[Pages S3369-S3381]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

______

By Mr. McCONNELL (for himself, Mr. Enzi, Mr. Thune, Mr. Paul, Mr.
Blunt, Mr. Vitter, and Mrs. Fischer):
S. 2414. A bill to amend the Clean Air Act to prohibit the regulation
of emissions of carbon dioxide from new or existing power plants under
certain circumstances; to the Committee on Environment and Public
Works.
Mr. McCONNEll. Mr. President, I ask unanimous consent that the text
of the bill be printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:

S. 2414

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Coal Country Protection
Act'' or the ``Protecting Jobs, Families, and the Economy
From EPA Overreach Act''.

SEC. 2. REGULATION OF EMISSIONS OF CARBON DIOXIDE FROM NEW OR
EXISTING POWER PLANTS.

(a) Limitation on Regulation.--The Clean Air Act is amended
by inserting after section 312 (42 U.S.C. 7612) the
following:

``SEC. 313. LIMITATION ON REGULATION OF EMISSIONS OF CARBON
DIOXIDE FROM NEW OR EXISTING POWER PLANTS.

``(a) Definition of New or Existing Power Plant.--In this
section, the term `new or existing power plant' means a
fossil fuel-fired power plant that commences operation at any
time.
``(b) Limitation.--Notwithstanding any other provision of
law (including regulations), the Administrator may not
promulgate any regulation or guidance that limits or
prohibits any new carbon dioxide emissions from a new or
existing power plant, and no such regulation or guidance
shall have any force or effect, until the date on which--
``(1) the Secretary of Labor certifies to the Administrator
that the regulation or guidance will not generate any loss of
employment;
``(2) the Director of the Congressional Budget Office
certifies to the Administrator that the regulation or
guidance will not result in any loss in the gross domestic
product of the United States;
``(3) the Administrator of the Energy Information
Administration certifies to the Administrator that the
regulation or guidance will not generate any increase in
electricity rates in the United States; and
``(4) the Chairperson of the Federal Energy Regulatory
Commission and the President of the North American Electric
Reliability Corporation certify to the Administrator the
reliability of electricity delivery under the regulation or
guidance.''.
(b) Technical Correction.--The Clean Air Act is amended by
redesignating the second section 317 (42 U.S.C. 7617)
(relating to economic impact assessment) as section 318.
______

By Mr. SANDERS (for himself, Mr. Rockefeller, Mr. Begich, Mrs.
Shaheen, Mr. Kaine, Mr. Reed, Mr. Merkley, Mr. Casey, Mr.
Whitehouse, Mr. Blumenthal, Mr. Heinrich, Mr. Udall of New
Mexico, Mr. Schatz, Ms. Baldwin, Mr. Wyden, Mr. Leahy, Mr.
Brown, Ms. Heitkamp, Ms. Landrieu, Mr. Booker, Mr. Durbin, Mr.
Schumer, and Ms. Hirono):
S. 2422. A bill to improve the access of veterans to medical services
from the Department of Veterans Affairs, and for other purposes; read
the first time.
Mr. SANDERS. Mr. President, as chairman of the Senate Committee on
Veterans' Affairs, I rise today to introduce the Ensuring Veterans
Access to Care Act of 2014.
I thank the 16 cosponsors of this legislation, and they are Senators
Rockefeller, Begich, Shaheen, Kaine, Reed, Merkley, Casey, Whitehouse,
Blumenthal, Heinrich, Udall of New Mexico, Schatz, Baldwin, Wyden,
Hirono, and Leahy.
It is safe to say there is broad bipartisan agreement among all of us
that every veteran in this country who enters the VA health care system
deserves high-quality care and deserves that care in a timely manner.
Overall, talking to veterans in Vermont and, in fact, throughout this
country, talking to the veterans service organizations who represent
their interests and reading independent studies, they all confirm that
by and large, once veterans get into the VA health care system, the
system is, in fact, quite good.
However, it has become clear--and I think all of us are aware of what
has happened in the last month--that while quality is generally good,
there are too many veterans throughout this country waiting too long to
access this care.
In recent years, the VA has seen a huge increase in its patient load.
In fact, in the last 4 years, 2 million new veterans have come into
the system, many of them with very complicated health care cases,
including TBI, post-traumatic stress disorder, and many of the needs
that older veterans and older people generally have.
Despite this fact, it is still absolutely unacceptable that some
veterans are forced onto long waiting lists for care, and it is totally
intolerable--it is reprehensible--that any VA employee could be
manipulating data in Phoenix or anyplace else to hide how long veterans
have been on waiting lists to see doctors. This is an issue that must
be dealt with and must be dealt with rapidly and strongly.
These problems are real, and they have to be addressed. But they
should not be an excuse to walk away from a system that serves 6.5
million veterans every single year and 230,000 veterans every single
day. This is a system we must fix, not a system that we should ditch.
We must focus on the underlying problems and work to transform the
VA.
In general, what our legislation does is it works in three basic
areas. No. 1, we give greater authority to the Secretary to fire
incompetent senior officials. No. 2, we take very significant steps to
shorten the wait times that many veterans are now experiencing. And No.
3, we address the long-term health care needs of the VA in terms of a
shortage of staff, doctors, and nurses that currently exists in various
locations around the country.
Let me go through some of those issues right now.
Several weeks ago my Republican colleague from Florida requested a
vote on legislation that would allow VA Secretaries to immediately
remove senior executives due to poor performance.
So let us be clear. I strongly support the effort to make sure that
we get rid of incompetent or worse senior executives at the VA. There
is no debate about that. But here is what the debate is about. I do not
think it is a good idea to give the Secretary of an institution, of an
agency that has some 300,000 employees, the ability to simply fire
without any due process.
What I worry about is that you can move toward a situation where the
VA health care system is politicized in a way that it should not be.
Let me give an example. A new President comes in with a new
Secretary. The new Secretary says--whether it is a Democratic President
or a Republican President--I want to get rid of 300 senior-level
appointees and bring in 300 new people. Four years later, another
President comes in--different party--and says: We are going to get rid
of those 300 people and bring in 300 more people.
I do not think that provides the kind of stability that the largest
integrated

[[Page S3370]]

health care system in America needs or deserves. I worry about the
politicization.
Second, I worry about an instance where a whistleblower stands up who
is critical of this or that aspect of the VA. That person could be
fired without due process.
I worry there may be a situation where somebody is fired--not because
of bad performance; maybe they are a woman and somebody doesn't like a
woman in that position; maybe they are gay, maybe they are black, maybe
they are whatever--and that person does not have any ability to appeal
that decision.
I think that is wrong. I think that is bad policy. On the other hand,
what I do believe is that person should be taken out of his or her job
immediately, but that person must have the right to have an expedited
appeal.
What our legislation does is give the person a week to bring forth
the appeal and gives the appropriate appeal body 3 weeks to make a
decision.
Now, we are dealing with people who are M.D.s, Ph.D.s, high-level
people whose professionalism is on the line. I don't think you can fire
people willy-nilly without giving them a chance in an expedited manner
to express their point of view.
That is one difference I have with my colleague from Florida on his
proposal.
Let me talk a little bit about the major concern I have; that is, how
do we shorten wait times? How do we make certain in those areas of the
country where there are long waiting periods or where veterans may be
geographically a long distance away from a facility that they get
timely care?
The legislation that I have authored takes immediate action to
provide timely access for care for our veterans. First, this
legislation would standardize VA's process for providing non-VA care
when the Department is unable to provide care to the veterans within
its stated goal. As the DVA--Disabled American Veterans--pointed out in
a release today, VA must continue to be responsible for coordinating
their care amongst various VA and non-VA providers. This legislation
accomplishes that goal by providing a framework for consistent
decisionmaking regarding non-VA care. Under this legislation VA would
coordinate non-VA care by taking into account wait times for care, the
health of the veteran, the distance the veteran would be required to
travel, as well as the veteran's choice.

This bill also addresses VA systemwide health care provider
shortages. But in terms of the wait lists, what we say in English is:
If there is an unacceptable wait time or if a veteran is a long
distance away from a provider, we are going to allow--and we must
allow--that veteran to get health care through a private provider,
through a federally qualified community health center, through a
Department of Defense military base, if that is available, through an
Indian health service, if that is available--and that exists now in
Alaska--and that might be expanded. So the bottom line is if there are
waiting lists beyond what is reasonable, the veterans in this country
should be able to get into non-VA health care in a timely manner, and
this bill does that.
But importantly, this bill also addresses a very significant issue
that I think we cannot ignore, and that is it appears to me that in
many parts of this country we simply don't have the doctors and nurses
we need when an influx of veterans is coming into the system.
I was talking to some very knowledgeable people today who were
telling me about burnout. Primary care physicians and psychiatrists are
seeing many more patients and turnover rates are much too high. The
last thing we want to do is to see rapid turnover because people are
burnt out and don't have the time to do the quality work they want to
do.
Let me quote an article that appears in the New York Times on May 29
which addresses this issue. This is what it says:

Dr. Phyllis Hollenbeck, a primary care physician, took a
job at the Veterans Affairs medical center in Jackson, Miss.,
in 2008 expecting fulfilling work and a lighter patient load
than she had in private practice. What she found was quite
different: 13-hour workdays fueled by large patient loads
that kept growing as colleagues quit and were not replaced.
Appalled by what she saw, Dr. Hollenbeck filed a whistle-
blower complaint and changed jobs. A subsequent investigation
by the Department of Veterans Affairs concluded last fall
that indeed the Jackson hospital did not have enough primary
care doctors, resulting in nurse practitioners' handling far
too many complex cases and in numerous complaints from
veterans about the delayed care. ``It was unethical to put us
in that position,'' Dr. Hollenbeck said of the overstressed
primary care unit in Jackson. ``Your heart gets broken.''

In this case we had a physician who wanted to do the right thing,
wanted to spend the appropriate amounts of time that were needed with
the patients, and she was unable to do that. What we are hearing is in
many parts of this country primary care physicians are saying: We
cannot do it; too many people are coming in. This is an issue that has
to be addressed, and our legislation does that.
Our legislation gives the VA the ability to rapidly hire new doctors,
nurses, and other health care providers in areas with identified
shortages. It also enables VA's ability to recruit qualified health
providers by enhancing scholarship and loan repayment opportunities.
As the Presiding Officer well knows as a member of the committee that
deals with this issue, we have a crisis in this country in terms of the
lack of primary care practitioners. This is a very serious problem.
There are experts who tell us, in fact, that we need 50,000 new primary
care physicians in the next 10 to 15 years. This is a national problem,
it is a problem within the VA, and what this legislation proposes is
that the VA work with the National Health Service Corps in order to
provide debt forgiveness, scholarships to medical school students, so
when they graduate they can get into the VA and practice the quality
medicine we need there.
This bill addresses another issue that has been discussed a lot--and
there is widespread bipartisan support for this and support in the
House as well--and that is the authorization of 27 major medical
facility leases. In many instances these leases would improve access to
care closer to home and would increase the availability of specialty
care services in those locations that would allow the VA to decompress
overutilized VA facilities. This is an important issue in this
legislation and I believe there is bipartisan support for it.
Furthermore, this bill would require the President to create a
commission to look at VA health care access issues and recommend action
to bolster capacity. In the last couple of days I have heard a lot of
good ideas about how we can deal with the issue, but we need a high-
level commission of some of the most knowledgeable people in this
country appointed by the President to report within 90 days some ideas
of how the VA can proceed.
I want to thank the 16 or so cosponsors we have. I look forward to
working with my Republican colleagues. We have got a problem we have to
address, and I hope we can do it in a bipartisan way.
Mr. President, I ask unanimous consent that the text of the bill be
printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:

S. 2422

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

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

Sec. 1. Short title; table of contents.

TITLE I--IMPROVEMENT OF SCHEDULING SYSTEM FOR HEALTH CARE APPOINTMENTS

Sec. 101. Implementation of upgraded Department of Veterans Affairs
electronic scheduling system for appointments for receipt
of health care from the Department.
Sec. 102. Independent assessment of the scheduling process for medical
appointments for care from Department of Veterans
Affairs.

TITLE II--TRAINING AND HIRING OF HEALTH CARE STAFF

Sec. 201. Modification of liability for breach of period of obligated
service under Health Professionals Educational Assistance
Program for primary care physicians.

[[Page S3371]]

Sec. 202. Program of education at Uniformed Services University of the
Health Sciences with specialization in primary care.
Sec. 203. Treatment of staffing shortage and biannual report on
staffing of medical facilities of the Department of
Veterans Affairs.
Sec. 204. Clinic management training program of the Department of
Veterans Affairs.
Sec. 205. Inclusion of Department of Veterans Affairs facilities in
National Health Service Corps Scholarship and loan
repayment programs.
Sec. 206. Authorization of emergency appropriations.

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

Sec. 301. Improvement of access by veterans to health care from non-
Department of Veterans Affairs providers.
Sec. 302. Extension of and report on joint incentives program of
Department of Veterans Affairs and Department of Defense.
Sec. 303. Transfer of authority for payments for hospital care, medical
services, and other health care from non-Department
providers to the Chief Business Office of the Veterans
Health Administration of the Department.
Sec. 304. Enhancement of collaboration between Department of Veterans
Affairs and Indian Health Service.
Sec. 305. Enhancement of collaboration between Department of Veterans
Affairs and Native Hawaiian health care systems.
Sec. 306. Authorization of emergency appropriations.

TITLE IV--HEALTH CARE ADMINISTRATIVE MATTERS

Sec. 401. Improvement of access of veterans to mobile vet centers of
the Department of Veterans Affairs.
Sec. 402. Commission on Access to Care.
Sec. 403. Commission on Capital Planning for Department of Veterans
Affairs Medical Facilities.
Sec. 404. Removal of Senior Executive Service employees of the
Department of Veterans Affairs for performance.

TITLE V--MAJOR MEDICAL FACILITY LEASES

Sec. 501. Authorization of major medical facility leases.
Sec. 502. Budgetary treatment of Department of Veterans Affairs major
medical facilities leases.

TITLE I--IMPROVEMENT OF SCHEDULING SYSTEM FOR HEALTH CARE APPOINTMENTS

SEC. 101. IMPLEMENTATION OF UPGRADED DEPARTMENT OF VETERANS
AFFAIRS ELECTRONIC SCHEDULING SYSTEM FOR
APPOINTMENTS FOR RECEIPT OF HEALTH CARE FROM
THE DEPARTMENT.

(a) Implementation.--
(1) In general.--Not later than March 31, 2016, the
Secretary of Veterans Affairs shall fully implement an
upgraded and centralized electronic scheduling system
described in subsection (b) for appointments by eligible
individuals for health care from the Department of Veterans
Affairs.
(2) Agile software development methodologies.--In
implementing the upgraded electronic scheduling system
required by paragraph (1), the Secretary shall use agile
software development methodologies to fully implement
portions of such system every 180 days beginning on the date
on which the Secretary begins the implementation of such
system, or enters into a contract for the implementation of
such system, and ending on the date on which such system is
fully implemented.
(b) Electronic Scheduling System.--The upgraded electronic
scheduling system described in this subsection shall include
mechanisms to achieve the following:
(1) An efficient and effective graphical user interface
with a calendar view for use by employees of the Department
in scheduling appointments that enables error-free scheduling
of the health care resources of the Department.
(2) A capability to assist employees of the Department to
easily and consistently implement policies of the Department
with respect to scheduling of appointments, including with
respect to priority for appointments for certain eligible
individuals.
(3) A capability for employees of the Department to sort
and view through a unified interface the availability for
each health care provider of the Department or other health
care resource of the Department.
(4) A capability for employees of the Department to sort
and view appointments for and appointment requests made by a
particular eligible individual.
(5) A capability for seamless coordination of appointments
for primary care, specialty care, consultations, or any other
health care matter among facilities of the Department.
(6) A capability for eligible individuals to access the
system remotely and schedule appointments directly through
the system.
(7) An electronic timestamp of each activity made by an
eligible individual or on behalf of such individual with
respect to an appointment or the scheduling of an appointment
that shall be kept in the medical record of such individual.
(8) A seamless connection to the Computerized Patient
Record System of the Department so that employees of the
Department, when scheduling an appointment for an eligible
individual, have access to recommendations from the health
care provider of such individual with respect to when such
individual should receive an appointment.
(9) A capability to provide automated reminders to eligible
individuals on upcoming appointments through various
electronic and voice media.
(10) A capability to provide automated reminders to
employees of the Department when an eligible individual who
is on the wait-list for an appointment becomes eligible to
schedule an appointment.
(11) A dashboard capability to support efforts to track the
following metrics in aggregate and by medical facility with
respect to health care provided to eligible individuals under
the laws administered by the Secretary:
(A) The number of days into the future that the schedules
of health care providers are available to schedule an
appointment.
(B) The number of providers available to see patients each
day.
(C) The number of support personnel working each day.
(D) The types of appointments available.
(E) The rate at which patients fail to appear for
appointments.
(F) The number of appointments canceled by a patient on a
daily basis.
(G) The number of appointments canceled by a health care
provider on a daily basis.
(H) The number of patients on the wait list at any given
time.
(I) The number of appointments scheduled on a daily basis;
(J) The number of appointments available to be scheduled on
a daily basis.
(K) The number of patients seen on a daily, weekly, and
monthly basis.
(L) Wait-times for an appointment with a health care
provider of the Department.
(M) Wait-times for an appointment with a non-Department
health care provider.
(N) Wait-times for a referral to a specialist or consult.
(12) A capability to provide data on the capacity of
medical facilities of the Department for purposes of
determining the resources needed by the Department to provide
health care to eligible individuals.
(13) Any other capabilities as specified by the Secretary
for purposes of this section.
(c) Plan.--
(1) 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 and the
Committee on Veterans' Affairs of the House of
Representatives a plan for implementing the upgraded
electronic scheduling system required by subsection (a).
(2) Elements.--The plan required by paragraph (1) shall
include the following:
(A) A description of the priorities of the Secretary for
implementing the requirements of the system under subsection
(b).
(B) A detailed description of the manner in which the
Secretary will fully implement such system, including
deadlines for completing each such requirement.
(3) Update.--Not later than 90 days after the submittal of
the plan required by paragraph (1), and not less frequently
than every 90 days thereafter until such system is fully
implemented, the Secretary shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives an update
on the status of the implementation of such plan.
(d) Use of Amounts.--The Secretary may use amounts
available to the Department of Veterans Affairs for the
appropriations account under the heading ``medical services''
in implementing and carrying out the upgraded electronic
scheduling system required by subsection (a).
(e) Eligible Individual Defined.--In this section, the term
``eligible individual'' means an individual eligible for
hospital, nursing home, domiciliary, medical care, or other
health care under the laws administered by the Secretary of
Veterans Affairs.

SEC. 102. INDEPENDENT ASSESSMENT OF THE SCHEDULING PROCESS
FOR MEDICAL APPOINTMENTS FOR CARE FROM
DEPARTMENT OF VETERANS AFFAIRS.

(a) Independent Assessment.--
(1) Contract.--Not later than 30 days after the date of the
enactment of this Act, the Secretary of Veteran Affairs shall
enter into a contract with an independent third party to
assess the process at each medical facility of the Department
of Veterans Affairs for scheduling appointments for veterans
to receive hospital care, medical services, or other health
care from the Department.
(2) Elements.--In carrying out the assessment required by
paragraph (1), the independent third party shall do the
following:
(A) Review all training materials pertaining to scheduling
of appointments at each medical facility of the Department.
(B) Assess whether all employees of the Department
conducting tasks related to scheduling are properly trained
for conducting such tasks.
(C) Assess whether changes in the technology or system used
in scheduling appointments are necessary to limit access to
the system to only those employees that have been properly
trained in conducting such tasks.

[[Page S3372]]

(D) Assess whether health care providers of the Department
are making changes to their schedules that hinder the ability
of employees conducting such tasks to perform such tasks.
(E) Assess whether the establishment of a centralized call
center throughout the Department for scheduling appointments
at medical facilities of the Department would improve the
process of scheduling such appointments.
(F) Assess whether booking templates for each medical
facility or clinic of the Department would improve the
process of scheduling such appointments.
(G) Recommend any actions to be taken by the Department to
improve the process for scheduling such appointments,
including the following:
(i) Changes in training materials provided to employees of
the Department with respect to conducting tasks related to
scheduling such appointments.
(ii) Changes in monitoring and assessment conducted by the
Department of wait-times of veterans for such appointments.
(iii) Changes in the system used to schedule such
appointments, including changes to improve how the
Department--

(I) measures wait-times of veterans for such appointments;
(II) monitors the availability of health care providers of
the Department; and
(III) provides veterans the ability to schedule such
appointments.

(iv) Such other actions as the independent third party
considers appropriate.
(3) Timing.--The independent third party carrying out the
assessment required by paragraph (1) shall complete such
assessment not later than 180 days after entering into the
contract described in such paragraph.
(b) Report.--Not later than 90 days after the date on which
the independent third party completes the assessment under
this section, 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 such assessment.

TITLE II--TRAINING AND HIRING OF HEALTH CARE STAFF

SEC. 201. MODIFICATION OF LIABILITY FOR BREACH OF PERIOD OF
OBLIGATED SERVICE UNDER HEALTH PROFESSIONALS
EDUCATIONAL ASSISTANCE PROGRAM FOR PRIMARY CARE
PHYSICIANS.

Section 7617 of title 38, United States Code, is amended--
(1) In subsection (c)(1), by striking ``If a participant''
and inserting ``Except as provided in subsection (d), if a
participant''; and
(2) by adding at the end the following new subsection:
``(d) Liability shall not arise under subsection (c) in the
case of a participant otherwise covered by that subsection
who has pursued a course of education or training in primary
care if--
``(1) the participant--
``(A) does not obtain, or fails to maintain, employment as
a Department employee due to staffing changes approved by the
Under Secretary for Health; or
``(B) does not obtain, or fails to maintain, employment in
a position of primary care physician in the Veterans Health
Administration due, as determined by the Secretary, to a
number of primary care physicians in the Administration that
is excess to the needs of the Administration; and
``(2) the participant agrees to accept and maintain
employment as a primary care physician with another
department or agency of the Federal Government (with such
employment to be under such terms and conditions as are
jointly agreed upon by the participant, the Secretary, and
the head of such department or agency, including terms and
conditions relating to a period of obligated service as a
primary care physician with such department or agency) if
such employment is offered to the participant by the
Secretary and the head of such department or agency.''.

SEC. 202. PROGRAM OF EDUCATION AT UNIFORMED SERVICES
UNIVERSITY OF THE HEALTH SCIENCES WITH
SPECIALIZATION IN PRIMARY CARE.

(a) Program Required Under Health Professionals Educational
Assistance Program.--
(1) In general.--Chapter 76 of title 38, United States
Code, is amended by adding after subchapter VII the following
new subchapter:

``SUBCHAPTER VIII--PROGRAM OF EDUCATION AT UNIFORMED SERVICES
UNIVERSITY OF THE HEALTH SCIENCES WITH SPECIALIZATION IN PRIMARY CARE

``Sec. 7691. Authority for program

``As part of the Educational Assistance Program, the
Secretary shall, in collaboration with the Secretary of
Defense, carry out a program to permit individuals to enroll
in the Uniformed Services University of the Health Sciences
under chapter 104 of title 10 to pursue a medical education
with a specialization in primary care. The program shall be
known as the Department of Veterans Affairs Primary Care
Educational Assistance Program (in this chapter referred to
as the `Primary Care Educational Assistance Program').

``Sec. 7692. Selection; agreement; ineligibility for certain
other educational assistance

``(a) Selection.--(1) Medical students at the Uniformed
Services University of the Health Sciences pursuant to the
Primary Care Educational Assistance Program shall be selected
by the Secretary, in consultation with the Secretary of
Defense, in accordance with procedures established by the
Secretaries for purposes of the Program.
``(2) The procedures referred to in paragraph (1) shall
emphasize the basic requirement that students demonstrate a
motivation and dedication to a medical career in primary
care.
``(3) The number of medical students selected each year for
first-year enrollment in the University pursuant to this
subsection shall be jointly determined by the Secretary and
the Secretary of Defense.
``(b) Agreement.--An agreement between the Secretary and a
participant in the Primary Care Educational Assistance
Program shall (in addition to the requirements set forth in
section 7604 of this title) include the following:
``(1) The Secretary's agreement to cover the costs of the
participant's education and training at the Uniformed
Services University of the Health Sciences under chapter 104
of title 10 as if the participant were a medical student
enrolled in the University pursuant to section 2114 of title
10.
``(2) The participant's agreement to serve as a full-time
employee in the Veterans Health Administration in a position
as a primary care physician for a period of time (in this
subchapter referred to as the `period of obligated service')
of one calendar year for each school year or part thereof for
which the participant was a medical student at the Uniformed
Services University of the Health Sciences pursuant to the
Primary Care Educational Assistance Program, but for not less
than one year.
``(c) Ineligibility for Other Educational Assistance.--An
individual who receives education and training under the
Primary Care Educational Assistance Program shall not be
eligible for other assistance under this chapter in
connection with such education and training.

``Sec. 7693. Obligated service

``(a) In General.--Each participant in the Primary Care
Educational Assistance Program shall provide service as a
full-time employee of the Department in the Veterans Health
Administration in a primary care position for the period of
obligated service provided in the agreement of the
participant entered into for purposes of this subchapter.
Such service shall be provided in a full-time primary care
clinical practice in an assignment or location determined by
the Secretary.
``(b) Service Commencement Date.--(1) Not later than 60
days before a participant's service commencement date, the
Secretary shall notify the participant of that service
commencement date. That date is the date for the beginning of
the participant's period of obligated service.
``(2) As soon as possible after a participant's service
commencement date, the Secretary shall--
``(A) in the case of a participant who is not a full-time
employee in the Veterans Health Administration, appoint the
participant as such an employee; and
``(B) in the case of a participant who is an employee in
the Veterans Health Administration but is not serving in a
position for which the participant's course of education or
training prepared the participant, assign the participant to
such a position.
``(3) A participant's service commencement for purposes of
this subsection date is the date upon which the participant
becomes licensed to practice medicine in a State.
``(c) Commencement of Obligated Service.--A participant in
the Primary Care Educational Assistance Program shall be
considered to have begun serving the participant's period of
obligated service--
``(1) on the date on which the participant is appointed as
a full-time employee in the Veterans Health Administration
pursuant to subsection (b)(2)(A); or
``(2) if the participant is a full-time employee in the
Veterans Health Administration and assigned to a position
pursuant to subsection (b)(2)(B), on the date on which the
participant is so assigned to such position.

``Sec. 7694. Breach of agreement: liability

``(a) Liability During Course of Education or Training.--
(1) A participant in the Primary Care Educational Assistance
Program shall be liable to the United States for the amount
which has been paid on behalf of the participant under the
agreement entered into for purposes of this subchapter if any
of the following occurs:
``(A) The participant fails to maintain an acceptable level
of academic standing in the Uniformed Services University of
the Health Sciences.
``(B) The participant is dismissed from the Uniformed
Services University of the Health Sciences for disciplinary
reasons.
``(C) The participant voluntarily terminates the course of
medical education and training in the Uniformed Services
University of the Health Sciences before the completion of
such course of education and training.
``(D) The participant fails to become licensed to practice
medicine in a State during a period of time determined under
regulations prescribed by the Secretary.
``(2) Liability under this subsection is in lieu of any
service obligation arising under a participant's agreement
for purposes of this subchapter.
``(b) Liability During Period of Obligated Service.--(1)
Except as provided in subsection (c) and subject to paragraph
(2), if

[[Page S3373]]

a participant in the Primary Care Educational Assistance
Program breaches the agreement entered into for purposes of
this subchapter by failing for any reason to complete the
participant's period of obligated service, the United States
shall be entitled to recover from the participant an amount
equal to--
``(A) the total amount paid under this subchapter on behalf
of the participant; multiplied by
``(B) a fraction--
``(i) the numerator of which is--
``(I) the total number of months in the participant's
period of obligated service; minus
``(II) the number of months served by the participant
pursuant to the agreement; and
``(ii) the denominator of which is the total number of
months in the participant's period of obligated service.
``(2) Any period of internship or residency training of a
participant shall not be treated as satisfying the
participant's period of obligated service for purposes of
this subsection.
``(c) Exceptions.--Liability shall not arise under
subsection (b) in the case of a participant otherwise covered
by that subsection if--
``(1) the participant--
``(A) does not obtain, or fails to maintain, employment as
a Department employee due to staffing changes approved by the
Under Secretary for Health; or
``(B) does not obtain, or fails to maintain, employment in
a position of primary care physician in the Veterans Health
Administration due, as determined by the Secretary, to a
number of primary care physicians in the Administration that
is excess to the needs of the Administration; and
``(2) the participant agrees to accept and maintain
employment as a primary care physician with another
department or agency of the Federal Government (with such
employment to be under such terms and conditions as are
jointly agreed upon by the participant, the Secretary, and
the head of such department or agency, including terms and
conditions relating to a period of obligated service as a
primary care physician with such department or agency) if
such employment is offered to the participant by the
Secretary and the head of such department or agency.

``Sec. 7695. Funding

``(a) In General.--Amounts for the Primary Care Educational
Assistance Program shall be derived from amounts available to
the Secretary for the Veterans Health Administration.
``(b) Transfer.--(1) The Secretary shall transfer to the
Secretary of Defense amounts required by the Secretary of
Defense to carry out the Primary Care Educational Assistance
Program.
``(2) Amounts transferred to the Secretary of Defense
pursuant to paragraph (1) shall be credited to the
appropriation or account providing funding for the Uniformed
Services University of the Health Sciences. Amounts so
credited shall be merged with amounts in the appropriation or
account to which credited and shall be available, subject to
the terms and conditions applicable to such appropriation or
account, for the Uniformed Services University of the Health
Sciences.''.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 76 of such title is amended by adding
after the item relating to section 7684 the following:

``subchapter viii--program of education at uniformed services
university of the health sciences with specialization in primary care

``7691. Authority for program.
``7692. Selection; agreement; ineligibility for certain other
educational assistance.
``7693. Obligated service.
``7694. Breach of agreement: liability.
``7695. Funding.''.
(b) Inclusion of Program in Health Professionals
Educational Assistance Program.--Section 7601(a) of such
title is amended--
(1) in paragraph (4), by striking ``; and'' and inserting a
semicolon;
(2) in paragraph (5), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following new paragraph:
``(6) the enrollment of individuals in the Uniformed
Services University of the Health Sciences for specialization
in primary care provided for in subchapter VIII of this
chapter.''.
(c) Application Requirements.--
(1) In general.--Subsection (a)(1) of section 7603 of such
title is amended in the matter preceding subparagraph (A) by
striking ``, or VI'' and inserting ``, VI, or VIII''.
(2) No priority for applications.--Subsection (d) of such
section is amended--
(A) by striking ``In selecting'' and inserting ``(1) Except
as provided in paragraph (2), in selecting''; and
(B) by adding at the end the following new paragraph:
``(2) Paragraph (1) shall not apply with respect to
applicants for participation in the Program of Education at
Uniformed Services University of the Health Sciences With
Specialization in Primary Care pursuant to subchapter VIII of
this chapter.''.
(d) Agreement Requirements.--Section 7604 of such title is
amended by striking ``, or VI'' each place it appears and
inserting ``, VI, or VIII''.

SEC. 203. TREATMENT OF STAFFING SHORTAGE AND BIANNUAL REPORT
ON STAFFING OF MEDICAL FACILITIES OF THE
DEPARTMENT OF VETERANS AFFAIRS.

(a) Staffing Shortage.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, and not later than September 30
each year thereafter, the Secretary of Veterans Affairs shall
determine, and publish in the Federal Register, the five
occupations of health care providers of the Department of
Veterans Affairs for which there is the largest staffing
shortage throughout the Department.
(2) Recruitment and appointment.--Notwithstanding sections
3304 and 3309 through 3318 of title 5, United States Code,
the Secretary may, upon a determination by the Secretary
under paragraph (1) or a modification to such determination
under paragraph (2), that there is a staffing shortage
throughout the Department with respect to a particular
occupation of health care provider, recruit and directly
appoint highly qualified health care providers to a position
to serve as a health care provider in that particular
occupation for the Department.
(3) Priority in health professionals educational assistance
program to certain providers.--Section 7612(b)(5) of title
38, United States Code, is amended--
(A) in subparagraph (A), by striking ``and'' at the end;
(B) by redesignating subparagraph (B) as subparagraph (C);
and
(C) by inserting after subparagraph (A) the following new
subparagraph (B):
``(B) shall give priority to applicants pursuing a course
of education or training towards a career in an occupation
for which the Secretary has, in the most current
determination published in the Federal Register pursuant to
section 203(a)(1) of the Ensuring Veterans Access to Care Act
of 2014, determined that there is one of the largest staffing
shortage throughout the Department with respect to such
occupation; and''.
(b) Reports.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, and not later than December 31 of
each even numbered year thereafter until 2024, the Secretary
of Veterans Affairs shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report
assessing the staffing of each medical facility of the
Department of Veterans Affairs.
(2) Elements.--Each report submitted under paragraph (1)
shall include the following:
(A) The results of a system-wide assessment of all medical
facilities of the Department to ensure the following:
(i) Appropriate staffing levels for health care providers
to meet the goals of the Secretary for timely access to care
for veterans.
(ii) Appropriate staffing levels for support personnel,
including clerks.
(iii) Appropriate sizes for clinical panels.
(iv) Appropriate numbers of full-time staff, or full-time
equivalent, dedicated to direct care of patients.
(v) Appropriate physical plant space to meet the capacity
needs of the Department in that area.
(vi) Such other factors as the Secretary considers
necessary.
(B) A plan for addressing any issues identified in the
assessment described in subparagraph (A), including a
timeline for addressing such issues.
(C) A list of the current wait times and workload levels
for the following clinics in each medical facility:
(i) Mental health.
(ii) Primary care.
(iii) Gastroenterology.
(iv) Women's health.
(v) Such other clinics as the Secretary considers
appropriate.
(D) A description of the results of the determination of
the Secretary under paragraph (1) of subsection (a) and a
plan to use direct appointment authority under paragraph (2)
of such subsection to fill staffing shortages, including
recommendations for improving the speed at which the
credentialing and privileging process can be conducted.
(E) The current staffing models of the Department for the
following clinics, including recommendations for changes to
such models:
(i) Mental health.
(ii) Primary care.
(iii) Gastroenterology.
(iv) Women's health.
(v) Such other clinics as the Secretary considers
appropriate.
(F) A detailed analysis of succession planning at medical
facilities of the Department, including the following:
(i) The number of positions in medical facilities
throughout the Department that are not filled by a permanent
employee.
(ii) The length of time each such position described in
clause (i) remained vacant or filled by a temporary or acting
employee.
(iii) A description of any barriers to filling the
positions described in clause (i).
(iv) A plan for filling any positions that are vacant or
filled by a temporary or acting employee for more than 180
days.
(v) A plan for handling emergency circumstances, such
administrative leave or sudden medical leave for senior
officials.
(G) The number of health care providers who have been
removed from their position or have retired, by provider
type, during the two-year period preceding the submittal of
the report.

[[Page S3374]]

(H) Of the health care providers specified in subparagraph
(G) that have been removed from their position, the
following:
(i) The number of such health care providers who were
reassigned to another position in the Department.
(ii) The number of such health care providers who left the
Department.

SEC. 204. CLINIC MANAGEMENT TRAINING PROGRAM OF THE
DEPARTMENT OF VETERANS AFFAIRS.

(a) In General.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall implement a clinic management training program to
provide in-person, standardized education on health care
management to all managers of, and health care providers at,
medical facilities of the Department of Veterans Affairs.
(b) Elements.--The clinic management training program
required by subsection (a) shall include the following:
(1) Training on how to manage the schedules of health care
providers of the Department, including the following:
(A) Maintaining such schedules in a manner that allows
appointments to be booked at least eight weeks in advance.
(B) Proper planning procedures for vacation, leave, and
graduate medical education training schedules.
(2) Training on the appropriate number of appointments that
a health care provider should conduct on a daily basis, based
on specialty.
(3) Training on how to determine whether there are enough
available appointment slots to manage demand for different
appointment types and mechanisms for alerting management of
insufficient slots.
(4) Training on how to properly use the data produced by
the scheduling dashboard required by section 101(b)(11) of
this Act to meet demand for health care, including the
following:
(A) Training on determining the next available appointment
for each health care provider at the medical facility.
(B) Training on determining the number of health care
providers needed to meet demand for health care at the
medical facility.
(C) Training on determining the number of exam rooms needed
to meet demand for such health care in an efficient manner.
(5) Training on how to properly use the appointment
scheduling system of the Department, including any new
scheduling system implemented by the Department.
(6) Training on how to optimize the use of technology,
including the following:
(A) Telemedicine.
(B) Electronic mail.
(C) Text messaging.
(D) Such other technologies as specified by the Secretary.
(7) Training on how to properly use physical plant space at
medical facilities of the Department to ensure efficient flow
and privacy for patients and staff.

SEC. 205. INCLUSION OF DEPARTMENT OF VETERANS AFFAIRS
FACILITIES IN NATIONAL HEALTH SERVICE CORPS
SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS.

(a) In General.--The Secretary of Health and Human Services
shall use the funds transferred under subsection (e) to award
scholarship and loan repayment contracts under sections 338A
and 338B of the Public Health Service Act (42 U.S.C. 254l,
254l-1) to eligible individuals who agree to a period of
obligated service under section 338A(f)(1) or 338B(f)(1) of
such Act, as applicable, at a health facility of the
Department of Veterans Affairs.
(b) Health Professional Shortage Areas.--For purposes of
selecting individuals eligible for the scholarships and loan
repayment contracts under subsection (a), all health
facilities of the Department of Veterans Affairs shall be
deemed health professional shortage areas, as defined in
section 332 of the Public Health Service Act (42 U.S.C.
254e).
(c) Requirement.--The Secretary of Health and Human
Services shall ensure that a minimum of 5 scholarships or
loan repayment contracts are awarded to individuals who agree
to a period of obligated service at Veterans Affairs
facilities in each State.
(d) Applicability of NHSC Program Requirements.--Except as
otherwise provided in this section, the terms of the National
Health Service Corps Scholarship Program and the National
Health Service Corps Loan Repayment Program shall apply to
participants awarded a grant or loan repayment contract under
subsection (a) in the same manner that such terms apply to
participants awarded a grant or loan repayment contract under
section 338A or 338B of the Public Health Service Act.
(e) Inclusion of Geriatricians.--For purposes of awarding
scholarships and loan repayments contracts to eligible
individuals who agree to a period of obligated service at a
health facility of the Department of Veterans Affairs
pursuant to this section, in sections 338A and 338B of the
Public Health Service Act (42 U.S.C. 254l, 254l-1), the term
``primary health services'' shall include geriatrics.
(f) Funding.--The Secretary of Veterans Affairs shall
transfer $20,000,000 for fiscal year 2014, and such sums as
may be necessary for each fiscal year thereafter, from
accounts of the Veterans Health Administration to the
Secretary of Health and Human Services to award scholarships
and loan repayment contracts, as described in subsection (a).
All funds so transferred shall be used exclusively for the
purposes described in such subsection.

SEC. 206. AUTHORIZATION OF EMERGENCY APPROPRIATIONS.

There is authorized to be appropriated for the Department
of Veterans Affairs such sums as may be necessary to carry
out this title.

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

SEC. 301. IMPROVEMENT OF ACCESS BY VETERANS TO HEALTH CARE
FROM NON-DEPARTMENT OF VETERANS AFFAIRS
PROVIDERS.

(a) Improvement of Access.--
(1) In general.--The Secretary of Veterans Affairs shall
ensure timely access of all veterans to the hospital care,
medical services, and other health care for which such
veterans are eligible under the laws administered by the
Secretary through the enhanced use of authorities specified
in paragraph (2) on the provision of such care and services
through non-Department of Veterans Affairs providers
(commonly referred to as ``non-Department of Veterans Affairs
medical care'').
(2) Authorities on provision of care through non-department
providers.--The authorities specified in this paragraph are
the following:
(A) Section 1703 of title 38, United States Code, relating
to contracts for the provision of hospital care and medical
services through non-Department facilities.
(B) Section 1725 of such title, relating to reimbursement
of certain veterans for the reasonable value of emergency
treatment at non-Department facilities.
(C) Section 1728 of such title, relating to reimbursement
of certain veterans for customary and usual charges of
emergency treatment from sources other than the Department.
(D) Section 1786 of such title, relating to health care
services furnished to newborn children of women veterans who
are receiving maternity care furnished by the Department at a
non-Department facility.
(E) Any other authority under the laws administered by the
Secretary to provide hospital care, medical services, or
other health care from a non-Department provider, including
the following:
(i) 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))).
(ii) The Department of Defense.
(iii) The Indian Health Service.
(3) Requirements.--In ensuring timely access of all
veterans to the care and services described in paragraph (1)
through the enhanced use of authorities specified in
paragraph (2), the Secretary shall require the following:
(A) That each veteran who has not received hospital care,
medical services, or other health care from the Department
and is seeking an appointment for primary care under the laws
administered by the Secretary receive an appointment for
primary care at a time consistent with timeliness measures
established by the Secretary for purposes of providing
primary care to all veterans.
(B) That the determination whether to refer a veteran for
specialty care through a non-Department provider shall take
into account the urgency and acuity of such veteran's need
for such care, including--
(i) the severity of the condition of such veteran requiring
specialty care; and
(ii) the wait-time for an appointment with a specialist
with respect to such condition at the nearest medical
facility of the Department with the capacity to provide such
care.
(C) That the determination whether a veteran shall receive
hospital care, medical services, or other health care from
the Department through facilities of the Department or
through non-Department providers pursuant to the authorities
specified in paragraph (2) shall take into account, in the
manner specified by the Secretary, the following:
(i) The distance the veteran would be required to travel to
receive care or services through a non-Department provider
compared to the distance the veteran would be required to
travel to receive care or services from a medical facility of
the Department.
(ii) Any factors that might limit the ability of the
veteran to travel, including age, access to transportation,
and infirmity.
(iii) The wait-time for the provision of care or services
through a non-Department provider compared to the wait-time
for the provision of care or services from a medical facility
of the Department.
(iv) Where the veteran would prefer to receive the care and
services described in paragraph (1), unless the preference of
the veteran conflicts with any of the other requirements of
this paragraph.
(D) That the Department maximize the use of hospital care,
medical services, and other health care available to the
Department through non-Department providers, including
providers available to provide such care and services as
follows:
(i) Pursuant to contracts under the Patient-Centered
Community Care Program of the Department.
(ii) Pursuant to contracts between a facility or facilities
of the Department and a local facility or provider.
(iii) Pursuant to contracts with 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))), the Department of
Defense, or the Indian Health Service.
(iv) On a fee-for-service basis.

[[Page S3375]]

(b) Medical Records.--In providing hospital care, medical
services, and other health care to veterans through non-
Department providers pursuant to the authorities specified in
paragraph (2), the Secretary shall ensure that any such
provider submits to the Department any medical record related
to the care and services provided to a veteran by that
provider for inclusion in the electronic medical record of
such veteran maintained by the Department upon the completion
of the provision of such care and services to such veteran.
(c) Reports.--
(1) Initial report.--Not later than 45 days after the date
of the enactment of this Act, the Secretary shall submit to
the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report on the implementation of the
requirements under subsection (a) and (b), including a plan
to enforce the proper implementation of such requirements
systematically throughout the Department.
(2) Periodic reports.--Not later than 90 days after the
submittal of the report required by paragraph (1), and every
90 days thereafter for one year, the Secretary shall submit
to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report that includes the following:
(A) The progress of the Secretary in carrying out the plan
under paragraph (1) to enforce the proper implementation of
the requirements under subsection (a) and (b) systematically
throughout the Department.
(B) The impact of the implementation of such requirements
on wait-times for veterans to receive hospital care, medical
services, and other health care, disaggregated by--
(i) new patients;
(ii) existing patients;
(iii) primary care; and
(iv) specialty care.
(C) Any recommendations for changes or improvements to such
requirements.
(D) Any requests for additional funding necessary to carry
out such requirements.

SEC. 302. EXTENSION OF AND REPORT ON JOINT INCENTIVES PROGRAM
OF DEPARTMENT OF VETERANS AFFAIRS AND
DEPARTMENT OF DEFENSE.

(a) Extension.--Section 8111(d)(3) of title 38, United
States Code, is amended by striking ``September 30, 2015''
and inserting ``September 30, 2020''.
(b) Reports.--
(1) Report on implementation of recommendations.--Not later
than 60 days after the date of the enactment of this Act, the
Secretary of Veterans Affairs and the Secretary of Defense
shall jointly submit to Congress a report on the
implementation by the Department of Veterans Affairs and the
Department of Defense of the findings and recommendations of
the Comptroller General of the United States in the September
2012 report entitled ``VA and DoD Health Care: Department-
Level Actions Needed to Assess Collaboration Performance,
Address Barriers, and Identify Opportunities'' (GAO-12-992).
(2) Comptroller general report.--
(A) In general.--Not later than one year after the date of
the enactment of this Act, the Comptroller General of the
United States shall submit to Congress a report assessing and
providing recommendations for improvement to the program to
identify, provide incentives to, implement, fund, and
evaluate creative coordination and sharing initiatives
between the Department of Veterans Affairs and the Department
of Defense required under section 8111(d) of such title.
(B) Elements.--The report required by subparagraph (A)
shall include the following:
(i) An assessment of the extent to which the program
described in subparagraph (A) has accomplished the goal of
such program to improve the access to, and quality and cost
effectiveness of, the health care provided by the Veterans
Health Administration and the Military Health System to the
beneficiaries of both the Department of Veterans Affairs and
the Department of Defense.
(ii) An assessment of whether administration of such
program through the Health Executive Committee of the
Department of Veterans Affairs-Department of Defense Joint
Executive Committee established under section 320 of such
title provides sufficient leadership attention and oversight
to ensure maximum benefits to the Department of Veterans
Affairs and the Department of Defense through collaborative
efforts.
(iii) An assessment of whether additional authorities to
jointly construct, lease, or acquire facilities would
facilitate additional collaborative efforts under such
program.
(iv) An assessment of whether the funding for such program
is sufficient to ensure consistent identification of
potential opportunities for collaboration and oversight of
existing collaborations to ensure a meaningful partnership
between the Department of Veterans Affairs and the Department
of Defense and remove any barriers to integration or
collaboration.
(v) An assessment of whether existing processes for
identifying opportunities for collaboration are sufficient to
ensure maximum collaboration between the Veterans Health
Administration and the Military Health System.
(vi) Such legislative or administrative recommendations for
improvement to such program as the Comptroller General
considers appropriate to enhance the use of such program to
increase access to health care.

SEC. 303. TRANSFER OF AUTHORITY FOR PAYMENTS FOR HOSPITAL
CARE, MEDICAL SERVICES, AND OTHER HEALTH CARE
FROM NON-DEPARTMENT PROVIDERS TO THE CHIEF
BUSINESS OFFICE OF THE VETERANS HEALTH
ADMINISTRATION OF THE DEPARTMENT.

(a) Transfer of Authority.--
(1) In general.--Effective on October 1, 2014, the
Secretary of Veterans Affairs shall transfer the authority to
pay for hospital care, medical services, and other health
care through non-Department providers to the Chief Business
Office of the Veterans Health Administration of the
Department of Veterans Affairs from the Veterans Integrated
Service Networks and medical centers of the Department of
Veterans Affairs.
(2) Manner of care.--The Chief Business Office shall work
in consultation with the Office of Clinical Operations and
Management of the Department of Veterans Affairs to ensure
that care and services described in paragraph (1) is provided
in a manner that is clinically appropriate and effective.
(3) No delay in payment.--The transfer of authority under
paragraph (1) shall be carried out in a manner that does not
delay or impede any payment by the Department for hospital
care, medical services, or other health care provided through
a non-Department provider under the laws administered by the
Secretary.
(b) Budgetary Effect.--The Secretary shall, for each fiscal
year that begins after the date of the enactment of this
Act--
(1) include in the budget for the Chief Business Office of
the Veterans Health Administration amounts to pay for
hospital care, medical services, and other health care
provided through non-Department providers, including any
amounts necessary to carry out the transfer of authority to
pay for such care and services under subsection (a),
including any increase in staff; and
(2) not include in the budget of each Veterans Integrated
Service Network and medical center of the Department amounts
to pay for such care and services.
(c) Removal From Performance Goals.--For each fiscal year
that begins after the date of the enactment of this Act, the
Secretary shall not include in the performance goals of any
employee of a Veterans Integrated Service Network or medical
center of the Department any performance goal that might
disincentivize the payment of Department amounts to provide
hospital care, medical services, or other health care through
a non-Department provider.

SEC. 304. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF
VETERANS AFFAIRS AND INDIAN HEALTH SERVICE.

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

[[Page S3376]]

(2) Medical facility of the indian health service.--The
term ``medical facility of the Indian Health Service''
includes a facility operated by an Indian tribe or tribal
organization through a contract or compact with the Indian
Health Service under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.).
(3) Tribal organization.--The term ``tribal organization''
has the meaning given the term in section 4 of the Indian
Self-Determination and Education Assistance Act (25 U.S.C.
450b).

SEC. 305. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF
VETERANS AFFAIRS AND NATIVE HAWAIIAN HEALTH
CARE SYSTEMS.

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

SEC. 306. AUTHORIZATION OF EMERGENCY APPROPRIATIONS.

There is authorized to be appropriated for the Department
of Veterans Affairs such sums as may be necessary to carry
out this title.

TITLE IV--HEALTH CARE ADMINISTRATIVE MATTERS

SEC. 401. IMPROVEMENT OF ACCESS OF VETERANS TO MOBILE VET
CENTERS OF THE DEPARTMENT OF VETERANS AFFAIRS.

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

SEC. 402. COMMISSION ON ACCESS TO CARE.

(a) Establishment of Commission.--
(1) In general.--There is established the Commission on
Access to Care (in this section referred to as the
``Commission'') to examine the access of veterans to health
care from the Department of Veterans Affairs and
strategically examine how best to organize the Veterans
Health Administration, locate health care resources, and
deliver health care to veterans during the next 10 to 20
years.
(2) Membership.--
(A) Voting members.--The Commission shall be composed of 10
voting members who are appointed by the President as follows:
(i) At least two members who represent an organization
recognized by the Secretary of Veterans Affairs for the
representation of veterans under section 5902 of title 38,
United States Code.
(ii) At least one member from among persons who are experts
concerning a public or private hospital system.
(iii) At least one member from among persons who are
familiar with government health care systems, including those
systems of the Department of Defense, the Indian Health
Service, and Federally-qualified health centers (as defined
in section 1905(l)(2)(B) of the Social Security Act (42
U.S.C. 1396d(l)(2)(B))).
(iv) At least two members from among persons who are
familiar with the Veterans Health Administration.
(B) Nonvoting members.--In addition to members appointed
under subparagraph (A), the Commission shall be composed of
10 nonvoting members who are appointed by the President as
follows:
(i) At least two members who represent an organization
recognized by the Secretary of Veterans Affairs for the
representation of veterans under section 5902 of title 38,
United States Code.
(ii) At least one member from among persons who are experts
in a public or private hospital system.
(iii) At least one member from among persons who are
familiar with government health care systems, including those
systems of the Department of Defense, the Indian Health
Service, and Federally-qualified health centers (as defined
in section 1905(l)(2)(B) of the Social Security Act (42
U.S.C. 1396d(l)(2)(B))).
(iv) At least two members from among persons who are
familiar with the Veterans Health Administration.
(C) Date.--The appointments of members of the Commission
shall be made not later than 60 days after the date of the
enactment of this Act.
(3) Period of appointment; vacancies.--Members shall be
appointed for the life of the Commission. Any vacancy in the
Commission shall not affect its powers, but shall be filled
in the same manner as the original appointment.
(4) Initial meeting.--Not later than 15 days after the date
on which seven voting members of the Commission have been
appointed, the Commission shall hold its first meeting.
(5) Meetings.--The Commission shall meet at the call of the
Chairperson.
(6) Quorum.--A majority of the members of the Commission
shall constitute a quorum, but a lesser number of members may
hold hearings.
(7) Chairperson and vice chairperson.--The Commission shall
select a Chairperson and Vice Chairperson from among its
members.
(b) Duties of Commission.--
(1) Evaluation and assessment.--The Commission shall
undertake a comprehensive evaluation and assessment of access
to health care at the Department of Veterans Affairs.
(2) Matters evaluated and assessed.--The matters evaluated
and assessed by the Commission shall include the following:
(A) The appropriateness of current standards of the
Department of Veterans Affairs concerning access to health
care.
(B) The measurement of such standards.
(C) The appropriateness of performance standards and
incentives in relation to standards described in subparagraph
(A).
(D) Staffing levels throughout the Veterans Health
Administration and whether they are sufficient to meet
current demand for health care from the Administration.
(3) Reports.--The Commission shall submit to the President,
through the Secretary of Veterans Affairs, reports as
follows:
(A) Not later than 90 days after the date of the initial
meeting of the Commission, an interim report on--
(i) the findings of the Commission with respect to the
evaluation and assessment required by this subsection; and
(ii) such recommendations as the Commission may have for
legislative or administrative action to improve access to
health care through the Veterans Health Administration.
(B) Not later than 180 days after the date of the initial
meeting of the Commission, a final report on--
(i) the findings of the Commission with respect to the
evaluation and assessment required by this subsection; and
(ii) such recommendations as the Commission may have for
legislative or administrative action to improve access to
health care through the Veterans Health Administration.
(c) Powers of the Commission.--
(1) Hearings.--The Commission may hold such hearings, sit
and act at such times and places, take such testimony, and
receive such evidence as the Commission considers advisable
to carry out this section.
(2) Information from federal agencies.--The Commission may
secure directly from any Federal department or agency such
information as the Commission considers necessary to carry
out this section. Upon request of the Chairperson of the
Commission, the head of such department or agency shall
furnish such information to the Commission.
(d) Commission Personnel Matters.--

[[Page S3377]]

(1) Compensation of members.--Each member of the Commission
who is not an officer or employee of the Federal Government
shall be compensated at a rate equal to the daily equivalent
of the annual rate of basic pay prescribed for level IV of
the Executive Schedule under section 5315 of title 5, United
States Code, for each day (including travel time) during
which such member is engaged in the performance of the duties
of the Commission. All members of the Commission who are
officers or employees of the United States shall serve
without compensation in addition to that received for their
services as officers or employees of the United States.
(2) Travel expenses.--The members of the Commission shall
be allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies
under subchapter I of chapter 57 of title 5, United States
Code, while away from their homes or regular places of
business in the performance of services for the Commission.
(3) Staff.--
(A) In general.--The Chairperson of the Commission may,
without regard to the civil service laws and regulations,
appoint and terminate an executive director and such other
additional personnel as may be necessary to enable the
Commission to perform its duties. The employment of an
executive director shall be subject to confirmation by the
Commission.
(B) Compensation.--The Chairperson of the Commission may
fix the compensation of the executive director and other
personnel without regard to chapter 51 and subchapter III of
chapter 53 of title 5, United States Code, relating to
classification of positions and General Schedule pay rates,
except that the rate of pay for the executive director and
other personnel may not exceed the rate payable for level V
of the Executive Schedule under section 5316 of such title.
(4) Detail of government employees.--Any Federal Government
employee may be detailed to the Commission without
reimbursement, and such detail shall be without interruption
or loss of civil service status or privilege.
(5) Procurement of temporary and intermittent services.--
The Chairperson of the Commission may procure temporary and
intermittent services under section 3109(b) of title 5,
United States Code, at rates for individuals which do not
exceed the daily equivalent of the annual rate of basic pay
prescribed for level V of the Executive Schedule under
section 5316 of such title.
(e) Termination of the Commission.--The Commission shall
terminate 30 days after the date on which the Commission
submits its report under subsection (b)(3)(B).
(f) Funding.--The Secretary of Veterans Affairs shall make
available to the Commission from amounts appropriated or
otherwise made available to the Secretary such amounts as the
Secretary and the Chairperson of the Commission jointly
consider appropriate for the Commission to perform its duties
under this section.
(g) Executive Action.--
(1) Action on recommendations.--The President shall require
the Secretary of Veterans Affairs and such other heads of
relevant Federal departments and agencies to implement each
recommendation set forth in a report submitted under
subsection (b)(3) that the President--
(A) considers feasible and advisable; and
(B) determines can be implemented without further
legislative action.
(2) Reports.--Not later than 60 days after the date on
which the President receives a report under subsection
(b)(3), the President shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives and such
other committees of Congress as the President considers
appropriate a report setting forth the following:
(A) An assessment of the feasibility and advisability of
each recommendation contained in the report received by the
President.
(B) For each recommendation assessed as feasible and
advisable under subparagraph (A) the following:
(i) Whether such recommendation requires legislative
action.
(ii) If such recommendation requires legislative action, a
recommendation concerning such legislative action.
(iii) A description of any administrative action already
taken to carry out such recommendation.
(iv) A description of any administrative action the
President intends to be taken to carry out such
recommendation and by whom.

SEC. 403. COMMISSION ON CAPITAL PLANNING FOR DEPARTMENT OF
VETERANS AFFAIRS MEDICAL FACILITIES.

(a) Establishment of Commission.--
(1) Establishment.--There is established the Commission on
Capital Planning for Department of Veterans Affairs Medical
Facilities (in this section referred to as the
``Commission'').
(2) Membership.--
(A) Voting members.--The Commission shall, subject to
subparagraph (B), be composed of 10 voting members as
follows:
(i) 1 shall be appointed by the President.
(ii) 1 shall be appointed by the Administrator of General
Services.
(iii) 3 shall be appointed by the Secretary of Veterans
Affairs, of whom--

(I) 1 shall be an employee of the Veterans Health
Administration;
(II) 1 shall be an employee of the Office of Asset
Enterprise Management of the Department of Veterans Affairs;
and
(III) 1 shall be an employee of the Office of Construction
and Facilities Management of the Department of Veterans
Affairs.

(iv) 1 shall be appointed by the Secretary of Defense from
among employees of the Army Corps of Engineers.
(v) 1 shall be appointed by the majority leader of the
Senate.
(vi) 1 shall be appointed by the minority leader of the
Senate.
(vii) 1 shall be appointed by the Speaker of the House of
Representatives.
(viii) 1 shall be appointed by the minority leader of the
House of Representatives.
(B) Requirement relating to certain appointments of voting
members.--Of the members appointed pursuant to clause (i),
(ii), and (iv) through (viii) of subparagraph (A), all shall
have expertise in capital leasing, construction, or health
facility management planning.
(C) Non-voting members.--The Commission shall be assisted
by 10 non-voting members, appointed by the vote of a majority
of members of the Commission under subparagraph (A), of
whom--
(i) 6 shall be representatives of veterans service
organizations recognized by the Secretary of Veterans
Affairs; and
(ii) 4 shall be individuals from outside the Department of
Veterans Affairs with experience and expertise in matters
relating to management, construction, and leasing of capital
assets.
(D) Date of appointment of voting members.--The
appointments of the members of the Commission under
subparagraph (A) shall be made not later than 60 days after
the date of the enactment of this Act.
(3) Period of appointment; vacancies.--Members shall be
appointed for the life of the Commission. Any vacancy in the
Commission shall not affect its powers, but shall be filled
in the same manner as the original appointment.
(4) Initial meeting.--Not later than 15 days after the date
on which 7 members of the Commission have been appointed, the
Commission shall hold its first meeting.
(5) Meetings.--The Commission shall meet at the call of the
Chair.
(6) Quorum.--A majority of the members of the Commission
shall constitute a quorum, but a lesser number of members may
hold hearings.
(7) Chair and vice chair.--The Commission shall select a
Chair and Vice Chair from among its members.
(b) Duties of Commission.--
(1) In general.--The Commission shall undertake a
comprehensive evaluation and assessment of various options
for capital planning for Department of Veterans Affairs
medical facilities, including an evaluation and assessment of
the mechanisms by which the Department currently selects
means for the delivery of health care, whether by major
construction, major medical facility leases, sharing
agreements with the Department of Defense, the Indian Health
Service, and Federally Qualified Health Clinics under section
330 of the Public Health Service Act (42 U.S.C. 254b),
contract care, multisite care, telemedicine, extended hours
for care, or other means.
(2) Context of evaluation and assessment.--In undertaking
the evaluation and assessment, the Commission shall
consider--
(A) the importance of access to health care through the
Department, including associated guidelines of the Department
on access to, and drive time for, health care;
(B) limitations and requirements applicable to the
construction and leasing of medical facilities for the
Department, including applicable laws, regulations, and costs
as determined by both the Congressional Budget Office and the
Office of Management and Budget;
(C) the nature of capital planning for Department medical
facilities in an era of fiscal uncertainty;
(D) projected future fluctuations in the population of
veterans; and
(E) the extent to which the Department was able to meet the
mandates of the Capital Asset Realignment for Enhanced
Services Commission.
(3) Particular considerations.--In undertaking the
evaluation and assessment, the Commission shall address, in
particular, the following:
(A) The Major Medical Facility Lease Program of the
Department, including an identification of potential
improvements to the lease authorization processes under that
Program.
(B) The management processes of the Department for its
Major Medical Facility Construction Program, including
processes relating to contract award and management, project
management, and processing of change orders.
(C) The overall capital planning program of the Department
for medical facilities, including an evaluation and
assessment of--
(i) the manner in which the Department determines whether
to use capital or non-capital means to expand access to
health care;
(ii) the manner in which the Department determines the
disposition of under-utilized and un-utilized buildings on
campuses of Department medical centers, and any barriers to
disposition;
(iii) the effectiveness of the facility master planning
initiative of the Department; and
(iv) the extent to which sustainable attributes are planned
for to decrease operating costs for Department medical
facilities.

[[Page S3378]]

(D) The current backlog of construction projects for
Department medical facilities, including an identification of
the most effective means to quickly secure the most critical
repairs required, including repairs relating to facility
condition deficiencies, structural safety, and compliance
with the Americans With Disabilities Act of 1990.
(4) Reports.--Subject to paragraph (5), the Commission
shall submit to the Secretary of Veterans Affairs, and to the
Committee Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives, reports
as follows:
(A) Not later than six months after its initial meeting
under subsection (a)(4), a report on the Major Medical
Facility Lease Program and the Congressional lease
authorization process.
(B) Not later than one year after its initial meeting, a
report--
(i) on the management processes of the Department for the
construction of Department medical facilities; and
(ii) setting forth an update of any matters covered in the
report under subparagraph (A).
(C) Not later than 18 months after its initial meeting, a
report--
(i) on the overall capital planning program of the
Department for medical facilities; and
(ii) setting forth an update of any matters covered in
earlier reports under this paragraph.
(D) Not later than two years after its initial meeting, a
report--
(i) on the current backlog of construction projects for
Department medical facilities;
(ii) setting forth an update of any matters covered in
earlier reports under this paragraph; and
(iii) including such other matters relating to the duties
of the Commission that the Commission considers appropriate.
(E) Not later than 27 months after its initial meeting, a
report on the implementation by the Secretary of Veterans
Affairs pursuant to subsection (g) of the recommendations
included pursuant to paragraph (5) in the reports under this
paragraph.
(5) Recommendations.--Each report under paragraph (4) shall
include, for the aspect of the capital asset planning process
of the Department covered by such report, such
recommendations as the Commission considers appropriate for
the improvement and enhancement of such aspect of the capital
asset planning process.
(c) Powers of Commission.--
(1) Hearings.--The Commission may hold such hearings, sit
and act at such times and places, take such testimony, and
receive such evidence as the Commission considers advisable
to carry out this section.
(2) Information from federal agencies.--The Commission may
secure directly from any Federal department or agency such
information as the Commission considers necessary to carry
out this section. Upon request of the Chair of the
Commission, the head of such department or agency shall
furnish such information to the Commission.
(d) Commission Personnel Matters.--
(1) Compensation of members.--Each member of the Commission
who is not an officer or employee of the Federal Government
shall be compensated at a rate equal to the daily equivalent
of the annual rate of basic pay prescribed for level IV of
the Executive Schedule under section 5315 of title 5, United
States Code, for each day (including travel time) during
which such member is engaged in the performance of the duties
of the Commission. All members of the Commission who are
officers or employees of the United States shall serve
without compensation in addition to that received for their
services as officers or employees of the United States.
(2) Travel expenses.--The members of the Commission shall
be allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies
under subchapter I of chapter 57 of title 5, United States
Code, while away from their homes or regular places of
business in the performance of services for the Commission.
(3) Staff.--
(A) In general.--The Chair of the Commission may, without
regard to the civil service laws and regulations, appoint and
terminate an executive director and such other additional
personnel as may be necessary to enable the Commission to
perform its duties. The employment of an executive director
shall be subject to confirmation by the Commission.
(B) Compensation.--The Chair of the Commission may fix the
compensation of the executive director and other personnel
without regard to chapter 51 and subchapter III of chapter 53
of title 5, United States Code, relating to classification of
positions and General Schedule pay rates, except that the
rate of pay for the executive director and other personnel
may not exceed the rate payable for level V of the Executive
Schedule under section 5316 of such title.
(4) Detail of government employees.--Any Federal Government
employee may be detailed to the Commission without
reimbursement, and such detail shall be without interruption
or loss of civil service status or privilege.
(5) Procurement of temporary and intermittent services.--
The Chair of the Commission may procure temporary and
intermittent services under section 3109(b) of title 5,
United States Code, at rates for individuals which do not
exceed the daily equivalent of the annual rate of basic pay
prescribed for level V of the Executive Schedule under
section 5316 of such title.
(e) Termination of Commission.--The Commission shall
terminate 60 days after the date on which the Commission
submits its report under subsection (b)(4)(E).
(f) Funding.--The Secretary of Veterans Affairs shall make
available to the Commission such amounts as the Secretary and
the Chair of the Commission jointly consider appropriate for
the Commission to perform its duties under this section.
(g) Action on Recommendations.--
(1) In general.--The Secretary of Veterans Affairs shall
implement each recommendation included in a report under
subsection (b)(4) that the Secretary considers feasible and
advisable and can be implemented without further legislative
action.
(2) Reports.--Not later than 120 days after receipt of a
report under subparagraphs (A) through (D) of subsection
(b)(4), the Secretary shall submit to the Committee Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report setting forth the
following:
(A) An assessment of the feasibility and advisability of
each recommendation contained in such report.
(B) For each recommendation assessed as feasible and
advisable--
(i) if such recommendation does not require further
legislative action for implementation, a description of the
actions taken, and to be taken, by the Secretary to implement
such recommendation; and
(ii) if such recommendation requires further legislative
action for implementation, recommendations for such
legislative action.

SEC. 404. REMOVAL OF SENIOR EXECUTIVE SERVICE EMPLOYEES OF
THE DEPARTMENT OF VETERANS AFFAIRS FOR
PERFORMANCE.

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

``Sec. 713. Senior Executive Service: removal based on
performance

``(a) In General.--The Secretary may remove any individual
from the Senior Executive Service if the Secretary determines
the performance of the individual warrants such removal. If
the Secretary so removes such an individual, the Secretary
may--
``(1) remove the individual from the civil service (as
defined in section 2101 of title 5); or
``(2) transfer the individual to a General Schedule
position at any grade of the General Schedule for which the
individual is qualified and that the Secretary determines is
appropriate.
``(b) Notice to Congress.--Not later than 30 days after
removing or transferring an individual from the Senior
Executive Service under paragraph (1), the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate
and House of Representatives notice in writing of such
removal or transfer and the reason for such removal or
transfer.
``(c) Appeal of Removal or Transfer.--Any removal or
transfer under subsection (a) may be appealed to the Merit
Systems Protection Board under section 7701 of title 5 not
later than 7 days after such removal or transfer.
``(d) Expedited Review by Merit Systems Protection Board.--
(1) The Merit Systems Protection Board shall expedite any
appeal under section 7701 of title 5 of a removal or transfer
under subsection (a) and, in any such case, shall issue a
decision not later than 21 days after the date of the appeal.
``(2) In any case in which the Merit Systems Protection
Board determines that it cannot issue a decision in
accordance with the 21-day requirement under paragraph (1),
the Merit Systems Protection Board shall submit to Congress a
report that explains the reason why the Merit Systems
Protection Board is unable to issue a decision in accordance
with such requirement in such case.
``(3) There is authorized to be appropriated such sums as
may be necessary for the Merit Systems Protection Board to
expedite appeals under paragraph (1).
``(4) The Merit Systems Protection Board may not stay any
personnel action taken under this section.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by adding at the end the
following new item:

``713. Senior Executive Service: removal based on performance.''.
(b) Establishment of Expedited Review Process.--
(1) In general.--Not later than 30 days after the date of
the enactment of this Act, the Merit Systems Protection Board
shall establish and put into effect a process to conduct
expedited reviews in accordance with section 713(d) of title
38, United States Code.
(2) Inapplicability of certain regulations.--Section
1201.22 of title 5, Code of Federal Regulations, as in effect
on the day before the date of the enactment of this Act,
shall not apply to expedited reviews carried out under
section 713(d) of title 38, United States Code.
(3) Report by merit systems protection board.--Not later
than 30 days after the date of the enactment of this Act, the
Merit Systems Protection Board shall submit to Congress a
report on the actions the Board plans to take to conduct
expedited reviews under section 713(d) of title 38, United
States Code, as added by subsection (a). Such report shall
include a description of the resources the

[[Page S3379]]

Board determines will be necessary to conduct such reviews
and a description of whether any resources will be necessary
to conduct such reviews that were not available to the Board
on the day before the date of the enactment of this Act.
(c) Temporary Exemption From Certain Limitation on
Initiation of Removal From Senior Executive Service.--During
the 120-day period beginning on the date of the enactment of
this Act, an action to remove an individual from the Senior
Executive Service at the Department of Veterans Affairs
pursuant to section 713 of title 38, United States Code, as
added by subsection (a), or section 7543 of title 5, United
States Code, may be initiated, notwithstanding section
3592(b) of title 5, United States Code, or any other
provision of law.
(d) Construction.--Nothing in this section or section 713
of title 38, United States Code, as added by subsection (a),
shall be construed to apply to an appeal of a removal,
transfer, or other personnel action that was pending before
the date of the enactment of this Act.

TITLE V--MAJOR MEDICAL FACILITY LEASES

SEC. 501. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.

The Secretary of Veterans Affairs may carry out the
following major medical facility leases at the locations
specified, and in an amount for each lease not to exceed the
amount shown for such location (not including any estimated
cancellation costs):
(1) For a clinical research and pharmacy coordinating
center, Albuquerque, New Mexico, an amount not to exceed
$9,560,000.
(2) For a community-based outpatient clinic, Brick, New
Jersey, an amount not to exceed $7,280,000.
(3) For a new primary care and dental clinic annex,
Charleston, South Carolina, an amount not to exceed
$7,070,250.
(4) For the Cobb County community-based Outpatient Clinic,
Cobb County, Georgia, an amount not to exceed $6,409,000.
(5) For the Leeward Outpatient Healthcare Access Center,
Honolulu, Hawaii, including a co-located clinic with the
Department of Defense and the co-location of the Honolulu
Regional Office of the Veterans Benefits Administration and
the Kapolei Vet Center of the Department of Veterans Affairs,
an amount not to exceed $15,887,370.
(6) For a community-based outpatient clinic, Johnson
County, Kansas, an amount not to exceed $2,263,000.
(7) For a replacement community-based outpatient clinic,
Lafayette, Louisiana, an amount not to exceed $2,996,000.
(8) For a community-based outpatient clinic, Lake Charles,
Louisiana, an amount not to exceed $2,626,000.
(9) For outpatient clinic consolidation, New Port Richey,
Florida, an amount not to exceed $11,927,000.
(10) For an outpatient clinic, Ponce, Puerto Rico, an
amount not to exceed $11,535,000.
(11) For lease consolidation, San Antonio, Texas, an amount
not to exceed $19,426,000.
(12) For a community-based outpatient clinic, San Diego,
California, an amount not to exceed $11,946,100.
(13) For an outpatient clinic, Tyler, Texas, an amount not
to exceed $4,327,000.
(14) For the Errera Community Care Center, West Haven,
Connecticut, an amount not to exceed $4,883,000.
(15) For the Worcester community-based Outpatient Clinic,
Worcester, Massachusetts, an amount not to exceed $4,855,000.
(16) For the expansion of a community-based outpatient
clinic, Cape Girardeau, Missouri, an amount not to exceed
$4,232,060.
(17) For a multispecialty clinic, Chattanooga, Tennessee,
an amount not to exceed $7,069,000.
(18) For the expansion of a community-based outpatient
clinic, Chico, California, an amount not to exceed
$4,534,000.
(19) For a community-based outpatient clinic, Chula Vista,
California, an amount not to exceed $3,714,000.
(20) For a new research lease, Hines, Illinois, an amount
not to exceed $22,032,000.
(21) For a replacement research lease, Houston, Texas, an
amount not to exceed $6,142,000.
(22) For a community-based outpatient clinic, Lincoln,
Nebraska, an amount not to exceed $7,178,400.
(23) For a community-based outpatient clinic, Lubbock,
Texas, an amount not to exceed $8,554,000.
(24) For a community-based outpatient clinic consolidation,
Myrtle Beach, South Carolina, an amount not to exceed
$8,022,000.
(25) For a community-based outpatient clinic, Phoenix,
Arizona, an amount not to exceed $20,757,000.
(26) For the expansion of a community-based outpatient
clinic, Redding, California, an amount not to exceed
$8,154,000.
(27) For the expansion of a community-based outpatient
clinic, Tulsa, Oklahoma, an amount not to exceed $13,269,200.

SEC. 502. BUDGETARY TREATMENT OF DEPARTMENT OF VETERANS
AFFAIRS MAJOR MEDICAL FACILITIES LEASES.

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

Mr. BLUMENTHAL. Mr. President, I am pleased to follow my friend and
colleague from Vermont, Senator Sanders, and I want to begin by
thanking him for his leadership, his persistence, and his perseverance
in the face of resistance that should not exist. This cause ought to be
one that galvanizes the Nation, and perhaps it will, since the Nation
has been appalled and astonished by reports of not only cooking the
books but covering up that potential criminality--destruction of
documents, falsification of records, secret waiting lists, delays that
are unacceptable and intolerable for basic, necessary health care our
veterans need.
But these issues are longstanding, decades old in this system, and
they need to be addressed with system-wide reform.
I am strongly in support, and proudly so, in advocating the Ensuring
Veterans Access to Health Care Act that Senator Sanders has just
introduced. It is a version of the omnibus bill and

[[Page S3380]]

other measures that have been introduced. It has essential features
that will provide better health care sooner and more accessibly to our
veterans. It is necessary to pass, but these provisions should have
passed literally years ago. In fact, the very first piece of
legislation I introduced in the Senate, S. 1060, called the Honoring
All Veterans Act, included a provision to deal with this shortage of
doctors in this system. It included other health care-related measures
to expand the availability and accessibility of health care. These
problems, far from new, have been existent for some time. And the
coverup, the lying, and falsification of records is potentially now
criminal and beyond a failure of public policy; it is a failure in
integrity.
I am pleased to join Senator Sanders to make sure the 9.3 million of
the Nation's 22 million who are enrolled in the VA health care system--
which is up from about 2.5 million at the end of the first gulf war--
have the kind of service they need. This bill will address some basic
needs. It provides authority to remove senior executives based on poor
job performance and preventing wholesale political firings. The
legislation would provide veterans who cannot get timely appointments
access to private clinics and the option of going to community health
care centers, military hospitals, or private doctors. It would
authorize the Veterans' Administration to lease 27 new health
facilities in 18 States, including funds for the enhanced lease of the
Errera Community Care Center in West Haven, CT, which does profoundly
important and excellent work.
The legislation authorizes emergency funding to hire new doctors and
nurses and other providers in order to address systemwide health care
provider shortages and to take other necessary steps to ensure timely
access to care. It addresses the health care primary care shortage for
the long term as well by authorizing the National Health Service Corps
to award scholarships to medical school students and to forgive college
loans for doctors and nurses who work at the VA. These kinds of
measures and others in the bill will act to fulfill our basic
obligation to our veterans, just as I attempted to do in the Honoring
All Veterans Act some years ago, and others have joined since in
seeking to do.
My hope is we can reach across the aisle. In fact, I am working with
Senator McCain on a bipartisan letter to the Attorney General urging
all possible involvement and leadership in a criminal investigation. I
hope a similar spirit of bipartisanship will enable us to work with
Senators McCain, Burr, and Coburn on their Veterans Choice Act and
combine these measures, enlist them in supporting a bipartisan solution
and join Senator Sanders in hoping for that bipartisan effort in this
measure because there is no question that the VA budget has grown, but
simply has failed to keep pace with surging demand, especially in
mental health services and primary care. Too many of our veterans are
coming home with serious mental health issues, including post-traumatic
stress, traumatic brain injury, and need the care we owe them. We need
accountability. Part of it will be firing the officials who should be
held responsible, but part of it may also be prosecuting them, and that
is the reason I have asked the Attorney General to take the lead to
assume much more immediate, significant involvement in any criminal
investigation that may be necessary.
In fact, there is credible and significant evidence of criminal
wrongdoing here. The Department of Justice must be involved and in my
view must take a leadership role, and that is the reason Senator McCain
and I have joined in a letter that we are seeking support for our
colleagues to send that would request the Attorney General to take such
steps. Only the Attorney General has the resources, expertise, and
authority, along with the FBI, to do a prompt and effective criminal
investigation. Only the Department of Justice can convene a grand jury
and take other necessary steps. Only the FBI can bring to bear the
expertise as well as the resources.
The inspector general of the Veterans' Administration has only 165
investigators for the entire Nation. This investigation now spans more
than 40 centers where criminality has been alleged. Of the 216 sites
visited by the auditors recently, many were found to have issues of
scheduling practice defects and potential integrity problems. So there
is a reason for the VA inspector general to not only consult with the
Department of Justice but also involve the Department of Justice in an
active leadership role here, and for the Acting Secretary of the VA to
request that involvement, which I hope he will do. I commend what he
has done so far, but now is the time for the Department of Justice to
be involved in leading.
The audit of the facilities around the country is to be made public--
not just the overall results which have been delivered to the President
in a report last Friday, but all of the results--site-specific results
for locations, for example, the two hospitals in Connecticut in West
Haven and in Newington as well as the six medical centers in
Connecticut. All of those site-specific audits should be made public.

I have written to the Acting Secretary Sloan Gibson, urging that he
make those face-to-face audits of the VA medical facilities public, not
only for Connecticut but for the whole country. Restoring trust and
credibility will be achieved only if there is more transparency.
Nondisclosure would be a bad way to begin a new era of leadership at
the VA. Full transparency is absolutely vital to help restore trust and
confidence, which has been so gravely threatened and, indeed,
undermined.
Finally, I have a few words to say about Secretary Shinseki. The
immediate challenge is not about replacing one person, it is about
fixing a system that is desperately wrong. I deeply respect Secretary
Shinseki's decision to resign last week after concluding that his
continued service would be a distraction from the urgent and necessary
overhaul of the Veterans' Administration. I respect even more his
dedicated service to our Nation. He is a decorated combat veteran who
led into battle many of the men and women who now use the Veterans'
Administration. His mentors and models, as he so eloquently told our
committee, now use the Veterans' Administration. In his heart, I
believe he is passionately committed to the cause of serving our
veterans, and he deserves gratitude and respect from the American
people for his service in the U.S. military and his telling truth to
power as the President so powerfully observed.
The Nation must recognize it owes our veterans world-class, first-
class medical care that is second to none. Putting them at risk in
medical facilities after they have put their lives on the line on the
battlefield is a disservice to them and our Nation.
It is abhorrent and atrocious that there have been these potentially
criminal acts--destruction of documents and falsification of records--
at many of the VA facilities around the country. There is no excuse for
it. Whether it is arbitrary deadlines or timelines, there is simply no
excuse for that kind of lying. The lying that happened within the VA
was not only to General Shinseki, but to the American people. The ones
who committed that kind of wrongdoing should be held accountable
administratively and criminally.
The wars in Iraq and Afghanistan, and the ongoing global military
operations since 9/11, have cast a long shadow on this Nation's
history. It involved less than 1 percent of the population, including
the families of the brave warriors who have been sent to battle. All of
us will live with the consequences, and all of us have an obligation to
keep faith with them, leave no veteran behind, and give them prompt and
world-class, first-class medical care when they need it right away.
The ``greatest generation'' set a model for them, and they are,
indeed, the next greatest generation. We have to do right by them as
they have done right by us. No matter what the era, conflict, or war,
let us keep faith with all of the veterans and leave no veteran behind.
______

By Mr. McCAIN (for himself, Mr. Coburn, Mr. Burr, Mr. Flake, Mr.
Isakson, Mr. Inhofe, Mr. Grassley, Mr. Roberts, Mr. Hoeven, Mr.
Coats, Mr. Barrasso, Mr. Johanns, Mr. Rubio, Mr. Cornyn, Mr.
Alexander, Mr. Kirk, Mr. Wicker, Mrs. Fischer, Mr. Portman, Mr.

[[Page S3381]]

Toomey, Mr. Boozman, Mr. Moran, Mr. Thune, Mr. Scott, Mr. Enzi,
and Mr. Graham):
S. 2424. A bill to provide veterans with the choice of medical
providers and to increase transparency and accountability of operations
of the Veterans Health Administration of the Department of Veterans
Affairs, and for other purposes; to the Committee on Veterans' Affairs.
Mr. McCAIN. Mr. President, it has been almost 2 months since
allegations that some 40 veterans died while waiting for care at the
Phoenix VA were first made public. Since that report, we have learned
of similar allegations of gross mismanagement and data manipulation at
42 VA medical facilities across the U.S. More troubling, according to
the Office of the Inspector General's preliminary report, 1,700
veterans in the Phoenix VA Health Care System who thought they were
about to receive care were never even placed on the VA's Electronic
Waiting List and are ``at risk of being forgotten or lost in Phoenix
HCS's convoluted scheduling process''. Today, it is clear that delaying
medical care and manipulating records to hide those delays in care is
systemic through the Department of Veterans' Affairs health system.
This has created in our veterans' community a crisis of confidence
toward the VA--the very agency that was established to care for them.
Today, I joined Senators Coburn, Burr, and Flake to introduce the
Veterans Choice Act of 2014. This bill would, principally, empower
veterans with greater flexibility when choosing their medical care and
increase transparency and accountability within the VA to ensure that
it delivers quality care to our veterans in a timely manner.
Specifically, it would give veterans the option to go to a different
doctor if the VA can't schedule an appointment within a reasonable time
or if the veteran lives too far away from a VA medical facility.
Additionally, this bill would prohibit scheduling or wait-time metrics/
goals from being used as factors to determining performance awards or
bonuses. It would also require the Secretary of the VA to punish
employees who falsify data, including civil penalties, suspension or
termination. And, empower the Secretary of the VA to remove any top
executive at the VA if the Secretary determines that his performance
warrants removal.
Put simply, unlike some other proposals that have been made to reform
how the VA delivers care, this bill would squarely address the root
causes of the tragic circumstances that have brought us to this point.
For almost all this century, Americans have been fighting in faraway
places to make this dangerous world safer for the rest of us. They have
been brave. They have sacrificed and suffered. They bear wounds and
mourn losses they will never completely recover from--and we can never
fully compensate them for. But, we can care for the injuries they
incurred on our behalf and provide for their physical and emotional
recovery from the battles they fought to protect us. Quality care for
our veterans is among the most solemn obligations a nation must pay,
and we will be judged by God and history by how well we discharge ours.
Indeed, we must be worthy of the sacrifices made on our behalf How we
care for those who risked everything for us is the most important test
of a Nation's character. Today, we are failing that test. We must do
better tomorrow. Much better.
For the 9 million American veterans who depend on the VA for their
health care, and for the families whose tragic stories we have heard
over the last two months, who I know are still grieving their losses,
it is time to provide our veterans with the care, choice, and
accountability that they so rightly deserve. I am pleased to be
associated with the bill Senator Burr, Senator Coburn and Senator Flake
introduced today, which would help the nation achieve those laudable,
necessary goals. I urge my colleagues--on both sides of the aisle--to
support it.

____________________