S.Amdt. 4656

SA 4656. Mr. BLUMENTHAL submitted an amendment intended to be
proposed by him to the bill S. 2943, to authorize appropriations for
fiscal year 2017 for military activities of the Department of Defense,
for military construction, and for defense activities of the Department
of Energy, to prescribe military personnel strengths for such fiscal
year, and for other purposes; which was ordered to lie on the table; as
follows:

At the end, add the following:

DIVISION F--VETERANS MATTERS

TITLE LXIV--VETERANS CHOICE PROGRAM

SEC. 6401. ESTABLISHMENT OF VETERANS CHOICE PROGRAM.

(a) Establishment of Program.--
(1) In general.--Subchapter I of chapter 17 of title 38,
United States Code, is amended by inserting after section
1703 the following new section:

``Sec. 1703A. Veterans Choice Program

``(a) Program.--
``(1) Furnishing of care.--Hospital care and medical
services under this chapter shall be furnished to an eligible
veteran described in subsection (b), at the election of such
veteran, through contracts authorized under subsection (e),
or any other law administered by the Secretary, with eligible
providers described in subsection (c) for the furnishing of
such care and services to veterans. The furnishing of
hospital care and medical services under this section may be
referred to as the `Veterans Choice Program'.
``(2) Coordination of care and services.--The Secretary
shall coordinate, through the Non-VA Care Coordination
Program of the Department, 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) the veteran is enrolled in the patient enrollment
system of the Department established and operated under
section 1705 of this title; and
``(2)(A) the veteran is unable to schedule an appointment
for the receipt of hospital care or medical services from a
health care provider of the Department within the lesser of--
``(i) the wait-time goals of the Veterans Health
Administration for such care or services; or
``(ii) a period determined by a health care provider of the
Department to be clinically necessary for the receipt of such
care or services;
``(B) the veteran does not reside within 40 miles driving
distance from a medical facility of the Department, including
a community-based outpatient clinic, with a full-time primary
care physician;
``(C) the veteran--
``(i) resides 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) does not reside within 20 miles driving distance
from a medical facility of the Department described in clause
(i);
``(D) the veteran faces an unusual or excessive burden in
accessing hospital care or medical services from a medical
facility of the Department that is within 40 miles driving
distance from the residence of the veteran due to--

[[Page S3747]]

``(i) geographical challenges;
``(ii) environmental factors, such as roads that are not
accessible to the general public, traffic, or hazardous
weather;
``(iii) a medical condition of the veteran that affects the
ability to travel; or
``(iv) such other factors as determined by the Secretary;
``(E) the veteran resides in a location, other than a
location in Guam, American Samoa, or the Republic of the
Philippines, that requires the veteran to travel by air,
boat, or ferry to reach a medical facility of the Department,
including a community-based outpatient clinic;
``(F) the veteran is enrolled in the pilot program under
section 403 of the Veterans' Mental Health and Other Care
Improvements Act of 2008 (Public Law 110-387; 38 U.S.C. 1703
note) as of the date on which such pilot program terminates
under such section; or
``(G) there is a compelling reason, as determined by the
Secretary, that the veteran needs to receive hospital care or
medical services from a medical facility other than a medical
facility of the Department.
``(c) Eligible Providers.--
``(1) In general.--A health care provider is an eligible
provider for purposes of this section if the health care
provider is a health care provider specified in paragraph (2)
and meets standards established by the Secretary for purposes
of this section, including standards relating to education,
certification, licensure, training, and employment history.
``(2) Health care providers specified.--The health care
providers specified in this paragraph are the following:
``(A) 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.), including any physician furnishing
services under such program.
``(B) Any health care provider of a 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))).
``(C) Any health care provider of the Department of
Defense.
``(D) Any health care provider of the Indian Health
Service.
``(E) Any health care provider of an academic affiliate of
the Department of Veterans Affairs.
``(F) Any health care provider of a health system
established to serve Alaska Natives.
``(G) Any other health care provider that meets criteria
established by the Secretary for purposes of this section.
``(3) Choice of provider.--An eligible veteran who makes an
election under subsection (d) to receive hospital care or
medical services under this section may select a provider of
such care or services from among the health care providers
specified in paragraph (2) that are accessible to the
veteran.
``(4) Eligibility.--To be eligible to furnish care or
services under this section, a health care provider must--
``(A) 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
``(B) submit, not less frequently than annually,
verification of such licenses and credentials maintained by
such health care provider.
``(5) Tiered network.--
``(A) In general.--To promote the provision of high-quality
and high-value health care under this section, the Secretary
may develop a tiered provider network of eligible providers
based on criteria established by the Secretary for purposes
of this section.
``(B) Exception.--In developing a tiered provider network
of eligible providers under subparagraph (A), the Secretary
may not prioritize providers in a tier over providers in any
other tier in a manner that limits the choice of an eligible
veteran in selecting an eligible provider under this section.
``(6) Alaska native defined.--In this subsection, the term
`Alaska Native' means a person who is a member of any Native
village, Village Corporation, or Regional Corporation, as
those terms are defined in section 3 of the Alaska Native
Claims Settlement Act (43 U.S.C. 1602).
``(d) 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 veteran--
``(A) provide the veteran an appointment that exceeds the
wait-time goals described in such subsection or place such
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; 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 (or other
digital channel) 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).
``(e) Care and Services Through Contracts.--
``(1) Contracts.--
``(A) In general.--Except as provided in subparagraph (B),
the Secretary shall enter into contracts with eligible
providers for furnishing care and services to eligible
veterans under this section.
``(B) Other processes.--Before entering into a contract
under this paragraph, the Secretary shall, to the maximum
extent practicable and consistent with the requirements of
this section, furnish such care and services to eligible
veterans under this section with eligible providers pursuant
to sharing agreements, existing contracts entered into by the
Secretary, or other processes available at medical facilities
of the Department.
``(C) Contract defined.--In this paragraph, the term
`contract' has the meaning given that term in subpart 2.101
of the Federal Acquisition Regulation.
``(2) Rates and reimbursement.--
``(A) In general.--In entering into a contract under
paragraph (1) with an eligible provider, the Secretary
shall--
``(i) negotiate rates for the furnishing of care and
services under this section; and
``(ii) reimburse the provider for such care and services at
the rates negotiated under clause (i) as provided in such
contract.
``(B) Limit on rates.--
``(i) In general.--Except as provided in clause (ii), and
to the extent practicable, 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) Exceptions.--

``(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) Other exceptions.--

``(aa) Alaska.--With respect to furnishing care or services
under this section in Alaska, the Alaska Fee Schedule of the
Department shall be followed, except for when another payment
agreement, including a contract or provider agreement, is in
place, in which case rates for reimbursement shall be set
forth under such payment agreement.
``(bb) Other states.--With respect to care or services
furnished under this section in a State with an All-Payer
Model Agreement in effect under the Social Security Act (42
U.S.C. 301 et seq.), the Medicare payment rates under clause
(i) shall be calculated based on the payment rates under such
agreement.

``(III) 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 a contract under paragraph (1), an
eligible provider may not collect any amount that is greater
than the rate negotiated pursuant to subparagraph (A)(i).
``(D) Value-based reimbursement.--In negotiating rates for
the furnishing of care and services under this section, the
Secretary may incorporate the use of value-based
reimbursement models to promote the provision of high-quality
care.
``(f) Responsibility for Costs of Certain Care.--In any
case in which an eligible veteran is furnished hospital care
or medical services under this section for a non-service-
connected disability described in subsection (a)(2) of
section 1729 of this title, the Secretary may recover or
collect reasonable charges for such care or services from a
health-plan contract (as defined in subsection (i) of such
section 1729) in accordance with such section 1729.
``(g) Veterans Choice Card.--
``(1) In general.--Except as provided in paragraph (5), for
purposes of receiving care and services under this section,
the Secretary shall 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.

[[Page S3748]]

``(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.
``(5) Previous program.--A Veterans Choice Card issued
under section 101 of the Veterans Access, Choice, and
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C.
1701 note), as in effect on the day before the date of the
enactment of the National Defense Authorization Act for
Fiscal Year 2017, shall be sufficient for purposes of
receiving care and services under this section and the
Secretary is not required to reissue a Veterans Choice Card
under paragraph (1) to any veteran that has such a card
issued under such section 101.
``(h) 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) When the veteran enrolls in the patient enrollment
system of the Department established and operated under
section 1705 of this title.
``(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), (D), (E), (F), or (G) of subsection (b)(2).
``(i) Follow-up Care.--The Secretary shall ensure that, at
the election of an eligible veteran who receives hospital
care or medical services from an eligible provider in an
episode of care under this section, the veteran receives such
care or services from that provider or another health care
provider selected by the veteran, including a health care
provider of the Department, through the completion of the
episode of care, including all specialty and ancillary
services deemed necessary as part of the treatment
recommended in the course of such care or services.
``(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 under this
chapter.
``(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 under this
chapter.
``(k) Claims Processing System.--
``(1) In general.--The Secretary shall provide for an
efficient nationwide system for prompt processing and paying
of bills or claims for authorized care and services furnished
to eligible veterans under this section.
``(2) 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) Annual report.--
``(i) In general.--Not less frequently than annually, 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 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 year covered by the report.

``(l) Disclosure of Information.--For purposes of section
7332(b)(1) of this title, an election by an eligible veteran
to receive care or services under this section shall serve as
written consent for the disclosure of information to health
care providers for purposes of treatment under this section.
``(m) Medical Records.--
``(1) In general.--The Secretary shall ensure that any
eligible provider that furnishes care or services under this
section to an eligible veteran submits to the Department a
copy of any medical record related to the care or services
provided to such veteran by such provider for inclusion in
the electronic medical record of such veteran maintained by
the Department upon the completion of the provision of such
care or services to such veteran.
``(2) Electronic format.--Any medical record submitted to
the Department under paragraph (1) shall, to the extent
possible, be in an electronic format.
``(n) Records Not Required for Reimbursement.--With respect
to care or services furnished to an eligible veteran by an
eligible provider under this section, the receipt by the
Department of a medical record under subsection (m) detailing
such care or services is not required before reimbursing the
provider for such care or services.
``(o) 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.
``(p) Rule of Construction.--Nothing in this section shall
be construed to alter the process of the Department for
filling and paying for prescription medications.
``(q) 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 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.
``(r) Waiver of Certain Printing Requirements.--Section 501
of title 44 shall not apply in carrying out this section.''.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 17 of such title is amended by inserting
after the item relating to section 1703 the following new
item:

``1703A. Veterans Choice Program.''.

(3) Conforming repeal of superseded authority.--
(A) In general.--Section 101 of the Veterans Access,
Choice, and Accountability Act of 2014 (Public Law 113-146;
38 U.S.C. 1701 note) is repealed.
(B) Conforming amendment.--Section 208(1) of such Act is
amended by striking ``section 101'' and inserting ``section
1703A of title 38, United States Code''.
(C) Effective date.--
(i) In general.--The amendments made by this paragraph
shall take effect on the date on which the Secretary of
Veterans Affairs begins implementation of section 1703A of
title 38, United States Code as added by paragraph (1).
(ii) Publication.--The Secretary shall publish the date
specified in clause (i) in the Federal Register and on an
publicly available Internet website of the Department of
Veterans Affairs not later than 30 days before such date.
(4) Report.--Not later than one year after the date of the
enactment of this Act , the Secretary of Veterans Affairs
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the furnishing of care and
services under section 1703A of title 38, United States Code,
as added by paragraph (1), that includes the following:
(A) The total number of veterans who have received care or
services under this section, disaggregated by--
(i) eligible veterans described in subsection (b)(2)(A) of
such section;
(ii) eligible veterans described in subsection (b)(2)(B) of
such section;
(iii) eligible veterans described in subsection (b)(2)(C)
of such section;
(iv) eligible veterans described in subsection (b)(2)(D) of
such section;
(v) eligible veterans described in subsection (b)(2)(E) of
such section;
(vi) eligible veterans described in subsection (b)(2)(F) of
such section; and
(vii) eligible veterans described in subsection (b)(2)(G)
of such section.
(B) A description of the types of care and services
furnished to veterans under such section.
(C) An accounting of the total cost of furnishing care and
services to veterans under such section.
(D) The results of a survey of veterans who have received
care or services under such section on the satisfaction of
such veterans with the care or services received by such
veterans under such section.
(E) An assessment of the effect of furnishing care and
services under such section on wait times for appointments
for the receipt of hospital care and medical services from
the Department of Veterans Affairs.
(b) Classification of Services.--Services provided under
the following programs, contracts, and agreements shall be
considered services provided under the Veterans Choice
Program established under section 1703A of title 38, United
States Code, as added by subsection (a)(1):
(1) The Patient-Centered Community Care program (commonly
referred to as ``PC3'').
(2) Contracts through the retail pharmacy network of the
Department.
(3) Veterans Care Agreements under section 1703C of title
38, United States Code, as added by section 6411(a).
(4) Health care agreements with Federal entities or
entities funded by the Federal Government, including the
Department of Defense, the Indian Health Service, tribal

[[Page S3749]]

health programs, 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))), and academic teaching
affiliates.
(c) Establishment of Criteria and Standards for Non-
Department Care.--
(1) In general.--Not later than December 31, 2017, the
Secretary of Veterans Affairs shall establish consistent
criteria and standards--
(A) for purposes of determining eligibility of non-
Department of Veterans Affairs health care providers to
provide health care under the laws administered by the
Secretary, including standards relating to education,
certification, licensure, training, and employment history;
and
(B) for the reimbursement of such health care providers for
care or services provided under the laws administered by the
Secretary, which to the extent practicable shall--
(i) except as provided in clauses (ii) and (iii), use rates
for reimbursement that are not 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))) 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) with respect to care or services provided in Alaska,
use rates for reimbursement set forth in the Alaska Fee
Schedule of the Department of Veterans Affairs, except for
when another payment agreement, including a contract or
provider agreement, is in place, in which case use rates for
reimbursement set forth under such payment agreement;
(iii) with respect to care or services provided in a State
with an All-Payer Model Agreement in effect under the Social
Security Act (42 U.S.C. 301 et seq.), use rates for
reimbursement based on the payment rates under such
agreement;
(iv) incorporate the use of value-based reimbursement
models to promote the provision of high-quality care to
improve health outcomes and the experience of care for
veterans; and
(v) be consistent with prompt payment standards required of
Federal agencies under chapter 39 of title 31, United States
Code.
(2) Inapplicability to certain care.--The criteria and
standards established under paragraph (1) shall not apply to
care or services furnished under section 1703A of title 38,
United States Code, as added by subsection (a)(1).

SEC. 6402. FUNDING FOR VETERANS CHOICE PROGRAM.

(a) In General.--All amounts required to carry out the
Veterans Choice Program shall be derived from the
appropriations account described in section 4003 of the
Surface Transportation and Veterans Health Care Choice
Improvement Act of 2015 (Public Law 114-41; 38 U.S.C. 1701
note).
(b) Transfer of Amounts.--
(1) In general.--All amounts in the Veterans Choice Fund
under section 802 of the Veterans Access, Choice, and
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C.
1701 note) shall be transferred to the appropriations account
described in section 4003 of the Surface Transportation and
Veterans Health Care Choice Improvement Act of 2015 (Public
Law 114-41; 38 U.S.C. 1701 note).
(2) Conforming repeal.--
(A) In general.--Section 802 of the Veterans Access,
Choice, and Accountability Act of 2014 (Public Law 113-146;
38 U.S.C. 1701 note) is repealed.
(B) Conforming amendment.--Section 4003 of the Surface
Transportation and Veterans Health Care Choice Improvement
Act of 2015 (Public Law 114-41; 38 U.S.C. 1701 note) is
amended by striking ``to be comprised of'' and all that
follows and inserting ``to be comprised of discretionary
medical services funding that is designated for hospital care
and medical services furnished at non-Department
facilities''.
(c) Veterans Choice Program Defined.--In this section, the
term ``Veterans Choice Program'' means--
(1) the program under section 1703A of title 38, United
States Code, as added by section 6401(a)(1); and
(2) the programs, contracts, and agreements of the
Department described in section 6401(b).

SEC. 6403. PAYMENT OF HEALTH CARE PROVIDERS UNDER VETERANS
CHOICE PROGRAM.

(a) Payment of Providers.--
(1) In general.--Subchapter I of chapter 17 of title 38,
United States Code, as amended by section 6401(a)(1), is
further amended by inserting after section 1703A the
following new section:

``Sec. 1703B. Veterans Choice Program: payment of health care
providers

``(a) Prompt Payment Compliance.--The Secretary shall
ensure that payments made to health care providers under the
Veterans Choice Program comply with chapter 39 of title 31
(commonly referred to as the `Prompt Payment Act') and the
requirements of this section. If there is a conflict between
the requirements of the Prompt Payment Act and the
requirements of this section, the Secretary shall comply with
the requirements of this section.
``(b) Submittal of Claim.--(1) A health care provider that
seeks reimbursement under this section for care or services
furnished under the Veterans Choice Program shall submit to
the Secretary a claim for reimbursement not later than 180
days after furnishing such care or services.
``(2) On and after January 1, 2019, the Secretary shall not
accept any claim under this section that is submitted to the
Secretary in a manner other than electronically.
``(c) Payment Schedule.--(1) The Secretary shall reimburse
a health care provider for care or services furnished under
the Veterans Choice Program--
``(A) in the case of a clean claim submitted to the
Secretary electronically, not later than 30 days after
receiving the claim; or
``(B) in the case of a clean claim submitted to the
Secretary in a manner other than electronically, not later
than 45 days after receiving the claim.
``(2)(A) If the Secretary determines that a claim received
from a health care provider for care or services furnished
under the Veterans Choice Program is a non-clean claim, the
Secretary shall submit to the provider, not later than 30
days after receiving the claim--
``(i) a notification that the claim is a non-clean claim;
``(ii) an explanation of why the claim has been determined
to be a non-clean claim; and
``(iii) an identification of the information or
documentation that is required to make the claim a clean
claim.
``(B) If the Secretary does not comply with the
requirements of subparagraph (A) with respect to a claim, the
claim shall be deemed a clean claim for purposes of paragraph
(1).
``(3) Upon receipt by the Secretary of information or
documentation described in paragraph (2)(A)(iii) with respect
to a claim, the Secretary shall reimburse a health care
provider for care or services furnished under the Veterans
Choice Program--
``(A) in the case of a claim submitted to the Secretary
electronically, not later than 30 days after receiving such
information or documentation; or
``(B) in the case of claim submitted to the Secretary in a
manner other than electronically, not later than 45 days
after receiving such information or documentation.
``(4) If the Secretary fails to comply with the deadlines
for payment set forth in this subsection with respect to a
claim, interest shall accrue on the amount owed under such
claim in accordance with section 3902 of title 31, United
States Code.
``(d) Information and Documentation Required.--(1) The
Secretary shall provide to all health care providers
participating in the Veterans Choice Program a list of
information and documentation that is required to establish a
clean claim under this section.
``(2) The Secretary shall consult with entities in the
health care industry, in the public and private sector, to
determine the information and documentation to include in the
list under paragraph (1).
``(3) If the Secretary modifies the information and
documentation included in the list under paragraph (1), the
Secretary shall notify all health care providers
participating in the Veterans Choice Program not later than
30 days before such modifications take effect.
``(e) Definitions.--In this section:
``(1) The term `clean claim' means a claim for
reimbursement for care or services furnished under the
Veterans Choice Program, on a nationally recognized standard
format, that includes the information and documentation
necessary to adjudicate the claim.
``(2) The term `non-clean claim' means a claim for
reimbursement for care or services furnished under the
Veterans Choice Program, on a nationally recognized standard
format, that does not include the information and
documentation necessary to adjudicate the claim.
``(3) The term `Veterans Choice Program' means--
``(A) the program under section 1703A of this title; and
``(B) the programs, contracts, and agreements of the
Department described in section 6401(b) of the National
Defense Authorization Act for Fiscal Year 2017.''.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 17 of such title, as amended by section
6401(a)(2), is further amended by inserting after the item
related to section 1703A the following new item:

``1703B. Veterans Choice Program: payment of health care providers.''.

(b) Electronic Submittal of Claims for Reimbursement.--
(1) Prohibition on acceptance of non-electronic claims.--
(A) In general.--Except as provided in subparagraph (B), on
and after January 1, 2019, the Secretary of Veterans Affairs
shall not accept any claim for reimbursement under section
1703B of title 38, United States Code, as added by subsection
(a), that is submitted to the Secretary in a manner other
than electronically, including medical records in connection
with such a claim.
(B) Exception.--If the Secretary determines that accepting
claims and medical records in a manner other than
electronically is necessary for the timely processing of
claims for reimbursement under such section 1703B due to a
failure or serious malfunction of the electronic interface
established under paragraph (2), the Secretary--
(i) after determining that such a failure or serious
malfunction has occurred, may accept claims and medical
records in a manner other than electronically for a period
not to exceed 90 days; and

[[Page S3750]]

(ii) 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--

(I) the reason for accepting claims and medical records in
a manner other than electronically;
(II) the duration of time that the Department of Veterans
Affairs will accept claims and medical records in a manner
other than electronically; and
(III) the steps that the Department is taking to resolve
such failure or malfunction.

(2) Electronic interface.--
(A) In general.--Not later than January 1, 2019, the Chief
Information Officer of the Department of Veterans Affairs
shall establish an electronic interface for health care
providers to submit claims for reimbursement under such
section 1703B.
(B) Functions.--The electronic interface established under
subparagraph (A) shall include the following functions:
(i) A function through which a health care provider may
input all relevant data required for claims submittal and
reimbursement.
(ii) A function through which a health care provider may
upload medical records to accompany a claim for
reimbursement.
(iii) A function through which a health care provider may
ascertain the status of a pending claim for reimbursement
that--

(I) indicates whether the claim is a clean claim or a non-
clean claim; and
(II) in the event that a submitted claim is indicated as a
non-clean claim, provides--

(aa) an explanation of why the claim has been determined to
be a non-clean claim; and
(bb) an identification of the information or documentation
that is required to make the claim a clean claim.
(iv) A function through which a health care provider is
notified when a claim for reimbursement is accepted or
rejected.
(v) Such other features as the Secretary considers
necessary.
(C) Protection of information.--
(i) In general.--The electronic interface established under
subparagraph (A) shall be developed and implemented based on
industry-accepted information security and privacy
engineering principles and best practices and shall provide
for the following:

(I) The elicitation, analysis, and prioritization of
functional and nonfunctional information security and privacy
requirements for such interface, including specific security
and privacy services and architectural requirements relating
to security and privacy based on a thorough analysis of all
reasonably anticipated cyber and noncyber threats to the
security and privacy of electronic protected health
information made available through such interface.
(II) The elicitation, analysis, and prioritization of
secure development requirements relating to such interface.
(III) The assurance that the prioritized information
security and privacy requirements of such interface--

(aa) are correctly implemented in the design and
implementation of such interface throughout the system
development lifecycle; and
(bb) satisfy the information objectives of such interface
relating to security and privacy throughout the system
development lifecycle.
(ii) Definitions.--In this subparagraph:

(I) Electronic protected health information.--The term
``electronic protected health information'' has the meaning
given that term in section 160.103 of title 45, Code of
Federal Regulations, as in effect on the date of the
enactment of this Act.
(II) Secure development requirements.--The term ``secure
development requirements'' means, with respect to the
electronic interface established under subparagraph (A),
activities that are required to be completed during the
system development lifecycle of such interface, such as
secure coding principles and test methodologies.

(3) Analysis of available technology for electronic
interface.--
(A) In general.--Not later than January 1, 2017, or before
entering into a contract to procure or design and build the
electronic interface described in paragraph (2) or making a
decision to internally design and build such electronic
interface, whichever occurs first, the Secretary shall--
(i) conduct an analysis of commercially available
technology that may satisfy the requirements of such
electronic interface set forth in such paragraph; and
(ii) 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 such analysis.
(B) Elements.--The report required under subparagraph
(A)(ii) shall include the following:
(i) An evaluation of commercially available systems that
may satisfy the requirements of paragraph (2).
(ii) The estimated cost of procuring a commercially
available system if a suitable commercially available system
exists.
(iii) If no suitable commercially available system exists,
an assessment of the feasibility of modifying a commercially
available system to meet the requirements of paragraph (2),
including the estimated cost associated with such
modifications.
(iv) If no suitable commercially available system exists
and modifying a commercially available system is not
feasible, an assessment of the estimated cost and time that
would be required to contract with a commercial entity to
design and build an electronic interface that meets the
requirements of paragraph (2).
(v) If the Secretary determines that the Department has the
capabilities required to design and build an electronic
interface that meets the requirements of paragraph (2), an
assessment of the estimated cost and time that would be
required to design and build such electronic interface.
(vi) A description of the decision of the Secretary
regarding how the Department plans to establish the
electronic interface required under paragraph (2) and the
justification of the Secretary for such decision.
(4) Limitation on use of amounts.--The Secretary may not
spend any amounts to procure or design and build the
electronic interface described in paragraph (2) until the
date that is 60 days after the date on which the Secretary
submits the report required under paragraph (3)(A)(ii).

SEC. 6404. TERMINATION OF CERTAIN PROVISIONS AUTHORIZING CARE
TO VETERANS THROUGH NON-DEPARTMENT OF VETERANS
AFFAIRS PROVIDERS.

(a) Termination of Authority to Contract for Care in Non-
Department Facilities.--
(1) In general.--Section 1703 of title 38, United States
Code, is amended by adding at the end the follow new
subsection:
``(e) The authority of the Secretary under this section
terminates on December 31, 2017.''.
(2) Conforming amendments.--
(A) In general.--
(i) Dental care.--Section 1712(a) of such title is
amended--

(I) in paragraph (3), by striking ``under clause (1), (2),
or (5) of section 1703(a) of this title'' and inserting
``under the Veterans Choice Program (as defined in section
1703B(e) of this title)''; and
(II) in paragraph (4)(A), in the first sentence--

(aa) by striking ``and section 1703 of this title'' and
inserting ``and the Veterans Choice Program (as defined in
section 1703B(e) of this title)''; and
(bb) by striking ``in section 1703 of this title'' and
inserting ``under the Veterans Choice Program''.
(ii) Readjustment counseling.--Section 1712A(e)(1) of such
title is amended by striking ``(under sections 1703(a)(2) and
1710(a)(1)(B) of this title)'' and inserting ``(under the
Veterans Choice Program (as defined in section 1703B(e) of
this title) and section 1710(a)(1)(B) of this title)''.
(iii) Death in department facility.--Section
2303(a)(2)(B)(i) of such title is amended by striking ``in
accordance with section 1703'' and inserting ``under the
Veterans Choice Program (as defined in section 1703B(e) of
this title)''.
(iv) Medicare provider agreements.--Section 1866(a)(1)(L)
of the Social Security Act (42 U.S.C. 1395cc(a)(1)(L)) is
amended--

(I) by striking ``under section 1703 of title 38'' and
inserting ``under the Veterans Choice Program (as defined in
section 1703B(e) of title 38, United States Code)''; and
(II) by striking ``such section'' and inserting ``such
program''.

(B) Effective date.--The amendments made by subparagraph
(A) shall take effect on January 1, 2018.
(b) Repeal of Authority to Contract for Scarce Medical
Specialists.--
(1) In general.--Section 7409 of such title is repealed.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 74 of such title is amended by striking
the item relating to section 7409.

TITLE LXV--HEALTH CARE ADMINISTRATIVE MATTERS

Subtitle A--Care From Non-Department Providers

SEC. 6411. AUTHORIZATION OF AGREEMENTS BETWEEN THE DEPARTMENT
OF VETERANS AFFAIRS AND NON-DEPARTMENT
PROVIDERS.

(a) In General.--Subchapter I of chapter 17 of title 38,
United States Code, as amended by section 6403(a)(1), is
further amended by inserting after section 1703B the
following new section:

``Sec. 1703C. Veterans Care Agreements

``(a) Agreements to Furnish Care.--(1) In addition to the
authority of the Secretary under this chapter to furnish
hospital care, medical services, and extended care at
facilities of the Department and under contracts or sharing
agreements entered into under authorities other than this
section, the Secretary may furnish hospital care, medical
services, and extended care through the use of agreements
entered into under this section. An agreement entered into
under this section may be referred to as a `Veterans Care
Agreement'.
``(2)(A) The Secretary may enter into agreements under this
section with eligible providers that are certified under
subsection (d) if the Secretary is not feasibly able to
furnish care or services described in paragraph (1) at
facilities of the Department.
``(B) The Secretary is not feasibly able to furnish care or
services described in paragraph (1) at facilities of the
Department if the Secretary determines that the medical
condition of the veteran, the travel involved, the nature of
the care or services required, or a combination of those
factors make the use of facilities of the Department
impracticable or inadvisable.
``(b) Receipt of Care.--Eligibility of a veteran under this
section for care or services

[[Page S3751]]

described in paragraph (1) shall be determined as if such
care or services were furnished in a facility of the
Department and provisions of this title applicable to
veterans receiving such care or services in a facility of the
Department shall apply to veterans receiving such care or
services under this section.
``(c) Eligible Providers.--For purposes of this section, an
eligible provider is one of the following:
``(1) A provider of services that has enrolled and entered
into a provider agreement under section 1866(a) of the Social
Security Act (42 U.S.C. 1395cc(a)).
``(2) A physician or supplier that has enrolled and entered
into a participation agreement under section 1842(h) of such
Act (42 U.S.C. 1395u(h)).
``(3) A provider of items and services receiving payment
under a State plan under title XIX of such Act (42 U.S.C.
1396 et seq.) or a waiver of such a plan.
``(4) A health care provider that is--
``(A) an Aging and Disability Resource Center, an area
agency on aging, or a State agency (as defined in section 102
of the Older Americans Act of 1965 (42 U.S.C. 3002)); or
``(B) a center for independent living (as defined in
section 702 of the Rehabilitation Act of 1973 (29 U.S.C.
796a)).
``(5) A provider that is located in--
``(A) an area 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)); or
``(B) a county that is not in a metropolitan statistical
area.
``(6) Such other health care providers as the Secretary
considers appropriate for purposes of this section.
``(d) Certification of Eligible Providers.--(1) The
Secretary shall establish a process for the certification of
eligible providers under this section that shall, at a
minimum, set forth the following.
``(A) Procedures for the submittal of applications for
certification and deadlines for actions taken by the
Secretary with respect to such applications.
``(B) Standards and procedures for approval and denial of
certification, duration of certification, revocation of
certification, and recertification.
``(C) Procedures for assessing eligible providers based on
the risk of fraud, waste, and abuse of such providers similar
to the level of screening under section 1866(j)(2)(B) of the
Social Security Act (42 U.S.C. 1395cc(j)(2)(B)) and the
standards set forth under section 9.104 of title 48, Code of
Federal Regulations, or any successor regulation.
``(2) The Secretary shall deny or revoke certification to
an eligible provider under this subsection if the Secretary
determines that the eligible provider is currently--
``(A) excluded from participation in a Federal health care
program (as defined in section 1128B(f) of the Social
Security Act (42 U.S.C. 1320a-7b(f))) under section 1128 or
1128A of the Social Security Act (42 U.S.C. 1320a-7 and
1320a-7a); or
``(B) identified as an excluded source on the list
maintained in the System for Award Management, or any
successor system.
``(e) Terms of Agreements.--Each agreement entered into
with an eligible provider under this section shall include
provisions requiring the eligible provider to do the
following:
``(1) To accept payment for care or services furnished
under this section at rates established by the Secretary for
purposes of this section, which shall be, to the extent
practicable, the rates paid by the United States for such
care or services to providers of services and suppliers under
the Medicare program under title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.).
``(2) To accept payment under paragraph (1) as payment in
full for care or services furnished under this section and to
not seek any payment for such care or services from the
recipient of such care or services.
``(3) To furnish under this section only the care or
services authorized by the Department under this section
unless the eligible provider receives prior written consent
from the Department to furnish care or services outside the
scope of such authorization.
``(4) To bill the Department for care or services furnished
under this section in accordance with a methodology
established by the Secretary for purposes of this section.
``(5) Not to seek to recover or collect from a health-plan
contract or third party, as those terms are defined in
section 1729 of this title, for any care or services for
which payment is made by the Department under this section.
``(6) To provide medical records for veterans furnished
care or services under this section to the Department in a
time frame and format specified by the Secretary for purposes
of this section.
``(7) To meet such other terms and conditions, including
quality of care assurance standards, as the Secretary may
specify for purposes of this section.
``(f) Termination of Agreements.--(1) An eligible provider
may terminate an agreement with the Secretary under this
section at such time and upon such notice to the Secretary as
the Secretary may specify for purposes of this section.
``(2) The Secretary may terminate an agreement with an
eligible provider under this section at such time and upon
such notice to the eligible provider as the Secretary may
specify for purposes of this section, if the Secretary--
``(A) determines that the eligible provider failed to
comply substantially with the provisions of the agreement or
with the provisions of this section and the regulations
prescribed thereunder;
``(B) determines that the eligible provider is--
``(i) excluded from participation in a Federal health care
program (as defined in section 1128B(f) of the Social
Security Act (42 U.S.C. 1320a-7b(f))) under section 1128 or
1128A of the Social Security Act (42 U.S.C. 1320a-7 and
1320a-7a); or
``(ii) identified as an excluded source on the list
maintained in the System for Award Management, or any
successor system;
``(C) ascertains that the eligible provider has been
convicted of a felony or other serious offense under Federal
or State law and determines that the continued participation
of the eligible provider would be detrimental to the best
interests of veterans or the Department; or
``(D) determines that it is reasonable to terminate the
agreement based on the health care needs of a veteran or
veterans.
``(g) Periodic Review of Certain Agreements.--(1) Not less
frequently than once every two years, the Secretary shall
review each Veterans Care Agreement of material size entered
into during the two-year period preceding the review to
determine whether it is feasible and advisable to furnish the
hospital care, medical services, or extended care furnished
under such agreement at facilities of the Department or
through contracts or sharing agreements entered into under
authorities other than this section.
``(2)(A) Subject to subparagraph (B), a Veterans Care
Agreement is of material size as determined by the Secretary
for purposes of this section.
``(B) A Veterans Care Agreement entered into after
September 30, 2016, for the purchase of extended care
services is of material size if the purchase of such services
under the agreement exceeds $1,000,000 annually. The
Secretary may adjust such amount to account for changes in
the cost of health care based upon recognized health care
market surveys and other available data and shall publish any
such adjustments in the Federal Register.
``(h) Treatment of Certain Laws.--(1) An agreement under
this section may be entered into without regard to any law
that would require the Secretary to use competitive
procedures in selecting the party with which to enter into
the agreement.
``(2)(A) Except as provided in subparagraph (B) and unless
otherwise provided in this section or regulations prescribed
pursuant to this section, an eligible provider that enters
into an agreement under this section is not subject to, in
the carrying out of the agreement, any law to which an
eligible provider described in subsection (b)(1), (b)(2), or
(b)(3) is not subject under the original Medicare fee-for-
service program under parts A and B of title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.) or the Medicaid
program under title XIX of such Act (42 U.S.C. 1396 et seq.).
``(B) The exclusion under subparagraph (A) does not apply
to laws regarding integrity, ethics, fraud, or that subject a
person to civil or criminal penalties.
``(3) Title VII of the Civil Rights Act of 1964 (42 U.S.C.
2000e et seq.) shall apply with respect to an eligible
provider that enters into an agreement under this section to
the same extent as such title applies with respect to the
eligible provider in providing care or services through an
agreement or arrangement other than under this section.
``(i) Monitoring of Quality of Care.--The Secretary shall
establish a system or systems, consistent with survey and
certification procedures used by the Centers for Medicare &
Medicaid Services and State survey agencies to the extent
practicable--
``(1) to monitor the quality of care and services furnished
to veterans under this section; and
``(2) to assess the quality of care and services furnished
by an eligible provider under this section for purposes of
determining whether to renew an agreement under this section
with the eligible provider.
``(j) Dispute Resolution.--The Secretary shall establish
administrative procedures for eligible providers with which
the Secretary has entered into an agreement under this
section to present any dispute arising under or related to
the agreement.''.
(b) Regulations.--The Secretary of Veterans Affairs shall
prescribe an interim final rule to carry out section 1703C of
such title, as added by subsection (a), not later than one
year after the date of the enactment of this Act.
(c) Clerical Amendment.--The table of sections at the
beginning of chapter 17 of such title, as amended by section
6403(a)(2), is further amended by inserting after the item
related to section 1703B the following new item:

``1703C. Veterans Care Agreements.''.

SEC. 6412. MODIFICATION OF AUTHORITY TO ENTER INTO AGREEMENTS
WITH STATE HOMES TO PROVIDE NURSING HOME CARE.

(a) Use of Agreements.--
(1) In general.--Paragraph (1) of section 1745(a) of title
38, United States Code, is amended, in the matter preceding
subparagraph (A), by striking ``a contract (or agreement
under section 1720(c)(1) of this title)'' and inserting ``an
agreement''.
(2) Payment.--Paragraph (2) of such section is amended by
striking ``contract (or agreement)'' each place it appears
and inserting ``agreement''.

[[Page S3752]]

(b) Treatment of Certain Laws.--Such section is amended by
adding at the end the following new paragraph:
``(4)(A) An agreement under this section may be entered
into without regard to any law that would require the
Secretary to use competitive procedures in selecting the
party with which to enter into the agreement.
``(B)(i) Except as provided in clause (ii) and unless
otherwise provided in this section or in regulations
prescribed pursuant to this section, a State home that enters
into an agreement under this section is not subject to, in
the carrying out of the agreement, any law to which providers
of services and suppliers are not subject under the original
Medicare fee-for-service program under parts A and B of title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) or
the Medicaid program under title XIX of such Act (42 U.S.C.
1396 et seq.).
``(ii) The exclusion under clause (i) does not apply to
laws regarding integrity, ethics, fraud, or that subject a
person to civil or criminal penalties.
``(C) Title VII of the Civil Rights Act of 1964 (42 U.S.C.
2000e et seq.) shall apply with respect to a State home that
enters into an agreement under this section to the same
extent as such title applies with respect to the State home
in providing care or services through an agreement or
arrangement other than under this section.''.
(c) Effective Date.--
(1) In general.--The amendments made by this section shall
apply to agreements entered into under section 1745 of such
title on and after the date on which the regulations
prescribed by the Secretary of Veterans Affairs to implement
such amendments take effect.
(2) Publication.--The Secretary shall publish the date
described in paragraph (1) in the Federal Register not later
than 30 days before such date.

SEC. 6413. EXPANSION OF REIMBURSEMENT FOR EMERGENCY TREATMENT
AND URGENT CARE.

(a) In General.--Section 1725 of title 38, United States
Code, is amended to read as follows:

``Sec. 1725. Reimbursement for emergency treatment and urgent
care

``(a) In General.--(1) Subject to the provisions of this
section, the Secretary shall reimburse a veteran described in
subsection (b) for the reasonable value of emergency
treatment or urgent care furnished the veteran in a non-
Department facility.
``(2) In any case in which reimbursement of a veteran is
authorized under paragraph (1), the Secretary may, in lieu of
reimbursing the veteran, make payment of the reasonable value
of the furnished emergency treatment or urgent care
directly--
``(A) to the hospital or other health care provider that
furnished the treatment or care; or
``(B) to the person or organization that paid for such
treatment or care on behalf of the veteran.
``(3) Notwithstanding section 111 of this title,
reimbursement for the reasonable value of emergency treatment
or urgent care under this section shall include reimbursement
for the reasonable value of transportation for such emergency
treatment or urgent care.
``(b) Eligibility.--A veteran described in this subsection
is an individual who--
``(1) is enrolled in the patient enrollment system of the
Department established and operated under section 1705 of
this title; and
``(2) has received care under this chapter during the 24-
month period preceding the furnishing of the emergency
treatment or urgent care for which reimbursement is sought
under this section.
``(c) Responsibility for Payment.--The Secretary shall be
the primary payer with respect to reimbursing or otherwise
paying the reasonable value of emergency treatment or urgent
care under this section.
``(d) Limitations on Payment.--(1) The Secretary, in
accordance with regulations prescribed by the Secretary for
purposes of this section, shall--
``(A) establish the maximum amount payable under subsection
(a); and
``(B) delineate the circumstances under which such payments
may be made, including such requirements on requesting
reimbursement as the Secretary may establish.
``(2)(A) Payment by the Secretary under this section on
behalf of a veteran to a provider of emergency treatment or
urgent care shall, unless rejected and refunded by the
provider within 30 days of receipt--
``(i) constitute payment in full for the emergency
treatment or urgent care provided; and
``(ii) extinguish any liability on the part of the veteran
for that treatment or care.
``(B) Neither the absence of a contract or agreement
between the Secretary and a provider of emergency treatment
or urgent care nor any provision of a contract, agreement, or
assignment to the contrary shall operate to modify, limit, or
negate the requirements of subparagraph (A).
``(C) An individual or entity may not seek to recover from
any third party the cost of emergency treatment or urgent
care for which the Secretary has made payment under this
section.
``(e) Recovery.--The United States has an independent right
to recover or collect reasonable charges for emergency
treatment or urgent care furnished under this section in
accordance with the provisions of section 1729 of this title.
``(f) Copayments.--(1) Except as provided in paragraph (2),
a veteran shall pay to the Department a copayment (in an
amount prescribed by the Secretary for purposes of this
section) for each episode of emergency treatment or urgent
care for which reimbursement is provided to the veteran under
this section.
``(2) The requirement under paragraph (1) to pay a
copayment does not apply to a veteran who--
``(A) would not be required to pay to the Department a
copayment for emergency treatment or urgent care furnished at
facilities of the Department;
``(B) meets an exemption specified by the Secretary in
regulations prescribed by the Secretary for purposes of this
section; or
``(C) is admitted to a hospital for treatment or
observation following, and in connection with, the emergency
treatment or urgent care for which the veteran is provided
reimbursement under this section.
``(3) The requirement that a veteran pay a copayment under
this section shall apply notwithstanding the authority of the
Secretary to offset such a requirement with amounts recovered
from a third party under section 1729 of this title.
``(g) Definitions.--In this section:
``(1) The term `emergency treatment' means medical care or
services furnished, in the judgment of the Secretary--
``(A) when such care or services are rendered in a medical
emergency of such nature that a prudent layperson reasonably
expects that delay in seeking immediate medical attention
would be hazardous to life or health; and
``(B) until--
``(i) such time as the veteran can be transferred safely to
a Department facility or community care provider authorized
by the Secretary and such facility or provider is capable of
accepting such transfer; or
``(ii) such time as a Department facility or community care
provider authorized by the Secretary accepts such transfer
if--

``(I) at the time the veteran could have been transferred
safely to such a facility or provider, no such facility or
provider agreed to accept such transfer; and
``(II) the non-Department facility in which such medical
care or services was furnished made and documented reasonable
attempts to transfer the veteran to a Department facility or
community care provider.

``(2) The term `health-plan contract' includes any of the
following:
``(A) An insurance policy or contract, medical or hospital
service agreement, membership or subscription contract, or
similar arrangement under which health services for
individuals are provided or the expenses of such services are
paid.
``(B) An insurance program described in section 1811 of the
Social Security Act (42 U.S.C. 1395c) or established by
section 1831 of such Act (42 U.S.C. 1395j).
``(C) A State plan for medical assistance approved under
title XIX of such Act (42 U.S.C. 1396 et seq.).
``(D) A workers' compensation law or plan described in
section 1729(a)(2)(A) of this title.
``(3) The term `third party' means any of the following:
``(A) A Federal entity.
``(B) A State or political subdivision of a State.
``(C) An employer or an employer's insurance carrier.
``(D) An automobile accident reparations insurance carrier.
``(E) A person or entity obligated to provide, or to pay
the expenses of, health services under a health-plan
contract.
``(4) The term `urgent care' shall have the meaning given
that term by the Secretary in regulations prescribed by the
Secretary for purposes of this section.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 17 is amended by striking the item
relating to section 1725 and inserting the following new
item:

``1725. Reimbursement for emergency treatment and urgent care.''.

(c) Repeal of Superseded Authority.--
(1) In general.--Section 1728 is repealed.
(2) Effective date.--
(A) In general.--The repeal made by paragraph (1) shall
take effect on the date on which the Secretary of Veterans
Affairs prescribes regulations to carry out section 1725 of
title 38, United States Code, as amended by subsection (a).
(B) Publication.--The Secretary shall publish the date
specified in subparagraph (A) in the Federal Register and on
an publicly available Internet website of the Department of
Veterans Affairs not later than 30 days before such date.
(d) Conforming Amendments.--
(1) Medical care for survivors and dependents.--Section
1781(a)(4) is amended by striking ``(as defined in section
1725(f) of this title)'' and inserting ``(as defined in
section 1725(g) of this title)''.
(2) Health care of family members of veterans stationed at
camp lejeune, north carolina.--Section 1787(b)(3) is amended
by striking ``(as defined in section 1725(f) of this title)''
and inserting ``(as defined in section 1725(g) of this
title)''.
(e) Regulations.--Not later than 270 days after the date of
the enactment of this Act, the Secretary shall prescribe
regulations to carry out the amendments made by this section.
(f) Effective Date.--The amendments made by this section
shall take effect one

[[Page S3753]]

year after the date of the enactment of this Act.

SEC. 6414. REQUIREMENT FOR ADVANCE APPROPRIATIONS FOR THE
VETERANS CHOICE PROGRAM ACCOUNT OF THE
DEPARTMENT OF VETERANS AFFAIRS.

(a) In General.--Section 117(c) of title 38, United States
Code, is amended by adding at the end the following new
paragraph:
``(7) Veterans Health Administration, Veterans Choice
Program.''.
(b) Conforming Amendment.--Section 1105(a)(37) of title 31,
United States Code, is amended by adding at the end the
following new subparagraph:
``(G) Veterans Health Administration, Veterans Choice
Program.''.
(c) Applicability.--The amendments made by this section
shall apply to fiscal years beginning on and after October 1,
2016.

SEC. 6415. ANNUAL TRANSFER OF AMOUNTS WITHIN DEPARTMENT OF
VETERANS AFFAIRS TO PAY FOR HEALTH CARE FROM
NON-DEPARTMENT PROVIDERS.

Section 106 of the Veterans Access, Choice, and
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C.
1701 note) is amended by adding at the end the following new
subsection:
``(c) Annual Transfer of Amounts.--
``(1) In general.--At the beginning of each fiscal year,
the Secretary of Veterans Affairs shall transfer to the
Veterans Health Administration an amount equal to the amount
estimated to be required to furnish hospital care, medical
services, and other health care through non-Department of
Veterans Affairs providers during that fiscal year.
``(2) Adjustments.--During a fiscal year, the Secretary may
make adjustments to the amount transferred under paragraph
(1) for that fiscal year to accommodate any variances in
demand for hospital care, medical services, or other health
care through non-Department providers.''.

SEC. 6416. APPLICABILITY OF DIRECTIVE OF OFFICE OF FEDERAL
CONTRACT COMPLIANCE PROGRAMS.

(a) In General.--Directive 2014-01 of the Office of Federal
Contract Compliance Programs of the Department of Labor
(effective as of May 7, 2014) shall apply to any health care
provider entering into a contract or agreement under section
1703A, 1703C, or 1745 of title 38, United States Code, in the
same manner as such directive applies to subcontractors under
the TRICARE program.
(b) Applicability Period.--The directive described in
subsection (a), and the moratorium provided under such
directive, shall not be altered or rescinded before May 7,
2019.
(c) TRICARE Program Defined.--In this section, the term
``TRICARE program'' has the meaning given that term in
section 1072 of title 10, United States Code.

Subtitle B--Other Health Care Administrative Matters

SEC. 6421. REIMBURSEMENT OF CERTAIN ENTITIES FOR EMERGENCY
MEDICAL TRANSPORTATION.

(a) In General.--Subchapter III of chapter 17 of title 38,
United States Code, is amended by inserting after section
1725 the following new section:

``Sec. 1725A. Reimbursement of certain entities for emergency
medical transportation

``(a) In General.--Notwithstanding any other provision of
law, the Secretary shall reimburse an ambulance provider or
any other entity that provides transportation to a veteran
described in section 1725(b) of this title for the purpose of
receiving emergency treatment at a non-Department facility
the cost of such transportation.
``(b) Service Connection.--(1) The Secretary shall
reimburse an ambulance provider or any other entity under
subsection (a) regardless of whether the underlying medical
condition for which the veteran is seeking emergency
treatment is in connection with a service-connected
disability.
``(2) If the Secretary determines that the underlying
medical condition for which the veteran receives emergency
treatment is not in connection with a service-connected
disability, the Secretary shall recoup the cost of
transportation paid under subsection (a) in connection with
such emergency treatment from any health-plan contract under
which the veteran is covered.
``(c) Timing.--Reimbursement under subsection (a) shall be
made not later than 30 days after receiving a request for
reimbursement under such subsection.
``(d) Definitions.--In this section, the terms `emergency
treatment' and `health-plan contract' have the meanings given
those terms in section 1725(f) of this title.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 17 of such title is amended by inserting
after the item related to section 1725 the following new
item:

``1725A. Reimbursement for emergency medical transportation.''.

SEC. 6422. REQUIREMENT THAT DEPARTMENT OF VETERANS AFFAIRS
COLLECT HEALTH-PLAN CONTRACT INFORMATION FROM
VETERANS.

(a) In General.--Subchapter I of chapter 17 is amended by
inserting after section 1705 the following new section:

``Sec. 1705A. Management of health care: information
regarding health-plan contracts

``(a) In General.--(1) Any individual who seeks hospital
care or medical services under this chapter shall provide to
the Secretary such current information as the Secretary may
require to identify any health-plan contract under which such
individual is covered.
``(2) The information required to be provided to the
Secretary under paragraph (1) with respect to a health-plan
contract shall include, as applicable, the following:
``(A) The name of the entity providing coverage under the
health-plan contract.
``(B) If coverage under the health-plan contract is in the
name of an individual other than the individual required to
provide information under this section, the name of the
policy holder of the health-plan contract.
``(C) The identification number for the health-plan
contract.
``(D) The group code for the health-plan contract.
``(b) Action to Collect Information.--The Secretary may
take such action as the Secretary considers appropriate to
collect the information required under subsection (a).
``(c) Effect on Services From Department.--The Secretary
may not deny any services under this chapter to an individual
solely due to the fact that the individual fails to provide
information required under subsection (a).
``(d) Health-plan Contract Defined.--In this section, the
term `health-plan contract' has the meaning given that term
in section 1725(g) of this title.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 17 of such title is amended by inserting
after the item relating to section 1705 the following new
item:

``1705A. Management of health care: information regarding health-plan
contracts.''.

SEC. 6423. MODIFICATION OF HOURS OF EMPLOYMENT FOR PHYSICIANS
AND PHYSICIAN ASSISTANTS EMPLOYED BY THE
DEPARTMENT OF VETERANS AFFAIRS.

Section 7423(a) of title 38, United States Code, is
amended--
(1) by striking ``(a) The hours'' and inserting ``(a)(1)
Except as provided in paragraph (2), the hours''; and
(2) by adding at the end the following new paragraph:
``(2) The Secretary may modify the hours of employment for
a physician or physician assistant appointed in the
Administration under any provision of this chapter on a full-
time basis to be more than or less than 80 hours in a
biweekly pay period if the total hours of employment for such
employee in a calendar year are not less than 2,080 hours.''.

TITLE LXVI--FAMILY CAREGIVERS

SEC. 6431. EXPANSION OF FAMILY CAREGIVER PROGRAM OF
DEPARTMENT OF VETERANS AFFAIRS.

(a) Family Caregiver Program.--
(1) Expansion of eligibility.--
(A) In general.--Subsection (a)(2)(B) of section 1720G of
title 38, United States Code, is amended to read as follows:
``(B) for assistance provided under this subsection--
``(i) before the date on which the Secretary submits to
Congress a certification that the Department has fully
implemented the information technology system required by
section 6432(a) of the National Defense Authorization Act for
Fiscal Year 2017, has a serious injury (including traumatic
brain injury, psychological trauma, or other mental disorder)
incurred or aggravated in the line of duty in the active
military, naval, or air service on or after September 11,
2001;
``(ii) during the two-year period beginning on the date
specified in clause (i), has a serious injury (including
traumatic brain injury, psychological trauma, or other mental
disorder) incurred or aggravated in the line of duty in the
active military, naval, or air service--
``(I) on or before May 7, 1975; or
``(II) on or after September 11, 2001; or
``(iii) after the date that is two years after the date
specified in clause (i), has a serious injury (including
traumatic brain injury, psychological trauma, or other mental
disorder) incurred or aggravated in the line of duty in the
active military, naval, or air service; and''.
(B) Publication in federal register.--Not later than 30
days after the date on which the Secretary of Veterans
Affairs submits to Congress the certification described in
subsection (a)(2)(B)(i) of section 1720G of such title, as
amended by subparagraph (A) of this paragraph, the Secretary
shall publish the date specified in such subsection in the
Federal Register.
(2) Expansion of needed services in eligibility criteria.--
Subsection (a)(2)(C) of such section is amended--
(A) in clause (ii), by striking ``; or'' and inserting a
semicolon;
(B) by redesignating clause (iii) as clause (iv); and
(C) by inserting after clause (ii) the following new clause
(iii):
``(iii) a need for regular or extensive instruction or
supervision without which the ability of the veteran to
function in daily life would be seriously impaired; or''.
(3) Expansion of services provided.--Subsection
(a)(3)(A)(ii) of such section is amended--
(A) in subclause (IV), by striking ``; and'' and inserting
a semicolon;
(B) in subclause (V), by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following new subclause:
``(VI) through the use of contracts with, or the provision
of grants to, public or private entities--
``(aa) financial planning services relating to the needs of
injured veterans and their caregivers; and

[[Page S3754]]

``(bb) legal services, including legal advice and
consultation, relating to the needs of injured veterans and
their caregivers.''.
(4) Modification of stipend calculation.--Subsection
(a)(3)(C) of such section is amended--
(A) by redesignating clause (iii) as clause (iv); and
(B) by inserting after clause (ii) the following new clause
(iii):
``(iii) In determining the amount and degree of personal
care services provided under clause (i) with respect to an
eligible veteran whose need for personal care services is
based in whole or in part on a need for supervision or
protection under paragraph (2)(C)(ii) or regular or extensive
instruction or supervision under paragraph (2)(C)(iii), the
Secretary shall take into account the following:
``(I) The assessment by the family caregiver of the needs
and limitations of the veteran.
``(II) The extent to which the veteran can function safely
and independently in the absence of such supervision,
protection, or instruction.
``(III) The amount of time required for the family
caregiver to provide such supervision, protection, or
instruction to the veteran.''.
(5) Periodic evaluation of need for certain services.--
Subsection (a)(3) of such section is amended by adding at the
end the following new subparagraph:
``(D) In providing instruction, preparation, and training
under subparagraph (A)(i)(I) and technical support under
subparagraph (A)(i)(II) to each family caregiver who is
approved as a provider of personal care services for an
eligible veteran under paragraph (6), the Secretary shall
periodically evaluate the needs of the eligible veteran and
the skills of the family caregiver of such veteran to
determine if additional instruction, preparation, training,
or technical support under those subparagraphs is
necessary.''.
(6) Use of primary care teams.--Subsection (a)(5) of such
section is amended, in the matter preceding subparagraph (A),
by inserting ``(in collaboration with the primary care team
for the eligible veteran to the maximum extent practicable)''
after ``evaluate''.
(7) Assistance for family caregivers.--Subsection (a) of
such section is amended by adding at the end the following
new paragraph:
``(11)(A) In providing assistance under this subsection to
family caregivers of eligible veterans, the Secretary may
enter into contracts, provider agreements, and memoranda of
understanding with Federal agencies, States, and private,
nonprofit, and other entities to provide such assistance to
such family caregivers.
``(B) The Secretary may provide assistance under this
paragraph only if such assistance is reasonably accessible to
the family caregiver and is substantially equivalent or
better in quality to similar services provided by the
Department.
``(C) The Secretary may provide fair compensation to
Federal agencies, States, and other entities that provide
assistance under this paragraph.''.
(b) Modification of Definition of Personal Care Services.--
Subsection (d)(4) of such section is amended--
(1) in subparagraph (A), by striking ``independent'';
(2) by redesignating subparagraph (B) as subparagraph (D);
and
(3) by inserting after subparagraph (A) the following new
subparagraphs:
``(B) Supervision or protection based on symptoms or
residuals of neurological or other impairment or injury.
``(C) Regular or extensive instruction or supervision
without which the ability of the veteran to function in daily
life would be seriously impaired.''.

SEC. 6432. IMPLEMENTATION OF INFORMATION TECHNOLOGY SYSTEM OF
DEPARTMENT OF VETERANS AFFAIRS TO ASSESS AND
IMPROVE THE FAMILY CAREGIVER PROGRAM.

(a) Implementation of New System.--
(1) In general.--Not later than December 31, 2016, the
Secretary of Veterans Affairs shall implement an information
technology system that fully supports the Program and allows
for data assessment and comprehensive monitoring of the
Program.
(2) Elements of system.--The information technology system
required to be implemented under paragraph (1) shall include
the following:
(A) The ability to easily retrieve data that will allow all
aspects of the Program (at the medical center and aggregate
levels) and the workload trends for the Program to be
assessed and comprehensively monitored.
(B) The ability to manage data with respect to a number of
caregivers that is more than the number of caregivers that
the Secretary expects to apply for the Program.
(C) The ability to integrate the system with other relevant
information technology systems of the Veterans Health
Administration.
(b) Assessment of Program.--Not later than 180 days after
implementing the system described in subsection (a), the
Secretary shall, through the Under Secretary for Health, use
data from the system and other relevant data to conduct an
assessment of how key aspects of the Program are structured
and carried out.
(c) Ongoing Monitoring of and Modifications to Program.--
(1) Monitoring.--The Secretary shall use the system
implemented under subsection (a) to monitor and assess the
workload of the Program, including monitoring and assessment
of data on--
(A) the status of applications, appeals, and home visits in
connection with the Program; and
(B) the use by caregivers participating in the Program of
other support services under the Program such as respite
care.
(2) Modifications.--Based on the monitoring and assessment
conducted under paragraph (1), the Secretary shall identify
and implement such modifications to the Program as the
Secretary considers necessary to ensure the Program is
functioning as intended and providing veterans and caregivers
participating in the Program with services in a timely
manner.
(d) Reports.--
(1) Initial report.--
(A) In general.--Not later than 90 days after the date of
the enactment of this Act, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate, the Committee
on Veterans' Affairs of the House of Representatives, and the
Comptroller General of the United States a report that
includes--
(i) the status of the planning, development, and deployment
of the system required to be implemented under subsection
(a), including any changes in the timeline for the
implementation of the system; and
(ii) an assessment of the needs of family caregivers of
veterans described in subparagraph (B), the resources needed
for the inclusion of such family caregivers in the Program,
and such changes to the Program as the Secretary considers
necessary to ensure the successful expansion of the Program
to include such family caregivers.
(B) Veterans described.--Veterans described in this
subparagraph are veterans who are eligible for the Program
under clause (ii) or (iii) of section 1720G(a)(2)(B) of title
38, United States Code, as amended by section 6431(a)(1) of
this Act, solely due to a serious injury (including traumatic
brain injury, psychological trauma, or other mental disorder)
incurred or aggravated in the line of duty in the active
military, naval, or air service before September 11, 2001.
(2) Notification by comptroller general.--The Comptroller
General shall review the report submitted under paragraph (1)
and notify the Committee on Veterans' Affairs of the Senate
and the Committee on Veterans' Affairs of the House of
Representatives with respect to the progress of the Secretary
in--
(A) fully implementing the system required under subsection
(a); and
(B) implementing a process for using such system to monitor
and assess the Program under subsection (c)(1) and modify the
Program as considered necessary under subsection (c)(2).
(3) Final report.--
(A) In general.--Not later than December 31, 2017, the
Secretary shall submit to the Committee on Veterans' Affairs
of the Senate, the Committee on Veterans' Affairs of the
House of Representatives, and the Comptroller General a
report on the implementation of subsections (a) through (c).
(B) Elements.--The report required by subparagraph (A)
shall include the following:
(i) A certification by the Secretary with respect to
whether the information technology system described in
subsection (a) has been implemented.
(ii) A description of how the Secretary has implemented
such system.
(iii) A description of the modifications to the Program, if
any, that were identified and implemented under subsection
(c)(2).
(iv) A description of how the Secretary is using such
system to monitor the workload of the Program.
(e) Definitions.--In this section:
(1) Active military, naval, or air service.--The term
``active military, naval, or air service'' has the meaning
given that term in section 101 of title 38, United States
Code.
(2) Program.--The term ``Program'' means the program of
comprehensive assistance for family caregivers under section
1720G(a) of title 38, United States Code, as amended by
section 6431 of this Act.

SEC. 6433. MODIFICATIONS TO ANNUAL EVALUATION REPORT ON
CAREGIVER PROGRAM OF DEPARTMENT OF VETERANS
AFFAIRS.

(a) Barriers to Care and Services.--Subparagraph (A)(iv) of
section 101(c)(2) of the Caregivers and Veterans Omnibus
Health Services Act of 2010 (Public Law 111-163; 38 U.S.C.
1720G note) is amended by inserting ``, including a
description of any barriers to accessing and receiving care
and services under such programs'' before the semicolon.
(b) Sufficiency of Training for Family Caregiver Program.--
Subparagraph (B) of such section is amended--
(1) in clause (i), by striking ``; and'' and inserting a
semicolon;
(2) in clause (ii), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following new clause:
``(iii) an evaluation of the sufficiency and consistency of
the training provided to family caregivers under such program
in preparing family caregivers to provide care to veterans
under such program.''.

SEC. 6434. ADVISORY COMMITTEE ON CAREGIVER POLICY.

(a) Establishment.--There is established in the Department
of Veterans Affairs an advisory committee on policies
relating to caregivers of veterans (in this section referred
to as the ``Committee'').
(b) Composition.--The Committee shall be composed of the
following:

[[Page S3755]]

(1) A Chair selected by the Secretary of Veterans Affairs.
(2) A representative from each of the following agencies or
organizations selected by the head of such agency or
organization:
(A) The Department of Veterans Affairs.
(B) The Department of Defense.
(C) The Department of Health and Human Services.
(D) The Department of Labor.
(E) The Centers for Medicare and Medicaid Services.
(3) Not fewer than seven individuals who are not employees
of the Federal Government selected by the Secretary from
among the following individuals:
(A) Academic experts in fields relating to caregivers.
(B) Clinicians.
(C) Caregivers.
(D) Individuals in receipt of caregiver services.
(E) Such other individuals with expertise that is relevant
to the duties of the Committee as the Secretary considers
appropriate.
(c) Duties.--The duties of the Committee are as follows:
(1) To regularly review and recommend policies of the
Department of Veterans Affairs relating to caregivers of
veterans.
(2) To examine and advise the implementation of such
policies.
(3) To evaluate the effectiveness of such policies.
(4) To recommend standards of care for caregiver services
and respite care services provided to a caregiver or veteran
by a nonprofit or private sector entity.
(5) To develop recommendations for legislative or
administrative action to enhance the provision of services to
caregivers and veterans, including eliminating gaps in such
services and eliminating disparities in eligibility for such
services.
(6) To make recommendations on coordination with State and
local agencies and relevant nonprofit organizations on
maximizing the use and effectiveness of resources for
caregivers of veterans.
(d) Reports.--
(1) Annual report to secretary.--
(A) In general.--Not later than September 1, 2017, and not
less frequently than annually thereafter until the
termination date specified in subsection (e), the Chair of
the Committee shall submit to the Secretary a report on
policies and services of the Department of Veterans Affairs
relating to caregivers of veterans.
(B) Elements.--Each report required by subparagraph (A)
shall include the following:
(i) An assessment of the policies of the Department
relating to caregivers of veterans and services provided
pursuant to such policies as of the date of the submittal of
the report.
(ii) A description of any recommendations made by the
Committee to improve the coordination of services for
caregivers of veterans between the Department and the
entities specified in subparagraphs (B) through (E) of
subsection (b)(2) and to eliminate barriers to the effective
use of such services, including with respect to eligibility
criteria.
(iii) An evaluation of the effectiveness of the Department
in providing services for caregivers of veterans.
(iv) An evaluation of the quality and sufficiency of
services for caregivers of veterans available from
nongovernmental organizations.
(v) A description of any gaps identified by the Committee
in care or services provided by caregivers to veterans and
recommendations for legislative or administrative action to
address such gaps.
(vi) Such other matters or recommendations as the Chair
considers appropriate.
(2) Transmittal to congress.--Not later than 90 days after
the receipt of a report under paragraph (1), the Secretary
shall transmit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a copy of such report, together with such
comments and recommendations concerning such report as the
Secretary considers appropriate.
(e) Termination.--The Committee shall terminate on December
31, 2022.

SEC. 6435. COMPREHENSIVE STUDY ON SERIOUSLY INJURED VETERANS
AND THEIR CAREGIVERS.

(a) Study Required.--During the period specified in
subsection (d), the Secretary of Veterans Affairs shall
provide for the conduct by an independent entity of a
comprehensive study on the following:
(1) Veterans who have incurred a serious injury or illness,
including a mental health injury or illness.
(2) Individuals who are acting as caregivers for veterans.
(b) Elements.--The comprehensive study required by
subsection (a) shall include the following with respect to
each veteran included in such study:
(1) The health of the veteran and, if applicable, the
impact of the caregiver of such veteran on the health of such
veteran.
(2) The employment status of the veteran and, if
applicable, the impact of the caregiver of such veteran on
the employment status of such veteran.
(3) The financial status and needs of the veteran.
(4) The use by the veteran of benefits available to such
veteran from the Department of Veterans Affairs.
(5) Such other information as the Secretary considers
appropriate.
(c) Contract.--The Secretary shall enter into a contract
with an appropriate independent entity to conduct the study
required by subsection (a).
(d) Period Specified.--The period specified in this
subsection is the one-year period beginning on the date that
is four years after the date specified in section
1720G(a)(2)(B)(i) of title 38, United States Code, as amended
by section 6431(a)(1) of this Act.
(e) Report.--Not later than 30 days after the end of the
period specified in subsection (d), the Secretary shall
submit to the Committee on Veterans' Affairs of the Senate
and the Committee on Veterans' Affairs of the House of
Representatives a report on the results of the study required
by subsection (a).

TITLE LXVII--FACILITY CONSTRUCTION AND LEASES

Subtitle A--Medical Facility Construction and Leases

SEC. 6441. AUTHORIZATION OF CERTAIN MAJOR MEDICAL FACILITY
PROJECTS OF THE DEPARTMENT OF VETERANS AFFAIRS.

The Secretary of Veterans Affairs may carry out the
following major medical facility projects, with each project
to be carried out in an amount not to exceed the amount
specified for that project:
(1) Seismic corrections to buildings, including
retrofitting and replacement of high-risk buildings, in San
Francisco, California, in an amount not to exceed
$317,300,000.
(2) Seismic corrections to facilities, including facilities
to support homeless veterans, at the medical center in West
Los Angeles, California, in an amount not to exceed
$370,800,000.
(3) Seismic corrections to the mental health and community
living center in Long Beach, California, in an amount not to
exceed $317,300,000.
(4) Construction of an outpatient clinic, administrative
space, cemetery, and columbarium in Alameda, California, in
an amount not to exceed $240,200,000.
(5) Realignment of medical facilities in Livermore,
California, in an amount not to exceed $415,600,000.
(6) Construction of a replacement community living center
in Perry Point, Maryland, in an amount not to exceed
$92,700,000.
(7) Seismic corrections and other renovations to several
buildings and construction of a specialty care building in
American Lake, Washington, in an amount not to exceed
$161,700,000.

SEC. 6442. AUTHORIZATION OF CERTAIN MAJOR MEDICAL FACILITY
LEASES OF THE DEPARTMENT OF VETERANS AFFAIRS.

The Secretary of Veterans Affairs may carry out the
following major medical facility leases at the locations
specified and in an amount for each lease not to exceed the
amount specified for such location (not including any
estimated cancellation costs):
(1) For an outpatient clinic, Ann Arbor, Michigan, an
amount not to exceed $17,093,000.
(2) For an outpatient mental health clinic, Birmingham,
Alabama, an amount not to exceed $6,971,000.
(3) For an outpatient specialty clinic, Birmingham,
Alabama, an amount not to exceed $10,479,000.
(4) For research space, Boston, Massachusetts, an amount
not to exceed $5,497,000.
(5) For research space, Charleston, South Carolina, an
amount not to exceed $6,581,000.
(6) For an outpatient clinic, Daytona Beach, Florida, an
amount not to exceed $12,664,000.
(7) For Chief Business Office Purchased Care office space,
Denver, Colorado, an amount not to exceed $17,215,000.
(8) For an outpatient clinic, Gainesville, Florida, an
amount not to exceed $4,686,000.
(9) For an outpatient clinic, Hampton Roads, Virginia, an
amount not to exceed $18,124,000.
(10) For research space, Mission Bay, California, an amount
not to exceed $23,454,000.
(11) For an outpatient clinic, Missoula, Montana, an amount
not to exceed $7,130,000.
(12) For an outpatient clinic, Northern Colorado, Colorado,
an amount not to exceed $8,776,000.
(13) For an outpatient clinic, Ocala, Florida, an amount
not to exceed $5,279,000.
(14) For an outpatient clinic, Oxnard, California, an
amount not to exceed $6,297,000.
(15) For an outpatient clinic, Pike County, Georgia, an
amount not to exceed $5,757,000.
(16) For an outpatient clinic, Portland, Maine, an amount
not to exceed $6,846,000.
(17) For an outpatient clinic, Raleigh, North Carolina, an
amount not to exceed $21,607,000.
(18) For an outpatient clinic, Santa Rosa, California, an
amount not to exceed $6,498,000.
(19) For a replacement outpatient clinic, Corpus Christi,
Texas, an amount not to exceed $7,452,000.
(20) For a replacement outpatient clinic, Jacksonville,
Florida, an amount not to exceed $18,136,000.
(21) For a replacement outpatient clinic, Pontiac,
Michigan, an amount not to exceed $4,532,000.
(22) For a replacement outpatient clinic, phase II,
Rochester, New York, an amount not to exceed $6,901,000.
(23) For a replacement outpatient clinic, Tampa, Florida,
an amount not to exceed $10,568,000.

[[Page S3756]]

(24) For a replacement outpatient clinic, Terre Haute,
Indiana, an amount not to exceed $4,475,000.

SEC. 6443. AUTHORIZATION OF APPROPRIATIONS.

(a) Authorization of Appropriations for Construction.--
There is authorized to be appropriated to the Secretary of
Veterans Affairs for fiscal year 2016 or the year in which
funds are appropriated for the Construction, Major Projects,
account $1,915,600,000 for the projects authorized in section
6441.
(b) Authorization of Appropriations for Medical Facility
Leases.--There is authorized to be appropriated to the
Secretary of Veterans Affairs for fiscal year 2016 or the
year in which funds are appropriated for the Medical
Facilities account $190,954,000 for the leases authorized in
section 6442.
(c) Limitation.--The projects authorized in section 6431
may only be carried out using--
(1) funds appropriated for fiscal year 2016 pursuant to the
authorization of appropriations in subsection (b);
(2) funds available for Construction, Major Projects, for a
fiscal year before fiscal year 2016 that remain available for
obligation;
(3) funds available for Construction, Major Projects, for a
fiscal year after fiscal year 2016 that remain available for
obligation;
(4) funds appropriated for Construction, Major Projects,
for fiscal year 2016 for a category of activity not specific
to a project;
(5) funds appropriated for Construction, Major Projects,
for a fiscal year before fiscal year 2016 for a category of
activity not specific to a project; and
(6) funds appropriated for Construction, Major Projects,
for a fiscal year after fiscal year 2016 for a category of
activity not specific to a project.

Subtitle B--Leases at Department of Veterans Affairs West Los Angeles
Campus

SEC. 6451. AUTHORITY TO ENTER INTO CERTAIN LEASES AT THE
DEPARTMENT OF VETERANS AFFAIRS WEST LOS ANGELES
CAMPUS.

(a) In General.--The Secretary of Veterans Affairs may
carry out leases described in subsection (b) at the
Department of Veterans Affairs West Los Angeles Campus in Los
Angeles, California (hereinafter in this section referred to
as the ``Campus'').
(b) Leases Described.--Leases described in this subsection
are the following:
(1) Any enhanced-use lease of real property under
subchapter V of chapter 81 of title 38, United States Code,
for purposes of providing supportive housing, as that term is
defined in section 8161(3) of such title, that principally
benefit veterans and their families.
(2) Any lease of real property for a term not to exceed 50
years to a third party to provide services that principally
benefit veterans and their families and that are limited to
one or more of the following purposes:
(A) The promotion of health and wellness, including
nutrition and spiritual wellness.
(B) Education.
(C) Vocational training, skills building, or other training
related to employment.
(D) Peer activities, socialization, or physical recreation.
(E) Assistance with legal issues and Federal benefits.
(F) Volunteerism.
(G) Family support services, including child care.
(H) Transportation.
(I) Services in support of one or more of the purposes
specified in subparagraphs (A) through (H).
(3) A lease of real property for a term not to exceed 10
years to The Regents of the University of California, a
corporation organized under the laws of the State of
California, on behalf of its University of California, Los
Angeles (UCLA) campus (hereinafter in this section referred
to as ``The Regents''), if--
(A) the lease is consistent with the master plan described
in subsection (g);
(B) the provision of services to veterans is the
predominant focus of the activities of The Regents at the
Campus during the term of the lease;
(C) The Regents expressly agrees to provide, during the
term of the lease and to an extent and in a manner that the
Secretary considers appropriate, additional services and
support (for which The Regents is not compensated by the
Secretary or through an existing medical affiliation
agreement) that--
(i) principally benefit veterans and their families,
including veterans who are severely disabled, women, aging,
or homeless; and
(ii) may consist of activities relating to the medical,
clinical, therapeutic, dietary, rehabilitative, legal,
mental, spiritual, physical, recreational, research, and
counseling needs of veterans and their families or any of the
purposes specified in any of subparagraphs (A) through (I) of
paragraph (2); and
(D) The Regents maintains records documenting the value of
the additional services and support that The Regents provides
pursuant to subparagraph (C) for the duration of the lease
and makes such records available to the Secretary.
(c) Limitation on Land-Sharing Agreements.--The Secretary
may not carry out any land-sharing agreement pursuant to
section 8153 of title 38, United States Code, at the Campus
unless such agreement--
(1) provides additional health-care resources to the
Campus; and
(2) benefits veterans and their families other than from
the generation of revenue for the Department of Veterans
Affairs.
(d) Revenues From Leases at the Campus.--Any funds received
by the Secretary under a lease described in subsection (b)
shall be credited to the applicable Department medical
facilities account and shall be available, without fiscal
year limitation and without further appropriation,
exclusively for the renovation and maintenance of the land
and facilities at the Campus.
(e) Easements.--
(1) In general.--Notwithstanding any other provision of law
(other than Federal laws relating to environmental and
historic preservation), pursuant to section 8124 of title 38,
United States Code, the Secretary may grant easements or
rights-of-way on, above, or under lands at the Campus to--
(A) any local or regional public transportation authority
to access, construct, use, operate, maintain, repair, or
reconstruct public mass transit facilities, including, fixed
guideway facilities and transportation centers; and
(B) the State of California, County of Los Angeles, City of
Los Angeles, or any agency or political subdivision thereof,
or any public utility company (including any company
providing electricity, gas, water, sewage, or
telecommunication services to the public) for the purpose of
providing such public utilities.
(2) Improvements.--Any improvements proposed pursuant to an
easement or right-of-way authorized under paragraph (1) shall
be subject to such terms and conditions as the Secretary
considers appropriate.
(3) Termination.--Any easement or right-of-way authorized
under paragraph (1) shall be terminated upon the abandonment
or nonuse of the easement or right-of-way and all right,
title, and interest in the land covered by the easement or
right-of-way shall revert to the United States.
(f) Prohibition on Sale of Property.--Notwithstanding
section 8164 of title 38, United States Code, the Secretary
may not sell or otherwise convey to a third party fee simple
title to any real property or improvements to real property
made at the Campus.
(g) Consistency With Master Plan.--The Secretary shall
ensure that each lease carried out under this section is
consistent with the draft master plan approved by the
Secretary on January 28, 2016, or successor master plans.
(h) Compliance With Certain Laws.--
(1) Laws relating to leases and land use.--If the Inspector
General of the Department of Veterans Affairs determines, as
part of an audit report or evaluation conducted by the
Inspector General, that the Department is not in compliance
with all Federal laws relating to leases and land use at the
Campus, or that significant mismanagement has occurred with
respect to leases or land use at the Campus, the Secretary
may not enter into any lease or land-sharing agreement at the
Campus, or renew any such lease or land-sharing agreement
that is not in compliance with such laws, until the Secretary
certifies to the Committee on Veterans' Affairs of the
Senate, the Committee on Veterans' Affairs of the House of
Representatives, and each Member of the Senate and the House
of Representatives who represents the area in which the
Campus is located that all recommendations included in the
audit report or evaluation have been implemented.
(2) Compliance of particular leases.--Except as otherwise
expressly provided by this section, no lease may be entered
into or renewed under this section unless the lease complies
with chapter 33 of title 41, United States Code, and all
Federal laws relating to environmental and historic
preservation.
(i) Community Veterans Engagement Board.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary shall establish a
Community Veterans Engagement Board (in this subsection
referred to as the ``Board'') for the Campus to coordinate
locally with the Department of Veterans Affairs to--
(A) identify the goals of the community; and
(B) provide advice and recommendations to the Secretary to
improve services and outcomes for veterans, members of the
Armed Forces, and the families of such veterans and members.
(2) Members.--The Board shall be comprised of a number of
members that the Secretary determines appropriate, of which
not less than 50 percent shall be veterans. The nonveteran
members shall be family members of veterans, veteran
advocates, service providers, or stakeholders.
(3) Community input.--In carrying out subparagraphs (A) and
(B) of paragraph (1), the Board shall--
(A) provide the community opportunities to collaborate and
communicate with the Board, including by conducting public
forums on the Campus; and
(B) focus on local issues regarding the Department that are
identified by the community, including with respect to health
care, benefits, and memorial services at the Campus.
(j) Notification and Reports.--
(1) Congressional notification.--With respect to each lease
or land-sharing agreement intended to be entered into or
renewed at the Campus, the Secretary shall notify the
Committee on Veterans' Affairs of the Senate, the Committee
on Veterans' Affairs of the House of Representatives, and
each Member of the Senate and the House of Representatives
who represents the area in which the Campus is located of the
intent of the Secretary to enter into or renew the lease or
land-sharing agreement not later

[[Page S3757]]

than 45 days before entering into or renewing the lease or
land-sharing agreement.
(2) Annual report.--Not later than one year after the date
of the enactment of this Act, and not less frequently than
annually thereafter, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate, the Committee
on Veterans' Affairs of the House of Representatives, and
each Member of the Senate and the House of Representatives
who represents the area in which the Campus is located an
annual report evaluating all leases and land-sharing
agreements carried out at the Campus, including--
(A) an evaluation of the management of the revenue
generated by the leases; and
(B) the records described in subsection (b)(3)(D).
(3) Inspector general report.--
(A) In general.--Not later than each of two years and five
years after the date of the enactment of this Act, and as
determined necessary by the Inspector General of the
Department of Veterans Affairs thereafter, the Inspector
General shall submit to the Committee on Veterans' Affairs of
the Senate, the Committee on Veterans' Affairs of the House
of Representatives, and each Member of the Senate and the
House of Representatives who represents the area in which the
Campus is located a report on all leases carried out at the
Campus and the management by the Department of the use of
land at the Campus, including an assessment of the efforts of
the Department to implement the master plan described in
subsection (g) with respect to the Campus.
(B) Consideration of annual report.--In preparing each
report required by subparagraph (A), the Inspector General
shall take into account the most recent report submitted to
Congress by the Secretary under paragraph (2).
(k) Rule of Construction.--Nothing in this section shall be
construed as a limitation on the authority of the Secretary
to enter into other agreements regarding the Campus that are
authorized by law and not inconsistent with this section.
(l) Principally Benefit Veterans and Their Families
Defined.--In this section the term ``principally benefit
veterans and their families'', with respect to services
provided by a person or entity under a lease of property or
land-sharing agreement--
(1) means services--
(A) provided exclusively to veterans and their families; or
(B) that are designed for the particular needs of veterans
and their families, as opposed to the general public, and any
benefit of those services to the general public is distinct
from the intended benefit to veterans and their families; and
(2) excludes services in which the only benefit to veterans
and their families is the generation of revenue for the
Department of Veterans Affairs.
(m) Conforming Amendments.--
(1) Prohibition on disposal of property.--Section 224(a) of
the Military Construction and Veterans Affairs and Related
Agencies Appropriations Act, 2008 (Public Law 110-161; 121
Stat. 2272) is amended by striking ``The Secretary of
Veterans Affairs'' and inserting ``Except as authorized under
section 6451 of the National Defense Authorization Act for
Fiscal Year 2017, the Secretary of Veterans Affairs''.
(2) Enhanced-use leases.--Section 8162(c) of title 38,
United States Code, is amended by inserting ``, other than an
enhanced-use lease under section 6451 of the National Defense
Authorization Act for Fiscal Year 2017,'' before ``shall be
considered''.

TITLE LXVIII--OTHER VETERANS MATTERS

SEC. 6461. CLARIFICATION OF PRESUMPTIONS OF EXPOSURE FOR
VETERANS WHO SERVED IN VICINITY OF REPUBLIC OF
VIETNAM.

(a) Compensation.--Subsections (a)(1) and (f) of section
1116 of title 38, United States Code, are amended by
inserting ``(including its territorial seas)'' after ``served
in the Republic of Vietnam'' each place it appears.
(b) Health Care.--Section 1710(e)(4) of such title is
amended by inserting ``(including its territorial seas)''
after ``served on active duty in the Republic of Vietnam''.
(c) Effective Date.--The amendments made by subsections (a)
and (b) shall take effect as if enacted on September 25,
1985.

TITLE LXIX--OTHER MATTERS

SEC. 6471. TEMPORARY VISA FEE FOR EMPLOYERS WITH MORE THAN 50
PERCENT FOREIGN WORKFORCE.

(a) In General.--Section 411 of the Air Transportation
Safety and System Stabilization Act (49 U.S.C. 40101 note),
as added by section 402(g) of the James Zadroga 9/11 Victim
Compensation Fund Reauthorization Act (title IV of division O
of Public Law 114-113), is amended--
(1) by amending to section heading to read as follows:
``temporary visa fee for employers with more than 50 percent
foreign workforce''; and
(2) by striking subsections (a) and (b) and inserting the
following:
``(a) Temporary L Visa Fee Increase.--Notwithstanding
section 281 of the Immigration and Nationality Act (8 U.S.C.
1351) or any other provision of law, the filing fee required
to be submitted with a petition filed under section
101(a)(15)(L) of the Immigration and Nationality Act (8
U.S.C. 1101(a)(15)(L)), except for an amended petition
without an extension of stay request, shall be increased by
$4,500 for petitioners that employ 50 or more employees in
the United States if more than 50 percent of the petitioner's
employees are nonimmigrants described in subparagraph
(H)(1)(b) or (L) of section 101(a)(15) of such Act. This fee
shall also apply to petitioners described in this subsection
who file an individual petition on the basis of an approved
blanket petition.
``(b) Temporary H-1b Visa Fee Increase.--Notwithstanding
section 281 of the Immigration and Nationality Act (8 U.S.C.
1351) or any other provision of law, the filing fee required
to be submitted with a petition under section
101(a)(15)(H)(i)(b) of the Immigration and Nationality Act (8
U.S.C. 1101(a)(15)(H)(i)(b)), except for an amended petition
without an extension of stay request, shall be increased by
$4,000 for petitioners that employ 50 or more employees in
the United States if more than 50 percent of the petitioner's
employees are nonimmigrants described in subparagraph
(H)(1)(b) or (L) of section 101(a)(15) of such Act.''.
(b) Effective Dates.--The amendments made by subsection
(a)--
(1) shall take effect on the date that is 30 days after the
date of the enactment of this Act; and
(2) shall apply to any petition filed during the period
beginning on such effective date and ending on September 30,
2025.
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