointees in the Senior Executive Service (hereinafter, 
``SES'') may be removed from government service for misconduct, 
neglect of duty, malfeasance, or failure to accept a directed 
reassignment or to accompany a position in a transfer of 
function. Senior executives removed as a result of these 
conduct-related issues are entitled to certain rights, 
including at least 30 days advance written notice; a reasonable 
time but not less than seven days to reply; representation by 
an attorney or other representative; a written decision from 
the agency involved; and appeal rights to the Merit Systems 
Protection Board (hereinafter, ``MSPB'').
      Under current law, section 3592 of title 5, U.S.C., 
career appointees in the SES may be removed from the SES and 
placed into a non-SES position for performance-related issues. 
This removal may occur at any time during a one-year 
probationary period or at any time for less than fully 
successful executive performance. Generally, senior executives 
removed from the SES and placed into a civil service position 
are entitled to an informal hearing before the MSPB.
      Also under current law, section 3592(b) of title 5, 
U.S.C., there is a 120-day moratorium from removing a career 
appointee in the SES following the appointment of the head of 
the agency or the SES employee's immediate supervisor.
Senate Amendment
      The Senate amendment would provide the Secretary with the 
authority to remove or demote any individual from the SES if 
the Secretary determines the performance of the individual 
warrants such removal and requires the Secretary to notify 
Congress within 30 days of removing or demoting a senior 
executive under this authority. The senior executive would be 
allowed an opportunity for an expedited review by the MSPB. 
Under such expedited appeal, the senior executive would have 
seven days to appeal a removal or demotion and the MSPB would 
be required to adjudicate the appeal within 21 days.
      The MSPB would be required to establish and implement a 
process to conduct expedited reviews and submit to Congress a 
report on their established process within 30 days of 
enactment.
      The Senate amendment would also provide authority for the 
Secretary to immediately remove senior executives 
notwithstanding the 120-day moratorium in current law.
House Amendment
      The House amendment would provide the Secretary with the 
authority to remove or demote any individual from the SES if 
the Secretary determines the performance of the individual 
warrants such removal and requires the Secretary to notify 
Congress within 30 days of removing or demoting a senior 
executive under this authority.
Conference Agreement
      The Conference substitute generally adopts the Senate 
provision with an amendment to change the level of review at 
the MSPB. The substitute requires that the expedited review by 
the MSPB be conducted by an Administrative Judge at the MSPB, 
and if the MSPB Administrative Judge does not conclude their 
review within 21 days then the removal or demotion is final. 
The substitute does not allow for any further appeal beyond the 
Administrative Judge, and does not allow for a second level 
review by the three-person board at the MSPB. The substitute 
also requires that if the senior executive is removed, and then 
appeals VA's decision, the senior executive is not entitled to 
any type of pay, bonus, or benefit while appealing the decision 
of removal. Furthermore, the substitute requires that if a 
senior executive is demoted, and then appeals VA's decision, 
the employee may only receive any type of pay, bonus, or 
benefit at the rate appropriate for the position they were 
demoted to, and only if the individual shows up for duty, while 
appealing the decision of demotion. The substitute requires 
that the MSPB submit to Congress a plan within 14 days of 
enactment of how the expedited review would be implemented. The 
substitute also adds language to include title 38 SES 
equivalents under this new authority and includes 
``misconduct'' along with ``poor performance'' as a reason to 
remove or demote a senior executive.

                       Title VIII--Other Matters

                        APPROPRIATION OF AMOUNTS

Current Law
      Congress uses an appropriation to provide funding for 
discretionary spending programs of the Federal government.
Senate Amendment
      The Senate amendment would authorize and appropriate for 
FYs 2014, 2015, and 2016, the emergency funds necessary to 
carry out this Act.
      In addition, the Senate amendment would make available, 
at the end of FYs 2014 and 2015, unobligated balances in VA's 
medical care accounts (medical services, medical support and 
compliance, and medical facilities) for the hiring of 
additional health care professionals.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute authorizes and appropriates $5 
billion to increase veterans access to care through the hiring 
of physicians and other medical staff and by improving VA's 
physical infrastructure.

                          VETERANS CHOICE FUND

Current Law
      There is no provision of law establishing a Veterans 
Choice Fund.
Senate Amendment
      The Senate amendment contained no similar provision.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute establishes in the Treasury a 
fund to be known as the Veterans Choice Fund to carry out the 
expanded availability of hospital care and medical services for 
veterans created by section 101 of the Conference substitute. 
The Conference substitute also authorizes and appropriates $10 
billion for deposit in the Veterans Choice Fund.

                         EMERGENCY DESIGNATIONS

Current Law
      Congress may exempt the budgetary effects of a provision 
from certain enforcement procedures by designating it as an 
emergency requirement. An emergency designation causes the 
spending and revenue effects estimated to result from such 
bills as exempt for purposes of enforcing budget procedures.
Senate Amendment
      The Senate amendment would designate this Act as an 
emergency requirement under the Statutory Pay-As-You-Go Act of 
2010 and the Concurrent Resolution on the budget for FY 2010.
House Amendment
      The House amendment contained no similar provision.
Conference Agreement
      The Conference substitute adopts the Senate provision.
                                   Jeff Miller,
                                   Doug Lamborn,
                                   David P. Roe,
                                   Bill Flores,
                                   Dan Benishek,
                                   Mike Coffman,
                                   Brad R. Wenstrup,
                                   Jackie Walorski,
                                   Michael H. Michaud,
                                   Corrine Brown,
                                   Mark Takano,
                                   Julia Brownley,
                                   Ann Kirkpatrick,
                                   Timothy J. Walz,
                                 Managers on the part of the House.

                                   Bernard Sanders,
                                   John D. Rockefeller IV,
                                   Patty Murray,
                                   Sherrod Brown,
                                   Jon Tester,
                                   Mark Begich,
                                   Richard Blumenthal,
                                   Mazie K. Hirono,
                                   Richard Burr,
                                   Johnny Isakson,
                                   Mike Johanns,
                                   John McCain,
                                   Tom Coburn,
                                   Marco Rubio,
                                Managers on the part of the Senate.

   COMPLIANCE WITH RULES OF THE HOUSE OF REPRESENTATIVES AND SENATE 
     REGARDING EARMARKS AND CONGRESSIONALLY DIRECTED SPENDING ITEMS

      Pursuant to clause 9 of rule XXI of the Rules of the 
House of Representatives and rule XLIV of the Standing Rules of 
the Senate, neither this Conference report nor the accompanying 
joint statement of Conferees contains any congressional 
earmarks, congressionally directed spending items, limited tax 
benefits, or limited tariff benefits, as defined in such rules.
                For consideration of the House amendment and 
                the Senate amendment, and modifications 
                committed to conference:
                                   Jeff Miller of Florida,
                                   Doug Lamborn,
                                   David P. Roe of Tennessee,
                                   Bill Flores,
                                   Dan Benishek,
                                   Mike Coffman,
                                   Brad R. Wenstrup,
                                   Jackie Walorski,
                                   Michael H. Michaud,
                                   Corrine Brown of Florida,
                                   Mark Takano,
                                   Julia Brownley of California,
                                   Ann Kirkpatrick,
                                   Timothy J. Walz,
                                 Managers on the part of the House.

                                   Bernard Sanders,
                                   John D. Rockefeller IV,
                                   Patty Murray,
                                   Sherrod Brown,
                                   Jon Tester,
                                   Mark Begich,
                                   Richard Blumenthal,
                                   Mazie K. Hirono,
                                   Richard Burr,
                                   Johnny Isakson,
                                   Mike Johanns,
                                Managers on the part of the Senate.