SenateS. 4744119th Congress
Take Care of America’s Veterans Act
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[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 4744 Placed on Calendar Senate (PCS)]
<DOC>
Calendar No. 433
119th CONGRESS
2d Session
S. 4744
To amend titles 10 and 38, United States Code, and other Federal laws,
to improve benefits for veterans and the administration of the
Department of Veterans Affairs.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 10, 2026
Mr. Moran (for himself, Mr. Boozman, and Mr. Cramer) introduced the
following bill; which was read the first time
June 11, 2026
Read the second time and placed on the calendar
_______________________________________________________________________
A BILL
To amend titles 10 and 38, United States Code, and other Federal laws,
to improve benefits for veterans and the administration of the
Department of Veterans Affairs.
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 ``Take Care of
America's Veterans Act''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--COMPENSATION
Sec. 101. Major Richard Star Act.
Sec. 102. Love Lives On Act.
Sec. 103. Extension of increased dependency and indemnity compensation
to surviving spouses of veterans who die
from amyotrophic lateral sclerosis.
Sec. 104. Sharri Briley and Eric Edmundson Veterans Benefits Expansion
Act of 2026.
Sec. 105. Claims: prohibition on denial solely for certain reason;
improved efficiency of adjudications and
appeals.
Sec. 106. Annual report on causes of death among veterans.
Sec. 107. Plan for use of automation tools to process claims under laws
administered by the Secretary of Veterans
Affairs.
Sec. 108. Reforms relating to Department of Veterans Affairs disability
ratings.
Sec. 109. Improvements to temporary licensure requirements for contract
health care professionals who perform
medical disability examinations for the
Department of Veterans Affairs.
Sec. 110. Disability examinations: study on access in rural areas;
review of training; review of inadequate or
unnecessary examinations.
Sec. 111. Improvements to processing and outreach regarding claims
involving military sexual trauma.
Sec. 112. Independent assessment of notices that the Secretary of
Veterans Affairs sends to claimants.
Sec. 113. Independent assessment of forms that the Secretary of
Veterans Affairs sends to claimants.
TITLE II--EDUCATION AND ECONOMIC OPPORTUNITY
Sec. 201. Vets Opportunity Act.
Sec. 202. Improvements to process for making payments to automobile
sellers for automobiles purchased for
certain disabled veterans.
Sec. 203. Monthly housing stipend under the Post-9/11 Educational
Assistance Program for individuals who
pursue summer programs of education solely
through distance learning.
Sec. 204. Clarification regarding inclusion of medically necessary
automobile adaptations in Department of
Veterans Affairs definition of ``medical
services''.
Sec. 205. Digital communications: Solid Start program; educational
assistance.
Sec. 206. Improvements to Transition Assistance Program and
Skillbridge.
Sec. 207. Transition Assistance Program: presentation in preseparation
counseling to promote benefits available to
veterans.
Sec. 208. Elimination of requirement that on-campus educational and
vocational counseling is provided by
certain Department of Veterans Affairs
employees.
Sec. 209. Expansion of entitlement for payment for licensing or
certification tests for veterans entitled
to educational assistance.
Sec. 210. Increase of amount of educational assistance paid by the
Secretary of Veterans Affairs for first
year of a full-time program of
apprenticeship or other on-job training.
Sec. 211. Improving emerging technology opportunities for veterans.
TITLE III--HEALTH CARE
Sec. 301. Extension and modification of transportation grant program of
Department of Veterans Affairs.
Sec. 302. Veteran Caregiver Reeducation, Reemployment, and Retirement
Act.
Sec. 303. Veterans TBI Breakthrough Exploration of Adaptive Care
Opportunities Nationwide Act.
Sec. 304. Department of Veterans Affairs Assignment of Traveling
Physicians to Serve Territories,
Possessions, and Freely Associated States.
Sec. 305. Inclusion of adaptive prostheses and terminal devices for
sports and other recreational activities in
medical services furnished to eligible
veterans by the Secretary of Veterans
Affairs.
Sec. 306. Modifications to and reauthorization of Staff Sergeant Parker
Gordon Fox Suicide Prevention Grant Program
of Department of Veterans Affairs.
Sec. 307. Reports on the use of hyperbaric oxygen therapy.
Sec. 308. Department of Veterans Affairs pilot program to provide
grants to mental health care providers for
the provision of mental health care for
veterans.
Sec. 309. Furnishing of certain health services to veterans in the
Freely Associated States.
Sec. 310. Modification of Precision Medicine for Veterans Initiative;
reporting on suicide by veterans and
members of the Armed Forces.
Sec. 311. Establishment of the Blast Overpressure Task Force of the
Department of Veterans Affairs.
Sec. 312. Extension of sharing of Department of Veterans Affairs and
Department of Defense Health Care
Resources; resource sharing oversight and
implementation plan.
Sec. 313. Timely reporting of the death of a veteran.
Sec. 314. Expansion of access by veterans to critical access hospitals
and affiliated clinics under the Veterans
Community Care Program.
Sec. 315. Pilot platform for services for veterans; collection from
veterans of information related to social
determinants of health.
Sec. 316. Improvements to Department of Veterans Affairs prosthetic and
rehabilitative items and service.
Sec. 317. Improvement of submission of medical documentation to the
Secretary of Veterans Affairs by community
care providers.
Sec. 318. Implementation of and report on efforts of Department of
Veterans Affairs to improve health care
appointment scheduling.
Sec. 319. Pilot program on coordination of care between Department of
Veterans Affairs and Medicare program.
Sec. 320. Fisher House availability.
Sec. 321. Agreements between medical facilities of Department of
Veterans Affairs and rural medical
facilities.
Sec. 322. Study on quality of care difference between mental health and
addiction therapy care provided by health
care providers of Department of Veterans
Affairs compared to non-Department
providers.
Sec. 323. Lactation spaces in medical centers of the Department of
Veterans Affairs.
Sec. 324. Research related to menopause, perimenopause, and mid-life
women's health: report; plan.
Sec. 325. Pilot program on provision of opioid rescue medications to
veterans.
Sec. 326. Establishment of Veterans Health Administration Policy
Advisory Commission.
Sec. 327. Access to health care.
Sec. 328. Research on health conditions of descendants of toxic-exposed
veterans.
Sec. 329. Veterans Spinal Trauma Access to New Devices Act.
Sec. 330. Department of Veterans Affairs pilot program to award grants
for the provision of service dogs to
veterans.
Sec. 331. Authorization of major medical facility project of Department
of Veterans Affairs for fiscal year 2027 in
Manchester, New Hampshire.
Sec. 332. Bowel and bladder care program of Department of Veterans
Affairs.
TITLE IV--ORGANIZATION
Sec. 401. Authorization of appropriations to the Office of Information
and Technology of the Department of
Veterans Affairs for certain purposes.
Sec. 402. Establishment of Under Secretary for Management and Chief
Financial Officer.
Sec. 403. Department of Veterans Affairs acquisition reform and cost
assessment.
Sec. 404. Improvement of telephone communication by Department of
Veterans Affairs.
Sec. 405. Advancing Department of Veterans Affairs emergency response
to crisis.
Sec. 406. Membership of Department of Veterans Affairs Geriatrics and
Gerontology Advisory Committee.
Sec. 407. Scheduling of appointments under the Veterans Community Care
Program.
TITLE V--MEMORIAL AFFAIRS
Sec. 501. Expansion of eligibility for Department of Veterans Affairs
memorial headstone or marker for certain
individuals.
Sec. 502. Department of Veterans Affairs provision of additional burial
benefits when an urn or commemorative
plaque is furnished.
Sec. 503. Fallen Servicemembers Religious Heritage Restoration Program.
TITLE VI--VETERANS' ASSURING CRITICAL CARE EXPANSIONS TO SUPPORT
SERVICEMEMBERS
Subtitle A--Improvement of Veterans Community Care Program
Sec. 601. Codification of requirements for eligibility standards for
access to community care from Department of
Veterans Affairs.
Sec. 602. Requirement that Secretary notify veterans of eligibility for
care or denial of request for care under
Veterans Community Care Program.
Sec. 603. Consideration under Veterans Community Care Program of
continuity of care and need for caregiver
or attendant.
Sec. 604. Discussion of telehealth options under Veterans Community
Care Program.
Sec. 605. Extension of deadline for submittal of claims by health care
entities and providers under prompt payment
standard.
Sec. 606. Audit of representative sample of veterans receiving care and
services under Veterans Community Care
Program.
Sec. 607. Information on wait time and drive time options for receipt
of care by veterans.
Sec. 608. Establishment of period during which a referral under
Veterans Community Care Program remains
valid.
Sec. 609. Updates to contracting requirements under Veterans Community
Care Program.
Sec. 610. Publication of community care network sufficiency and payment
waiver requests and approvals.
Sec. 611. Requirements relating to quality of community care providers.
Sec. 612. Provider training.
Sec. 613. Oversight authority over community care.
Subtitle B--Mental Health Treatment Programs
Sec. 621. Veteran participation in certain mental health programs.
Sec. 622. Access to mental health residential rehabilitation treatment
programs for veterans with spinal cord
injury or disorder.
Subtitle C--Staffing Matters
Sec. 631. Treatment of psychologists.
Sec. 632. Mentorship program for executive leadership teams at medical
centers of the Department of Veterans
Affairs.
Sec. 633. Requirement for equivalent role postings for vacant positions
at Department of Veterans Affairs.
Sec. 634. Improvements to Department of Veterans Affairs hiring
processes.
Sec. 635. Department of Veterans Affairs telework policy.
Sec. 636. Expansion of reimbursement of continuing professional
education expenses.
Sec. 637. Department of Veterans Affairs personnel transparency.
Sec. 638. Modification of authority of licensure of health care
professionals providing treatment via
telemedicine.
Sec. 639. Provision of data on educational assistance programs of
Veterans Health Administration.
Subtitle D--Optimization of Workforce
Sec. 641. Department of Veterans Affairs strategic human capital plan.
Sec. 642. Department of Veterans Affairs reduction in force notice
requirement.
Sec. 643. Detailed plans and justifications for reorganization of
offices.
Sec. 644. Rule of construction.
Subtitle E--Veterans Infrastructure and Transformation
Sec. 651. Short title.
Sec. 652. Modification of authority for sharing of health-care
resources of Department of Veterans Affairs
to include flexible space utilization and
streamlined service agreements.
Sec. 653. Use of commercial construction and facilities code and
standards.
Sec. 654. Feasibility study for full-service hospital of Department of
Veterans Affairs in certain States.
Sec. 655. Report on strategic plan for infrastructure and capital
assets of Department of Veterans Affairs.
Sec. 656. Permanent extension of pilot program on acceptance by the
Department of Veterans affairs of donated
facilities and related improvements.
Sec. 657. Authority to accept donations of construction services, minor
construction or nonrecurring maintenance
projects, and targeted contributions.
Sec. 658. Report on use of additional authorities relating to
recruitment and retention of personnel.
Sec. 659. Reports on key capital asset investments, activities, and
performance of Department of Veterans
Affairs.
Sec. 660. Development of streamlined procurement model; report.
Sec. 661. Submission and notification of cost estimates for medical
facility leases.
Sec. 662. Report on capital asset and information technology needs of
the research and development program of
Department of Veterans Affairs.
Sec. 663. Improving prevention, detection, and reporting of waste,
fraud, and abuse in Department of Veterans
Affairs capital asset projects and
activities.
Sec. 664. Report on long-term care physical infrastructure needs of
Department of Veterans Affairs.
Subtitle F--Other Health Care Matters
Sec. 671. Prescription, delivery, distribution, and dispensation of
controlled substance medications by covered
health care professionals of Department of
Veterans Affairs via telemedicine.
Sec. 672. Copayments for limited supplies of medications.
Sec. 673. Plan on establishment of interactive, online self-service
module for care.
Sec. 674. Modification of requirements for Center for Innovation for
Care and Payment of the Department of
Veterans Affairs and transfer of authority.
Sec. 675. Report on improvements to clinical appeals process.
Sec. 676. Plan on increasing accessibility of care for veterans with
spinal cord injury or disorder.
TITLE I--COMPENSATION
SEC. 101. MAJOR RICHARD STAR ACT.
(a) Concurrent Receipt Generally.--Section 1414(b) of title 10,
United States Code, is amended by striking paragraph (2) and inserting
the following new paragraphs:
``(2) Combat-related disability retirees.--
``(A) In general.--A member retired under chapter
61 of this title with a combat-related disability who
is entitled for any month to retired pay under chapter
61 of this title and is also entitled for that month to
veterans' disability compensation under title 38, is
entitled to be paid both without regard to sections
5304 and 5305 of title 38, as provided by subparagraphs
(B) and (C).
``(B) Career retirees.--In the case of a member
retired under chapter 61 of this title who has a
combat-related disability that is not a qualifying
service-connected disability (as defined in subsection
(a)(2)) and who, at the time of the member's
retirement, had 20 years or more of service otherwise
creditable under section 1405 of this title or at least
20 years of service computed under section 12732 of
this title, the member may receive, without regard to
sections 5304 and 5305 of title 38, both--
``(i) the amount of retired pay to which
the member would have been entitled under any
other provision of law based on the member's
service in the uniformed services if the member
had not been retired under chapter 61 of this
title; and
``(ii) veterans' disability compensation
under title 38.
``(C) Disability retirees with less than 20 years
of service.--In the case of a member retired under
chapter 61 of this title with a combat-related
disability and who, at the time of the member's
retirement, had less than 20 years of service otherwise
creditable under section 1405 of this title or less
than 20 years of service computed under section 12732
of this title, the member may receive, without regard
to sections 5304 and 5305 of title 38, the lesser of--
``(i) both--
``(I) the retired pay for which the
member is eligible under chapter 61 of
this title; and
``(II) veterans' disability
compensation under title 38; or
``(ii) both--
``(I) an amount equal to the
product of the retired pay base
computed under section 1406(b) or 1407
of this title and the retired pay
multiplier determined under section
1409 of this title, as such base pay
and multiplier would be computed if the
member had 20 years of service
creditable under section 1405 of this
title; and
``(II) veterans' disability
compensation under title 38.
``(D) Combat-related disability defined.--In this
paragraph, the term `combat-related disability' has the
meaning given that term in subsection (e) of section
1413a of this title and as determined under the
criteria and procedures used for purposes of such
section.
``(3) Exclusion of other retirees.--Subsection (a) does not
apply to a member retired under chapter 61 of this title if the
member is not covered by paragraph (1) or (2).''.
(b) Technical and Conforming Amendments.--
(1) Coordination with combat-related special compensation
program.--Section 1414(d) of title 10, United States Code, is
amended by striking ``qualified retiree under this section''
and inserting ``qualified retiree under subsection (a) or is
entitled to a payment under subsection (b)(2)''.
(2) Amendments reflecting end of concurrent receipt phase-
in period.--Section 1414 of title 10, United States Code, is
further amended--
(A) in subsection (a)(1)--
(i) by striking the second sentence; and
(ii) by striking subparagraphs (A) and (B);
(B) by striking subsection (c) and redesignating
subsections (d) and (e) as subsections (c) and (d),
respectively; and
(C) in subsection (d), as redesignated, by striking
paragraphs (3) and (4).
(3) Section heading.--The heading of section 1414 of such
title is amended to read as follows:
``Sec. 1414. Members eligible for retired pay who are also eligible for
veterans' disability compensation: concurrent receipt''.
(4) Conforming amendment.--Section 1413a(f) of such title
is amended by striking ``Subsection (d)'' and inserting
``Subsection (c)''.
(c) Effective Date.--The amendments made by this section shall take
effect on January 1, 2027, and shall apply to payments for months
beginning on or after that date.
SEC. 102. LOVE LIVES ON ACT.
(a) Modification of Entitlement to Veterans Dependency and
Indemnity Compensation for Surviving Spouses Who Remarry.--Section
103(d) of title 38, United States Code, is amended--
(1) in paragraph (2)(B)--
(A) by inserting ``(i)'' before ``The remarriage'';
(B) in clause (i), as designated by subparagraph
(A), by striking ``Notwithstanding the previous
sentence'' and inserting the following:
``(ii) Notwithstanding clause (i)''; and
(C) by adding at the end the following new clause:
``(iii) Notwithstanding clause (ii), the remarriage of a surviving
spouse shall not bar the furnishing of benefits under section 1311 or
1562 of this title to the surviving spouse of a veteran.''; and
(2) in paragraph (5)--
(A) by striking subparagraph (A); and
(B) by renumbering subparagraphs (B) through (E) as
subparagraphs (A) through (D), respectively.
(b) Continued Eligibility for Survivor Benefit Plan for Certain
Surviving Spouses Who Remarry.--Section 1450(b)(2) of title 10, United
States Code, is amended--
(1) by striking ``An annuity'' and inserting the following:
``(A) In general.--(A) Subject to subparagraph (B),
an annuity''; and
(2) by adding at the end the following new subparagraph:
``(B) Treatment of survivors of members who die on
active duty.--The Secretary may not terminate payment
of an annuity for a surviving spouse described in
subparagraph (A) or (B) of section 1448(d)(1) solely
because that surviving spouse remarries. In the case of
a surviving spouse who remarried before reaching age 55
and before the date of the enactment of Take Care of
America's Veterans Act, the Secretary shall resume
payment of the annuity to that surviving spouse--
``(i) except as provided by clause (ii),
for each month that begins on or after the date
that is one year after such date of enactment;
or
``(ii) on the first day of the first month
beginning after such date of enactment, in the
case of a surviving spouse who elected to
transfer payment of that annuity to a surviving
child or children under the provisions of
section 1448(d)(2)(B) of title 10, United
States Code, as in effect on December 31,
2019.''.
(c) Expansion of Definition of Dependent Under TRICARE Program to
Include a Remarried Widow or Widower Whose Subsequent Marriage Has
Ended.--Section 1072(2) of title 10, United States Code, is amended--
(1) in subparagraph (H), by striking ``; and'' and
inserting a semicolon;
(2) in subparagraph (I)(v), by striking the period at the
end and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(J) a remarried widow or widower whose subsequent
marriage has ended due to death, divorce, or
annulment.''.
SEC. 103. EXTENSION OF INCREASED DEPENDENCY AND INDEMNITY COMPENSATION
TO SURVIVING SPOUSES OF VETERANS WHO DIE FROM AMYOTROPHIC
LATERAL SCLEROSIS.
(a) Extension.--Section 1311(a)(2) of title 38, United States Code,
is amended--
(1) by inserting ``(A)'' before ``The rate''; and
(2) by adding at the end the following new subparagraph:
``(B) A veteran whom the Secretary determines died from amyotrophic
lateral sclerosis shall be treated as a veteran described in
subparagraph (A) without regard for how long the veteran had such
disease prior to death.''.
(b) Applicability.--Subparagraph (B) of section 1311(a)(2) of title
38, United States Code, as added by subsection (a), shall apply to a
veteran who dies from amyotrophic lateral sclerosis on or after October
1, 2022.
SEC. 104. SHARRI BRILEY AND ERIC EDMUNDSON VETERANS BENEFITS EXPANSION
ACT OF 2026.
(a) Increase in Rates of Certain Disability Compensation and
Dependency and Indemnity Compensation Under Laws Administered by
Secretary of Veterans Affairs.--
(1) Increase to rates of wartime disability compensation.--
(A) In general.--Section 1114 of title 38, United
States Code, is amended by adding at the end the
following new subsection:
``(u) In the case of a veteran eligible for a monthly aid and
attendance allowance under subsection (r) or subsection (t) of this
section, the Secretary shall, in addition to the total amount of
compensation for which the veteran is eligible under this section, pay
the veteran a supplemental monthly allowance at the rate of $833.33.''.
(B) Effective date; applicability.--Subsection (u)
of such section (as added by subparagraph (A)) shall
take effect on December 1, 2026, and shall apply to
months beginning on or after such date.
(2) Increase to rates of dependency and indemnity
compensation.--Section 5312 of such title is amended by adding
at the end the following new subsection:
``(d)(1) Whenever there is an increase in benefit amounts payable
under title II of the Social Security Act (42 U.S.C. 401 et seq.) as a
result of a determination made under section 215(i) of such Act (42
U.S.C. 415(i)), the Secretary shall, except as provided in paragraph
(2), effective on the date of such increase in benefit amounts,
increase the dollar amounts in effect for the payment of dependency and
indemnity compensation by the Secretary under paragraph (1) and
paragraph (3) of section 1311(a) of this title, as such amounts were in
effect immediately before the date of such increase in benefit amounts
payable under title II of the Social Security Act, by a percentage
equal to the sum of--
``(A) the percentage by which such benefit amounts are
increased; and
``(B) one percent.
``(2) Whenever there is an increase under paragraph (1) in amounts
in effect for the payment of dependency and indemnity compensation, the
Secretary shall publish such amounts, as increased pursuant to such
paragraph, in the Federal Register at the same time as the material
required by section 215(i)(2)(D) of the Social Security Act (42 U.S.C.
415(i)(2)(D)) is published by reason of a determination under section
215(i) of such Act (42 U.S.C. 415(i)).
``(3) The requirement to increase, pursuant to paragraph (1), the
amounts in effect for the payment of dependency and indemnity
compensation under paragraph (1) and paragraph (3) of section 1311 (a)
of this title by the Secretary shall--
``(A) take effect on December 1, 2026, and shall apply with
respect to months beginning on or after such date; and
``(B) terminate after the date on which the third increase
to such amounts pursuant to such paragraph occurs.''.
(b) Modification of Waivers of Fees Collected for Housing Loans
Guaranteed, Insured, or Made by the Secretary of Veterans Affairs.--
Section 3729(b)(2) of such title is amended, in the loan fee table--
(1) in subparagraph (E), by striking ``0.50'' both places
it appears and inserting ``1.42''; and
(2) in subparagraph (I), by striking ``0.50'' each place it
appears and inserting ``1.0''.
(c) Home Affordability for Guard and Reserve.--
(1) Eligibility of certain members of the reserve
components and the national guard for guaranteed housing
loans.--
(A) Expanded definition of ``active duty'' for
purposes of housing loans.--Section 3701(b) of title
38, United States Code, is amended by adding at the end
the following new paragraph:
``(9) The term `active duty' has the meanings as follows:
``(A) In the case of members of the regular
components of the Armed Forces, the meaning given such
term in section 101(21)(A).
``(B) In the case of members of the reserve
components of the Armed Forces--
``(i) service on active duty (as defined in
section 101(d) of title 10), inactive-duty
training (as defined in section 101(d) of title
10), or annual training duty; or
``(ii) service on active duty under a call
or order to active duty under section 688,
12301(a), 12301(d), 12301(g), 12301(h), 12302,
12304, 12304a, or 12304b of title 10 or section
713 of title 14, but not including inactive
duty training (as defined in section 101(d) of
title 10) or annual training duty.
``(C) In the case of a member of the Army National
Guard of the United States or Air National Guard of the
United States, in addition to service described in
subparagraph (B), full-time service--
``(i) in the National Guard of a State for
the purpose of organizing, administering,
recruiting, instructing, or training the
National Guard;
``(ii) in the National Guard when
performing full-time National Guard duty (as
defined in section 101 of title 32); or
``(iii) in the National Guard when
performing active duty (as defined in section
101 of title 32).''.
(B) Retroactive applicability to service
performed.--The amendments made by this subsection
shall apply with respect to any service performed on or
after September 11, 2001.
(2) Expansion of eligibility for guaranteed housing loans
to certain additional personnel upon payment of additional loan
fee.--
(A) Expansion to individuals with at least 14 days
of service.--Section 3701(b) of title 38, United States
Code, is amended by inserting after paragraph (7) the
following new paragraph:
``(8) The term `veteran' also includes, for purposes of
home loans (subject to the additional loan fee in section
3729(b)(4)(J) of this title), an individual who--
``(A) is not otherwise eligible for the benefits of
this chapter;
``(B) has completed a total service of at least 14
days on active duty under paragraph (B) or (C) of
paragraph (9); and
``(C) following completion of such service,
continued to serve until the completion of entry level
and skill training (as defined in section 3301(3) of
this title).''.
(B) Basic entitlement.--Section 3702(a)(2) of title
38, United States Code, is amended by adding at the end
the following:
``(H) Each individual described in section 3701(b)(8) of
this title.''.
(C) Additional loan fee for such individuals.--
Section 3729(b)(4) of title 38, United States Code, is
amended by adding at the end the following new
subparagraph:
``(J) In the case of a housing loan in which the veteran
has eligibility under section 3701(b)(8) of this title and does
not otherwise have eligibility, the loan fee table in paragraph
(2) shall be applied to the veteran or other obligor (as
applicable) by adding 1.00 to the percentage in the table.''.
(D) Notification to personnel.--The Secretary of
Veterans Affairs shall provide information about this
benefit to the Secretary of Defense to ensure that each
member of a reserve component or a member of the Army
National Guard of the United States or Air National
Guard of the United States who completes entry level
and skill training (as defined in section 3301(3) of
title 38, United States Code) after the date of the
enactment of this Act is notified of their eligibility
for housing loan benefits under chapter 37 of such
title, including eligibility (subject to the additional
loan fee) under section 3701(b)(8) of such title.
SEC. 105. CLAIMS: PROHIBITION ON DENIAL SOLELY FOR CERTAIN REASON;
IMPROVED EFFICIENCY OF ADJUDICATIONS AND APPEALS.
(a) Prohibition on Denial of Claims for Benefits Under Laws
Administered by Secretary of Veterans Affairs on Sole Basis That
Veteran Failed to Appear for Certain Medical Examination.--Subsection
(d) of section 5103A of title 38, United States Code, is amended--
(1) in the heading, by striking ``Compensation Claims'' and
inserting ``Claims for Benefits'';
(2) in paragraph (2), by striking ``treat an examination or
opinion as being necessary to make a decision on a claim for
purposes of'' and inserting ``provide for a medical examination
or obtain a medical opinion under''; and
(3) by adding at the end the following new paragraph:
``(3) If a veteran fails to appear for a medical examination
provided by the Secretary in conjunction with a claim for a benefit
under a law administered by the Secretary, the Secretary may not deny
such claim on the sole basis that such veteran failed to appear for
such medical examination.''.
(b) Improvements to Efficiency of Adjudications and Appeals of
Claims for Benefits Under Laws Administered by Secretary of Veterans
Affairs.--
(1) Annual report on length of adjudications.--
(A) In general.--Section 5109B of title 38, United
States Code, is amended--
(i) by striking ``The Secretary'' and
inserting ``(a) In General.--The Secretary'';
and
(ii) by adding at the end the following new
subsection:
``(b) Annual Report.--The Secretary shall submit to the Committees
on Veterans' Affairs of the House of Representatives and the Senate an
annual report that includes, with respect to the period covered by the
report--
``(1) the average length of time a claim (or an issue
within a claim) that was remanded by the Board of Veterans'
Appeals was or has been pending before the Secretary after such
remand;
``(2) the number of cases that advanced on the docket by
reason of a motion that was filed under section 7107(b) of this
title and on which the Board ruled, disaggregated by--
``(A) whether a motion was granted or denied; and
``(B) the reason provided for the motion; and
``(3) the number of appeals dismissed by the Board,
disaggregated by--
``(A) whether or not the dismissal was by reason of
the death of the appellant; and
``(B) in the case of a dismissal by reason of the
death of the appellant, whether or not such death was a
result of suicide.''.
(B) Deadline.--The Secretary of Veterans Affairs
shall submit the first report required by subsection
(b) of section 5109B of such title (as added by
subparagraph (A)) by not later than one year after the
date of the enactment of this Act.
(2) Guidelines for advancement of cases on docket of
board.--Not later than one year after the date of the enactment
of this Act, the Secretary of Veterans Affairs, in consultation
with the Board of Veterans' Appeals and the General Counsel of
the Department of Veterans Affairs, shall prescribe guidelines
for the advancement of a case on the docket of the Board on a
motion for earlier consideration and determination under
section 7107(b)(3) of title 38, United States Code. Such
guidelines shall include the type of evidence that may be
submitted with the motion for the advancement of the case to
show grounds for such a motion.
(3) Requirement to track certain claims for benefits.--
(A) In general.--Chapter 51 of title 38, United
States Code, is amended by inserting after section
5109B the following new section:
``Sec. 5109C. Requirement to track and maintain information on certain
claims for benefits; notice of certain assignments
``(a) In General.--The Secretary shall use technology to track and
maintain information (including information with respect to timeliness)
on--
``(1) claims for benefits under the laws administered by
the Secretary (including issues within such claims) that are--
``(A) continuously pursued in accordance with--
``(i) sections 5104C(a) and 5110(a)(2) of
this title; or
``(ii) any other policy established by the
Secretary;
``(B) filed in the National Work Queue (or any
successor system) but have not been assigned to an
office of the Veterans Benefits Administration for
adjudication;
``(C) afforded expeditious treatment by the
Veterans Benefits Administration pursuant to section
5109B of this title or any other policy established by
the Secretary;
``(D) remanded by the Board of Veterans' Appeals to
the Secretary pursuant to section 7104 of this title;
or
``(E) pending a hearing by the Board of Veterans'
Appeals under section 7107 of this title;
``(2) instances in which an adjudicator of the Veterans
Benefits Administration does not comply with a relevant
decision of the Board of Veterans' Appeals to remand a claim
for benefits under the laws administered by the Secretary (or
an issue within such a claim), including any such instance in
which the relevant decision concerned a failure on the part of
the agency of original jurisdiction to satisfy the duty of the
Secretary to assist under section 5103A of this title;
``(3) supplemental claims under section 5108 of this title
that are filed--
``(A) in accordance with section 5104C(a) and
section 5110(a)(2) of this title; and
``(B) after the date of the applicable final
decision of the Secretary with respect to a claim for
benefits under the laws administered by the Secretary
(or an issue within such a claim); and
``(4) first notices submitted to the Secretary of the death
of individuals in receipt of benefits under the laws
administered by the Secretary, disaggregated by such
individuals who were--
``(A) assigned a fiduciary; and
``(B) not assigned a fiduciary.
``(b) Annual Report.--(1) The Secretary shall submit to the
Committees on Veterans' Affairs of the House of Representatives and the
Senate an annual report that includes all information maintained and
tracked pursuant to subsection (a).
``(2) The first report required by paragraph (1) shall be submitted
by not later than one year after the date of the enactment of the Take
Care of America's Veterans Act.''.
(B) Clerical amendment.--The table of sections at
the beginning of such chapter is amended by inserting
after the item relating to section 5109B the following
new item:
``5109C. Requirement to track and maintain information on certain
claims for benefits; notice of certain
assignments.''.
(4) Improvements to board of veterans' appeals.--
(A) Authority to aggregate certain claims.--
(i) In general.--Section 7104(a) of such
title is amended by inserting after the second
sentence the following new sentence: ``If the
Chairman of the Board determines that more than
one appeal involves common questions of law or
fact, the Chairman may aggregate such appeals
to decide such questions of law or fact.''.
(ii) Effective date.--The amendment made by
clause (i) shall take effect on the date of the
enactment of this Act and apply beginning on
the date 90 days after the date on which the
Secretary of Veterans Affairs submits to the
Committees on Veterans' Affairs of the Senate
and House of Representatives a copy of the
policies and procedures required under
paragraph (7)(D)(i)(II).
(iii) Sunset.--The authority to aggregate
appeals pursuant to clause (i) shall expire on
the date that is three years after the date on
which the Secretary of Veterans Affairs
completes the development of the policies and
procedures required under paragraph
(7)(D)(i)(II).
(B) Requirement to ensure substantial compliance
with certain decisions.--Such section is further
amended--
(i) by redesignating subsection (f) as
subsection (g); and
(ii) by inserting after subsection (e) the
following new subsection (f):
``(f)(1) The Secretary, acting through a member of the Board, shall
ensure substantial compliance with any decision of the Board to remand
a claim.
``(2) The agency of original adjudication may waive the requirement
under paragraph (1) with respect to a decision of the Board to remand a
claim to the Secretary, if a member of the Board determines--
``(A) evidence added to the evidentiary record after the
date of such decision is sufficient to resolve the issues
underlying such decision; or
``(B) such decision was unnecessary.
``(3) If the Secretary waives such requirement, the applicable
member of the Board shall include, pursuant to subsection (d), a
determination of such waiver in the decision of the Board.''.
(C) Definition of aggregate; report.--Such section
is further amended by adding at the end the following
new subsections:
``(h) Not later than three years after the date on which the
Secretary of Veterans Affairs completes the development of the policies
and procedures required under paragraph (7)(D)(i)(II), and every five
years thereafter, the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives a report
on the aggregation of claims by the Board under subsection (a). Each
such report shall include--
``(1) an identification of each instance in which the Board
aggregated appeals during the period covered by the report,
including, for each such instance, the number of appeals that
were aggregated;
``(2) an assessment of whether the aggregation of appeals
has contributed to improved efficiency at the Board with
issuing decisions on appeals; and
``(3) such other matters as the Secretary determines
appropriate.
``(i) In this section, the term `aggregate'--
``(1) means any practice or procedure to collect common
issues, claims, or appeals by multiple parties for the purposes
of resolving such issues, claims, or appeals; and
``(2) includes the use of joinder, consolidation,
intervention, class actions, and any other multiparty
proceedings.''.
(5) Expansion of jurisdiction of court of appeals for
veterans claims.--Section 7252 of title 38, United States Code,
is amended--
(A) by redesignating subsections (b) and (c) as
subsections (d) and (e), respectively; and
(B) by inserting after subsection (a) the following
new subsections:
``(b)(1) In an appeal over which the Court has jurisdiction
pursuant to section 7266 of this title, if the appellant files a
request for class certification pursuant to the rules prescribed by the
Court pursuant to section 7264 of this title, the Court shall have
supplemental jurisdiction over any claim for benefits under the laws
administered by the Secretary--
``(A) filed by a claimant who satisfies the definition of
the class contained in such request (including a claimant who
has filed a claim for benefits under such laws that are
specified in such request); and
``(B) regarding which--
``(i) the agency of original jurisdiction has
issued a nonfinal decision; and
``(ii) the claimant has filed a notice of
disagreement under section 5104C(a) or section 7105 of
this title, including any case in which a claimant has
filed a supplemental claim within one year of a Board
decision under section 5110(a)(2)(D) and 5108 of this
title following a notice of disagreement and decision
of the Board.
``(2) A claimant may submit a request for administrative review of
such a claim under section 5104C(a) of this title during the period
beginning on the date on which the named claimant of the motion for
class action review submits to the Court a motion for class action
review and ending on the date that is 60 days after the later of the
following dates:
``(A) The date on which the Court issues a final decision
with respect to such claim.
``(B) The date on which the Court issues a final decision
with respect to such motion for class action review.
``(3) In the case of a claimant whose claim is decided by the Board
during the period when the Court is reviewing the motion for class
action review the deadline for such claimant to file an appeal to the
Court with respect to the decision of the Board shall be tolled if the
Court denies the motion for class action review.
``(c)(1) In the case of a claim for benefits under the laws
administered by the Secretary, the Court may remand a matter to the
Board of Veterans' Appeals for the limited purpose of ordering the
Board to address a question of law or fact if the Court determines the
Board failed to--
``(A) address, in the relevant decision of the Board, an
issue that--
``(i) the claimant or the representative of the
claimant raised; or
``(ii) was reasonably raised by the evidentiary
record of the claim; or
``(B) provide adequate reasons or bases for the decision of
the Board with respect to such question.
``(2) The Court shall issue Rules that provide for each of the
following:
``(A) When and how a party to an appeal (either the
appellant or the Secretary) may request that the Court issue a
limited remand.
``(B) The period of time within which the Board is required
to issue a decision on the relevant question identified in a
limited remand.
``(C) Guidelines for when the Court may grant a request for
a limited remand.
``(D) Guidelines for when the Court may decide sua sponte
to issue a limited remand without a request from any party.
``(E) A requirement that the parties to an appeal for which
a limited remand is issued provide notice to the Court when the
Board issues its decision on the relevant question identified
in the limited remand.
``(3) With respect to any matter remanded to the Board pursuant to
paragraph (1), the Court shall--
``(A) retain jurisdiction over such matter; and
``(B) stay the proceedings of the Court on such matter
until the date on which the Board issues the decision required
by such remand.''.
(6) Study and report on common questions of law or fact
before board of veterans' appeals.--
(A) Study.--The Chairman of the Board of Veterans'
Appeals shall carry out a study to identify questions
of law or fact the Board commonly considers when
reviewing appeals pursuant to section 7104 of title 38,
United States Code, for which precedential guidance
would assist the Board in issuing final decisions on
such appeals. The Chairman may use artificial
intelligence and other technology in carrying out such
study.
(B) Report.--Not later than one year after the date
of the enactment of this Act, the Chairman of the Board
of Veterans Appeals shall submit to the Committees on
Veterans Affairs of the House of Representatives and
the Senate a report that includes the findings of the
study required by subparagraph (A).
(7) Independent assessment of potential modifications to
authority of board of veterans' appeals.--
(A) Agreement.--Not later than 30 days after the
date of the enactment of this Act, the Secretary of
Veterans Affairs shall seek to enter into an agreement
with an FFRDC under which the FFRDC shall conduct an
assessment of the feasibility of modifying the
authority of the Board of Veterans' Appeals established
under chapter 71 of title 38, United States Code, to
permit the Board to issue precedential decisions with
respect to questions of law or fact arising in matters
before the Board.
(B) Report; briefings.--If the Secretary fails to
finalize an agreement with an FFRDC under subparagraph
(A) before the date that is 180 days after the date on
which the Secretary enters negotiations with respect to
such agreement, the Secretary shall--
(i) submit to the Committees on Veterans'
Affairs of the House of Representatives and the
Senate a report that includes--
(I) an explanation of the reasons
the Secretary failed to satisfy such
requirement; and
(II) an estimate of the date on
which the Secretary will finalize the
agreement under subparagraph (A); and
(ii) not less frequently than once every 60
days after the date on which the Secretary
failed to satisfy such requirement, provide to
the Committees on Veterans' Affairs of the
House of Representatives and the Senate a
briefing on the progress of the Secretary
toward finalizing such agreement.
(C) Assessment.--An FFRDC that enters into an
agreement under subparagraph (A) shall, in consultation
with veterans service organizations, veterans' and
survivors' advocate groups, relevant legal experts, and
the Chair of the Administrative Conference of the
United States (or the designee or designees of such
Chair) submit to the Secretary a written assessment
that includes the following:
(i) The determination of the FFRDC of
whether modifying the authority of the Board to
permit the Board to issue precedential
decisions with respect to questions of law or
fact arising in matters before the Board is
feasible.
(ii) An assessment of the authority of the
Board of Veterans' Appeals to aggregate, for
review, more than one appeal under chapter 71
of such title that involves common questions of
law or fact pursuant to section 7104 of such
title, as amended by paragraph (4)(A).
(iii)(I) The recommendations of the FFRDC
with respect to rules or principles to which
the Board should adhere when aggregating
appeals for review pursuant to section 7104(a)
of title 38, United States Code, as so amended,
including--
(aa) whether the use of an opt-out
system is appropriate in a class
certification described in section
7104(a) of title 38, United States
Code, as amended;
(bb) whether aggregation described
in clause (ii) is better carried out by
one member, or a panel of members, of
the Board;
(cc) whether such aggregation may
be accomplished in accordance with
section 7107 of title 38, United States
Code; and
(dd) how an accredited
representative, attorney, or authorized
agent may be selected to represent a
class before the Board.
(II) The recommendations shall include, but
not be limited to, the following:
(aa) How the Board should provide
notice to claimants of the Board's
intent to aggregate their claim.
(bb) This shall include standards
for ensuring that information provided
to claimants regarding aggregation is
written in plain language and clearly
explains the potential effects of
aggregation on adjudication timelines,
appeal rights, and participation
options.
(cc) The options the Board should
provide to claimants to opt out of
participation in aggregation of their
claim.
(dd) The rights of the claimants to
appeal decisions that arise out of
aggregation of claims, and whether or
not such rights may be limited by
existing statute, regulation, or
judicial decisions.
(ee) Safeguards to ensure that
aggregation of appeals does not
diminish the requirement that each
appeal be decided based on the
individual facts, evidence, and
circumstances specific to the claimant.
(ff) Recommendations regarding
quality review procedures and oversight
mechanisms to monitor the impact of
aggregation on claim accuracy,
consistency, timeliness, and claimant
outcomes.
(D) Report; implementation.--
(i) In general.--Not later than 90 days
after the Secretary receives the assessment
under subparagraph (C), the Secretary shall--
(I) submit to the Committees on
Veterans' Affairs of the Senate and
House of Representatives a copy of such
assessment; and
(II) begin developing policies and
procedures to implement the
recommendations in the assessment with
respect to the authority of the Board
of Veterans' Appeals referred to in
subparagraph (C).
(ii) Deadline.--The Secretary shall
complete the development of the policies and
procedures required under clause (i)(II) and
submit to the Committees on Veterans' Affairs
of the Senate and House of Representatives a
copy of such policies and procedures not later
than six months after the date on which the
Secretary begins developing such policies and
procedures.
(E) Definitions.--In this paragraph:
(i) The term ``FFRDC'' means a federally
funded research and development center.
(ii) The term ``veterans service
organization'' means an organization recognized
by the Secretary for the representation of
veterans under section 5902 of title 38, United
States Code.
(c) Improvements to System for Adjudication of Claims for Benefits
Under Laws Administered by Secretary of Veterans Affairs.--
(1) Program for quality assurance in decisions of board of
veterans' appeals; performance reviews.--
(A) In general.--Section 7101 of title 38, United
States Code, is amended by adding at the end the
following new subsection:
``(f)(1) The Chairman shall carry out a program to ensure quality
in the decisions of the Board. Under such program, the Chairman shall--
``(A) develop policies and procedures for--
``(i) measuring quality in such decisions;
``(ii) maintaining data and identifying trends with
respect to--
``(I) errors in such decisions;
``(II) errors in decisions remanded or
returned to the Board by the Court of Appeals
for Veterans Claims; and
``(III) specific members of the Board that
issued decisions that were subsequently vacated
by the Court of Appeals for Veterans Claims;
and
``(iii) ensuring any such decision of the Board to
remand a claim for a benefit under a law administered
by the Secretary is necessary under any applicable law
or regulation;
``(B) with respect to a claim for such a benefit that is
remanded to the Board by the Court of Appeals for Veterans
Claims--
``(i) inform any employee of the Board responsible
for drafting the decision of the Board with respect to
such claim that such decision was remanded;
``(ii) provide any such employee with a copy of the
relevant order of the Court of Appeals for Veterans
Claims (including a copy of any accompanying joint
motion for remand); and
``(iii) provide incentives to such employees to
review such relevant orders and joint motions for
remand; and
``(C) ensure, to the maximum extent practicable, that any
error identified by the Board under such program is corrected
before the date on which the Board issues the final decision
associated with such error.
``(2) In developing policies and procedures to measure quality in
decisions of the Board pursuant to clause (i) of subparagraph (A) of
paragraph (1), the Chairman shall consider the data and trends
maintained and identified pursuant to clause (ii) of such subparagraph.
``(3) The Chairman may use technology, including artificial
intelligence, to maintain such data and identify such trends.
``(4) The Secretary shall submit to the Committees on Veterans'
Affairs of the House of Representatives and the Senate an annual report
on the program required by this subsection that includes, with respect
to the period covered by the report, an identification of--
``(A) elements, if any of the process of the Board for
reviewing an appeal under this chapter that lead to errors in
decisions of the Board; and
``(B) the most common reasons that a claim for a benefit
under a law administered by the Secretary was remanded to such
Board by the Court of Appeals for Veterans Claims.''.
(B) Deadline.--The Secretary shall submit the first
report required by paragraph (2) of such section (as
added by subparagraph (A)) by not later than one year
after the date of the enactment of this Act.
(2) Training program for certain employees of board of
veterans' appeals; performance reviews.--
(A) Training program.--
(i) In general.--Chapter 71 of such title
(as amended by paragraph (1)) is further
amended by inserting after section 7101A the
following new section:
``Sec. 7101B. Training program for members of Board on timely and
correct adjudication of appeals
``(a) In General.--The Secretary, in conjunction with the Chairman
of the Board of Veterans' Appeals, shall develop and carry out a
program to provide Members of the Board training on timely and correct
adjudication of appeals under this chapter.
``(b) Required Considerations.--In carrying out the program
required by subsection (a), the Secretary shall consider the following:
``(1) Feedback, if any, from members of the Board and
covered employees with respect to such program.
``(2) Data on errors in decisions of the Board maintained
pursuant to the program for quality assurance required by
subsection (f) of section 7101 of this title.
``(3) Any decision of the Court of Appeals for Veterans
Claims to remand a claim for benefits under the laws
administered by the Secretary to the Board for further action,
including a joint motion to remand such claim.
``(c) Assessments of Effectiveness.--The Secretary, in conjunction
with the Chairman of the Board of Veterans' Appeals, shall develop a
method to assess, on an annual basis, the effectiveness of the training
program under this section. In developing such method, the Secretary
shall consider best practices for assessing the effectiveness of
training programs, including the Kirkpatrick evaluation model.
``(d) Report.--The Secretary shall submit to the Committees on
Veterans' Affairs of the House of Representatives and the Senate an
annual report on the program required by subsection (a) that includes,
with respect to the period covered by the report--
``(1) a statement of the topics of the training provided
pursuant to this section, disaggregated by--
``(A) mandatory training; and
``(B) non-mandatory training; and
``(2) the results of the assessment of the effectiveness of
such program required under subsection (c).
``(e) Covered Employee Defined.--In this section, the term `covered
employee' means an employee of the Board who is--
``(1) not a member of the Board; and
``(2) responsible for drafting decisions of the Board.''.
(ii) Clerical amendment.--The table of
sections at the beginning of such chapter is
amended by inserting after the item relating to
section 7101A the following new item:
``7101B. Training program for Members of Board on timely and
correct adjudication of appeals.''.
(B) Performance reviews of members of the board.--
Section 7101A of such title is amended--
(i) in subparagraph (B) of subsection
(c)(1) by striking ``not less often than once
every three years'' and inserting ``not less
often than annually''; and
(ii) by adding at the end the following new
subsection:
``(h)(1) With respect to any performance review of a covered
employee, the Secretary may not consider the timeliness or quality of
work of any Member of the Board.
``(2) In this subsection, the term `covered employee' has the
meaning given such term in section 7101B of this title.''.
(3) Decisions of board to remand.--
(A) Information relating to decisions to remand.--
Section 7104 of such title is amended in subsection
(d)--
(i) by redesignating paragraphs (1) through
(3) as paragraphs (2) through (4),
respectively; and
(ii) by inserting before paragraph (2) (as
so redesignated), the following new paragraph:
``(1) with respect to a claim that the Board remands for
further action, a statement of the specific reasons such claim
was remanded, including any failure on the part of the
Secretary to comply with--
``(A) the Secretary's duty to assist under section
5103A of this title; and
``(B) the Secretary's duty to notify under section
5103 of this title;''.
(B) Notice of remanded decision for certain
employees.--Such section is further amended in--
(i) subsection (e)--
(I) by redesignating paragraphs (1)
through (3) as subparagraphs (A)
through (C), respectively;
(II) by striking ``After'' and
inserting ``(1) After''; and
(III) by adding at the end the
following new paragraph:
``(2) If, pursuant to a decision on an appeal, the Board remands a
claim for a benefit under a law administered by the Secretary for
further action, the Secretary shall, to the maximum extent practicable,
issue a copy of such decision to each employee of the Veterans Benefits
Administration who committed the error resulting in the decision of the
Board to remand, when applicable.''; and
(ii) in subsection (g), as redesignated by
section 3(d)(2)(A), by striking ``under
subsection (e)'' and inserting ``under
paragraph (1) of subsection (e)''.
(4) Annual reports for board of veterans' appeals.--
(A) In general.--Chapter 71 of title 38, United
States Code, is amended by inserting after section 7114
the following new section:
``Sec. 7115. Annual report on Board of Veterans' Appeals
``The Chairman of the Board shall submit to the Committees on
Veterans' Affairs of the House of Representatives and the Senate an
annual report that includes, for each decision of the Board to remand a
claim for a benefit under a law administered by the Secretary to the
Secretary for further adjudication during the period covered by the
report, a statement of the reasons for such decision of the Board,
disaggregated by decisions on--
``(1) claims with a rating decision dated on or after
February 19, 2019; and
``(2) claims with a rating decision dated before such
date.''.
(B) Deadlines.--The Secretary shall submit the
first reports required by subsections (a) and (b) of
section 7115 of such title (as added by paragraph (1))
by not later than one year after the date of the
enactment of this Act.
(C) Clerical amendment.--The table of sections at
the beginning of such chapter is amended by inserting
after the item relating to section 7114 the following
new item:
``7115. Annual report on Board of Veterans' Appeals''.
(5) Plan for improvements to quality in decisions of
board.--
(A) In general.--Not later than six months after
the date of the enactment of this Act, the Secretary of
Veterans Affairs, in consultation with the Chairman of
the Board of Veterans' Appeals and the head of the
Office of Administrative Review of the Veterans
Benefits Administration, shall develop a plan to--
(i) improve the quality of decisions of the
Board to remand, pursuant to section 7104 of
title 38, United States Code, claims for a
benefit under a law administered by the
Secretary to the Secretary for further action;
and
(ii) mitigate the number of such decisions
that are unnecessary under any applicable law
or regulation.
(B) Report.--The Secretary shall submit to the
Committees on Veterans' Affairs of the House of
Representatives and the Senate a report on such plan by
not later than six months after the date of the
enactment of this Act.
(d) Notice of Avoidable Deferrals of Claims for Benefits Under Laws
Administered by the Secretary of Veterans Affairs; Study and Report on
Certain Opinions of Department of Veterans Affairs Office of General
Counsel.--
(1) Notice of avoidable deferrals.--Not later than one year
after the date of the enactment of this Act, the Secretary of
Veterans Affairs shall develop policies, procedures, and
technological capabilities to ensure that each employee of the
Veterans Benefits Administration that commits an avoidable
deferral with respect to a claim for benefits under the laws
administered by the Secretary of Veterans Affairs in the
National Work Queue is notified of any avoidable deferrals that
such employee commits with respect to the same claim.
(2) Study and report on certain ogc opinions.--
(A) Study.--Not later than one year after the date
of the enactment of this Act, the Secretary of Veterans
Affairs, in consultation with the Office of the General
Counsel of the Department of Veterans Affairs and the
Chairman of the Board of Veterans' Appeals, shall
complete a study to identify--
(i) issues about which an opinion from the
Office of the General Counsel of the Department
would foster consistency in the decisions of
the Secretary with respect to claims for
benefits under the laws administered by the
Secretary; and
(ii) issues raised in appeals of such
decisions to the United States Court of Appeals
for Veterans Claims before the date of the
enactment of this Act about which the Office of
the General Counsel has had inconsistent
opinions in matters involving substantially
similar questions of law or fact.
(B) Report.--Not later than one year after the date
of the enactment of this Act, the Secretary of Veterans
Affairs shall submit to the Committees on Veterans'
Affairs of the Senate and House of Representatives a
report that includes--
(i) the findings of the study required by
subparagraph (A);
(ii) a statement of which issues identified
pursuant to such study about which the Office
of the General Counsel of the Department
intends to publish an opinion; and
(iii) a timeline for the publication of any
such opinion.
SEC. 106. ANNUAL REPORT ON CAUSES OF DEATH AMONG VETERANS.
(a) In General.--Subchapter II of chapter 5 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 534. Annual report on causes of death among veterans
``(a) In General.--The Secretary shall submit to the Committees on
Veterans' Affairs of the House of Representatives and the Senate an
annual report that contains data and information on causes of death
among veterans.
``(b) Elements.--Such report shall include--
``(1) for each veteran that died during the period covered
by the report an identification of--
``(A) whether such veteran had a service-connected
disability rated as total;
``(B) the primary cause of death;
``(C) the secondary cause of death, if applicable;
and
``(D) the manner of death;
``(2) for each primary cause of death identified pursuant
to paragraph (1), a statement of the total number of veterans
that died from such primary cause of death during the period
covered by the report; and
``(3) for each manner of death identified pursuant to
paragraph (1), a statement of the total number of veterans that
died in such manner during the period covered by the report.
``(c) Sunset.--This section shall terminate on the date that is
five years after the date of the enactment of the Take Care of
America's Veterans Act.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 5 of such title is amended by inserting after the item relating
to section 533 the following new item:
``534. Annual report on causes of death among veterans''.
SEC. 107. PLAN FOR USE OF AUTOMATION TOOLS TO PROCESS CLAIMS UNDER LAWS
ADMINISTERED BY THE SECRETARY OF VETERANS AFFAIRS.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit
to the Committees on Veterans' Affairs of the Senate and House of
Representatives the plan of the Secretary to make available, to the
maximum extent practicable, an automation tool described in subsection
(b) to elements of the Department of Veterans Affairs for the purpose
of processing claims under laws administered by the Secretary.
(b) Automation Tool Described.--An automation tool described in
this subsection is a technology developed for the Compensation Service
of the Veterans Benefits Administration that--
(1) automates the retrieval of the service record or health
records of a veteran;
(2) compiles evidence relevant to the determination of a
claim for benefits under laws administered by the Secretary;
(3) provides automated decision support relevant to such a
determination;
(4) automates information sharing between Federal agencies;
and
(5) assists in generating correspondence regarding such a
claim.
(c) Analysis.--In developing the plan required under subsection
(a), the Secretary shall conduct an analysis of each of the following:
(1) The feasibility and benefits of the use of an
automation tool described in subsection (b) by elements of the
Department for the purpose of processing claims under laws
administered by the Secretary.
(2) Any modification to an existing automation tool that
could render such tool usable for such purpose by such an
element.
(3) Any requirement of any such element pertaining to such
purpose that cannot be addressed by using an automation tool.
(4) The extent to which the technology offices of such
elements may need to collaborate with the technology office
responsible for developing an automation tool in the course of
the development and use of the tool by the element for such
purpose.
(5) A timeline for modifying and implementing any
automation tool for use by such elements for such purpose.
(d) Priority.--In providing or expanding an automation tool
described in subsection (b) to elements of the Department pursuant to
the plan required under subsection (a), the Secretary shall give
priority to the following elements:
(1) The Compensation Service.
(2) The Pension and Fiduciary Service of the Veterans
Benefits Administration.
(3) The Education Service of the Veterans Benefits
Administration.
(4) Program offices of the Veterans Benefits
Administration, as determined by the Secretary.
(5) The Debt Management Center.
(6) The Board of Veterans' Appeals.
(e) Other Requirements Relating to Technology at Department of
Veterans Affairs.--
(1) Automatic notices regarding benefits for certain
children of veterans.--
(A) In general.--Not later than one year after the
date of the enactment of this Act, the Secretary of
Veterans Affairs shall implement policies, processes,
and technological capabilities, including in the
National Work Queue (or successor system), to ensure
that, in the case of any covered situation, a claims
processors is made aware of, and assigned to address,
such covered situation.
(B) Definitions.--In this subsection:
(i) The term ``covered situation'' means--
(I) any increase in the amount of
dependency compensation paid to a
beneficiary for a child under the laws
administered by the Secretary; and
(II) any educational assistance
paid to the child of a veteran under
the laws administered by the Secretary.
(ii) The term ``child'' has the meaning
given such term in section 101(4)(A)(iii) of
title 38, United States Code.
(2) Correct labeling of documents.--Not later than one year
after the date of the enactment of this Act, the Secretary
shall submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a plan to ensure that
documents in the Veterans Benefits Management System (or any
successor system) are correctly labeled when such documents are
uploaded, including when such documents are labeled using
automation tools.
SEC. 108. REFORMS RELATING TO DEPARTMENT OF VETERANS AFFAIRS DISABILITY
RATINGS.
(a) Ratings for Sleep Apnea.--
(1) In general.--The Secretary of Veterans Affairs shall
revise the schedule for rating disabilities adopted and applied
under section 1155 of title 38, United States Code, as follows:
(A) A grade of disability of 0 percent shall be
assigned for sleep apnea syndrome when the syndrome is
asymptomatic, with or without treatment.
(B) A grade of disability of 10 percent shall be
assigned for sleep apnea syndrome when treatment yields
incomplete relief.
(C) A grade of disability of 50 percent shall be
assigned for sleep apnea syndrome only if--
(i) treatment is either ineffective or the
veteran is unable to use the prescribed
treatment due to comorbid conditions; and
(ii) there is no end-organ damage.
(D) A grade of disability of 100 percent shall be
assigned for sleep apnea syndrome only if there is also
end-organ damage.
(2) Qualifying comorbid conditions.--For purposes of
paragraph (1)(C)(i), a comorbid condition is a condition that,
in the opinion of a qualified medical provider, directly
impedes or prevents the use of, or implementation of, a
recognized form of treatment intervention normally shown to be
effective.
(b) Ratings for Tinnitus.--The Secretary of Veterans Affairs shall
revise the schedule for rating disabilities adopted and applied under
section 1155 of title 38, United States Code, as follows:
(1) Except as provided in paragraph (2), tinnitus may not
be assigned a separate compensable disability rating.
(2) A grade of disability of 10 percent shall be assigned
for tinnitus only when tinnitus is diagnosed as associated with
service-connected (as defined in section 101(16) of title 38,
United States Code) hearing loss that is otherwise
noncompensable under the laws administered by the Secretary.
(c) Applicability.--
(1) In general.--The revisions to the schedule for rating
disabilities adopted and applied under section 1155 of title
38, United States Code, made pursuant to this section shall
apply with respect to claims filed after the date of the
enactment of this Act.
(2) Protection of existing ratings.--The revisions to the
schedule for rating disabilities made pursuant to this section
may not serve as the basis for reducing, discontinuing, or
otherwise adversely affecting compensation that was in effect
on the day before the date of the enactment of this Act.
SEC. 109. IMPROVEMENTS TO TEMPORARY LICENSURE REQUIREMENTS FOR CONTRACT
HEALTH CARE PROFESSIONALS WHO PERFORM MEDICAL DISABILITY
EXAMINATIONS FOR THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Expansion.--Section 504 of the Veterans' Benefits Improvements
Act of 1996 (Public Law 104-275; 38 U.S.C. 5101 note), as amended by
paragraph (1) of subsection (a) of section 2002 of the Johnny Isakson
and David P. Roe, M.D. Veterans Health Care and Benefits Improvement
Act of 2020 (Public Law 116-315; 38 U.S.C. 5101 note), is further
amended, subject to the sunset in paragraph (4) of such subsection, by
striking paragraph (2) of subsection (c) and inserting the following:
``(2) Health care professional described.--A health care
professional described in this paragraph is a person who is
eligible for appointment to a position in the Veterans Health
Administration covered by section 7402(b) of title 38, United
States Code, who--
``(A) has a current and unrestricted license to
practice the health care profession for which they are
licensed;
``(B) is not barred from practicing such health
care profession in any State, the District of Columbia,
or a Commonwealth, territory, or possession of the
United States; and
``(C) is performing authorized duties for the
Department pursuant to a contract entered into under
subsection (a).
``(3) Source of funds.--Expenses of carrying out this
section, including payments for examination travel and
incidental expenses under the terms and conditions set forth by
section 111 of this title, shall be reimbursed to the accounts
available for the general operating expenses of the Veterans
Benefits Administration and information technology systems from
amounts available to the Secretary for payment of compensation
and pensions.
``(4) Mechanism for transmittal of evidence introduced by
applicants during examinations.--The Secretary shall establish
a mechanism whereby a health care professional who conducts
medical examinations or opinions under section 5103A(d) of this
title may transmit to a veteran's claims file, evidence
introduced by the applicant during a medical examination or in
conjunction with a medical opinion that examiner used to inform
such medical examination or opinion.''.
(b) Delayed Sunset of Amendment.--Paragraph (4) of subsection (a)
of section 2002 of the Johnny Isakson and David P. Roe, M.D. Veterans
Health Care and Benefits Improvement Act of 2020 (Public Law 116-315;
38 U.S.C. 5101 note) is amended by striking ``On the date that is five
years after the date of the enactment of this Act'' and inserting ``On
September 30, 2033''.
(c) Conforming Amendment.--Paragraph (2) of such subsection is
amended by striking ``physicians assistants, nurse practitioners,
audiologists, and psychologists'' and inserting ``health care
professionals''.
(d) Report.--Not later than 15 months after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit
to the Committees on Veterans' Affairs of the Senate and House of
Representatives a report regarding the use of the authority under
section 504 of the Veterans' Benefits Improvements Act of 1996 (Public
Law 104-275; 38 U.S.C. 5101 note), as temporarily amended by section
2002(a)(1) of the Johnny Isakson and David P. Roe, M.D. Veterans Health
Care and Benefits Improvement Act of 2020 (Public Law 116-315; 38
U.S.C. 5101 note) and this section. Such report shall include, with
respect to the one-year period after the date of the enactment of this
Act, the following elements:
(1) The number of examinations conducted pursuant to a
contract under such authority.
(2) The cost, timeliness, and legal adequacy of such
examinations, disaggregated by--
(A) health care professional; and
(B) contract.
(3) The number of such examinations conducted in each
State, the District of Columbia, or a Commonwealth, territory,
or possession of the United States.
(4) The numbers of each kind of health care professionals
who conducted such examinations.
(5) The number of examinations that were erroneously
conducted by a health care professional--
(A) without such a contract; or
(B) unauthorized to enter into such a contract.
(6) The plan of the Secretary to correct errors in the use
of such authority.
SEC. 110. DISABILITY EXAMINATIONS: STUDY ON ACCESS IN RURAL AREAS;
REVIEW OF TRAINING; REVIEW OF INADEQUATE OR UNNECESSARY
EXAMINATIONS.
(a) Study on Improvements to Department of Veterans Affairs Covered
Medical Disability Examinations in Rural Areas.--
(1) Study required.--Not later than one year after the date
of the enactment of this Act, the Secretary of Veterans Affairs
shall complete a study on access by veterans who reside in
rural and highly rural areas to covered medical disability
examinations.
(2) Elements.--
(A) In general.--The study conducted under
paragraph (1) shall include the following:
(i) A comparison of the average number of
days to complete covered medical disability
examinations, disaggregated by type of
examination, for veterans who reside in rural
and highly rural areas compared to an average
time for veterans who reside in other areas to
complete a covered medical disability
examination, by either contractors or employees
of the Department.
(ii) A root cause analysis of differences
identified pursuant to clause (i).
(iii) The plan of the Secretary for the
following year to improve access described in
paragraph (1), which shall include a plan for
the pursuit of a commercial or industry-
standard solution or technology that could
enable housebound veterans or veterans who live
in rural areas to receive examinations without
traveling long distances.
(B) Number of days to complete defined.--For
purposes of subparagraph (A)(i), the term ``number of
days to complete'' means the number of days in the
period--
(i) beginning on the date on which a
contractor or employee of the Department
received a request from the Secretary to
conduct a covered medical disability
examination; and
(ii) ending on the date on which the
examination was completed.
(3) Report on study.--Not later than one year 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 findings of the Secretary with respect to the
study completed under paragraph (1).
(4) Definitions.--In this subsection:
(A) The term ``covered medical disability
examination'' means a medical nexus examination or
medical opinion for the purposes of adjudicating a
claim for a benefit under chapter 11 or 15 of title 38,
United States Code, regardless of whether conducted by
an employee or a contractor of the Department.
(B) The terms ``rural'' and ``highly rural'' have
the meanings given those terms under the rural-urban
commuting areas coding system of the Department of
Agriculture.
(b) Review of Training for Veterans Service Representatives and
Rating Veterans Service Representatives.--
(1) Review required.--The Secretary of Veterans Affairs
shall conduct a comprehensive review of the training provided
to Veterans Service Representatives (VSRs) and Rating Veterans
Service Representatives (RVSRs) regarding covered medical
disability examinations for the purpose of claims adjudication.
(2) Scope of review.--The review shall include, at minimum,
an evaluation of training and policies relating to--
(A) assessing the adequacy of covered medical
disability examinations for claims adjudication;
(B) determining the necessity of medical disability
examinations where claims can be adjudicated based on
existing evidence without ordering additional
examinations;
(C) relevant statutes, judicial decisions,
regulations, and Department policies, including--
(i) the duty to assist claimants;
(ii) evidentiary standards regarding
causation;
(iii) required elements and standards for
covered medical disability examinations,
including the need for reasoned medical
opinions; and
(iv) the absence of statutory or regulatory
presumptions of service connection in covered
medical disability examinations; and
(D) input from impacted Department employees,
including duly appointed labor representatives.
(3) Second-level review for new employees.--The Secretary
shall evaluate the effectiveness of current policies requiring
a second level of review of claims decisions made by new
Veterans Service Representatives and Rating Veterans Service
Representatives before such employees are authorized to order
covered medical disability examinations, including any
applicable accuracy thresholds.
(4) Report to congress.--Not later than 180 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 detailing the findings of the Secretary with respect
to the review conducted under paragraph (1), the data used by
the Secretary to support such findings, and such
recommendations as the Secretary may have for improvements to
training or policies.
(5) Comptroller general of the united states review of
findings.--Not later than 180 days after the date on which the
Secretary submits the report under paragraph (4), the
Comptroller General of the United States shall conduct a review
of the findings and recommendations contained in the report.
(6) Modification of reports by the board of veterans'
appeals and united states court of appeals for veterans
claims.--
(A) Board of veterans' appeals.--Section 7101(d)(2)
of title 38, United States Code, is amended--
(i) in subparagraph (F), by striking ``;
and'' and inserting a semicolon;
(ii) in subparagraph (G), by striking the
period at the end and inserting ``; and''; and
(iii) by adding at the end the following
new subparagraph:
``(H) a summary of recurring issues that result in
the Board remanding appeals back to the agency of
original jurisdiction.''.
(B) United states court of appeals for veterans
claims.--Section 7288(b) of title 38, United States
Code, is amended by adding at the end the following new
paragraph:
``(16) A summary of recurring issues that result in
remands.''.
(7) Definition of covered medical disability examination.--
In this subsection, the term ``covered medical disability
examination'' means a medical examination or medical opinion
that the Secretary determines necessary for the purposes of
adjudicating a claim for a benefit under chapter 11 or 15 of
title 38, United States Code, regardless of whether conducted
by an employee or a contractor of the Department.
(c) Review and Priority Processing of Claims With Inadequate or
Unnecessary Examinations.--
(1) Review.--Not later than 1 year after the date of the
enactment of this Act and not less frequently than once every
three months thereafter, the Secretary of Veterans Affairs
shall review a random and representative sample of all covered
medical disability examinations completed during the previous
three-month period.
(2) Further sample requirements.--Under each review
required by paragraph (1), the Secretary shall ensure the
review includes--
(A) a statistically significant sample of covered
medical disability examinations completed by employees
of the Department of Veterans Affairs; and
(B) a statistically significant sample of covered
medical disability examinations completed by each
contractor that provides such examinations for the
Department.
(3) Analysis.--Under each review required by paragraph (1),
the Secretary shall--
(A) analyze the samples specified in paragraph (2);
and
(B) pursuant to such analysis, identify--
(i) the percentage of examinations that
were adequate for purposes of adjudicating the
particular claim for a benefit under chapter 11
or 15 of title 38, United States Code, for
which the examination was ordered by the
Department; and
(ii) the percentage of examinations
considered overdeveloped for purposes of
adjudicating claims for a benefit under chapter
11 or 15 of title 38, United States Code, for
which the examination was ordered by the
Department.
(4) Priority processing.--
(A) In general.--Except as provided for in
subparagraph (B), if during a review under paragraph
(1) the Secretary finds any covered medical disability
examination to be not adequate for adjudicating a
claim, the Secretary shall ensure the claimant examined
by that examination--
(i) receives another examination, if
necessary, on a priority basis; and
(ii) receives priority processing for the
entirety of impacted claim.
(B) Exception.--The Secretary is not required to
furnish an additional examination under subparagraph
(A) if the Secretary determines such an examination to
be unnecessary for purposes of adjudicating the claim.
(5) Comptroller general of the united states study.--The
Comptroller General of the United States shall conduct a review
of the methodology and effectiveness of the Departments review
required in paragraph (1).
(6) Covered medical disability examination defined.--In
this subsection, the term ``covered medical disability
examination'' means a medical examination or opinion for the
purposes of adjudicating a claim for a benefit under chapter 11
or 15 of title 38, United States Code, regardless of whether
conducted by an employee or a contractor of the Department.
(d) Review and Plan Regarding Department of Veterans Affairs
Scheduling of Medical Examinations.--
(1) Review required.--Not later than one year after the
date of the enactment of this Act, the Secretary of Veterans
Affairs shall complete a review of scheduling request tools,
contracts, and systems used by employees and contractors of the
Department of Veterans Affairs to order and conduct medical
disability examinations.
(2) Plan required.--Not later than one year 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 to
ensure the following:
(A) Systems and processes used by the Department
enable seamless and clear communication of requirements
between the claims processors who request medical
disability examinations and the persons who conduct
such examinations, including through a contract.
(B) Medical disability examiners, including through
a contract, have access to the medical records and
claims information they need to conduct exams that are
adequate for purposes of rating claims for benefits
under laws administered by the Secretary.
(C) Claimants or appellants for whom a medical
disability examination is requested of the Department
have agency in determining when and where the
examination is conducted.
(D) Claimants or appellants for whom a medical
disability examination is requested of the Department
have a seamless experience when scheduling their
examinations without regard to who conducts the
examinations.
(E) The Department conducts customer satisfaction
and experience surveys of claimants or appellants who
attend medical disability examinations provided under
laws administered by the Secretary.
SEC. 111. IMPROVEMENTS TO PROCESSING AND OUTREACH REGARDING CLAIMS
INVOLVING MILITARY SEXUAL TRAUMA.
(a) Evaluation of Claims Involving Military Sexual Trauma.--
(1) In general.--Subchapter VI of chapter 11 of such title
is amended by inserting after section 1166 the following new
section:
``Sec. 1166A. Evaluation of claims involving military sexual trauma
``(a) Notice and Opportunity to Supply Evidence.--The Secretary may
not deny a claim of a veteran for compensation under this chapter for
military sexual trauma without first--
``(1) advising the veteran of the evidence that would
constitute credible corroborating evidence of the military
sexual trauma; and
``(2) allowing the veteran an opportunity to furnish such
corroborating evidence.
``(b) Point of Contact.--The Secretary shall ensure that each
document provided to a veteran relating to a claim for compensation
under this chapter for a military sexual trauma includes contact
information for an appropriate point of contact with the Department.
``(c) Specialized Teams.--The Secretary shall ensure that all
claims for compensation under this chapter for a military sexual trauma
are reviewed and processed by a specialized team established under
section 1166 of this title.
``(1) The Secretary shall ensure that not less than
annually, the policies and procedures employed by the
specialized team established under section 1166 of this title
are reviewed by medical or mental health professionals as the
Secretary considers appropriate to determine whether the
current standard of evidentiary review for acceptable
documentation adequately evaluates the likelihood a military
sexual trauma occurred.
``(2) The Secretary shall also conduct periodic quality
reviews of claims processed by the specialized teams
established under section 1166 to identify inconsistencies,
training deficiencies, or procedural shortcomings and implement
corrective actions as appropriate.''.
(2) Outreach.--
(A) In general.--Not later than 180 days after the
date of the enactment of this Act, the Secretary of
Veterans Affairs shall implement, with input from the
veteran community, an informative outreach program for
veterans regarding the standard of proof for evaluation
of claims relating to military sexual trauma, including
requirements for a medical examination and opinion.
(B) Targeted outreach.--In implementing the program
under subparagraph (A), the Secretary shall, to the
extent practicable, target outreach to veterans who
submitted a claim relating to military sexual trauma
that was denied.
(3) Clerical amendment.--The table of sections at the
beginning of chapter 11 of such title is amended by inserting
after the item relating to section 1166 the following new item:
``1166A. Evaluation of claims involving military sexual trauma.''.
(b) Communications From the Department of Veterans Affairs to
Individuals Who Have Experienced Military Sexual Trauma.--
(1) Review working group.--
(A) In general.--The Secretary of Veterans Affairs
shall establish a working group to review
correspondence relating to military sexual trauma.
(B) Membership.--The working group established
under subparagraph (A) shall be composed of members who
shall be appointed by the Secretary from among
employees of the Department of Veterans Affairs who are
experts in military sexual trauma and mental health, of
whom--
(i) one or more shall be appointed from
among mental health providers of the Veterans
Health Administration;
(ii) one or more shall be appointed from
among experts on sexual assault and sexual
harassment of the Veterans Benefits
Administration; and
(iii) one or more shall be appointed from
among experts on sexual assault and sexual
harassment of the Board of Veterans' Appeals.
(C) Duties.--The working group established under
subparagraph (A) shall--
(i) review standard correspondence, which
may include templates for notices under
sections 5103, 5104, 5104B, and 7104 of title
38, United States Code, from the Department to
individuals who have experienced military
sexual trauma for sensitivity; and
(ii) ensure that the correspondence--
(I) treats such individuals with
dignity and respect; and
(II) does not re-traumatize such
individuals.
(D) Individual who has experienced military sexual
trauma defined.--In this subsection, the term
``individual who has experienced military sexual
trauma'' means--
(i) an individual who has filed a claim for
compensation under chapter of title 38, United
States Code, relating to military sexual
trauma;
(ii) a veteran who has been awarded
compensation under such chapter relating to
military sexual trauma; or
(iii) a member of the Armed Forces
(including a member of the National Guard or
Reserves), a former member of the Armed Forces,
or a veteran who is receiving care from the
Department relating to military sexual trauma.
(2) Contents of certain written communications to
individuals who have experienced military sexual trauma.--
(A) Notice to claimants of required information and
evidence.--Section 5103 of title 38, United States
Code, is amended by adding at the end the following new
subsection:
``(c) Written Communications to Individuals Who Have Experienced
Military Sexual Trauma.--
``(1) The Secretary shall ensure that any written
communication under this section from the Department to an
individual who has experienced military sexual trauma includes
each of the following:
``(A) Contact information for each of the
following:
``(i) The military sexual trauma
coordinator of the Veterans Benefits
Administration.
``(ii) The military sexual trauma
coordinator of the Veterans Health
Administration.
``(iii) The Veterans Crisis Line.
``(iv) The facility of the Veterans Health
Administration closest to where the individual
resides.
``(v) The Readjustment Counseling Service
location closest to where the individual
resides.
``(B) Information on the eligibility of the
individual for services provided through the
Readjustment Counseling Service location described in
subparagraph (A)(v).
``(2) In this subsection:
``(A) The term `individual who has experienced
military sexual trauma' means--
``(i) an individual who has filed a claim
for compensation under chapter 11 of this title
relating to military sexual trauma;
``(ii) a veteran who has been awarded
compensation under such chapter relating to
military sexual trauma; or
``(iii) a member of the Armed Forces
(including a member of the National Guard or
Reserves), a former member of the Armed Forces,
or a veteran who is receiving care from the
Department relating to military sexual trauma.
``(B) The term `military sexual trauma' has the
meaning given that term in section 1166(d)(2) of this
title.
``(C) The term `Veterans Crisis Line' means the
toll-free hotline for veterans established under
section 1720F(h) of this title.''.
(B) Decisions and notices of decisions.--Section
5104 of title 38, United States Code, is amended by
adding at the end the following new subsection:
``(e)(1) The Secretary shall ensure that any written communication
under this section from the Department to an individual who has
experienced military sexual trauma includes each of the following:
``(A) Contact information for each of the following:
``(i) The military sexual trauma coordinator of the
Veterans Health Administration.
``(ii) The Veterans Crisis Line.
``(iii) The facility of the Veterans Health
Administration closest to where the individual resides.
``(iv) The Readjustment Counseling Service location
closest to where the individual resides.
``(B) Information on the eligibility of the individual for
services provided through the Readjustment Counseling Service
location described in subparagraph (A)(iv).
``(2) The Secretary shall ensure that any written communication
under this section from the Department to an individual who has
experienced military sexual trauma that includes notification of an
award of compensation under chapter 11 of this title relating to
military sexual trauma includes--
``(A) the contact information described in paragraph (1);
and
``(B) the contact information for the military sexual
trauma coordinator of the Veterans Benefits Administration.
``(3) In this subsection:
``(A) The term `individual who has experienced military
sexual trauma' means--
``(i) an individual who has filed a claim for
compensation under chapter 11 of this title relating to
military sexual trauma;
``(ii) a veteran who has been awarded compensation
under such chapter relating to military sexual trauma;
or
``(iii) a member of the Armed Forces (including a
member of the National Guard or Reserves), a former
member of the Armed Forces, or a veteran who is
receiving care from the Department relating to military
sexual trauma.
``(B) The term `military sexual trauma' has the meaning
given that term in section 1166(d)(2) of this title.
``(C) The term `Veterans Crisis Line' means the toll-free
hotline for veterans established under section 1720F(h) of this
title.''.
(C) Higher-level review by the agency of original
jurisdiction.--Section 5104B of title 38, United States
Code, is amended by adding at the end the following new
subsection:
``(f) Written Communications to Individuals Who Have Experienced
Military Sexual Trauma.--
``(1) The Secretary shall ensure that any written
communication under this section from the Department to an
individual who has experienced military sexual trauma includes
each of the following:
``(A) Contact information for each of the
following:
``(i) The military sexual trauma
coordinator of the Veterans Health
Administration.
``(ii) The Veterans Crisis Line.
``(iii) The facility of the Veterans Health
Administration closest to where the individual
resides.
``(iv) The Readjustment Counseling Service
location closest to where the individual
resides.
``(B) Information on the eligibility of the
individual for services provided through the
Readjustment Counseling Service location described in
subparagraph (A)(iv).
``(2) The Secretary shall ensure that any written
communication under this section from the Department to an
individual who has experienced military sexual trauma that
includes notification of an award of compensation under chapter
11 of this title relating to military sexual trauma includes--
``(A) the contact information described in
paragraph (1); and
``(B) the contact information for the military
sexual trauma coordinator of the Veterans Benefits
Administration.
``(3) In this subsection:
``(A) The term `individual who has experienced
military sexual trauma' means--
``(i) an individual who has filed a claim
for compensation under chapter 11 of this title
relating to military sexual trauma;
``(ii) a veteran who has been awarded
compensation under such chapter relating to
military sexual trauma; or
``(iii) a member of the Armed Forces
(including a member of the National Guard or
Reserves), a former member of the Armed Forces,
or a veteran who is receiving care from the
Department relating to military sexual trauma.
``(B) The term `military sexual trauma' has the
meaning given that term in section 1166(d)(2) of this
title.
``(C) The term `Veterans Crisis Line' means the
toll-free hotline for veterans established under
section 1720F(h) of this title.''.
(D) Board of veterans' appeals.--Section 7104 of
title 38, United States Code, is amended by adding at
the end the following new subsection:
``(g)(1) The Secretary shall ensure that any written communication
under this section from the Department to an individual who has
experienced military sexual trauma include each of the following:
``(A) Contact information for each of the following:
``(i) The military sexual trauma coordinator of the
Veterans Health Administration.
``(ii) The Veterans Crisis Line.
``(iii) The facility of the Veterans Health
Administration closest to where the individual resides.
``(iv) The Readjustment Counseling Service location
closest to where the individual resides.
``(B) Information on the eligibility of the individual for
services provided through the Readjustment Counseling Service
location described in subparagraph (A)(iv).
``(2) The Secretary shall ensure that any written communication
under this section from the Department to an individual who has
experienced military sexual trauma that includes notification of an
award of compensation under chapter 11 of this title relating to
military sexual trauma includes--
``(A) the contact information described in paragraph (1);
and
``(B) the contact information for the military sexual
trauma coordinator of the Veterans Benefits Administration.
``(3) In this subsection:
``(A) The term `individual who has experienced military
sexual trauma' means--
``(i) an individual who has filed a claim for
compensation under chapter 11 of this title relating to
military sexual trauma;
``(ii) a veteran who has been awarded compensation
under such chapter relating to military sexual trauma;
or
``(iii) a member of the Armed Forces (including a
member of the National Guard or Reserves), a former
member of the Armed Forces, or a veteran who is
receiving care from the Department relating to military
sexual trauma.
``(B) The term `military sexual trauma' has the meaning
given that term in section 1166(d)(2) of this title.
``(C) The term `Veterans Crisis Line' means the toll-free
hotline for veterans established under section 1720F(h) of this
title.''.
(c) Study on Training and Processing Relating to Claims for
Disability Compensation Relating to Military Sexual Trauma.--
(1) Study required.--The Secretary of Veterans Affairs
shall conduct a study on--
(A) the quality of training provided to personnel
of the Department of Veterans Affairs who review claims
for disability compensation under chapter 11 of title
38, United States Code, for disabilities relating to
military sexual trauma; and
(B) the quality of the procedures of the Department
for reviewing the accuracy of the processing of such
claims.
(2) Elements.--The study required by subsection (a) shall
include the following:
(A) With respect to the quality of training
described in paragraph (1) of such subsection:
(i) Whether the Department ensures
personnel complete such training on time.
(ii) Whether the training has resulted in
improvements to the processing of claims
described in such subsection and issue-based
accuracy.
(iii) Such recommendations as the Secretary
may have for improving the training.
(B) With respect to the quality of procedures
described in paragraph (2) of such subsection:
(i) Whether the procedures of the
Department for reviewing the accuracy of the
processing of claims described in such
subsection comport with generally accepted
statistical methodologies to ensure reasonable
accuracy of such reviews.
(ii) Whether such procedures adequately
include mechanisms to correct errors found in
such reviews.
(iii) A summary of quality assurance
reviews and reports conducted as part of such
procedures.
(iv) Such recommendations as the Secretary
may have for improving such procedures.
(3) Report required.--Not later than one year 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 detailing the findings of the Secretary with respect
to the study conducted under paragraph (1).
(d) Annual Special Focus Review of Claims for Disability
Compensation for Disabilities Relating to Military Sexual Trauma.--
(1) Annual special focus review.--
(A) In general.--Each year, the Under Secretary for
Benefits of the Department of Veterans Affairs shall
conduct a special focus review on the accuracy of the
processing of claims for disability compensation under
chapter 11 of title 38, United States Code, for
disabilities relating to military sexual trauma.
(B) Elements.--Each review conducted under
subparagraph (A) shall include a review of the
following:
(i) A statistically significant, nationally
representative sample of all claims for
benefits under the laws administered by the
Secretary of Veterans Affairs relating to
military sexual trauma filed during the fiscal
year preceding the fiscal year in which the
report is submitted.
(ii) The accuracy of each decision made
with respect to each claim described in clause
(i).
(iii) The types of benefit entitlement
errors found, disaggregated by category.
(iv) Trends from year to year.
(v) Training completion rates for personnel
of the Department who process claims described
in subparagraph (A).
(2) Reprocessing of claims.--If the Under Secretary finds,
pursuant to a special focus review conducted under paragraph
(1)(A), that an error was made with respect to the entitlement
of a veteran to a benefit under the laws administered by the
Secretary, the Secretary shall return the relevant claim of the
veteran to the appropriate office of the Department for
reprocessing to ensure that the veteran receives an accurate
decision with respect to the claim.
(3) Report.--Section 5501(b) of the Johnny Isakson and
David P. Roe, M.D. Veterans Health Care and Benefits
Improvement Act of 2020 (Public Law 116-315; 134 Stat. 5048) is
amended--
(A) in paragraph (1), by striking ``through 2027''
and inserting ``until the date described in section
109(d)(4) of the Take Care of America's Veterans Act'';
and
(B) in paragraph (2), by adding at the end the
following new subparagraph:
``(I) The findings of the most recent special focus
review conducted under subsection (d)(1)(A) of section
109 of the Take Care of America's Veterans Act,
including--
``(i) the elements under subsection
(d)(1)(B) of such section;
``(ii) the number of claims returned for
reprocessing under subsection (d)(2) of such
section; and
``(iii) the number of claims described in
clause (ii) for which the decision relating to
service-connection or entitlement to
compensation changed as a result of
reprocessing the claim.''.
(4) Sunset.--On the date that is 5 years after the
enactment of this Act, paragraph (1)(A) shall cease to be in
effect.
(e) Working Group on Medical Examinations for Claims for Disability
Compensation for Disabilities Relating to Military Sexual Trauma.--
(1) In general.--Not later than 90 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall establish a working group on medical examinations for
claims for disability compensation under chapter 11 of title
38, United States Code, for disabilities relating to military
sexual trauma (in this section referred to as the ``working
group'').
(2) Membership.--The working group shall be composed of the
following:
(A) Staff of the operations center for military
sexual trauma of the Department of Veterans Affairs who
have experience reviewing the quality of medical
examinations in support of claims for disability
compensation under chapter 11 of title 38, United
States Code.
(B) Staff of the Medical Disability Examination
Office of the Department.
(C) Veterans service officers who have experience
with claims described in paragraph (1).
(D) Medical examiners who have experience with such
claims.
(E) Staff of the Veterans Experience Office of the
Department.
(F) Such other individuals as the Secretary
considers appropriate.
(3) Duties.--Not later than 180 days after the date of the
enactment of this Act, the working group shall--
(A) review the quality of medical examinations
described in paragraph (1);
(B) review the feasibility of minimizing re-
examinations for conditions relating to military sexual
trauma; and
(C) submit to the Under Secretary for Benefits of
the Department and the Secretary recommendations on how
to--
(i) eliminate re-traumatization of
individuals who file claims described in
paragraph (1); and
(ii) reduce the overdevelopment of such
claims.
(4) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary shall submit to Congress a
report that includes the following:
(A) The views of the working group on efforts by
the Department to eliminate re-traumatization of
individuals who file claims described in subsection
(a).
(B) Legislative proposals to improve the experience
of such individuals in pursuing such claims.
(C) The recommendations submitted under paragraph
(3)(C).
(D) The plan of the Under Secretary for Benefits of
the Department and the Secretary to implement such
recommendations.
(5) Review and implementation.--Not later than one year
after the date of the enactment of this Act, the Under
Secretary for Benefits of the Department and the Secretary
shall--
(A) review the recommendations submitted under
paragraph (3)(C); and
(B) implement the recommendations that, as
determined by the Under Secretary and the Secretary,
would improve the claims process for individuals who
file claims described in paragraph (1).
(f) Military Sexual Trauma Claims Performance Dashboard.--
(1) Establishment.--The Secretary of Veterans Affairs shall
establish an interactive performance dashboard displaying
information about claims relating to military sexual trauma
submitted to the Secretary for benefits under laws administered
by the Secretary.
(2) Elements.--The dashboard established pursuant to
paragraph (1) shall cover the following:
(A) Claims relating to military sexual trauma
submitted to the Secretary for benefits under laws
administered by the Secretary that have been submitted,
completed, or appealed, including appeals pending at
the agency of jurisdiction and at the Board of
Veterans' Appeals.
(B) For comparison purposes with subparagraph (A),
claims not relating to military sexual trauma submitted
to the Secretary for benefits under laws administered
by the Secretary that have been submitted, completed,
or appealed.
(C) Overall, cumulative information relating to
claims relating to military sexual trauma submitted to
the Secretary for benefits under laws administered by
the Secretary, including the following:
(i) Average number of days a claim is
pending review.
(ii) Average number of days for completed
adjudication.
(iii) Total number of pending claims,
disaggregated by whether the claims have been
partially adjudicated or not adjudicated at
all.
(iv) Total number of claims completely
adjudicated.
(v) Of the number specified in clause (iv),
the percentage that were approved, denied, or
appealed.
(D) The total number of claims relating to military
sexual trauma submitted to the Secretary for benefits
under laws administered by the Secretary.
(E) The methods used for submittal of claims
relating to military sexual trauma to the Secretary for
benefits under laws administered by the Secretary.
(F) The most frequent reasons the Secretary denies
a claim relating to military sexual trauma submitted to
the Secretary for a benefit under a law administered by
the Secretary.
(G) The most frequent conditions or disabilities
for which a claim relating to military sexual trauma is
denied.
(H) The most frequent conditions or disabilities
for which a claim relating to military sexual trauma is
submitted to the Secretary for disability compensation
under chapter 11 of title 38, United States Code,
including the grant rate for such contentions.
(3) Additional resource information.--The Secretary shall
make available via the performance dashboard established
pursuant to subsection (a) the following information:
(A) Veterans Crisis Line contact information.
(B) Information regarding the availability of
services from military sexual trauma coordinators of
the Veterans Health Administration.
(C) Information regarding the availability of
services from military sexual trauma coordinators of
the Veterans Benefits Administration.
(D) Information on availability of specialized
care, services, and benefits from the Department for
individuals who have experienced military sexual
trauma.
(E) Such additional information as the Secretary
considers appropriate.
(4) Availability.--The Secretary shall ensure that the
dashboard established pursuant to paragraph (1) is available to
the public from the website of the Department of Veterans
Affairs and is updated not less frequently than once every 30
days.
(5) Reporting requirements.--(A) Not later than 2 years
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 detailing--
(i) the annual cost to implement the dashboard
required by paragraph (2);
(ii) areas for improvement of the dashboard; and
(iii) such additional information as the Secretary
considers appropriate.
(B) Not later than 180 days after the date of the enactment
of this Act, the Secretary shall commence providing, on a
quarterly basis, to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a quarterly briefing on the Department's
processing of military sexual trauma-related claims.
(6) Definition.--In this section, the term ``military
sexual trauma'' has the meaning given such term in section
1166(d)(2) of title 38, United States Code.
SEC. 112. INDEPENDENT ASSESSMENT OF NOTICES THAT THE SECRETARY OF
VETERANS AFFAIRS SENDS TO CLAIMANTS.
(a) Agreement.--Not later than 30 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall seek to
enter into an agreement with an FFRDC for an assessment of notices that
the Secretary sends to claimants.
(b) Assessment.--An FFRDC that enters into an agreement under
subsection (a) shall submit to the Secretary a written assessment of
such notices. The assessment shall include the following:
(1) The determination of the FFRDC, made in consultation
with covered entities, whether each such notice may be feasibly
altered to reduce paper consumption by, and costs to, the
Federal Government.
(2) The recommendations of the FFRDC regarding how the
Secretary may make such notices clearer to claimants, better
organized, and more concise.
(c) Report; Implementation.--Not later than 90 days after the
Secretary receives the assessment under subsection (b), the Secretary
shall--
(1) submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a copy of such assessment;
and
(2) implement the recommendations in the assessment that
are in compliance with the laws administered by the Secretary.
(d) Deadline for Implementation.--The Secretary shall complete the
implementation of such recommendations pursuant to subsection (c)(2) by
not later than one year after the date on which the Secretary commences
such implementation.
(e) Definitions.--In this section:
(1) The term ``FFRDC'' means a federally funded research
and development center.
(2) The term ``covered entities'' includes--
(A) the Secretary of Veterans Affairs;
(B) an expert in laws administered by the Secretary
of Veterans Affairs;
(C) a veterans service organization recognized
under section 5902 of title 38, United States Code;
(D) an entity that advocates for veterans; and
(E) an entity that advocates for the survivors of
veterans.
(3) The terms ``claimant'' and ``notice'' have the meanings
given such terms in section 5100 of title 38, United States
Code.
SEC. 113. INDEPENDENT ASSESSMENT OF FORMS THAT THE SECRETARY OF
VETERANS AFFAIRS SENDS TO CLAIMANTS.
(a) Agreement.--Not later than 30 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall seek to
enter into an agreement with an FFRDC for an assessment of forms that
the Secretary sends to claimants.
(b) Assessment.--An FFRDC that enters into an agreement under
subsection (a) shall submit to the Secretary a written assessment, made
in consultation with covered entities, of such forms. The assessment
shall include the recommendations of the FFRDC regarding how the
Secretary may make such forms clearer to claimants and better
organized.
(c) Report; Implementation.--Not later than 90 days after the
Secretary receives the assessment under subsection (b), the Secretary
shall--
(1) submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a copy of such assessment;
and
(2) implement the recommendations in the assessment that
are in compliance with the laws administered by the Secretary.
(d) Deadline for Implementation.--The Secretary shall complete the
implementation of such recommendations pursuant to subsection (c)(2) by
not later than two years after the date on which the Secretary
commences such implementation.
(e) Definitions.--In this section:
(1) The term ``FFRDC'' means a federally funded research
and development center.
(2) The term ``covered entities'' includes--
(A) the Secretary of Veterans Affairs;
(B) an expert in laws administered by the Secretary
of Veterans Affairs;
(C) a veterans service organization recognized
under section 5902 of title 38, United States Code;
(D) an entity that advocates for veterans; and
(E) an entity that advocates for survivors of
veterans.
(3) The term ``claimant'' has the meaning given such term
in section 5100 of title 38, United States Code.
TITLE II--EDUCATION AND ECONOMIC OPPORTUNITY
SEC. 201. VETS OPPORTUNITY ACT.
(a) Repayment of Members of the Armed Forces for Contributions
Towards Post-9/11 Educational Assistance: Timing; Mechanism for
Individuals Not Eligible for a Monthly Housing Stipend.--
(1) In general.--Subsection (f) of section 3327 of title
38, United States Code, is amended--
(A) in paragraph (3), by striking ``together'' and
all that follows through ``before'' and inserting ``not
later than 60 days after''; and
(B) by adding at the end the following new
paragraph:
``(4) Additional assistance for an individual not eligible
for a monthly housing stipend.--In the case of an individual
making an election under subsection (a) who is described by
subparagraph (A), (C), or (E) of paragraph (1) of that
subsection, and who is not eligible for a monthly stipend
payable under section 3313(c) of this title, the educational
assistance payable to the individual under this chapter shall
be paid--
``(A) in a lump sum calculated by multiplying--
``(i) the total amount of contributions
described in paragraph (1)(A) with regards to
such individual; and
``(ii) the sum of the number of months
described in subclauses (I) and (II) of
paragraph (1)(B)(i) with regards to such
individual; and
``(B) to the individual not later than 60 days
after the exhaustion of the individual's entitlement to
educational assistance under this chapter.''.
(2) Technical corrections and conforming amendment.--Such
subsection is further amended--
(A) by striking ``paragraphs (2) through (7)'' and
inserting ``paragraphs (2) through (6)''; and
(B) in paragraph (1), in the heading, by inserting
``for an individual eligible for a monthly housing
stipend'' after ``Additional assistance''.
(3) Effective date.--The amendments made by this section
shall take effect on August 1, 2027.
(b) Treatment of Certain Independent Study Programs Under
Educational Assistance Programs of Department of Veterans Affairs.--
(1) In general.--Section 3680A(a)(4)(A)(ii)(III) of such
title is amended--
(A) by inserting ``that requires regular and
substantive interaction between students and
instructors'' after ``course of study'';
(B) in item (aa), by striking ``; or'' and
inserting a semicolon;
(C) in item (bb), by striking ``; and'' and
inserting ``; or''; and
(D) by adding at the end by following new item:
``(cc) an institution of
higher education, as such term
is defined in section 102 of
the Higher Education Act of
1965 (20 U.S.C. 1002), that is
approved to participate or is
participating in the student
financial assistance programs
authorized by title IV of that
Act; and''.
(2) Applicability.--The amendment made by paragraph (1)
shall apply with respect to a quarter, semester, or term, as
applicable, that begins on or after August 1, 2027.
(3) Oversight.--During the first six years beginning on the
date of enactment of this Act, the Secretary, in coordination
with State approving agencies, shall, every two years, conduct
risk-based surveys or reviews of institutions approved pursuant
to section 3680A(a)(4)(A)(ii)(III)(cc) of title 38, United
States Code, as added by paragraph (1).
(4) GAO report.--Not later than 3 years after the date of
enactment of this Act, the Comptroller General of the United
States shall submit to the Committees on Veterans' Affairs of
the Senate and House of Representatives a report on the
oversight and implementation of the amendments made by
paragraph (1), including--
(A) the effectiveness of oversight activities
conducted by the Department of Veterans Affairs and
State approving agencies;
(B) institutional compliance with applicable
requirements under chapter 36 of title 38, United
States Code;
(C) participation and outcomes of veterans enrolled
in programs approved pursuant to section
3680A(a)(4)(A)(ii)(III)(cc) of such title, as added by
paragraph (1); and
(D) any recommendations to improve oversight,
program integrity, or educational outcomes for
veterans.
(5) Applicability.--To the extent practicable for any
program requiring practical, laboratory, clinical, shop, or
hands on competencies, the online portion of instruction may
not substitute for the supervised in person training necessary
to demonstrate such competencies.
(c) Absence From Certain Education Due to Certain Service.--
(1) Options.--Section 3691A of such title is amended by
striking paragraph (1) of subsection (a) and inserting the
following:
``(1) A covered member may, after receiving orders to enter a
period of covered service--
``(A) withdraw from covered education;
``(B) take a leave of absence from covered education; or
``(C) subject to subsection (d), enter into an agreement
with the institution concerned to complete a course of covered
education to the satisfaction of such institution concerned.''.
(2) Conforming amendment.--Such subsection is further
amended, in paragraph (2)(A), by striking ``or takes a leave of
absence'' and inserting ``, takes a leave of absence, or enters
into an agreement''.
(3) Agreement.--Such section is further amended--
(A) by redesignating subsection (d) as subsection
(e); and
(B) by inserting, after subsection (c), the
following new subsection (d):
``(d) Agreement With Institution Concerned.--A covered member may
enter into an agreement under subsection (a) only if the covered member
has completed at least half of a course of covered education.''.
(4) Section heading.--Such section is further amended by
striking the heading and inserting ``Absence from certain
education due to certain service''.
(5) Table of sections.--The table of sections at the
beginning of chapter 36 of such title is amended by striking
the item relating to section 3691A and inserting the following
new item:
``3691A. Absence from certain education due to certain service.''.
(d) Department of Veterans Affairs Compliance Surveys.--Section
3693 of such title is amended--
(1) in subsection (c)--
(A) by striking ``not more than 10 business days of
notice'';
(B) by striking ``this section.'' and inserting
``this section--''; and
(C) by adding at the end the following new
paragraphs:
``(1) in the case of an educational institution or training
establishment with a time stamp database collection feature,
not fewer than 10, and not more than 15, business days of
notice; and
``(2) in the case of any other educational institution or
training establishment, not more than 10 business days of
notice.''; and
(2) by striking subsection (d) and inserting the following
new subsection (d):
``(d) Definitions.--In this section:
``(1) The terms `educational institution' and `training
establishment' have the meanings given such terms in section
3452 of this title.
``(2) The term `school certifying official' means an
employee of an educational institution with primary
responsibility for certifying veteran enrollment at the
educational institution.''.
(e) Notification of School Certifying Officials of Handbook
Updates.--
(1) In general.--Not later than 14 business days after
updating the school certifying official handbook of the
Department of Veterans Affairs, the Secretary of Veterans
Affairs shall provide notice to all school certifying officials
of such update.
(2) School certifying official defined.--The term ``school
certifying official'' means an employee of an educational
institution with primary responsibility for certifying veteran
enrollment at the educational institution.
SEC. 202. IMPROVEMENTS TO PROCESS FOR MAKING PAYMENTS TO AUTOMOBILE
SELLERS FOR AUTOMOBILES PURCHASED FOR CERTAIN DISABLED
VETERANS.
(a) Timeliness of Payments.--Section 3902 of title 38, United
States Code, is amended, in subsection (a)--
(1) by inserting ``(1)'' before ``The Secretary''; and
(2) by adding at the end the following new paragraph:
``(2) The Secretary shall--
``(A) make payments under this section in compliance with
regulations prescribed under section 3903(a) of title 31,
except that no interest penalties shall be required to be paid
under this section; and
``(B) in the case of any payment under this section that is
not processed during the period of 30 days following receipt by
the Secretary of the final invoice for such payment, the
Secretary shall publish in the Federal Register the number of
days required to process the payment.''.
(b) Centralization of Process for Making Payments.--Such section is
amended by adding at the end the following new subsection:
``(f)(1) The Secretary shall process payments under this section
through one office of the Department that the Secretary determines has
the capacity and expertise to make such payments in compliance with
regulations described in subsection (a)(2).
``(2) The Secretary shall accurately track and resolve payments due
to sellers under this section that are more than 90 days overdue.''.
(c) Reporting.--The Secretary of Veterans Affairs shall submit to
the Committees on Veterans' Affairs of the Senate and House of
Representatives, and publish on a publicly accessible website of the
Department of Veterans Affairs, four semiannual reports after the date
of the enactment of this Act, regarding the administration of section
3902 of title 38, United States Code, as amended by this section. Each
such report shall include, with respect to the period of six months
preceding the date of the report, the following elements:
(1) The average and median number of days between receipt
of a invoice for payment under such section by the Claims
Intake Center of the Department and the day when the Secretary
makes such payment, disaggregated by whether the claim was
under review or being processed by--
(A) the Veterans Health Administration;
(B) the Veterans Benefits Administration; or
(C) the seller.
(2) Improvements to information technology of the
Department that the Secretary determines would reduce the time
required for such review or processing.
(d) GAO Report; Briefing.--
(1) Report.--Not later than 180 days after the day the
Secretary completes centralization under subsection (f) of
section 3902 of title 38, United States Code, as added by this
section, the Comptroller General of the United States shall
review such centralization and publish a report containing the
results of such review. Such report shall include the
determinations of the Comptroller General regarding the
following:
(A) The capacity of the office determined by the
Secretary under such subsection, to carry out
processing described in such subsection, including--
(i) a comprehensive assessment of employees
of the Department who carry out chapter 39 of
such title;
(ii) a comprehensive skills assessment
indicating what resources the Secretary
requires to otherwise improve such
centralization, including additional funds,
employees, or contractors; and
(iii) a review of systems of information
technology, including systems in use or to be
acquired, to carry out such centralization.
(B) Recommendations to improve such processing.
(C) Estimated costs to the United States to
implement such recommendations.
(2) Briefing.--Not later than 30 days after publishing the
report under paragraph (1), the Comptroller General shall
provide to the Committees on Veterans' Affairs of the House of
Representatives and Senate a briefing on such report. Such
briefing shall include any response from the Secretary to the
Comptroller General regarding the recommendations in the
report.
SEC. 203. MONTHLY HOUSING STIPEND UNDER THE POST-9/11 EDUCATIONAL
ASSISTANCE PROGRAM FOR INDIVIDUALS WHO PURSUE SUMMER
PROGRAMS OF EDUCATION SOLELY THROUGH DISTANCE LEARNING.
(a) In General.--Section 3313(c)(1)(B) of title 38, United States
Code, is amended--
(1) in clause (i), by striking ``and (iii)'' and inserting
``, (iii), and (iv)'';
(2) by redesignating clause (iv) as clause (v); and
(3) by inserting after clause (iii) the following new
clause (iv):
``(iv) In the case of an individual
pursuing, solely through distance learning, a
program of education that is shorter than 12
weeks during the summer, for each month the
individual pursues the program of education, a
monthly housing stipend equal to the product
of--
``(I) the national average of the
monthly amount of the basic allowance
for housing payable under section 403
of title 37 for a member with
dependents in pay grade E-5, multiplied
by
``(II) the lesser of--
``(aa) 1.0 and
``(bb) the number of course
hours borne by the individual
in pursuit of the program of
education, divided by the
minimum number of course hours
required for full-time pursuit
of the program of education,
rounded to the nearest multiple
of 10.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to a program of education beginning on or after August 1, 2027.
SEC. 204. CLARIFICATION REGARDING INCLUSION OF MEDICALLY NECESSARY
AUTOMOBILE ADAPTATIONS IN DEPARTMENT OF VETERANS AFFAIRS
DEFINITION OF ``MEDICAL SERVICES''.
Section 1701(6)(I) of title 38, United States Code, is amended to
read as follows:
``(I) The provision of any medically necessary automobile
adaptations for driver or passenger use, including--
``(i) ramp and kneeling systems;
``(ii) raised doors or lowered floors;
``(iii) raised roofs;
``(iv) air conditioning;
``(v) occupied and unoccupied mobility lifts;
``(vi) ingress or egress accessibility
modifications;
``(vii) wheelchair tiedowns; and
``(viii) adapted seating.''.
SEC. 205. DIGITAL COMMUNICATIONS: SOLID START PROGRAM; EDUCATIONAL
ASSISTANCE.
(a) Improvement to Certain Outreach Under Solid Start Program of
Department of Veterans Affairs.--Section 6320(b) of title 38, United
States Code, is amended--
(1) in paragraph (1)(B)--
(A) by striking ``calling'' and inserting
``communicating with''; and
(B) by inserting ``through the use of tailored
lines of communication, including mailings, text
messaging, virtual chatting, and other electronic forms
of messaging'' after ``Armed Forces''; and
(2) in paragraph (2), by striking ``tailored mailings'' and
inserting ``tailored lines of communication, including
mailings, text messaging, virtual chatting, and other
electronic forms of messaging,''.
(b) Department of Veterans Affairs Use of Tailored Lines of
Communication for Correspondence Relating to Educational Assistance
Benefits.--Section 3680 of title 38, United States Code, is amended by
adding at the end the following new subsection:
``(i)(1) The Secretary shall provide a mechanism by which an
eligible veteran or eligible person may use tailored lines of
communication to send and receive correspondence with the Department of
Veterans related to entitlement to and use of educational assistance
benefits under the laws administered by the Secretary. The Secretary
shall ensure that an eligible veteran or eligible person is provided
with an opportunity to opt into sending and receiving such
correspondence using such lines of communication rather than by mail.
``(2) The Secretary shall provide to eligible veterans and eligible
persons who are enrolled in a course or program of education or
training notice of the opportunity to opt in to sending and receiving
correspondence using tailored lines of communication pursuant to
paragraph (1).
``(3) In this subsection, the term `tailored lines of
communication' includes mailings, text messaging, virtual chatting, and
other electronic forms of messaging.''.
SEC. 206. IMPROVEMENTS TO TRANSITION ASSISTANCE PROGRAM AND
SKILLBRIDGE.
(a) Transition Assistance Program: Amendments; Pilot Program;
Reports.--
(1) Special operations forces.--Subsection (a) of section
1142 of title 10, United States Code, is amended, in paragraph
(1), by inserting ``(including each member of the special
operations forces)'' after ``armed forces''.
(2) Requirement of preseparation counseling: number of
days.--Such subsection is further amended, in paragraph (1)--
(A) by inserting ``(A)'' before ``Within''; and
(B) by adding at the end the following new
subparagraph:
``(B) The Secretary concerned shall ensure that a member
described in subparagraph (A) receives preseparation counseling
in the following amounts:
``(i) In the case of a member who has accepted an
offer of full-time employment, or has enrolled in a
program of education or vocational training, that shall
commence after the member separates, retires, or is
discharged, not fewer than three days.
``(ii) In the case of a member other than a member
described in clause (i), not fewer than five days.''.
(3) Repeat attendance.--Such subsection is further amended
by adding at the end the following new paragraph:
``(6) A member who received preseparation counseling under
this section may, before separation, retirement, or discharge,
request to receive, on a space-available basis, such
preseparation counseling a second time.''.
(4) Pathways: standardization; establishment of pathway for
members of the reserve components.--Such section is further
amended, in paragraph (1) of subsection (c), in the matter
preceding subparagraph (A)(1)--
(A) by striking ``Each Secretary concerned'' and
inserting ``The Secretaries of Defense and Homeland
Security''; and
(B) by striking ``pathways for members of the
military department concerned'' and inserting
``pathways, standardized across the armed forces''.
(5) Pathways: record of pathway assignment.--Such
subsection is further amended by adding at the end the
following new paragraph:
``(4) The Secretary concerned shall ensure that the pathway
in which a member is placed, and the reasons for such
placement, are noted in the service record of such member.''.
(6) Coordination between departments of defense, veterans
affairs, and labor.--Such section is further amended, in
subsection (d)--
(A) by striking the heading and inserting
``Transmission of Certain Information to Other
Departments'';
(B) by inserting ``(1)'' before ``In the case'';
and
(C) by adding at the end the following new
paragraphs:
``(2) Before a member described in subsection (a)
separates, retires, or is discharged, the Secretary concerned
shall transmit to the Secretary of Veterans Affairs the
Department of Defense Form DD-2648 regarding such member.
``(3)(A) In the case of a member described in subsection
(a) whom the Secretary determined as tier 3 status the
Secretary concerned shall, before the member separates,
retires, or is discharged, provide such member with the contact
information of an employee of the Department of Veterans
Affairs and an employee of the Department of Labor; and
``(B) Each employee described in subparagraph (A) shall
contact the member described in such subparagraph not later
than 60 days after such member separates, retires, or is
discharged.
``(C) The Secretary of Veterans Affairs and the Secretary
of Labor shall each submit to the Committees on Armed Services
and on Veterans' Affairs of the Senate and House of
Representatives an annual report that identifies the number of
times, and reasons why, an employee of the department under the
jurisdiction of such Secretary failed to carry out subparagraph
(B) in the year preceding the date of the report.
``(D) The Secretary of Defense and Secretary of Homeland
Security shall prescribe regulations to ensure that, for
purposes of this paragraph, each Secretary concerned uses the
same definition of the term `at risk for a difficult transition
to civilian life'.''.
(7) Report.--Not later than two years after the date of the
enactment of this Act and annually thereafter for four years,
the Secretary of Defense shall submit to the Committees on
Armed Services, and the Committees on Veterans' Affairs, of the
Senate and House of Representatives, a report on data recorded
with such tracking system during the year preceding the date of
such report. Such a report shall include a list of the seven
military installations located inside the continental United
States, and three military installations located outside the
continental United States, where members are least likely to
receive preseparation counseling in accordance with such time
periods.
(A) The number of members who, in the course of
such preseparation counseling, were referred to another
Federal agency or department.
(B) The Federal agencies or departments to which
members were so referred.
(C) The number of members who should have been, but
were not, so referred, and reasons why such referrals
did not occur.
(D) The number of members who receive such
preseparation counseling and apply for unemployment
compensation under subchapter II of chapter 85 of title
5, United States Code.
(E) The total amount of such unemployment
compensation paid to members separating from the Armed
Forces.
(F) The frequency with which the commander of the
military installation received a briefing regarding
attendance of members in accordance with statutory
requirements of the Transition Assistance Program.
(8) Contracting: standardization.--Such section is further
amended by adding at the end the following new subsection:
``(f) Contracting.--A Secretary concerned may enter into an
agreement with an entity under which such entity shall provide
preseparation counseling under this section. If more than one Secretary
seeks to enter into such an agreement, such Secretaries concerned
shall, to the extent practicable, seek to enter into such agreements
with the same entity.''.
(9) Annual report on tap participation.--The frequency with
which the commander of the military installation received a
briefing regarding attendance of members in accordance with
statutory requirements of the Transition Assistance Program.
(b) Skillbridge: GAO Study.--
(1) Study required.--The Comptroller General of the United
States shall conduct a study of the Skillbridge programs under
section 1143(e) of title 10, United States Code.
(2) Report.--Not later than two years after the date of the
enactment of this Act, the Comptroller General shall submit to
the Committees on Armed Services, and the Committees on
Veterans' Affairs, of the Senate and House of Representatives,
a report regarding such study. Such report shall include
observations and recommendations of the Comptroller regarding,
with respect to members and employers who participate in
Skillbridge--
(A) differences in criteria for participation
between the Armed Forces;
(B) other differences in Skillbridge programs
between the Armed Forces;
(C) best practices in Skillbridge programs across
the Armed Forces, including--
(i) the selection of employers; and
(ii) the development of contracts; and
(D) the feasibility of making Skillbridge programs
uniform across the Armed Forces.
SEC. 207. TRANSITION ASSISTANCE PROGRAM: PRESENTATION IN PRESEPARATION
COUNSELING TO PROMOTE BENEFITS AVAILABLE TO VETERANS.
(a) In General.--Section 1142(b) of title 10, United States Code,
is amended by adding at the end the following new paragraph:
``(20) A presentation that promotes the benefits available
to veterans under the laws administered by the Secretary of
Veterans Affairs. Such presentation--
``(A) shall be standardized;
``(B) shall, before implementation, be reviewed and
approved by the Secretary of Veterans Affairs and
Secretary of Defense in collaboration with veterans
service organizations that provide claims assistance
under the benefits delivery at discharge program of the
Department of Veterans Affairs;
``(C) shall be submitted by the Secretary of
Veterans Affairs to the Committees on Veterans' Affairs
and Armed Services of the Senate and the House of
Representatives for review at least 90 days before
implementation;
``(D) where available, shall be presented with the
participation of--
``(i) an employee or representative of the
Department of Veterans Affairs assisted by a
representative of a veterans service
organization recognized under section 5902 of
title 38; or
``(ii) an employee or representative of the
Department of Veterans Affairs assisted by an
individual recognized under section 5903 of
such title and authorized by the Secretary
concerned to so participate;
``(E) shall include information on how a veterans
service organization may assist the member in filing a
claim described in paragraph (19);
``(F) may not encourage the member to join a
particular veterans service organization; and
``(G) may not be longer than one hour.''.
(b) Annual Report.--Not less frequently than once each year after
the date of the enactment of this Act, the Secretary of Veterans
Affairs shall submit, to the Committees on Armed Services of the Senate
and House of Representatives, and to the Committees on Veterans'
Affairs of the Senate and House of Representatives, a report that--
(1) identifies each veterans service organization that
participated in a presentation under paragraph (20) of section
1142(b) of title 10, United States Code, as added by subsection
(a);
(2) contains the number of members of the Armed Forces who
attended such presentations; and
(3) includes any recommendations of the Secretary regarding
changes to such presentation or to such paragraph.
SEC. 208. ELIMINATION OF REQUIREMENT THAT ON-CAMPUS EDUCATIONAL AND
VOCATIONAL COUNSELING IS PROVIDED BY CERTAIN DEPARTMENT
OF VETERANS AFFAIRS EMPLOYEES.
(a) In General.--Section 3697B(a) of title 38, United States Code,
is amended--
(1) by striking the second sentence;
(2) by inserting ``(1)'' before ``The Secretary''; and
(3) by adding at the end the following new paragraph:
``(2) Any individual providing services under paragraph (1) on
behalf of the Department who is not an employee of the Department shall
be subject to the same oversight, training, and accountability
standards applicable to Department employees providing such
services.''.
(b) Expansion of VetSuccess on Campus Program to at Least One
Location in Each State.--
(1) In general.--The Secretary of Veterans Affairs shall
ensure that the VetSuccess on Campus program of the Department
of Veterans Affairs is located in every State.
(2) Counselors.--In carrying out paragraph (1), the
Secretary shall ensure that at least one counselor of the
VetSuccess on Campus program is located in each State,
notwithstanding the number of individuals in a State or at an
educational institution who may qualify to participate in the
program.
(3) Preference.--In carrying out this section, the
Secretary shall give preference to educational institutions
that have the largest populations of students who are pursuing
programs of education at such institutions with educational
assistance provided under laws administered by the Secretary.
(4) State defined.--In this section, the term ``State'' has
the meaning given such term in section 101 of title 38, United
States Code.
SEC. 209. EXPANSION OF ENTITLEMENT FOR PAYMENT FOR LICENSING OR
CERTIFICATION TESTS FOR VETERANS ENTITLED TO EDUCATIONAL
ASSISTANCE.
Section 3315 of title 38, United States Code, is amended--
(1) in subsection (a), by striking ``educational assistance
under this chapter'' and inserting ``covered assistance'';
(2) in subsection (b)(3), by striking ``under this
chapter'' and inserting ``with respect to covered assistance'';
(3) in subsection (c), in the matter preceding paragraph
(1), by striking ``under this chapter'' and inserting ``with
respect to covered assistance''; and
(4) by adding at the end the following new subsection:
``(d) Warnings.--Before providing any payment to or on behalf of an
individual described in subsection (a), the Secretary shall provide
notice to the individual a warning that use of entitlement under this
section for a licensing or certification test may not lead to a license
or certification.
``(e) Covered Assistance Defined.--In this section, the term
`covered assistance' means educational assistance available under--
``(1) this chapter, chapter 30 of this title, chapter 35 of
this title, or chapter 1606 of title 10; or
``(2) any other provision of law providing educational
assistance to a veteran, or to another individual in connection
with the service of a veteran in the Armed Forces.''.
SEC. 210. INCREASE OF AMOUNT OF EDUCATIONAL ASSISTANCE PAID BY THE
SECRETARY OF VETERANS AFFAIRS FOR FIRST YEAR OF A FULL-
TIME PROGRAM OF APPRENTICESHIP OR OTHER ON-JOB TRAINING.
Section 3313(g)(3)(B) of title 38, United States Code, is amended--
(1) in the matter preceding clause (i), by inserting
``using educational assistance under this chapter''; and
(2) in clause (i)(II), by striking ``80 percent'' and
inserting ``100 percent''.
SEC. 211. IMPROVING EMERGING TECHNOLOGY OPPORTUNITIES FOR VETERANS.
(a) Inclusion of Emerging Technologies in High Technology
Program.--
(1) In general.--Section 3699C of title 38, United States
Code, is amended--
(A) in the section heading by striking ``High
technology'' and inserting ``High technology and
emerging technology'';
(B) by striking ``high technology'' and inserting
``high technology or emerging technology'' each place
such term appears; and
(C) in subsection (c)(4) by adding at the end the
following new subparagraph:
``(E) Such criteria shall also identify which technologies of
critical importance, such as artificial intelligence and semiconductor
manufacturing, shall be treated as emerging technologies for purposes
of this section.''.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 36 of such title is amended by striking
the item relating to section 3699C and inserting the following
new item:
``3699C. High technology and emerging technology program.''.
(3) Conforming amendments.--Section 3680A of title 38,
United States Code, is amended in subsections (a)(4)(B) and
(d)(8) by striking ``high technology'' each place such term
appears and inserting ``high technology or emerging
technology''.
(b) Employment Rate Calculation for VET-TEC High Technology and
Emerging Technology Program.--Section 3699C of title 38, United States
Code, is amended--
(1) in subsection (f)--
(A) in the matter preceding paragraph (1) by
inserting after ``House of Representatives'' the
following: ``, and make available to the public,''; and
(B) in paragraph (3) by adding at the end the
following: ``Such rate shall be calculated as a
fraction, the denominator of which is the number of
covered individuals who completed such a program during
such year and the numerator of which is the number of
individuals counted in the denominator who are employed
on the date that is 180 days after the date on which
the individual completed the program, and expressed as
a percentage. Notwithstanding the previous sentence,
the numerator shall not count a case in which the
individual is employed by the same organization that
was the provider of the individual's program of
education or a case in which the individual is
employed, by a parent or affiliate of such
organization, as an instructor for a substantially
similar program of education. To the maximum extent
practicable, the Secretary shall also report the rates
of full-time employment, part-time employment, and
self-employment.''; and
(2) in subsection (g) by adding at the end the following
new paragraph:
``(3) The Secretary on an ongoing basis shall solicit, collect, and
analyze feedback about the program from covered individuals who
participate in the program and from the GI Bill School Feedback Tool.
The Secretary shall use such feedback to evaluate and improve the
implementation of the program.''.
TITLE III--HEALTH CARE
SEC. 301. EXTENSION AND MODIFICATION OF TRANSPORTATION GRANT PROGRAM OF
DEPARTMENT OF VETERANS AFFAIRS.
Section 307 of the Caregivers and Veterans Omnibus Health Services
Act of 2010 (Public Law 111-163; 38 U.S.C. 1710 note) is amended--
(1) in subsection (a)--
(A) in paragraph (2), by adding at the end the
following new subparagraphs:
``(C) Indian tribes.
``(D) Tribal organizations.
``(E) Native Hawaiian organizations.
``(F) County veterans service organizations.'';
(B) in paragraph (3), in the matter preceding
subparagraph (A), by striking ``State veterans service
agency or veterans service organization awarded'' and
inserting ``recipient of''; and
(C) by amending paragraph (4) to read as follows:
``(4) Maximum amount.--
``(A) In general.--Except as provided in
subparagraphs (B) and (C), the amount of a grant under
this section may not exceed $50,000.
``(B) Off-road communities.--In the case of a
county that has more than five communities that are off
the road system, the amount of a grant awarded with
respect to that county under this section may be
increased by an amount not to exceed 50 percent of the
amount specified in subparagraph (A).
``(C) Purchasing a vehicle.--
``(i) Amount.--The amount of a grant
awarded under this section to a recipient may
be increased by not more than $80,000 if the
recipient is purchasing a vehicle to comply
with requirements under the Americans with
Disabilities Act of 1990 (42 U.S.C. 12101 et
seq.) in carrying out this section.
``(ii) Limitations.--The Secretary may
prescribe limitations on the number of vehicles
purchased by each recipient under this
section.'';
(2) by striking subsection (d);
(3) by redesignating subsections (b) and (c) as subsections
(d) and (e), respectively;
(4) by inserting after subsection (a) the following new
subsections:
``(b) Additional Services.--
``(1) Nearby rural areas.--In addition to providing
innovative transportation options to veterans in highly rural
areas, a recipient of a grant under this section may use
amounts provided under the grant to provide innovative
transportation options to veterans in nearby rural areas.
``(2) Priority.--A recipient of a grant under this section
shall prioritize the provision of innovative transportation
options to veterans in highly rural areas, and shall
demonstrate to the Secretary such priority, and may only
provide services under paragraph (1) to veterans in nearby
rural areas if--
``(A) it does not impede the services provided to
veterans in highly rural areas; and
``(B) the grantee has excess capacity and resources
available to provide such services to veterans in
nearby rural areas.
``(c) Eligibility of Previous Areas.--Areas eligible for assistance
under the grant program under this section on the day before the date
of the enactment of the Supporting Rural Veterans Access to Healthcare
Services Act shall remain eligible for such assistance on and after
such date of enactment.''; and
(5) in subsection (e), as redesignated by paragraph (2)--
(A) by redesignating paragraph (2) as paragraph
(5); and
(B) by striking paragraph (1) and inserting the
following:
``(1) Indian tribe; tribal organization.--The terms `Indian
tribe' and `Tribal organization' have the meanings given those
terms in section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 5304).
``(2) Native hawaiian organization.--The term `Native
Hawaiian organization' has the meaning given that term in
section 6207 of the Elementary and Secondary Education Act f
1965 (20 U.S.C. 7517).
``(3) Nearby.--The term `nearby', with respect to a rural
area, includes rural areas adjacent to a highly rural area and
rural areas geographically between the highly rural area and
the nearest Department of Veterans Affairs medical center.
``(4) Rural; highly rural.--The terms `rural' and `highly
rural' have the meanings given those terms under the Rural-
Urban Commuting Areas (RUCA) coding system of the Department of
Agriculture.''.
SEC. 302. VETERAN CAREGIVER REEDUCATION, REEMPLOYMENT, AND RETIREMENT
ACT.
(a) Extension of Period of Medical Care Coverage for Caregivers
Designated as Primary Providers of Personal Care Services for
Veterans.--Section 1781(a)(4) of title 38, United States Code, is
amended by inserting before the comma at the end the following: ``,
including during the 180-day period following discharge from the
program under section 1720G(a) of this title unless the designation of
the individual was revoked due to fraud, abuse, mistreatment, or other
misconduct''.
(b) Employment and Other Benefits for Caregivers Designated as
Primary Providers of Personal Care Services for Veterans.--
(1) Employment assistance.--Section 1720G of title 38,
United States Code, is amended by adding at the end the
following new subsection:
``(e) Employment Assistance.--(1) The Secretary shall, subject to
paragraph (2), provide to an individual designated as a primary
provider of personal care services under subsection (a)(7)(A)
employment assistance as follows:
``(A) Reimbursement of fees associated with certifications
or relicensure necessary for such employment.
``(B) For purposes of gaining credit for continuing
professional education requirements, access to training modules
of the Department at no cost.
``(C) In consultation with the Secretary of Defense and the
Secretary of Labor, access to existing employment assistance
resources and programs as considered appropriate.
``(2) An individual described in paragraph (1) shall have access to
assistance described in such paragraph--
``(A) while participating in the program established under
subsection (a)(1); and
``(B) during the 180-day period following the date on which
the individual is no longer participating in such program
unless the designation of such individual under subsection
(a)(7)(A) was revoked for fraud, abuse, mistreatment, or other
misconduct.
``(3) The maximum lifetime amount that may be reimbursed for an
individual under paragraph (1)(A) is $1,000.''.
(2) Expansion of available services.--Subsection
(a)(3)(A)(ii) of such section is amended--
(A) in subclause (V), by striking ``; and'' and
inserting a semicolon;
(B) in subclause (VI)--
(i) in the matter preceding item (aa), by
inserting ``or agreements'' after
``contracts'';
(ii) in item (aa), by inserting ``,
including retirement planning services,'' after
``services''; and
(iii) in item (bb), by striking the period
at the end and inserting ``; and''; and
(C) by adding at the end the following new
subclause:
``(VII) such instruction, preparation, training,
and support as the Secretary considers appropriate to
assist in transitioning away from caregiving during the
180-day period following the date on which the family
caregiver is no longer participating in the program
required by paragraph (1), unless such designation was
revoked for fraud, abuse, or mistreatment, or other
misconduct.''.
(3) Assistance returning to workforce.--Subclause (VI) of
such subsection is further amended--
(A) in item (aa), by striking ``; and'' and
inserting a semicolon; and
(B) by adding at the end the following new item:
``(cc) assistance returning to the
workforce upon discharge or dismissal from the
program required by paragraph (1) unless such
designation was revoked for fraud, abuse,
mistreatment, or other misconduct; and''.
(4) Bereavement counseling and support.--Subsection
(a)(3)(A)(i)(III) of such section is amended by inserting
before the semicolon the following: ``, including bereavement
counseling and support following the death of the eligible
veteran''.
(5) Study on provision of returnship program.--
(A) In general.--Not later than one year after the
date of the enactment of this Act, the Secretary of
Veterans Affairs, in partnership with the Secretary of
Labor, shall complete a study on the feasibility and
advisability of conducting a returnship program to
assist individuals who are designated as a primary
provider of personal care services under section
1720G(a)(7)(A) of title 38, United States Code, or who
were discharged from such program, in returning to the
workforce.
(B) Report.--Not later than 180 days after
completion of the study under subparagraph (A), the
Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives a report on the
study.
(6) Study on incorporating former caregivers into workforce
of department of veterans affairs.--
(A) In general.--Not later than one year after the
date of the enactment of this Act, the Secretary of
Veterans Affairs shall complete a study on barriers and
incentives to hiring individuals who were designated as
a primary provider of personal care services under
section 1720G(a)(7)(A) of title 38, United States Code,
at facilities of the Department of Veterans Affairs to
address staffing needs.
(B) Report.--Not later than 180 days after
completion of the study under subparagraph (A), the
Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives a report on the
study, which shall include--
(i) a plan for increasing employment
opportunities at facilities of the Department
for individuals who were designated as a
primary provider of personal care services
under section 1720G(a)(7)(A) of title 38,
United States Code; and
(ii) such recommendations for legislative
or administrative action as the Secretary
considers appropriate.
(c) Comptroller General Report on Efforts of Department of Veterans
Affairs in Supporting Family Caregivers Transitioning Away From
Caregiving.--Not later than two years after the date of the enactment
of this Act, the Comptroller General of the United States shall submit
to Congress a report assessing the efforts of the Secretary of Veterans
Affairs to support individuals serving as family caregivers under
section 1720G(a) of title 38, United States Code, in transitioning away
from caregiving, either by assisting those individuals with retirement
planning or returning to work.
(d) Report on Feasibility and Advisability of Establishing a
Retirement Plan or Retirement Savings for Family Caregivers of Certain
Veterans.--Not later than one year after the date of the enactment of
this Act, the Secretary of Veterans Affairs, in consultation with the
Secretary of the Treasury and the heads of such other relevant entities
as the Secretary of Veterans Affairs determines necessary, shall submit
to Congress a report on the feasibility and advisability of, for
individuals serving as family caregivers under section 1720G(a) of
title 38, United States Code--
(1) establishing an individual retirement plan (as defined
in section 7701(a)(37) of the Internal Revenue Code of 1986 (26
U.S.C. 7701(a)(37))) or similar retirement plan; or
(2) permitting such individuals to join an already
established pathway to retirement savings.
SEC. 303. VETERANS TBI BREAKTHROUGH EXPLORATION OF ADAPTIVE CARE
OPPORTUNITIES NATIONWIDE ACT.
(a) Department of Veterans Affairs Grant Program for Supplemental
Neurorehabilitation Approaches to Chronic Mild TBI Treatment.--
(1) Grant program.--
(A) In general.--The Secretary of Veterans Affairs
shall carry out a three-year program (to be known as
the ``TBI Innovation Grant Program'') under which the
Secretary shall award grants to eligible entities
described in paragraph (2) for the development,
implementation, and evaluation of approaches and
methodologies for prospective randomized control trials
for neurorehabilitation treatments for the treatment of
chronic mild traumatic brain injury (in this Act
referred to as ``mTBI'') in veterans.
(B) Relationship to other department activities.--
The grant program required under subparagraph (A) shall
be carried out in a manner that--
(i) supplements, and does not supplant,
other clinical care and research of the
Department of Veterans Affairs relating to
mTBI; and
(ii) facilitates, as practicable,
coordination with Veterans Health
Administration facilities for referral,
continuity of care, and dissemination of
findings.
(2) Eligible entities described.--An eligible entity
described in this paragraph is any of the following:
(A) A nonprofit organization with demonstrated
capability to conduct clinical trials and to deliver or
research effective neurorehabilitation treatments for
mTBI, including through patient care delivery.
(B) An academic institution that conducts
significant research on mTBI and has demonstrated
capability to conduct clinical trials relating to
neurorehabilitation treatments.
(C) A non-Department health care provider with
expertise in neurorehabilitative therapies and
demonstrated capability to conduct clinical trials and
to evaluate mTBI treatments through patient care
delivery.
(D) A partnership or consortium of two or more
entities described in subparagraphs (A) through (C).
(3) Use of funds.--An eligible entity in receipt of a grant
under this subsection shall use such grant to support
activities that include--
(A) designing and testing novel or integrative
treatments for mTBI that prioritize patient-centered
care, including non-pharmacological therapies;
(B) conducting clinical studies and assessments to
measure the effectiveness of funded approaches to--
(i) improve mental health outcomes among
veterans;
(ii) reduce suicidality, and common risk
factors for completing suicide, including
depression and substance use disorders among
veterans; and
(iii) mitigate long-term effects of mTBI
and, to the extent outcomes are collected under
the applicable clinical protocol, measure
durability of outcomes at approximately six
months following completion of treatment;
(C) providing training for clinicians and outreach
to veterans and their families to improve awareness and
accessibility of innovative mTBI treatments, including
information on available Department resources and
pathways to access such resources; and
(D) establishing partnerships with community
organizations, academic institutions, and health care
facilities, including, as practicable, coordination
with Veterans Health Administration facilities to
facilitate referral of eligible veterans, continuity of
care, and dissemination of aggregate findings.
(4) Limitation on grant amount.--The Secretary may not
award an eligible entity a grant under this section in an
amount that exceeds $5,000,000 for any fiscal year.
(5) Program administration.--
(A) Applications.--An eligible entity desiring a
grant under this subsection shall submit to the
Secretary an application in such form, at such time,
and containing such information and assurances as the
Secretary determines appropriate, including a detailed
description of--
(i) activities proposed to be conducted
using the grant;
(ii) expected outcomes of such activities;
(iii) plans for evaluating the
effectiveness of such activities;
(iv) how the eligible entity will
coordinate, as practicable, with Veterans
Health Administration facilities for referral
and continuity of care for veterans who
participate in activities carried out using
grant funds, and for dissemination of aggregate
findings;
(v) the budget of the entity for the use of
the grant, including a narrative justification
and an identification of the estimated amount
of grant funds to be used for administrative or
overhead costs; and
(vi) assurances of compliance with
applicable Federal laws and regulations
relating to human subjects protections and
patient safety.
(B) Priority.--In awarding grants under this
subsection, the Secretary shall give priority to
eligible entities that have demonstrated the capacity
to coordinate with the Department to facilitate
referral and continuity of care for veterans who
participate in activities carried out using grant
funds.
(C) Periodic reports.--As a condition of receiving
a grant under this section, an eligible entity shall,
not less frequently than annually during the grant
period and not later than 180 days after the end of the
grant period, submit to the Secretary a report that
includes, with respect to the period covered by the
report--
(i) a description of how the eligible
entity used such grant;
(ii) a summary of the progress of
activities funded with amounts from such grant;
(iii) measured outcomes relating to such
activities;
(iv) a detailed accounting of expenditures
of grant funds, including administrative or
overhead costs;
(v) to the extent collected under the
applicable clinical protocol or in the ordinary
course of care, a description of any adverse
events and serious adverse events, including
self-harm or suicide-related events; and
(vi) a description of actions taken
pursuant to the coordination plan described in
subparagraph (A)(iv).
(D) Oversight; annual evaluations.--The Secretary
shall--
(i) ensure rigorous oversight of the grant
program under this section, including by
monitoring financial compliance and timely
receipt of the reports required under
subparagraph (B); and
(ii) on an annual basis until the
termination date specified in paragraph (9)(A),
evaluate the efficacy of activities carried out
using grant funds based on the reports
submitted under subparagraph (B) and other
appropriate information.
(E) Rule of construction.--Nothing in this section
shall be construed to authorize the Secretary to
require prior approval of, or changes to, any clinical
protocol, study design, outcome measures, or follow-up
schedule of an eligible entity that receives a grant
under this section, except as necessary to ensure
compliance with applicable Federal laws and regulations
relating to human subjects protections and patient
safety.
(F) Enforcement authority.--The Secretary may
suspend, modify, or terminate a grant awarded under
this section, if the Secretary determines that the
recipient of such grant has failed to comply with
reporting requirements under subparagraph (B) or other
applicable terms and conditions of the grant.
(6) Available amounts; authorization of appropriations.--
(A) Available amounts.--The Secretary may carry out
the program under this section using amounts available
to the Secretary for general mental health care
programs, if the use of such amounts supplements, and
does not supplant, amounts otherwise available for
Department mental health and traumatic brain injury
programs.
(B) Authorization of appropriations.--There is
authorized to be appropriated to the Secretary
$10,000,000 for each of fiscal years 2026 through 2028
to carry out this section.
(7) Duration; annual review.--
(A) Duration.--The authority of the Secretary to
carry out the grant program under this section shall
terminate on the date that is three years after the
date of the enactment of this Act, except that the
Secretary may continue to use amounts made available to
carry out this section after such date solely for the
purpose of administering activities and obligations
incurred before such termination date.
(B) Annual review.--During such three-year period,
the Secretary shall, on an annual basis, review the
effectiveness of the grant program to determine the
potential of such grant program for continuation or
expansion.
(b) Department of Veterans Affairs Grant Program for Independent
Third-party Research Studies and Treatment With Respect to Supplemental
Neurorehabilitation Treatments for MTBI.--
(1) Establishment.--The Secretary of Veterans Affairs shall
establish and carry out a research grant program to award
grants to eligible entities described in paragraph (2) to be
used to carry out studies and applied programs on approaches
and methodologies for the treatment of mTBI in veterans.
(2) Eligible entities described.--An eligible entity
described in this paragraph is any of the following:
(A) A nonprofit organization that has demonstrated
the capability to conduct clinical trials and to
evaluate traumatic brain injury treatments through
patient care delivery.
(B) An academic institution that conducts
significant research on traumatic brain injury and has
demonstrated the capability to conduct clinical trials
relating to neurorehabilitation treatments.
(C) A partnership or consortium of two or more
entities described in subparagraphs (A) and (B).
(3) Applications.--An eligible entity desiring a grant
under this section shall submit to the Secretary an application
in such form, at such time, and containing such information and
assurances as the Secretary determines appropriate, including a
summary of--
(A) the research and treatment activities proposed
to be carried out using grant funds;
(B) the methodology to be used for such activities;
(C) the expected outcomes of such activities;
(D) how the eligible entity will coordinate, as
practicable, with Veterans Health Administration
facilities for referral and continuity of care for
veterans who participate in activities carried out
using grant funds, and for dissemination of aggregate
findings;
(E) the budget of the entity for the use of the
grant, including a narrative justification and an
identification of the estimated amount of grant funds
to be used for administrative or overhead costs; and
(F) assurances of compliance with applicable
Federal laws and regulations relating to human subjects
protections and patient safety.
(4) Administration.--
(A) Grant categories.--In carrying out the grant
program under this subsection, each fiscal year the
Secretary shall--
(i) subject to the requirement under
subparagraph (B), award four grants for
exploratory or pilot research and treatment
projects, each of which shall be in an amount
of not more than $625,000; and
(ii) award five grants for collaborative or
multidisciplinary research and treatment
initiatives, each of which shall be in an
amount of not more than $1,500,000.
(B) Priority.--Of the grants awarded under
subparagraph (A)(i), the Secretary shall award not
fewer than three to nonprofit organizations.
(C) Enforcement authority.--The Secretary may
suspend, modify, or terminate a grant awarded under
this subsection, if the Secretary determines that the
recipient of such grant has failed to comply with the
applicable terms and conditions of the grant.
(5) Agreement with independent organization.--
(A) In general.--The Secretary shall seek to enter
into an agreement with an independent organization that
is not a component of the Department and that has
demonstrated expertise in randomized controlled trials,
neurorehabilitation outcomes evaluation, and research
integrity, under which the organization agrees to--
(i) administer the research grant program
under this subsection;
(ii) carry out studies and implement
efforts that include--
(I) analyzing data from mTBI
treatment methodologies developed
pursuant to the research grant program
to assess the effect, among veterans,
of such methodologies on enhanced brain
health outcomes, mental health, and
long-term recovery, including, to the
extent outcomes are collected under the
applicable clinical protocol,
durability of outcomes at approximately
six months following completion of
treatment;
(II) identifying data-driven best
practices and providing recommendations
for further research or clinical
application, including recommendations
for dissemination to Veterans Health
Administration clinicians and
facilities (as appropriate); and
(III) randomized, controlled
clinical trials to--
(aa) validate and deliver
treatments;
(bb) establish a standard
of care; and
(cc) improve access to such
treatments for veterans;
(iii) submit to the Secretary not less
frequently than annually a report describing
activities carried out under this section,
including outcome data and methodology; and
(iv) make available to the Secretary all
data and findings from the grants made under
this section, consistent with applicable
Federal law, regulation, and Department
policies relating to patient protections, data
security, and privacy.
(B) Rule of construction.--Nothing in this section
shall be construed to authorize the Secretary, or an
independent organization that enters into an agreement
with the Secretary under subparagraph (A), to require
prior approval of, or changes to, any clinical
protocol, study design, outcome measures, or follow-up
schedule established by an eligible entity that
receives a grant under this section, except as
necessary to ensure compliance with applicable Federal
laws and regulations relating to human subjects
protections and patient safety.
(C) Report.--An agreement under subparagraph (A)
shall include a requirement that the independent
organization submits to Congress and the Secretary a
comprehensive report that includes--
(i) the findings of the studies required
under such agreement;
(ii) recommendations with respect to the
expansion of successful TBI treatment
methodologies and standard of care
recommendations, if any, developed pursuant to
the research grant program; and
(iii) to the extent available from the
reports and study materials of grant
recipients, a summary of--
(I) the durability of outcomes at
approximately six months following
completion of treatment, if collected
under the applicable clinical protocol;
(II) adverse events and serious
adverse events, including self-harm or
suicide-related events, if collected
under the applicable clinical protocol
or in the ordinary course of care; and
(III) aggregate expenditures of
grant funds, including administrative
or overhead costs.
(D) Surveys.--The Secretary may conduct surveys of
any independent organization that enters into an
agreement with the Secretary under subparagraph (A) in
order to assess the effectiveness of such organization
in administering the research grant program under this
subsection.
(6) Available amounts; authorization of appropriations.--
(A) Available amounts.--The Secretary may use
amounts available to the Secretary for the operating
budget of the National Center for Posttraumatic Stress
Disorder to carry out the research grant program under
this subsection, if the use of such amounts
supplements, and does not supplant, amounts otherwise
available for Department programs and services.
(B) Authorization of appropriations.--There is
authorized to be appropriated to the Secretary
$10,000,000 for each of fiscal years 2026 through 2028
to carry out this subsection.
(7) Termination date.--The authority of the Secretary to
carry out the research grant program under this section shall
terminate on the date that is three years after the date of the
enactment of this Act.
(c) Reports to Congress.--Not later than two years after the date
on which the Secretary commences the research grant program under
subsection (a), and on an annual basis thereafter until the termination
date specified in paragraph (8) of such subsection, the Secretary shall
submit to Congress a report on the grant programs under subsections (a)
and (b). Each such report shall include--
(1) the findings of the studies under subsection (a)(6)(B);
(2) a description of any agreement entered into by the
Secretary under subsection (b)(5)(A);
(3) recommendations of the Secretary with respect to policy
and programmatic improvements to services of the Department to
treat mTBI among veterans;
(4) any findings derived from surveys conducted under
subsection (b)(5)(D), including any recommendations of the
Secretary for improvements to the structure, oversight,
administration, or performance of the independent organization
that enters into an agreement with the Secretary under
subsection (b)(5)(A); and
(5) such other matters as the Secretary determines
appropriate.
(d) Definitions.--In this section:
(1) The terms ``chronic mild traumatic brain injury'' and
``mTBI'' mean a mild traumatic brain injury with symptoms that
persist for not fewer than six months after the inciting
injury, as determined using validated clinical criteria.
(2) The term ``nonprofit organization''--
(A) means an organization described in section
501(c)(3) of the Internal Revenue Code of 1986 and
exempt from taxation under section 501(a) of such Code;
and
(B) includes such an organization that is a
hospital, nonprofit health system, academic medical
center, or clinic that delivers neurorehabilitation
care or conducts clinical research relating to mTBI.
(3) The term ``veteran'' has the meaning given such term in
section 101 of title 38, United States Code.
SEC. 304. DEPARTMENT OF VETERANS AFFAIRS ASSIGNMENT OF TRAVELING
PHYSICIANS TO SERVE TERRITORIES, POSSESSIONS, AND FREELY
ASSOCIATED STATES.
(a) In General.--Subchapter I of chapter 74 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 7415. Traveling physicians
``(a) In General.--(1) The Secretary may assign a physician
appointed under section 7401 or section 7431 of this title to serve as
a traveling physician for a period of not more than one year at a time.
A physician assigned to serve as a traveling physician under this
section may be assigned to provide health care to veterans residing in
American Samoa, Guam, the Commonwealth of the Northern Mariana Islands,
the Commonwealth of Puerto Rico, the Virgin Islands of the United
States, the Freely Associated States (as defined in section 1724(f) of
this title), or any other territory or possession of the United States
at Department facilities or other approved facilities located in such
territory, possession, or Freely Associated State.
``(2) The Secretary may assign multiple physicians to serve as
traveling physicians under this section and may assign each such
physician to serve in a specific territory, possession, or Freely
Associated State.
``(b) Coordination of Care.--In providing care under this section,
traveling physicians shall coordinate with non-Department medical
providers to the extent practicable and necessary to ensure high
quality and coordinated care for veterans receiving hospital care and
medical services.
``(c) Pay.--In addition to pay under section 7431 of this title,
the Secretary shall provide a relocation or retention bonus to
traveling physicians under this section. Such relocation or retention
bonus shall be substantially similar to a relocation or retention bonus
offered under section 7410(a) of this title, as the Secretary considers
appropriate.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
7414 the following new item:
``7415. Traveling physicians.''.
(c) Technical and Conforming Amendments.--Title 38, United States
Code, is further amended as follows:
(1) In section 7410(a)(1), by--
(A) by striking ``retention allowances'' and
inserting ``retention bonuses''; and
(B) by striking the second comma after ``section
7401(1) of this title''; and
(2) In section 7431(e)(5)(B), by striking ``retention
allowances'' and inserting ``retention bonuses''.
SEC. 305. INCLUSION OF ADAPTIVE PROSTHESES AND TERMINAL DEVICES FOR
SPORTS AND OTHER RECREATIONAL ACTIVITIES IN MEDICAL
SERVICES FURNISHED TO ELIGIBLE VETERANS BY THE SECRETARY
OF VETERANS AFFAIRS.
Section 1701 of title 38, United States Code, is amended, in
paragraph (6)(F)(i), by inserting ``(including adaptive prostheses and
terminal devices for sports and other recreational activities that are
determined to be clinically appropriate by the Secretary)'' after
``artificial limbs''.
SEC. 306. MODIFICATIONS TO AND REAUTHORIZATION OF STAFF SERGEANT PARKER
GORDON FOX SUICIDE PREVENTION GRANT PROGRAM OF DEPARTMENT
OF VETERANS AFFAIRS.
(a) Coordination by Secretary.--Subsection (b) of section 201 of
the Commander John Scott Hannon Veterans Mental Health Care Improvement
Act of 2019 (Public Law 116-171; 38 U.S.C. 1720F note) is amended by
striking the second sentence.
(b) Use of Grant Funds.--Subsection (c) of such section is
amended--
(1) in the subsection heading, by inserting ``; Use of
Grant Funds'' after ``Grants''; and
(2) by adding at the end the following new paragraphs:
``(3) Renewal of grant amounts.--
``(A) In general.--In determining whether to renew
a grant awarded under this section to an eligible
entity, the Secretary shall consider, among such other
factors as the Secretary may consider appropriate--
``(i) the compliance by the eligible entity
in administering pre- and post-intervention
assessments required under subsection (e)(6);
and
``(ii) any demonstrated improvements in
participant outcomes.
``(B) Additional amounts.--Based on a consideration
of the factors described in subparagraph (A), the
Secretary may award amounts, not to exceed $250,000 per
grantee per fiscal year, to a grantee in addition to
the maximum amount under paragraph (2)(A) based on a
performance-based metric established by the
Secretary.''.
(c) Priority for New Recipients.--Subsection (d) of such section is
amended--
(1) in the subsection heading, by striking ``and
Preference'' and inserting ``, Preference, and Priority'';
(2) in paragraph (1)(A)--
(A) in clause (iv), by striking the semi-colon at
the end and inserting ``; and'';
(B) by striking clause (v); and
(C) by redesignating clause (vi) as clause (v); and
(3) by adding at the end the following new paragraph:
``(3) Priority for new recipients.--To the maximum extent
practicable, the Secretary shall prioritize grants for eligible
entities that have satisfied the requirements provided under
subsection (f) and are located in States in which a grant has
not been awarded under this section.''.
(d) Requirements for Receipt of Grants.--Subsection (e) of such
section is amended--
(1) in paragraph (3)--
(A) by redesignating subparagraphs (B) and (C) as
subparagraphs (C) and (D), respectively; and
(B) by inserting after subparagraph (A) the
following new subparagraph (B):
``(B) coordinate with the Secretary to develop a
plan for communication between the entity and local
mental health providers of the Department regarding
whether veterans receiving assistance under this
section from the entity are attending appointments to
ensure continuity of care;''; and
(2) by adding at the end the following new paragraph:
``(6) Assessments.--An eligible entity receiving a grant
under this section shall conduct a pre- and post-intervention
assessment with respect to each eligible individual who
receives suicide prevention services pursuant to such grant
across all relevant metrics, as determined by the Secretary.
``(7) Metrics and outcomes.--An eligible entity receiving a
grant under this section shall collect and submit to the
Secretary such metrics and outcome data as the Secretary may
require, including--
``(A) throughput measures, including the number of
veterans screened, referred, connected to care, and
retained in services under the grant program;
``(B) reductions in severity scale measurements,
including reductions in suicidality identified through
applicable inventories or assessments; and
``(C) such other quantifiable metrics as the
Secretary determines appropriate.''.
(e) Training and Technical Assistance.--Subsection (g) of such
section is amended--
(1) in paragraph (1)--
(A) in the matter preceding subparagraph (A), by
inserting ``, or interested in receiving such grants,''
after ``this section''; and
(B) in subparagraph (A), by inserting ``, including
training on how to properly use the Columbia Protocol
(also known as the Columbia-Suicide Severity Rating
Scale (C-SSRS)) and other screening tools selected by
the Secretary'' after ``management''; and
(2) by adding at the end the following new paragraphs:
``(3) Training for department employees.--The Secretary
shall provide training to employees of the Department as the
Secretary considers appropriate on the grant program under this
section.''.
(f) Briefing for Local VAMCS.--Subsection (h) of such section is
amended by adding at the end the following new paragraph:
``(5) Briefing for local vamcs.--Not less frequently than
once per year, unless the Secretary determines that such
frequency is not advisable, the Secretary shall provide, to the
appropriate personnel of each medical center of the Department
identified on the grantee's application under this section, a
briefing about the grant program under this section in order to
improve coordination between such recipient and personnel.''.
(g) Duration.--Subsection (j) of such section is amended by
striking ``September 30, 2026'' and inserting ``September 30, 2029''.
(h) Reports.--Subsection (k)(2) is amended--
(1) in the paragraph heading, by striking ``Final report''
and inserting ``Annual reports''; and
(2) in subparagraph (B)--
(A) by redesignating clauses (iii) and (iv) as (v)
and (vi), respectively; and
(B) by adding the following new clauses (iii) and
(iv):
``(iii) A description of the Secretary's
compliance with the requirement to train
employees of the Department under subsection
(g)(3).
``(iv) An optional description and
inclusion of subjective or narrative stories of
community or individual impact to allow grant
recipients to share meaningful
accomplishments.''.
(i) Referral for Care.--Subsection (m) of such section is amended
by adding at the end the following new paragraph:
``(4) Required response or action.--(A) If the Secretary
receives a referral under paragraph (1) for additional care,
the Secretary shall review such referral and contact the
veteran not later than 72-hours following the referral.
``(B) If the Secretary receives a referral under paragraph
(2) for emergent suicide care, the Secretary shall review such
referral and contact the veteran not later than 24 hours
following the referral by such entity under subsection
(m)(1).''.
(j) Reauthorization.--Subsection (p) of such section is amended--
(1) by striking ``section a total'' and inserting
``section--
``(1) a total'';
(2) by striking the period at the end and inserting ``;
and''; and
(3) by adding at the end the following new paragraph:
``(2) a total of $200,000,000 for fiscal years 2027 through
2029.''.
(k) Technical Correction to Definitions.--Subsection (q)(5) of such
section is amended, in the first sentence--
(1) by striking ``Medical services'' and inserting ``The
term `emergency treatment' means medical services''; and
(2) by striking ``was rendered'' and inserting
``rendered''.
(l) Identification of Demand for Other Services and Support.--
Subsection (e) of such section, as amended, is further amended--
(1) by redesignating paragraphs (5) and (6) as (6) and (7),
respectively; and
(2) by adding after paragraph (4) the following new
paragraph:
``(5) Demand for other services and support.--An entity
receiving a grant under this section shall submit to the
Secretary information concerning--
``(A) the number of individuals seeking services
from the entity who are not eligible individuals and
the most common reason such individuals are not
eligible individuals;
``(B) a description of the types of services that
eligible individuals or individuals described in
subparagraph (A) require based on any screening
conducted by the entity; and
``(C) any actions taken by the entity to provide
the services described in subparagraph (B) or to refer
the individual or eligible individual to another entity
for the receipt of such services.''.
(m) Suicide Prevention Services.--
(1) Required use of certain screening protocol.--Subsection
(q)(11)(A)(ii) of such section is amended by adding at the end
the following new sentence: ``In the case of a recipient of a
grant awarded under this section on or after the date of the
enactment of the Take Care of America's Veterans Act, such
screening shall be Columbia Protocol (also known as the
Columbia-Suicide Severity Rating Scale (C-SSRS)) or the Patient
Health Questionnaire-9 (PHQ9), or a successor screening tool
selected by the Secretary.'';
(2) Transportation.--Subsection (q)(11)(A) of such section
is amended--
(A) by redesignating clause (xi) as clause (xii);
and
(B) by inserting after clause (x) the following new
clause:
``(xi) Transportation and rideshare
services for eligible individuals to use for
appointments.''.
(n) Eligible Individuals.--Subsection (q)(4)(C) of such section is
amended by striking ``clauses (i) through (iv)'' and inserting
``clauses (i) through (vi)''.
(o) Effective Date.--The amendments made by this section shall take
effect on--
(1) the effective date of award following the date the
Secretary publishes a notice of funding opportunity for the
program required by section 201(a) of the Commander John Scott
Hannon Veterans Mental Health Care Improvement Act of 2019
(Public Law 116-171; (38 U.S.C. 1720F)), if the Secretary
determines such amendments do not require rulemaking; or
(2) the effective date of award following the date the
Secretary publishes a notice of funding opportunity following
the effective date of subsequent rulemaking, if the Secretary
determines such amendments do require rulemaking.
SEC. 307. REPORTS ON THE USE OF HYPERBARIC OXYGEN THERAPY.
(a) GAO Report on the Use of Hyperbaric Oxygen Therapy to Treat
Traumatic Brain Injury and Post-traumatic Stress Disorder.--Not later
than one year after the date of the enactment of this Act, the
Comptroller General of the United States shall submit to the Committees
on Veterans' Affairs of the Senate and House of Representatives an
update to the report titled ``Research on Hyperbaric Oxygen Therapy to
Treat Traumatic Brain Injury and Post-Traumatic Stress Disorder'' (GAO-
16-154). Such report shall include the assessment of the Comptroller
General of clinical trials conducted, since the publication of such
report--
(1) regarding the use of hyperbaric oxygen therapy to treat
traumatic brain injury and post-traumatic stress disorder; and
(2) by--
(A) the Secretary of Veterans Affairs;
(B) the Secretary of Defense; and
(C) private entities.
(b) Follow-up Study.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary shall conduct a
systematic review of published research literature on the off-
label use of hyperbaric oxygen therapy to treat post-traumatic
stress disorder and traumatic brain injury among veterans and
nonveterans.
(2) Elements.--The review conducted under paragraph (1)
shall include the following:
(A) An analysis of available research literature
published after the review completed pursuant to
section 702 of the Commander John Scott Hannon Veterans
Mental Health Care Improvement Act (Public Law 116-
171);
(B) An assessment of the current parameters for
research on the use by the Department of Veterans
Affairs of hyperbaric oxygen therapy, including--
(i) tests and questionnaires used to
determine the efficacy of such therapy; and
(ii) metrics for determining the success of
such therapy.
(C) A comparative analysis of tests and
questionnaires used to study post-traumatic stress
disorder and traumatic brain injury in other research
conducted by the Department of Veterans Affairs, other
Federal agencies, and entities outside the Federal
Government.
(D) A market assessment of available hyperbaric
oxygen therapy facilities or units within facilities to
assess the most effective locations and practices,
including--
(i) an analysis of whether multi-person
chambers could reduce per-veteran costs;
(ii) an analysis of areas with lower prices
compared to a national average; and
(iii) an identification of not fewer than
two VISNs in which the provision or furnishing
of hyperbaric oxygen therapy would benefit the
most number of veterans at the lowest cost to
the Department.
SEC. 308. DEPARTMENT OF VETERANS AFFAIRS PILOT PROGRAM TO PROVIDE
GRANTS TO MENTAL HEALTH CARE PROVIDERS FOR THE PROVISION
OF MENTAL HEALTH CARE FOR VETERANS.
(a) Establishment.--The Secretary of Veterans Affairs shall carry
out a three-year pilot program under which the Secretary shall make
grants to eligible mental health care providers for the provision of
mental health care, including evidence-based mental health care
delivered in person or via telehealth.
(b) Eligibility.--To be eligible to receive a grant under the pilot
program, a mental health care provider shall--
(1) be a non-profit organization;
(2) have operated at least one outpatient mental health
facility in the United States for a continuous period of at
least three years;
(3) be licensed or certified under applicable state law to
provide outpatient mental health services;
(4) be accredited by--
(A) the Joint Commission on Accreditation of
Healthcare Organizations;
(B) the Commission on Accreditation of
Rehabilitation Facilities; or
(C) any other nationally recognized accrediting
body the Secretary determines appropriate; and
(5) submit to the Secretary an application that includes
such information and assurances as the Secretary may require,
including--
(A) an identification of the outpatient facility or
facilities where the mental health care services will
be provided;
(B) a plan for providing clinicians at each
facility in receipt of grant funds with units of
continuing education with respect to veterans issues;
and
(C) an identification of the percentage of the
operating budget for each such facility that was
provided through Federal grants during the fiscal year
preceding the year during which the application is
submitted.
(c) Use of Funds.--
(1) In general.--The recipient of a grant under the pilot
program shall use the grant--
(A) to deliver evidence-based mental health care
for veterans in person or via telehealth.
(B) to operate or expand an existing outpatient
mental health facility or establish a new outpatient
mental health facility for the purpose of providing
such care;
(C) to encourage veterans who are eligible for
enrollment in the patient enrollment system under
section 1705 of title 38, United States Code, to enroll
in such system and to receive medical services
furnished by the Department of Veterans Affairs;
(D) to support activities necessary to deliver or
sustain care, including--
(i) outreach;
(ii) care coordination;
(iii) veteran engagement;
(iv) clinician training;
(v) implementation support; and
(vi) program evaluation; and
(E) to support continuous quality improvement and
outcomes measurement activities, including the
collection and reporting of clinical outcomes and
operational metrics; and
(F) to support activities of the program that are
not billable, reimbursable, or otherwise authorized by
law, including--
(i) outreach;
(ii) care coordination;
(iii) engagement;
(iv) implementation support; and
(v) program evaluation; and
(G) to provide services to individuals for which
reimbursement is not otherwise available, including
such individuals who are--
(i) uninsured;
(ii) ineligible for health care furnished
by the Department of Veterans Affairs; or
(iii) in receipt of health care that is not
reimbursable as of the date of the enactment of
this Act.
(2) Limitations on use of grant funds.--The recipient of a
grant under the pilot program may not--
(A) charge an eligible veteran a fee associated
with the receipt of mental health care funded by such
grant;
(B) refuse to provide mental health care to an
eligible veteran on the basis that the veteran is not
eligible for reimbursement for such care under another
payer source; or
(C) use grant funds to--
(i) duplicate payments made under any
contract or agreement to which the Department
is a party as of the date of the enactment of
this Act; or
(ii) pay for the same clinical services or
service units that are otherwise billable to a
Federal payer, including the Veterans Community
Care Program under section 1703 of title 38,
United States Code, or any other public or
private health plan.
(3) Rules of construction.--Nothing in this subsection may
be construed to--
(A) prohibit a grant recipient from seeking
reimbursement from non-Department payers for mental
health services provided by the grant recipient, except
that grant funds shall not be used to supplant or
duplicate a reimbursement otherwise available under
Federal law; or
(B) authorize double billing or duplicate payments
for the same clinical service or unit of service.
(4) Spouse and dependent care.--A recipient may use grant
funds to provide care to spouses and dependent children of a
veteran when such services are integral to achieving a
successful clinical outcome. Permissible services include--
(A) family therapy;
(B) couples therapy;
(C) group therapy;
(D) family psychoeducation; and
(E) other counseling services the Secretary
determines are clinically necessary.
(d) Selection of Facilities.--In awarding grants under the pilot
program, the Secretary--
(1) shall ensure that grants are distributed geographically
evenly among rural and urban areas;
(2) may consider the proportion of veterans historically
served by the grant recipient; and
(3) may prioritize outpatient mental health facilities
located in areas that the Secretary determines--
(A) are medically underserved;
(B) have large veteran populations;
(C) are located near military installations; or
(D) have large numbers of veterans at high risk of
suicide.
(e) Amount of Grant.--
(1) In general.--
(A) In general.--Except as provided in subparagraph
(B), no grant under the pilot program for a facility
for any fiscal year may exceed $1,500,000.
(B) Limitation.--In the case of an outpatient
mental health facility for which at least 50 percent of
the operating budget of the facility for the preceding
fiscal year was provided through Federal grants, no
grant under the pilot program for the facility for any
fiscal year may exceed the lesser of--
(i) 50 percent of the operating budget of
the facility; or
(ii) $1,500,000.
(2) Multiple grants.--The recipient of a grant under the
pilot program--
(A) may apply for, and receive, grants for more
than one facility of the recipient for any fiscal year;
and
(B) may apply for, and receive, a grant for a
facility that has already received a grant under the
pilot program.
(f) Regulations; Accountability.--The Secretary shall prescribe
regulations to carry out this section, which shall include a
requirement that each recipient of a grant under the pilot program
shall--
(1) demonstrate the capacity to provide accountability;
(2) demonstrate clinical outcomes;
(3) justify the effective use of any private investment
funds or Federal grant funds through data collection and
reporting metrics; and
(4) collect standardized outcome measures including symptom
improvement and program completion.
(g) Continuity of Care.--A recipient of a grant under the pilot
program shall adhere to the continuity of care model established by the
Secretary to the Veterans Community Care Program.
(h) Report.--Not later than 180 days after the completion of the
pilot program under this section, the Secretary shall submit to
Congress a report on the pilot program that includes the following:
(1) The number of veterans who received mental health care
under the program.
(2) An identification of the types of mental health care
provided and the time period for which such care was provided.
(3) An identification and summary of program outcomes.
(4) The number of veterans who received mental health care
under the program and subsequently enrolled in the patient
enrollment system under section 1705 of title 38, United States
Code.
(5) An identification of any obstacles faced by grant
recipients in providing mental health care under the program.
(6) A summary of clinical outcomes based on pre- and post-
client functioning--
(A) the number of veterans who improved clinically
based on relevant clinical evaluation metrics that the
Secretary determines appropriate;
(B) the degree of clinical improvement based on
such relevant clinical evaluation metrics;
(C) the total number of veterans participating in
the program; and
(D) any other outcome metrics as the Secretary
determines appropriate.
(7) Findings with respect to the sustainability of the
program.
(i) Authorization of Appropriations.--There is authorized to be
appropriated to the Secretary to carry out the pilot program under this
section $20,000,000 for each of fiscal years 2027 through 2029.
SEC. 309. FURNISHING OF CERTAIN HEALTH SERVICES TO VETERANS IN THE
FREELY ASSOCIATED STATES.
(a) Agreements Required.--Consistent with section 1724(f) of title
38, United States Code, and section 209(a)(4)(A) of the Compact of Free
Association Amendments Act of 2024 (48 U.S.C. 1988(a)(4)(A)), the
Secretary of Veterans Affairs shall work expeditiously with the
governments of the Freely Associated States to enter into the
agreements described in such sections.
(b) Inclusion of Telehealth and Mail Order Pharmacy Services
Required.--Consistent with such sections and with the agreements
required by subsection (a), the Secretary shall furnish to veterans in
the Freely Associated States services that include, at a minimum--
(1) medical services authorized to be provided under
chapter 17 of title 38, United States Code, which can be
administered through telehealth; and
(2) pharmaceutical products authorized to be provided under
such chapter, delivered by mail.
(c) Implementation Dates.--In carrying out subsections (a) and (b),
the Secretary shall--
(1) initiate outreach to each such government not later
than 30 days after the date of the enactment of this Act;
(2) enter into each agreement required by subsection (a)
not later than one year after the date of the enactment of this
Act; and
(3) begin furnishing the services required by paragraphs
(1) and (2) of subsection (b) not later than one year after the
date of the enactment of this Act.
(d) Beneficiary Travel.--Section 111(h)(1) of title 38, United
States Code, is amended by striking ``the Secretary may make payments''
and inserting ``beginning not later than one year after the date of the
enactment of the Take Care of America's Veterans Act, the Secretary
shall make payments''.
(e) Reports.--Not less frequently than quarterly, the Secretary
shall submit to the appropriate committees of Congress a report on the
implementation of this section and the cost of such implementation.
Until the Secretary has entered into the agreements required by
paragraph (1) and begun furnishing the services required by
subparagraphs (A) and (B) of paragraph (2), the report shall also
describe the technical and logistical factors that have prevented or
impeded the Secretary from doing so.
(f) Definitions.--In this subsection:
(1) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Veterans' Affairs and the
Committee on Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the
Committee on Appropriations of the House of
Representatives.
(2) Freely associated states.--The term ``Freely Associated
States'' has the meaning given such term in section 1724(f) of
title 38, United States Code.
SEC. 310. MODIFICATION OF PRECISION MEDICINE FOR VETERANS INITIATIVE;
REPORTING ON SUICIDE BY VETERANS AND MEMBERS OF THE ARMED
FORCES.
(a) Modification of Precision Medicine for Veterans Initiative.--
Section 305 of the Commander John Scott Hannon Veterans Mental Health
Care Improvement Act of 2019 (Public Law 116-171; 38 U.S.C. 1712A note)
is amended--
(1) in subsection (a), by striking ``and such other mental
health conditions'' and inserting ``repetitive low-level blast
exposure, dementia, and such other brain and mental health
conditions'';
(2) in subsection (d)(4), by adding at the end the
following new subparagraph:
``(E) Data-sharing partnership.--
``(i) In general.--The Secretary shall work
with the Secretary of Defense to establish a
data-sharing partnership between the Department
of Veterans Affairs and the Department of
Defense.
``(ii) Storage.--The partnership
established under clause (i) shall be stored in
the open platform made available under this
paragraph.
``(iii) Data.--The data supplied by the
Secretary of Defense under the partnership
established under clause (i) shall include
relevant data throughout the Department of
Defense relating to low-level repetitive blast
exposure and traumatic brain injury collected
by the Armed Forces and other appropriate
entities, as determined jointly by the
Secretary of Defense and the Secretary of
Veterans Affairs.''; and
(3) by adding at the end the following new subsections:
``(f) Repetitive Low-level Blast Exposure Research.--In carrying
out the initiative under subsection (a), the Secretary shall prioritize
research--
``(1) to identify and validate biomarkers associated with
repetitive low-level blast exposure and traumatic brain injury;
``(2) to evaluate clinical and non-clinical interventions
that improve cognitive function, quality of life, and mental
health outcomes among veterans with symptoms associated with
repetitive low-level blast exposure;
``(3) to improve the diagnosis, treatment, and care
coordination for veterans with a history of low-level
repetitive blast exposure or traumatic brain injury, including
veterans who performed duties or tasks associated with
increased risk of low-level repetitive blast exposure; and
``(4) to develop evidence-based strategies to reduce
suicide risk among veterans with a history of low-level
repetitive blast exposure or traumatic brain injury.
``(g) Assistance and Report by National Academies of Sciences,
Engineering, and Medicine.--Not later than 180 days after the date of
the enactment of the Take Care of America's Veterans Act, the Secretary
of Veterans Affairs shall seek to enter into a contract with the
National Academies of Sciences, Engineering, and Medicine under which
the National Academies shall--
``(1) work in tandem with the initiative under subsection
(a) on validation of brain and mental health biomarkers among
veterans; and
``(2) not less frequently than once every two years, 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 work completed under paragraph (1).
``(h) Assessment.--
``(1) In general.--The Secretary of Veterans Affairs shall
conduct an assessment of all translational research studies in
progress and planned under the initiative under subsection (a),
including research under subsection (f).
``(2) Report.--Not later than 60 days after completion of
the assessment conducted under paragraph (1), 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 assessment.
``(i) Reports.--
``(1) In general.--Not less frequently than once every two
years, 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 initiative under subsection (a).
``(2) Recommendations.--Each report required by paragraph
(1) may include recommendations for immediate administrative
and legislative action to improve the initiative under
subsection (a).
``(j) Authorization of Appropriations.--There is authorized to be
appropriated to the Secretary of Veterans Affairs $5,000,000 to carry
out the initiative under subsection (a) for each of fiscal years 2027
through 2032.''.
(b) Inclusion of Information in Reports on Suicide Prevention Among
Veterans and Members of the Armed Forces.--
(1) Inclusion of information in national veteran suicide
prevention annual report.--Section 149(a)(4)(B) of the Senator
Elizabeth Dole 21st Century Veterans Healthcare and Benefits
Improvement Act (Public Law 118-210; 38 U.S.C. 1709B note) is
amended by adding at the end the following:
``(iv) Military occupation data of veterans
who attempt or commit suicide.''.
(2) Inclusion of information in department of defense
annual report.--The Secretary of Defense shall include in the
annual report of the Defense Suicide Prevention Office, or
successor office, information on--
(A) occupational data of members of the Armed
Forces who attempt suicide; and
(B) outcomes of suicide prevention interventions
among members of the Armed Forces.
SEC. 311. ESTABLISHMENT OF THE BLAST OVERPRESSURE TASK FORCE OF THE
DEPARTMENT OF VETERANS AFFAIRS.
(a) Establishment.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall appoint,
through the Department of Veterans Affairs-Department of Defense Joint
Executive Committee under section 320 of title 38, United States Code,
the Blast Overpressure Task Force of the Department of Veterans Affairs
(in this section referred to as the ``Task Force'').
(b) Membership.--Each member of the Task Force appointed under
subsection (a) shall be a member of the Health Executive Committee
under subsection (b)(2) of such section who, at the time of
appointment, is involved in research regarding the mitigation and
treatment of blast overpressure or blast exposure.
(c) Duties.--The duties of the Task Force are the following:
(1) To improve how the Secretary of Veterans Affairs, in
consultation with the Secretary of Defense, provides health
care and other benefits to veterans or members of the Armed
Forces diagnosed with traumatic brain injury, post-traumatic
stress disorder, or other symptoms, from blast overpressure or
blast exposure.
(2) To align research agendas and acquisition strategies of
the Department regarding such health care.
(3) To establish physiological and cognitive performance
baselines for such veterans and members.
(4) To prioritize translational research regarding such
veterans and members, including research regarding--
(A) sleep therapy;
(B) blast-related gut health;
(C) mobile diagnostics;
(D) vestibular dysfunction and balance impairment;
(E) autonomic nervous system dysregulation;
(F) cumulative mild traumatic brain injury;
(G) neuroinflammation and glial activation; and
(H) any other issue determined appropriate by the
Secretary.
(5) To monitor sensory decline (including with regards to
vision, hearing, and vestibular function) and stress-related
impairments among such veterans and members.
(6) To support continuity of such care by integrating
mobile and longitudinal diagnostic tools.
(d) Reports.--The Task Force shall issue annual reports to the
Committees on Veterans' Affairs and on Armed Services of the Senate and
House of Representatives. Each such report shall include the following
elements:
(1) Details of research initiatives, coordination outcomes,
and clinical advancements of the Task Force.
(2) Recommendations of the Task Force regarding--
(A) how claims processors of the Department of
Veterans Affairs should evaluate evidence that links
such conditions to active military, naval, air, or
space service; and
(B) best practices regarding the evaluation of
neurological injuries in examinations for benefits
under chapters 11 or 15 of title 38, United States
Code.
(e) Sunset.--The Task Force shall terminate on September 30, 2029.
SEC. 312. EXTENSION OF SHARING OF DEPARTMENT OF VETERANS AFFAIRS AND
DEPARTMENT OF DEFENSE HEALTH CARE RESOURCES; RESOURCE
SHARING OVERSIGHT AND IMPLEMENTATION PLAN.
(a) Extension.--Section 8111(d)(3) of title 38, United States Code,
is amended by striking ``September 30, 2026'' and inserting ``September
30, 2027''.
(b) Oversight.--
(1) Justification.--Such section is further amended in
subsection (a)--
(A) by inserting ``(1)'' before ``To the maximum
extent practicable, the Secretary''; and
(B) by adding at the end the following new
paragraph:
``(2) If the Secretary of Veterans Affairs elects not to
enter into such an agreement or contract, notwithstanding
paragraph (1), the Secretary and the Department of Veterans
Affairs-Department of Defense Joint Executive Committee shall
submit to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a written justification for such
election.''.
(2) Form of information.--If the Committee on Veterans'
Affairs of the House of Representatives or the Senate requests
information from the Secretary of Veterans Affairs regarding
section 8111 of title 38, United States Code, the Secretary
shall provide such information in the form requested by such
committee, including underlying records, datasets,
methodologies, contracts, and communications, and may not be
limited to summaries or briefing materials in lieu of original
source documents unless authorized by the requesting committee.
(3) Interference with transmission of information.--In
response to such a request, no official or employee of the
Department of Veterans Affairs shall--
(A) withhold, screen, or alter responsive
information;
(B) delay or condition production on initial
clearance or political review;
(C) require a nondisclosure agreement unless
required by law;
(D) substitute summaries for requested 2 records;
or
(E) otherwise impede or interfere with direct
transmission of information to the Committee on
Veterans' Affairs of the House of Representatives or
the Senate.
(4) Classified information.--If the Secretary of Veterans'
Affairs determines that any information regarding such section
requested by the Committee on Veterans' Affairs of the House of
Representatives or the Senate is classified, the Secretary
shall make arrangements to present such information to the
Chair and Ranking Member of the such committee using
appropriate security measures.
(c) Implementation Plan and Report.--
(1) Joint resource sharing implementation plan.--Not later
than 90 days after the date of the enactment of this Act, the
Secretary of Veterans Affairs, in coordination with the
Secretary of Defense, shall submit to the Committees on
Veterans' Affairs of the House of Representatives and the
Senate a Joint Resource Sharing Implementation Plan. Such plan
shall include--
(A) a comprehensive inventory of all agreements
under section 8111 of title 38, United States Code;
(B) a standardized reimbursement methodology;
(C) capacity assessments of Department of Veterans
Affairs and Department of Defense facilities; and
(D) identification of priority regions for
expansion.
(2) Report.--Not later than 2 years after date of the
enactment of this Act, the Comptroller General shall submit a
report to Congress on the implementation of section 8111 of
title 38, United States Code. Such report shall include--
(A) a description of use and effectiveness of
agreements under such section;
(B) a description of the role and output of the
Joint Executive Committee under such section;
(C) an evaluation of the effectiveness of
coordination of care and sharing of resources by the
Department of Veterans Affairs and the Department of
Defense under such section; and
(D) a description of any statutory, operational, or
cultural barriers to the implementation of such
section.
SEC. 313. TIMELY REPORTING OF THE DEATH OF A VETERAN.
(a) Findings.--Congress finds the following:
(1) States and counties have reported significant delays in
the signing of death certificates for veterans who pass away
from natural causes.
(2) Such delays, caused by the refusal of, or postponement
by, physicians of the Department of Veterans Affairs have, in
some cases, lasted as long as eight weeks.
(3) Such delays prevent the timely burial of deceased
veterans and access to survivor benefits.
(b) Timely Certification of the Death of a Veteran.--
(1) In general.--
(A) VA physician, nurse practitioner, or physician
assistant.--Subject to subparagraph (B), a physician,
nurse practitioner, or physician assistant employed by
the Secretary of Veterans Affairs who is the primary
care provider of a veteran who dies of natural causes
shall certify the death of such veteran not later than
two business days after such physician, nurse
practitioner, or physician assistant learns of such
death.
(B) Coroner or medical examiner.--If a physician,
nurse practitioner, or physician assistant described in
subparagraph (A) cannot comply with such paragraph with
respect to a death described in such paragraph, a
coroner or medical examiner in the jurisdiction where
such death occurred may certify such death.
(2) Report.--
(A) In general.--Not later than one year after the
date of the enactment of this Act, and annually
thereafter for the following five years, 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 regarding
compliance with paragraph (1).
(B) Elements.--Each report required under
subparagraph (A) shall include, with respect to the
year preceding the date of the report, the following
elements:
(i) The percentage of cases in which a
physician, nurse practitioner, or physician
assistant employed by the Secretary complied
with paragraph (1)(A).
(ii) The number of cases in which such a
physician, nurse practitioner, or physician
assistant could not so comply.
(iii) An identification of the most common
reasons why such a physician, nurse
practitioner, or physician assistant could not
so comply.
(3) Rule of construction.--Nothing in this section shall be
construed to authorize a physician assistant or nurse
practitioner to certify a death in any State in which such
authority is not permitted under State or local law.
SEC. 314. EXPANSION OF ACCESS BY VETERANS TO CRITICAL ACCESS HOSPITALS
AND AFFILIATED CLINICS UNDER THE VETERANS COMMUNITY CARE
PROGRAM.
(a) Pilot Program to Improve Care Coordination for Veterans From
Critical Access Hospitals and Affiliated Clinics.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall commence a five-year pilot program to improve care
coordination for eligible veterans who receive care from a
critical access hospital or a provider-based rural health
clinic affiliated with such hospital (in this section referred
to as the ``pilot program'').
(2) Contracts, agreements, or other arrangements.--
(A) In general.--In carrying out the pilot program,
the Secretary shall enter into contracts, agreements,
or other arrangements with facilities participating in
the pilot program to reimburse critical access
hospitals and affiliated clinics for outpatient health
care and medical services provided to eligible
veterans.
(B) Elements.--The Secretary, in coordination with
participating critical access hospitals, shall ensure
that any contract, agreement, or other arrangement
entered into under subparagraph (A) establishes
criteria, as the Secretary considers appropriate, to
ensure--
(i) the provision of timely, safe, and
high-quality health care services to
participants in the pilot program, including
through timely sharing of pertinent medical
record and other information between medical
facilities participating in the pilot program
and medical facilities of the Department of
Veterans Affairs;
(ii) the provision of health care services
through the pilot program is in accordance with
the medical benefits package of the Department;
(iii) no additional charges are imposed on
veterans participating in the pilot program or
the health care insurer of such veterans for
any medical service for which payment is made
by the Secretary;
(iv) appropriate reimbursement rates,
including through the consideration of cost-
based reimbursements; and
(v) such other considerations as the
Secretary considers appropriate.
(3) Locations.--The Secretary shall ensure participation in
the pilot program is open to all qualified facilities located
in States that are designated by the Centers for Medicare &
Medicaid Services as frontier States.
(4) Authorization for care.--The Secretary shall provide
eligible veterans opting to participate in the pilot program a
one-year authorization from the Department to receive
outpatient services at facilities participating in the pilot
program.
(5) Outreach.--
(A) Eligible veterans.--Not less frequently than
annually during each year in which the pilot program is
carried out, the Secretary shall conduct direct
outreach to eligible veterans in areas in which the
pilot program is carried out to notify such veterans of
their ability to participate in the pilot program.
(B) Hospitals.--The Secretary shall conduct direct
outreach to critical access hospitals in areas in which
the pilot program is carried out to notify those
hospitals of their ability to participate in the pilot
program.
(6) Staff.--The Secretary shall ensure that each medical
facility of the Department within the catchment area of a
location in which the pilot program is carried out has
sufficient dedicated staff to handle--
(A) administrative and technical challenges that
arise from the pilot program;
(B) care coordination and follow up with the
veteran and the facility participating in the pilot
program after an episode of care; and
(C) timely records return following an episode of
care.
(7) Limitation.--The Secretary may not extend the pilot
program beyond the five-year period specified under subsection
(a) or expand the pilot program to additional States or convert
the pilot program into a permanent authority unless expressly
authorized by a subsequent Act of Congress.
(8) Report.--
(A) In general.--Not later than one year after the
date of the enactment of this Act, and annually
thereafter for the duration of the pilot program, 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
pilot program.
(B) Elements.--
(i) In general.--Each report required under
subparagraph (A) shall contain the
recommendation of the Secretary for the
expansion or continuation of the pilot program.
(ii) Initial report.--The initial report
required under clause (i) shall contain--
(I) a description of the outreach
conducted to critical access hospitals
concerning the pilot program;
(II) a list of facilities that have
opted to participate in the pilot
program;
(III) information, by facility,
regarding total obligations and
expenditures, utilization average time
from authorization to care, timeliness
regarding medical records return and
claim payment, emergency department
utilization, veteran satisfaction, and
any effect on care furnished by
Department facilities; and
(IV) a list of the barriers, if
any, cited by facilities that opted not
to participate in the pilot program.
(iii) Subsequent reports.--Each report
required under clause (i) after the initial
report shall contain--
(I) an updated list of facilities
participating in the pilot program;
(II) the number of veterans
participating in the pilot program,
disaggregated by facility;
(III) an overview of the types of
care received through the pilot
program;
(IV) feedback from the facilities
participating in the pilot program,
with identifying information removed,
regarding the status of the pilot
program, challenges in participating in
the pilot program, and the interest of
the facility in continued participation
in such a program; and
(V) any additional information that
the Secretary determines relevant or
necessary.
(9) Definitions.--In this subsection:
(A) Critical access hospital.--The term ``critical
access hospital'' has the meaning given that term in
section 1861(mm) of the Social Security Act (42 U.S.C.
1395x(mm)).
(B) Eligible veteran.--The term ``eligible
veteran'' means a veteran--
(i) enrolled in the patient enrollment
system of the Department of Veterans Affairs
established and operated under section 1705(a)
of title 38, United States Code;
(ii) who has received care at a facility of
the Department or in-network provider under the
Veterans Community Care Program under section
1703 of such title during the previous two-year
period;
(iii) who lives within 35 miles of a
critical access hospital; and
(iv) who would be eligible for care or
services under the Veterans Community Care
Program.
(b) Action Plan to Address Barriers to Care for Veterans Living in
Rural Areas.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall develop and submit to the Committee on Veterans' Affairs
of the Senate and the Committee on Veterans' Affairs of the
House of Representatives a comprehensive action plan to
identify, address, and eliminate barriers to accessing care for
veterans residing in rural, highly rural, and frontier areas.
(2) Elements.--In developing the action plan required under
paragraph (1), the Secretary shall--
(A) consult with health care providers that provide
care in the community under the laws administered by
the Secretary, State Offices of Rural Health, Tribal
health authorities, and other relevant stakeholders in
rural, highly rural, and frontier areas as the
Secretary determines appropriate;
(B) assess barriers to care in the community for
veterans residing in rural and highly rural areas,
including challenges with respect to--
(i) network adequacy;
(ii) provider participation;
(iii) geographic distance;
(iv) transportation;
(v) information technology;
(vi) physical infrastructure;
(vii) outreach and understanding of
eligibility for such care;
(viii) timeliness of referrals,
authorization, and medical documentation
exchange; and
(ix) any other matter the Secretary
determines appropriate;
(C) list specific and measurable strategies and
actions to address the barriers and challenges assessed
under subparagraph (B), to include the consideration
of--
(i) expanding participation in the Veterans
Community Care Program under section 1703 of
title 38, United States Code, among providers
in rural, highly rural, and frontier areas;
(ii) physically locating health care
facilities of the Department of Veterans
Affairs within the same building or on the
campuses of other health care facilities
located in rural, highly rural, or frontier
areas;
(iii) enhancing transportation assistance;
(iv) increasing reimbursement rates,
including through cost-based reimbursements;
and
(v) improving coordination with State,
Tribal, and local partners; and
(D) assess legislative and regulatory barriers, if
any, to addressing the barriers assessed under
subparagraph (B).
(3) Implementation.--Not later than 90 days after
submitting the action plan under paragraph (1), the Secretary
shall begin implementation of the plan and shall ensure full
implementation not later than two years after the date of the
enactment of this Act.
(c) Outreach.--
(1) Outreach to veterans.--Not later than one year after
the date of the enactment of this Act, and annually thereafter,
the Secretary of Veterans Affairs, through the Office of Rural
Health (or successor office) and the Office of Integrated
Veteran Care (or successor office), shall conduct outreach to
veterans residing in rural, highly rural, and frontier areas
regarding--
(A) opportunities to seek care through facilities
and programs of the Department of Veterans Affairs,
including via telehealth, existing programs provided
through grantees or contractors of the Department, Vet
Centers (as defined in section 1712A of title 38,
United States Code), and volunteer programs and
services for transportation;
(B) opportunities to seek care though the Veterans
Community Care Program under section 1703 of title 38,
United States Code;
(C) opportunities to seek care at critical access
hospitals with contracts, partnerships, or agreements
with the Department of Veterans Affairs; and
(D) any other matters the Secretary considers
appropriate.
(2) Outreach to providers.--Not later than one year after
the date of the enactment of this Act, and annually thereafter,
the Secretary of Veterans Affairs, through the Office of Rural
Health (or successor office) and the Office of Integrated
Veteran Care (or successor office), shall--
(A) conduct outreach to health care facilities and
critical access hospitals in rural areas regarding--
(i) the Veterans Community Care program
under section 1703 of title 38, United States
Code, and the pilot program under subsection
(a) of this section; and
(ii) any other matters the Secretary
considers appropriate; and
(B) seek to enter into contracts, partnerships,
agreements, or other arrangements with health care
facilities and critical access hospitals in rural
areas.
(3) Critical access hospital defined.--In this section, the
term ``critical access hospital'' has the meaning given that
term in section 1861(mm) of the Social Security Act (42 U.S.C.
1395x(mm)).
SEC. 315. PILOT PLATFORM FOR SERVICES FOR VETERANS; COLLECTION FROM
VETERANS OF INFORMATION RELATED TO SOCIAL DETERMINANTS OF
HEALTH.
(a) Pilot Program on Establishment or Enhancement of Community
Integration Platform for Veterans.--
(1) In general.--Commencing not later than 18 months after
the date of the enactment of this Act, the Secretary, acting
through the Center for Innovation for Care and Payment of the
Department of Veterans Affairs, shall carry out a pilot program
under which the Secretary shall establish a new, or enhance an
existing, interoperable community integration platform to
coordinate local support services for veterans through other
governmental and nongovernmental organizations (in this section
referred to as the ``pilot program'').
(2) Elements of pilot program.--In carrying out the pilot
program, the Secretary shall ensure that the community
integration platform established or enhanced under the pilot
program--
(A) permits veterans to identify and connect with
covered entities that furnish covered services;
(B) permits covered entities to identify and
connect with veterans in need of covered services;
(C) utilizes, to the extent practicable, existing
interoperable technology networks;
(D) prioritizes connectivity with appropriate
existing technology networks developed by public or
private organizations that comply with, as applicable,
standards adopted by the Secretary of Health and Human
Services under section 3004 of the Public Health
Service Act (42 U.S.C. 300jj-14), for the provision of
covered services;
(E) ensures that--
(i) reasonable measures are taken to
promote connectivity and interoperable exchange
among covered entities and between covered
entities and veterans; and
(ii) appropriate privacy and security
protections are in place, in accordance with
applicable Federal and State privacy law;
(F) is accessible by employees of the Department,
covered entities, and veterans;
(G) connects covered entities and veterans for
purposes of communication, service coordination, and
consumer assistance, referral and capacity management,
outcome tracking and reporting, and related services;
and
(H) is accessible via a web-based platform for all
veterans and via a non-web-based alternative platform
or process for veterans who are unable to easily and
reliably access the web-based platform.
(3) Locations.--
(A) Initial locations.--The Secretary shall carry
out the pilot program at not fewer than five medical
facilities of the Department of Veterans Affairs
selected by the Secretary for purposes of the pilot
program.
(B) Expansion.--The Secretary may expand beyond
initial sites for the pilot program selected under
paragraph (1) not before two years after the date of
enactment, not before thirty days after briefing the
Committees on Veterans' Affairs of the Senate and the
House of the expansion plan, and after demonstrated
success.
(C) Variety of facilities.--In selecting facilities
under subparagraph (A), the Secretary shall ensure the
selection of a variety of different types of
facilities, including--
(i) frontier facilities;
(ii) under-resourced facilities;
(iii) facilities at which there are
existing efforts to coordinate with community
resources; and
(iv) facilities located in communities with
an established community-based veteran service
coordination network capable of integration
with the pilot program.
(4) Procurement of technology.--In carrying out the pilot
program, the Secretary shall ensure full and open competition
in the procurement of any services or technology and shall not
enter into an exclusive national contract for the operation of
the community integration platform under the pilot program. In
procuring technology under this section, the Secretary may
prioritize, to the maximum extent practicable, technologies,
platforms, or capabilities that are already deployed,
validated, interoperable, or otherwise in operational use
within medical centers or other components of the Department,
unless the Secretary determines and documents that an
alternative solution would better achieve the purposes of this
section.
(5) Application process.--
(A) In general.--The Secretary may require covered
entities that seek to participate in the pilot program
to submit to the Secretary an application therefore in
such form, in such manner, and containing such
commitments and information as the Secretary considers
necessary to carry out this section.
(B) Review.--
(i) In general.--The Secretary shall review
the applications of covered entities submitted
under subparagraph (A) to ensure that the
participation of such entities would be safe
and appropriate for veterans participating in
the pilot program.
(ii) Due diligence.--In reviewing
applications under clause (i), the Secretary
shall conduct due diligence consistent with how
the Secretary conducts due diligence for
public-private partnerships under other laws
administered by the Secretary.
(6) Screening and tracking of participants.--
(A) In general.--The Secretary shall require
veterans participating in the community integration
platform under the pilot program to provide information
regarding social determinants of health using the ICD-
10 diagnostic codes Z55 through Z63 and Z75 (as in
effect on the date of the enactment of this Act) in a
standardized risk assessment or screening tool and such
other information as the Secretary considers necessary
to administer the pilot program.
(B) Informed consent.--Information collected under
the pilot program with respect to a veteran shall be
obtained with the informed consent of the veteran and
used solely for purposes of care coordination, service
delivery, or program evaluation under the pilot
program.
(C) Tracking of information.--
(i) In general.--The Secretary shall
track--
(I) the number of referrals of
veterans to covered entities through
the community integration platform
under the pilot program;
(II) the response time of covered
entities to which such veterans are
referred; and
(III) the outcome of the initial
meeting by a veteran and a covered
entity to which the veteran is
referred, including a description of
the services that are provided to the
veteran by such entity.
(ii) Tracking by entities.--The Secretary
may require covered entities participating in
the pilot program to track the information
required under clause (i) in a medium
determined appropriate by the Secretary.
(7) Coordination and integration of programs.--
(A) Coordination with existing networks.--In
carrying out the pilot program, the Secretary shall
coordinate with existing community networks.
(B) Coordination and integration with state
medicaid programs.--The Secretary may consult and
coordinate with the Secretary of Health and Human
Services and with States regarding existing Federal and
State programs, but nothing in this section shall be
construed to authorize the Secretary of Veterans
Affairs to administer, direct, or modify a State
Medicaid program or waiver.
(8) Performance benchmarks.--The Secretary shall establish
performance benchmarks for the pilot program, including
measures of referral completion, timeliness of service
connection, and veteran-reported satisfaction.
(9) Report and briefings.--
(A) Report.--Not later than three years after the
commencement of the pilot program, the Secretary shall
submit to the appropriate committees of Congress a
report analyzing the needs of veterans for covered
services reflected by the use of such services under
the community integration platform under the pilot
program, including an assessment of--
(i) the need for such services that is
being met through such platform; and
(ii) the need for such services that is not
being met through such platform.
(B) Briefing on entities not selected.--Not later
than 180 days after the commencement of the pilot
program, and not less frequently than once every 180
days thereafter until the conclusion of the pilot
program, the Secretary shall brief the appropriate
committees of Congress on the covered entities that
submitted an application to participate in the pilot
program but were not selected for participation and the
reason those entities were not selected.
(10) Comptroller general evaluation, report, and
recommendations.--
(A) Evaluation.--The Comptroller General of the
United States shall conduct an evaluation that measures
the overall impact of the community integration
platform established or enhanced under the pilot
program with respect to--
(i) changes in individual and population
health outcomes among veterans;
(ii) changes in access to health care or
social services among veterans; and
(iii) such other factors as the Comptroller
General considers appropriate.
(B) Report and recommendations.--
(i) In general.--Not later than four years
after the commencement of the pilot program,
the Comptroller General shall--
(I) submit to Congress a report on
the evaluation conducted under
subparagraph (A);
(II) make such report publicly
available; and
(III) based on such evaluation,
make recommendations to the Secretary
on how to improve and sustain the
community integration platform
established or enhanced under the pilot
program.
(ii) Elements of report.--The report under
clause (i)(I) shall include data on--
(I) what covered sources under the
pilot program are being utilized the
most;
(II) what requests for services
under the pilot program cannot be met;
and
(III) the impact of the provision
of services under the pilot program on
health outcomes of veterans.
(11) Limitations.--(A) The Secretary may not use the pilot
program established under subsection (a) to supplant services
otherwise required to be furnished by the Department under
title 38, United States Code.
(B) No covered entity participating in the pilot program
established under subsection (a) may receive access to
personally identifiable information, protected health
information, or social determinants information of a veteran
without the veteran's informed written consent, and such
information may be used only for the specific referral or
service authorized by the veteran.
(12) Definitions.--In this subsection:
(A) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means the
Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives.
(B) Community integration platform.--The term
``community integration platform'' means an
interoperable platform or network of interoperable
systems used to enable the coordination, alignment, and
connection of covered entities and veterans at the
local level for purposes of communication, service
coordination, and referral management of covered
services.
(C) Covered entity.--The term ``covered entity''
means any of the following entities or providers that
have entered into an agreement with the Secretary to
participate in the pilot program:
(i) A community-based organization that--
(I) accepts referrals from health
care organizations; and
(II) provides covered services.
(ii) A public or private health care
provider organization.
(iii) A public or private funded payor of
health care services, including home- or
community-based services.
(iv) A State, local, territorial, or Tribal
health or social services agency.
(v) A State public housing authority or
housing finance agency.
(vi) A public health information exchange
or public health information network, as
defined by the Secretary.
(vii) A faith-based service provider.
(viii) Any other similar entity, as
determined by the Secretary.
(D) Covered services.--The term ``covered
services'' means any of the following:
(i) Nutritional assistance.
(ii) Housing.
(iii) Health care, including preventive
health intervention, chronic disease
management, and behavioral health care.
(iv) Transportation.
(v) Job training and employment.
(vi) Child development or care.
(vii) Caregiving and respite care.
(viii) Disability assistance.
(ix) Suicide prevention.
(x) Sexual assault services.
(xi) Legal aid.
(xii) Transition assistance for veterans
newly separated or discharged from active
military, naval, air, or space service (as
defined in section 101(24) of title 38, United
States Code).
(xiii) Assistance with utilities necessary
for safe habitation.
(xiv) Other services directly related to
health care access, suicide prevention,
homelessness prevention, food insecurity,
transportation to health care, or assistance
separating from military service and reentering
civilian life, as expressly authorized under
laws administered by the Secretary.
(E) Secretary.--The term ``Secretary'' means the
Secretary of Veterans Affairs.
(F) State.--The term ``State'' has the meaning
given that term in section 101 of title 38, United
States Code.
(b) Collection of Information From Veterans Related to Social
Determinants of Health.--
(1) In general.--The Secretary of Veterans Affairs shall
collect from veterans enrolled in the system of annual patient
enrollment of the Department of Veterans Affairs established
and operated under section 1705(a) of title 38, United States
Code, as part of routine screenings of such veterans under the
laws administered by the Secretary, information related to
social determinants that may factor into the health of such
veterans.
(2) Social determinants of health.--
(A) In general.--The information collected under
subsection (a) shall include standardized definitions
for identifying social determinants of health needs
identified in the ICD-10 diagnostic codes Z55 through
Z63 and Z75 (as in effect on the date of enactment of
this Act).
(B) Incorporation of measures.--Definitions
included under subparagraph (A) with respect to
identifying social determinants of health needs shall
incorporate measures for quantifying the relative
severity of any such social determinant of health need
identified in an individual.
SEC. 316. IMPROVEMENTS TO DEPARTMENT OF VETERANS AFFAIRS PROSTHETIC AND
REHABILITATIVE ITEMS AND SERVICE.
(a) Prosthetic and Rehabilitative Items and Services Formulary.--
(1) In general.--Chapter 17 of title 38, United States
Code, is amended by inserting after section 1709C the following
new section:
``Sec. 1709D. Prosthetic and Rehabilitative Items and Services
Formulary
``(a) In General.--The Secretary shall establish a list of
prosthetic and rehabilitative items and services, which may be referred
to as the `Prosthetic and Rehabilitative Items and Services Formulary'
or the `Formulary', for purposes of furnishing medical services under
section 1701(6)(F) of this title pursuant to section 1710 of this
title.
``(b) Requirements.--
``(1) Input.--In developing the Formulary, the Secretary
shall solicit input from veterans and the public.
``(2) Availability of items.--The Secretary shall ensure
that all items and services included in the Formulary are
available at or through all facilities of the Department.
``(3) Items to be included.--In developing the Formulary,
the Secretary shall rely on the best available evidence to
identify which items and services should be included on the
Formulary.
``(c) Publication and Communication.--
``(1) Publication and update.--The Secretary shall publish
the Formulary on a website of the Department and shall update
the Formulary periodically.
``(2) Communication.--The Secretary shall communicate to
veterans the contents of the Formulary and information about
how to appeal decisions regarding the provision of items and
services on the Formulary.
``(d) Contracts.--The Secretary shall enter into such contracts as
the Secretary considers necessary to support the availability of items
and services included in the Formulary.
``(e) Training.--The Secretary shall ensure the availability of
training on the Formulary for clinicians and other staff of the
Department.
``(f) Exceptions.--
``(1) In general.--The Secretary shall establish a process
for clinicians of the Department to request, prescribe, and
furnish prosthetic and rehabilitative items and services that
are not included on the Formulary when medically necessary.
``(2) Monitoring of non-formulary items and services.--The
Secretary shall monitor requests and prescriptions for and the
furnishing of prosthetic and rehabilitative items and services
under paragraph (1)--
``(A) to ensure that such items and services are
being consistently and appropriately prescribed at all
facilities of the Department; and
``(B) to determine whether such items or services
should be added to the Formulary.
``(3) Prior authorization for non-formulary procurement.--
The Secretary shall establish a prior authorization process for
the procurement of prosthetic and rehabilitative items that are
not included on the Formulary or available through a national
contract.
``(4) Open market procurement.--The Secretary shall ensure
that procurement of items that are not included on the
Formulary or available through a national contract is permitted
only if a clinician determines the item is medically necessary.
``(g) Consideration.--In developing the Formulary, the Secretary
shall consider how the approach of the Pharmacy Benefits Management
Services of the Department for formulary management and medication
safety can be adapted to support the efficient and effective
administration of the Formulary.
``(h) Enterprise Procurement and Ordering System.--
``(1) In general.--The Secretary shall implement an
enterprise electronic ordering system for prosthetic and
rehabilitative items and services furnished under this section.
``(2) Systems elements.--The system required under
paragraph (1) shall--
``(A) enable the automated ordering of items
included on the Formulary;
``(B) provide visibility of contract pricing and
availability across all facilities of the Department;
``(C) allow enterprise loading of nationally
contracted products;
``(D) provide procurement analytics to monitor
compliance with national contracts and reduce open
market purchasing; and
``(E) contain all data elements required for the
Federal Electronic Healthcare Record in a searchable
format.
``(3) Implementation.--The Secretary shall ensure that the
system required under paragraph (1) is implemented across all
medical centers of the Department by not later than three years
after the date of the enactment of this section.
``(i) Program Management.--
``(1) In general.--The Secretary shall ensure that the
Prosthetic and Sensory Aids Service of the Department maintains
adequate staffing to administer the Formulary and associated
procurement programs.
``(2) Staffing included.--Staffing required under paragraph
(1) shall include--
``(A) dedicated program managers for major
prosthetic product categories; and
``(B) full-time clinical staff responsible for
clinical evaluations and practice recommendations.
``(j) Report to Congress.--Not later than two years after the date
of the enactment of this section, and annually thereafter, the
Secretary shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report describing--
``(1) rates of compliance by the Department with national
prosthetic contracts;
``(2) open market purchasing trends of the Department;
``(3) utilization of the Formulary across facilities of the
Department; and
``(4) steps taken by the Department to improve enterprise
procurement efficiency.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 1709C the following new item:
``1709D. Prosthetic and rehabilitative items and services formulary''.
(b) Report.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report containing a comprehensive operational
and technology assessment of the Prosthetic and Rehabilitative
Items and Services Formulary established under section 1709D of
title 38, United States Code, as added by subsection (a).
(2) Elements.--The report required by paragraph (1) shall
identify potential impacts of the Prosthetic and Rehabilitative
Items and Services Formulary on--
(A) access by veterans to prosthetic and
rehabilitative items and services;
(B) clinician workload;
(C) procurement timelines; and
(D) innovation adoption.
SEC. 317. IMPROVEMENT OF SUBMISSION OF MEDICAL DOCUMENTATION TO THE
SECRETARY OF VETERANS AFFAIRS BY COMMUNITY CARE
PROVIDERS.
(a) In General.--The Secretary of Veterans Affairs shall ensure
that each contract, agreement, or other arrangement through which the
Secretary furnishes hospital care, medical services, or extended care
services to eligible veterans through non-Department of Veterans
Affairs entities or providers includes clear requirements, including
requirements regarding timeliness, regarding the submission of medical
documentation to the Secretary after a veteran receives such care or
services from the non-Department entity or provider.
(b) Internal Measures.--The Secretary shall establish such goals
and related performance measures for medical centers of the Department
as the Secretary determines appropriate in obtaining medical
documentation from non-Department entities or providers under
subsection (a).
(c) Training.--The Secretary may establish goals and related
performance measures for the completion by non-Department entities or
providers of core training related to the submission to the Secretary
of medical documentation under subsection (a) and may monitor the
completion of such training.
(d) Outreach.--The Secretary shall ensure that communications by
the Secretary with non-Department entities or providers contain clear
and accurate information regarding requirements for submitting medical
documentation under subsection (a) and completing the core training
described in subsection (c).
(e) Submission of Goals, Measures, and Materials.--Not later than
one year after the date of the enactment of this Act, and not less
frequently than annually thereafter for the following five years, the
Secretary shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives copies of any goals, performance measures, training
materials, or outreach materials pertaining to the submission of
medical documentation under this section.
SEC. 318. IMPLEMENTATION OF AND REPORT ON EFFORTS OF DEPARTMENT OF
VETERANS AFFAIRS TO IMPROVE HEALTH CARE APPOINTMENT
SCHEDULING.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit
to the appropriate committees of Congress a plan to improve the process
for scheduling appointments for health care from the Department of
Veterans Affairs, including improvements for both patients and
employees of the Department responsible for scheduling such
appointments.
(b) Elements of Plan.--
(1) In general.--The plan required by subsection (a) shall
include--
(A) such actions, resources, technology, and
process improvements as the Secretary determines
necessary to ensure the Department achieves, in a
timely manner, improved delivery of health care, access
to health care, customer experience and service
relating to the receipt of health care, and efficiency
with respect to the delivery of health care; and
(B) a proposed schedule and timeline to carry out
such plan.
(2) Objectives.--
(A) In general.--The Secretary shall ensure that
the plan required by subsection (a) addresses the
following objectives:
(i) To develop or continue the development
of a scheduling system that enables both
personnel and patients of the Department to
view available appointments for care furnished
by the Department, including primary care,
mental health care, and all forms of specialty
care.
(ii) To develop or continue the development
of a self-service scheduling platform,
available for use by all patients of the
Department, which shall--
(I) enable such patients to view
available appointments and, subject to
the process described in clause (iii),
fully schedule appointments for all
care furnished by the Department;
(II) if a referral is required for
an appointment, provide a method for
the patient to request a referral and
subsequently book an appointment if the
referral is approved; and
(III) provide such patients with
the ability to cancel or reschedule
appointments.
(iii) To create a process through which all
patients of the Department can telephonically
speak with a scheduler who can assist the
patient to determine appointment availability
and can fully schedule appointments on behalf
of the patient for all care furnished by the
Department.
(iv) To carry out such other functions,
oversight, metric development and tracking,
change management, cross-Department
coordination, and other related matters,
including improvements to employee-facing
information technology, training, and
processes, as the Secretary determines
appropriate as it relates to scheduling tools,
functions, and operations with respect to
health care appointments furnished by the
Department.
(B) Explanation of inability to implement certain
objectives, features, or services.--If the Secretary
determines that an objective under subparagraph (A), or
any feature or service in connection with that
objective, cannot be implemented or otherwise
incorporated into a final product pursuant to the plan
required by subsection (a), the Secretary shall include
with the plan submitted under such subsection a report
containing--
(i) an explanation as to why that
objective, feature, or service cannot be
implemented or incorporated, as the case may
be; and
(ii) a plan for implementing the plan
required by subsection (a) without that
objective, feature, or service.
(c) Implementation.--Not later than two years after submitting to
the appropriate committees of Congress the plan required by subsection
(a), the Secretary shall fully implement the plan.
(d) Coordination With Electronic Health Record Modernization
Program.--In developing the plan required by subsection (a), the
Secretary shall ensure that the elements and objectives of such plan
set forth under subsection (b) are developed in consideration of the
deployment schedule and capabilities of the Electronic Health Record
Modernization Program of the Department to ensure a smooth transition
to using the tools and features under such plan as relevant and
appropriate.
(e) Implementation Reports.--Not later than each of one year and
two years after the date on which the Secretary submits the plan
required by subsection (a), the Secretary shall submit to the
appropriate committees of Congress a report on the progress of the
Secretary in implementing such plan, including--
(1) the costs incurred to implement the plan as of the date
of the report;
(2) the expected costs to complete implementation of the
plan (including costs for management and technology);
(3) the schedule for deployment of any capabilities
developed pursuant to the plan; and
(4) the goals and metrics achieved, challenges, and lessons
learned in implementing the plan.
(f) Rule of Construction.--Nothing in this section shall be
construed to require the Secretary to include in the plan required by
subsection (a) any technology or process that would preclude or impede
the ability of a veteran to contact or schedule an appointment directly
with a facility or provider through a non-online scheduling process,
should the veteran choose to do so.
(g) Definitions.--In this section:
(1) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives.
(2) Fully schedule.--The term ``fully schedule'', with
respect to an appointment for health care, means that the
appointment booking is completed, rather than simply requested.
SEC. 319. PILOT PROGRAM ON COORDINATION OF CARE BETWEEN DEPARTMENT OF
VETERANS AFFAIRS AND MEDICARE PROGRAM.
(a) In General.--The Secretary, in consultation with the Secretary
of Health and Human Services, shall carry out a pilot program (in this
section referred to as the ``pilot program'') to coordinate, navigate,
and manage care and benefits for covered veterans.
(b) Purposes of Pilot Program.--The purposes of the pilot program
are as follows:
(1) To improve access to health care services for covered
veterans from the Department of Veterans Affairs and under the
Medicare program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.).
(2) To improve satisfaction with care received by covered
veterans.
(3) To improve quality of care received by covered
veterans.
(4) To lower costs to the Federal Government for care
received by covered veterans.
(5) To reduce gaps in care and duplication of services and
expenses for covered veterans.
(6) To improve care coordination for covered veterans,
including coordination of patient information and medical
records between providers and between the Department and the
Centers for Medicare & Medicaid Services.
(c) Locations.--The Secretary shall carry out the pilot program in
not fewer than three but not more than five Veterans Integrated Service
Networks with a significant number of covered veterans and geographic
diversity, including--
(1) locations that are in rural or highly rural areas, as
determined through the use of the Rural-Urban Continuum codes
of the Department of Agriculture; and
(2) locations that are in medically underserved communities
(as defined in section 799B of the Public Health Service Act
(42 U.S.C. 295p)).
(d) Case Manager.--In carrying out the pilot program, the Secretary
shall assign each covered veteran participating in the pilot program a
case manager responsible for--
(1) coordinating with the veteran, the primary care team of
the veteran, and any relevant care coordinators already
assisting the veteran to develop an individualized needs
assessment for the veteran and, based on such assessment, a
care coordination plan with defined treatment goals; and
(2) navigating the systems of care under the laws
administered by the Secretary and under the Medicare program
under title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.).
(e) Use of Existing Models.--In designing the pilot program, the
Secretary may use existing models used by commercial health care
programs to improve access, health outcomes, quality, and customer
experience and lower per capita costs.
(f) Contracting With Private Sector Entities.--
(1) In general.--The Secretary, to the extent practicable,
shall consider entering into contracts or agreements with
private sector entities carrying out commercial health care
programs for assistance in designing, implementing, and
managing care and benefits under the pilot program, to include
providing care coordination.
(2) Notification.--If the Secretary determines that
entering into contracts or agreements with private sector
entities under paragraph (1) is not necessary or practicable,
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) a notification of that determination;
(B) a description of the steps, if any, the
Secretary has taken to attempt to enter into a contract
or an agreement with a private sector entity;
(C) a justification for why the Secretary has
determined that such contract or agreement is not
necessary or practicable; and
(D) a plan for how the Secretary will carry out the
pilot program without entering into a contract or an
agreement with a private sector entity, including
through the use of employees of the Department of
Veterans Affairs or other government agencies,
nonprofit organizations, or other entities.
(g) Metrics.--
(1) In general.--The Secretary shall track metrics under
the pilot program, including the following:
(A) The number of veterans participating in the
pilot program, disaggregated by Veterans Integrated
Service Network.
(B) Reliance on health care services administered
by the Secretary.
(C) Reliance on health care services administered
under the Medicare program under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.).
(D) Quality of care, including patient outcomes.
(E) Cost of care.
(F) Access to care, including under the designated
access standards developed by the Secretary under
section 1703B of title 38, United States Code.
(G) Patient satisfaction.
(H) Provider satisfaction.
(I) Care coordination, including timely information
sharing and medical documentation return.
(2) Elements.--In tracking metrics under paragraph (1), the
Secretary shall track information relating to--
(A) whether care received by a covered veteran is
related to a service-connected disability (as defined
in section 101 of title 38, United States Code);
(B) the priority group under section 1705(a) of
title 38, United States Code, through which each
covered veteran was enrolled in the system of annual
patient enrollment of the Department of Veterans
Affairs under such section;
(C) the type of care and services provided to
covered veterans; and
(D) the demographics of covered veterans
participating in the pilot program, including age.
(h) Supplement Not Supplant.--The services provided under the pilot
program shall supplement, not supplant, the services provided under the
education program under section 121 of the VA MISSION Act of 2018
(Public Law 115-182; 38 U.S.C. 1701 note).
(i) Duration.--The Secretary shall carry out the pilot program for
a three-year period beginning on the commencement of the pilot program.
(j) Reports.--
(1) Development, implementation, results, and design of
pilot program.--
(A) In general.--Not less frequently than
biannually during the two-year period beginning on 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 development,
implementation, results, and design of the pilot
program, including information on the metrics tracked
under subsection (g).
(B) Final design.--One of the reports required
under subparagraph (A) shall contain a description of
the final design of the pilot program.
(2) Results of pilot program.--
(A) In general.--Not later than one year after the
submission of the final report under paragraph (1), and
not less frequently than annually thereafter during the
duration of the pilot program, the Secretary shall
submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the
House of Representatives a report on the results of the
pilot program.
(B) Final report.--In the final report submitted
under subparagraph (A), the Secretary shall include the
recommendation of the Secretary for whether the pilot
program should be extended or made permanent.
(k) Definitions.--In this section:
(1) Covered veteran.--The term ``covered veteran'' means a
veteran who is enrolled in both the Medicare program under
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.)
and the system of annual patient enrollment of the Department
of Veterans Affairs under section 1705(a) of title 38, United
States Code.
(2) Secretary.--The term ``Secretary'' means the Secretary
of Veterans Affairs.
SEC. 320. FISHER HOUSE AVAILABILITY.
Section 1708 of title 38, United States Code, is amended--
(1) in subsection (a), by striking ``in connection with''
and all that follows through the period at the end and
inserting ``in accordance with this section.'';
(2) in subsection (b)--
(A) in paragraph (2)--
(i) by inserting ``described in paragraph
(1)'' after ``family of a veteran''; and
(ii) by inserting ``such'' after
``accompany''; and
(B) by adding at the end the following new
paragraphs:
``(3) On a space-available basis, a covered beneficiary who
must travel a significant distance to receive care or services
at a Department or non-Department facility.
``(4) On a space-available basis, a member of the family of
a covered beneficiary described in paragraph (3) and others who
accompany such a covered beneficiary who is receiving care or
services and provide the equivalent of familial support for
such beneficiary when the covered beneficiary or the family
member is traveling to receive care or services at a Department
or non-Department facility.
``(5) On a space-available basis, a veteran and a member of
the family of a veteran and others who must travel a
significant distance for a member of the veteran's family to
receive care or services at a Department or non-Department
facility.
``(6) On a space available basis, a covered beneficiary and
a member of the family of a covered beneficiary and others who
must travel a significant distance for a member of the covered
beneficiary's family to receive care or services at a
Department or non-Department facility.'';
(3) by striking subsection (c) and redesignating
subsections (d) and (e) as subsections (c) and (d),
respectively;
(4) in subsection (d), as so redesignated--
(A) in paragraph (2), by striking ``subsection
(d)'' and inserting ``subsection (c)'';
(B) in paragraph (3), by striking ``under
subsection (b)(2)'' and inserting ``or a covered
beneficiary under subsection (b)'';
(C) in paragraph (4), by striking ``and'' after the
semicolon;
(D) by redesignating paragraph (5) as paragraph
(6); and
(E) by inserting after paragraph (4) the following
new paragraph (5):
``(5) establishing criteria for providing access to
temporary lodging facilities on a space-available basis under
paragraphs (3) through (6) of subsection (b); and''; and
(5) by adding at the end the following new subsection:
``(e) In this section:
``(1) The term `covered beneficiary' means a member of the
uniformed services, including members of the armed services
regardless of duty status.
``(2) The term `Fisher house' means a housing facility
that--
``(A) is located at, or in proximity to, a
Department medical facility;
``(B) is available for residential use on a
temporary basis by patients of that facility and others
described in subsection (b); and
``(C) is constructed by, and donated to the
Secretary by, the Zachary and Elizabeth M. Fisher Armed
Services Foundation or the Fisher House Foundation,
Inc.''.
SEC. 321. AGREEMENTS BETWEEN MEDICAL FACILITIES OF DEPARTMENT OF
VETERANS AFFAIRS AND RURAL MEDICAL FACILITIES.
(a) In General.--Not later than one year after the date of
enactment of this Act, the Secretary of Veterans Affairs shall commence
a 5-year pilot program to provide greater access to care for eligible
veterans in rural areas and reduce the initial or long-term costs to
the Department or the eligible entity of providing such care for
eligible veterans.
(b) Pilot Program.--In carrying out the pilot program, the
Secretary shall ensure that each medical center of the Department
participating in the pilot enters into or provides material support to
an agreement with an eligible entity related to one or more of the
following:
(1) Co-location of Department and non- Department health
care resources.
(2) The provision of telehealth to eligible veterans by
health care providers of the Department.
(3) Leasing of space or equipment by or from the
Department.
(4) Training by health care providers of the Department of
non-Department health care providers, subject to paragraph (4).
(5) Care coordination for authorized care furnished by the
eligible entity for eligible veterans.
(6) Care coordination, including transportation
coordination, for emergency treatment (as defined in section
1725(h) of title 38, United States Code.
(7) The provision by the eligible entity of hospital care,
medical services, or extended care services under section 1703
of this title.
(8) Such other conditions or services directly related to
health care as expressly authorized under laws administered by
the Secretary.
(c) Types of Arrangements.--An agreement under subsection (b) may
include a lease or co-location agreement, a memorandum of
understanding, a partnership agreement, a contract or agreement for the
mutual use or exchange of use of health-care resources, or any other
similar agreement or arrangement.
(d) Report.--For each year of the pilot, the Secretary shall submit
to the appropriate committees of Congress a report on the operation and
performance of agreements entered into under subsection (a) including--
(1) new agreements entered into, in the case of the initial
report, since the date of the enactment of the Take Care of
America's Veterans Act, and, in the case of any subsequent
report, during the period following the previous report;
(2) an assessment of the success of all agreements entered
into pursuant to this Act in delivering services to eligible
veterans, including--
(A) the number of eligible veterans, by region, who
received services under an agreement compared to the
previous five-year period;
(B) an evaluation of accessibility to services for
eligible veterans as compared to the accessibility of
services for those veterans prior to the implementation
of such agreements;
(C) an overview of best practices, including new
best practices, developed for such agreements and the
Department more broadly;
(D) the number of veterans receiving compensation
from the Department for a service-connected disability,
disaggregated by region, compared to the previous 5-
year period; and
(E) such other factors considered appropriate by
the Secretary of Veterans Affairs.
(e) Definitions.--In this section:
(1) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Veterans' Affairs and the
Committee on Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the
Committee on Appropriations of the House of
Representatives.
(2) Eligible entity.--The term ``eligible entity'' means a
non-Department entity or provider furnishing health care or
health care services in a rural area.
(3) Eligible veteran.--The term ``eligible veteran'' means
a covered veteran under section 1703(b)16 of this title.
(4) Material support.--The term ``material support'' means
support provided by a health care provider or other staff of
the Department to further the purpose or purposes of an
agreement under subsection (a)(1) and may include--
(A) the use of time or resources of health care
providers of the Department;
(B) the obligation or receipt of funds; and
(C) such other support as the Secretary determines
appropriate.
(5) Rural.--The term ``rural'', with respect to an area,
means the area has a code other than 1 or 1.1 in the Rural-
Urban Commuting Areas (RUCA) coding system of the Department of
Agriculture.
SEC. 322. STUDY ON QUALITY OF CARE DIFFERENCE BETWEEN MENTAL HEALTH AND
ADDICTION THERAPY CARE PROVIDED BY HEALTH CARE PROVIDERS
OF DEPARTMENT OF VETERANS AFFAIRS COMPARED TO NON-
DEPARTMENT PROVIDERS.
(a) In General.--Not later than 90 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall seek to
enter into an agreement with an independent and objective organization
outside the Department of Veterans Affairs under which that
organization shall--
(1) conduct a study on the quality of care difference
between mental health and addiction therapy care under the laws
administered by the Secretary provided by health care providers
of the Department compared to non-Department providers across
various modalities, such as telehealth, in-patient, intensive
out-patient, out-patient, and residential treatment; and
(2) submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives and publish on a publicly available website a
report containing the final results of such study.
(b) Timing.--The Secretary shall ensure that the organization with
which the Secretary enters into an agreement pursuant to subsection (a)
is able to complete the requirements under such subsection by not later
than 18 months after the date on which the agreement is entered into.
(c) Elements.--The report submitted pursuant to subsection (a)(2)
shall include an assessment of the following:
(1) The amount of improvement in health outcomes from start
of treatment to completion, including symptom scores and
suicide risk using evidence-based scales, including the
Columbia-Suicide Severity Rating Scale.
(2) Whether providers of the Department and non-Department
providers are using evidence-based practices in the treatment
of mental health and addiction therapy care, including criteria
set forth by the American Society of Addiction Medicine.
(3) Potential gaps in coordination between providers of the
Department and non-Department providers in responding to
individuals seeking mental health or addiction therapy care,
including the sharing of patient health records.
(4) Implementation of veteran-centric care, including the
level of satisfaction of patients with care and the competency
of providers with the unique experiences and needs of the
military and veteran population.
(5) Whether veterans with co-occurring conditions receive
integrated care to holistically address their needs.
(6) Whether providers monitor health outcomes continually
throughout treatment and at regular intervals for up to three
years after treatment.
(7) The average length of time to initiate services, which
shall include a comparison of the average length of time
between the initial point of contact after patient outreach to
the point of initial service, as measured or determined by the
Secretary.
SEC. 323. LACTATION SPACES IN MEDICAL CENTERS OF THE DEPARTMENT OF
VETERANS AFFAIRS.
(a) In General.--Subchapter II of chapter 17 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 1720M. Lactation spaces in medical centers of the Department
``(a) Lactation Space Required.--The Secretary shall ensure that
each medical center of the Department contains a lactation space.
``(b) No Unauthorized Entry.--Nothing in this section shall be
construed to authorize an individual to enter a medical center of the
Department or portion thereof that the individual is not otherwise
authorized to enter.
``(c) Lactation Space Defined.--In this section, the term
`lactation space' means a hygienic place, other than a bathroom, that--
``(1) is shielded from view;
``(2) is free from intrusion;
``(3) is accessible to disabled individuals (including such
individuals who use wheelchairs);
``(4) contains a chair and a working surface;
``(5) is easy to locate;
``(6) is clearly identified with signage; and
``(7) is available for use by women veterans and members of
the public to express breast milk.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item related to section
1720L the following new item:
``1720M. Lactation spaces in medical centers of the Department.''.
(c) Implementation.--The Secretary of Veterans Affairs shall ensure
that--
(1) not later than two years after the date of the
enactment of this Act, not fewer than 80 percent of medical
centers of the Department of Veterans Affairs are in compliance
with section 1720M of title 38, United States Code, as added by
subsection (a); and
(2) not later than three years after such date of
enactment, all medical centers of the Department are in
compliance with such section.
(d) Report.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, and annually 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
progress of the Secretary in meeting the requirements under
section 1720M of title 38, United States Code, as added by
subsection (a), including--
(A) a list of which medical centers of the
Department of Veterans Affairs currently have a
lactation space;
(B) a list of which medical centers of the
Department do not have a lactation space; and
(C) for each medical center listed under
subparagraph (B), a description of actions the
Department has taken to design and plan a lactation
space and a timeline for such lactation space to be
fully functional and open for use within the time
periods specified under subsection (c).
(2) Termination.--The Secretary is not required to submit a
report under paragraph (1) on or after the date on which the
Secretary confirms in a report submitted under such paragraph
that each medical center of the Department contains a lactation
space.
SEC. 324. RESEARCH RELATED TO MENOPAUSE, PERIMENOPAUSE, AND MID-LIFE
WOMEN'S HEALTH: REPORT; PLAN.
(a) Definitions.--In this section:
(1) Covered provider.--The term ``covered provider'' means
a health care provider employed by the Department of Veterans
Affairs.
(2) Menopause.--The term ``menopause'' means the stage of a
woman's life--
(A) when menstrual periods stop permanently and she
can no longer get pregnant; and
(B) that is not a disease state, but a normal part
of aging for women.
(3) Mid-life.--The term ``mid-life'' means a life stage
that--
(A) coincides with the menopausal transition in
women, which may be physical or emotional;
(B) encompasses the late reproductive age, which
can begin at approximately 35 years of age, to the late
postmenopausal stages of reproductive aging, which can
extend to approximately 65 years of age; and
(C) often marks the onset of many chronic diseases.
(4) Perimenopause.--The term ``perimenopause'' means the
time during a woman's life when levels of the hormone estrogen
fall unevenly in a woman's body and is also called the
menopausal transition.
(5) Postmenopausal.--The term ``postmenopausal'' means the
stage of a woman's life after a woman has been without a
menstrual period for 12 months that lasts for the rest of a
woman's life and reflects a time when women are at increased
risk for osteoporosis and heart disease.
(b) Evaluation of Certain Research Related to Menopause,
Perimenopause, or Mid-life Women's Health.--
(1) In general.--The Secretary of Veterans Affairs, shall
evaluate--
(A) the results of completed research related to
menopause, perimenopause, or mid-life women's health
among women who are members of the uniformed services
or veterans;
(B) the status of such research that is ongoing;
(C) any gaps in knowledge and research on--
(i) treatments for menopause-related
symptoms, including hormone and non-hormone
treatments;
(ii) the safety and effectiveness of
treatments for menopause-related symptoms;
(iii) the impact of perimenopause and
menopause on the mental health of women who are
members of the uniformed services or veterans;
(D) the availability of and uptake of professional
training resources for covered providers relating to
mid-life women's health with respect to the care,
treatment, and management of perimenopause and
menopausal symptoms, and related support services; and
(E) the availability of and uptake of treatments
for women who are members of the uniformed services or
veterans who are experiencing perimenopause or
menopause.
(2) Report; strategic plan.--Not later than 180 days after
the date of the enactment of this Act, the Secretary of
Veterans Affairs shall submit to Congress a report containing--
(A) the findings of the evaluation conducted under
paragraph (1);
(B) recommendations for improving professional
training resources described in paragraph (1)(D) for
covered providers; and
(C) a strategic plan that--
(i) resolves the gaps in knowledge and
research identified in the report; and
(ii) identifies topics in need of further
research relating to potential treatments for
menopause-related symptoms of women who are
members of the uniformed services or veterans.
(3) Nonduplication and supplementation of efforts.--In
carrying out activities under this section, the Secretary of
Veterans Affairs shall ensure that such activities minimize
duplication and supplement, not supplant, existing information-
sharing efforts of the Department of Health and Human Services.
(c) Sense of Congress on Additional Research Related to Menopause,
Perimenopause, or Mid-life Women's Health.--It is the sense of Congress
that the Secretary of Defense and the Secretary of Veterans Affairs
should each conduct research related to menopause, perimenopause, or
mid-life health regarding women who are members of the uniformed
services or veterans.
SEC. 325. PILOT PROGRAM ON PROVISION OF OPIOID RESCUE MEDICATIONS TO
VETERANS.
(a) In General.--Commencing not later than 120 days after the date
of the enactment of this Act, the Secretary of Veterans Affairs shall
carry out a one-year pilot program under which the Secretary shall make
covered medications available to any veteran at no charge (in this
section referred to as the ``pilot program'').
(b) Provision of Medication Prior to Confirmation of Status.--The
Secretary may provide covered medication to an individual under the
pilot program prior to confirming the status of the individual as a
veteran if the individual provides contact information for the
individual and a written self-attestation of veteran status.
(c) Site Selection.--The Secretary shall prioritize carrying out
the pilot program in geographical areas where data indicates a
disproportionately high risk of overdose among the veteran population.
(d) Limitation on Use of Information.--
(1) In general.--In carrying out this section, the
Secretary may only collect the personally identifiable
information needed for prescribing covered medication under the
pilot program, and any personally identifiable information
collected under this section may be used solely for the purpose
of delivering, evaluating, and enhancing the quality of health
care.
(2) Exclusion.--The Secretary may not use any personally
identifiable information collected under this section--
(A) for the purpose of preventing a veteran from
employment;
(B) as evidence of a history of drug use; or
(C) as evidence that an individual is an unlawful
user of or addicted to any controlled substance.
(e) Provision of Information.--The Secretary shall ensure that any
individual who receives covered medication under the pilot program also
receives--
(1) information about addiction services, suicide
prevention services, mental health services, and other related
services provided by the Department of Veterans Affairs; and
(2) information on the use and application of covered
medications.
(f) Report.--
(1) In general.--Not later than 30 days before the
completion of the pilot program under this section, the
Secretary shall submit to Congress a report on the pilot
program.
(2) Elements.--The report required by paragraph (1) shall
include the following:
(A) The number of veterans who received a covered
medication under the pilot program, disaggregated by
those enrolled in the system of annual patient
enrollment of the Department of Veterans Affairs under
section 1705(a) of title 38, United States Code, and
those not enrolled in such system.
(B) An assessment of the feasibility of expanding
the pilot program to provide covered medications to
immediate family members of veterans.
(C) Any considerations associated with continuing,
expanding, or making permanent the pilot program.
(D) Any other recommendations of the Secretary with
respect to modifying or continuing the pilot program.
(g) Definitions.--In this section:
(1) Covered medication.--The term ``covered medication''
means any opioid overdose rescue medication, such as naloxone.
(2) Veteran.--The term ``veteran'' has the meaning given
that term in section 101 of title 38, United States Code.
SEC. 326. ESTABLISHMENT OF VETERANS HEALTH ADMINISTRATION POLICY
ADVISORY COMMISSION.
(a) In General.--Chapter 1 of title 38, United States Code, is
amended by adding at the end the following new section:
``Sec. 120. Veterans Health Administration Policy Advisory Commission
``(a) Establishment.--There is established the Veterans Health
Administration Policy Advisory Commission (in this section referred to
as the `Commission').
``(b) Membership.--
``(1) Composition.--The Commission shall be composed of 17
members appointed by the Comptroller General of the United
States, of which not fewer than 2 shall be veterans.
``(2) Qualifications.--
``(A) In general.--An individual is eligible for
appointment to the Commission under paragraph (1) if
the individual has significant expertise in operating
or advising large medical systems, including expertise
in quality of care, staffing issues, health information
technology, artificial intelligence in health care,
medical research, and managed care plans and networks.
``(B) Experience of members.--In appointing members
under paragraph (1), the Comptroller General shall
select individuals from backgrounds that reflect the
broad diversity of health care received by veterans,
including nonprofit health systems, public and private
health systems, care furnished by the Veterans Health
Administration, and care furnished by the Department of
Defense.
``(3) Ethical disclosure.--A member of the Commission shall
be considered an employee of Congress whose compensation is
disbursed by the Secretary of the Senate for purposes of
applying subchapter I of chapter 131 of title 5, United States
Code, except that a member of the Commission is required to
file public financial disclosure reports without regard to
their number of days of service or rate of pay.
``(c) Period of Appointment; Vacancies.--
``(1) Vacancies.--
``(A) In general.--A vacancy on the Commission
shall be filled in the manner in which the original
appointment was made and shall be subject to any
conditions that applied with respect to the original
appointment.
``(B) Filling unexpired term.--An individual chosen
to fill a vacancy shall be appointed for the unexpired
term of the member replaced.
``(2) Expiration of terms.--The term of any member shall
not expire before the date on which the member's successor
takes office.
``(d) Meetings.--
``(1) Frequency.--The Commission shall meet at the call of
the Chairman, but not less frequently than once per year.
``(2) Quorum.--A majority of the members of the Commission
shall constitute a quorum, but a lesser number of members may
hold meetings.
``(e) Chairman and Vice Chairman.--The Comptroller General shall
designate one member of the Commission as Chairman and one member of
the Commission as Vice Chairman, at the time of appointment of such
member and for the term of appointment of such member, except that in
the case of vacancy of the Chairmanship or Vice Chairmanship, the
Comptroller General may designate another member for the remainder of
that member's term.
``(f) Duties of the Commission.--
``(1) Review.--The Commission shall--
``(A) review operations at the Veterans Health
Administration; and
``(B) prepare reports for Congress based on such
review, including recommendations to Congress.
``(2) Topics to be reviewed.--In conducting a review under
paragraph (1)(A), the Commission shall include periodic reviews
of the following, taking into consideration other independent
assessments in selecting topics to limit duplicative efforts:
``(A) Information technology infrastructure at
medical facilities of the Department, including with
respect to electronic health record systems.
``(B) Referrals to care at facilities of the
Department and under the Veterans Community Care
Program under section 1703 of this title, and factors
impacting those referrals.
``(C) Access and wait times at medical facilities
of the Department and under the Veterans Community Care
Program, including both primary and specialty care, and
factors impacting those wait times.
``(D) The quality of health care furnished by the
Department and through the Veterans Community Care
Program.
``(E) Workforce issues, including workforce
performance, recruitment, and retention factors.
``(F) Patient satisfaction and customer service at
medical facilities of the Department and through the
Veterans Community Care Program.
``(G) The training of health care providers and the
standards of care at facilities of the Department and
in the Veterans Community Care Program.
``(H) The long-term budgetary outlook of the
Veterans Health Administration, as well as key
components driving budgetary changes over time.
``(I) The research program of the Department,
including both internal and external research.
``(J) The interaction of care under the Medicare
program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.), the Medicaid program under
title XIX of such Act (42 U.S.C. 1396 et seq.), the
TRICARE program under chapter 55 of title 10, and
commercial health care plans with care furnished by the
Veterans Health Administration.
``(3) Use of existing data.--In carrying out the
requirements of this subsection, the Commission, to the extent
practicable, shall use existing data that has been compiled by
the Department, compiled for the Department, or purchased by
the Department, including--
``(A) data described in subsection (c)(1) of
section 1704A of this title; and
``(B) the results of the independent assessments
conducted under such section.
``(4) Issues regarding veteran health care delivery
generally.--In carrying out the requirements of this
subsection, the Commission shall review the effect of policies
under this title on the delivery of health care services to
veterans and assess the implications of changes in health care
delivery for veterans under the laws administered by the
Secretary.
``(5) Transmittal of certain reports.--If the Secretary or
the Inspector General of the Department of Veterans Affairs
submits to Congress (or a committee of Congress) a report that
is required by law and that relates to policies for health care
furnished under the laws administered by the Secretary, the
Secretary shall transmit a copy of that report to the
Commission.
``(6) Consultation and additional reviews and studies.--
``(A) Consultation.--In carrying out the
requirements of this subsection, the Commission shall
consult periodically with the chairmen and ranking
members of the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the
House of Representatives regarding the agenda of the
Commission and progress towards achieving that agenda.
``(B) Additional reviews and reports.--The
Commission may conduct additional reviews, and may
submit additional reports to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives, from time to
time on such topics relating to the activities of the
Commission as may be requested by the Chairman and
members and as the Commission determines appropriate.
``(C) Special studies.--The Commission may conduct
special studies requested by the chairman or ranking
member of the Committee on Veterans' Affairs of the
Senate or the Committee on Veterans' Affairs of the
House of Representatives and as the Commission
determines appropriate.
``(7) Coordination.--In carrying out reviews, preparing
reports, and conducting studies under this section, the
Commission shall, to the extent practicable, coordinate with
the Inspector General of the Department to ensure the work of
the Commission does not interfere with investigations or
remediations underway by the Inspector General.
``(8) Budgetary considerations.--Before making any
recommendations to Congress, the Commission shall examine the
budget consequences of such recommendations, directly or
through consultation with appropriate expert entities.
``(9) Report.--
``(A) In general.--By not later than March 15 of
each year, the Commission shall submit to Congress a
report containing the results and recommendations from
the review conducted under paragraph (1).
``(B) Inclusion of recommendations.--A
recommendation may be included in a report under
subparagraph (A) if a simple majority of the members of
the Commission vote to include the recommendation in
the report.
``(10) Limitation.--Nothing in this section shall be
construed to authorize the Commission to direct, control,
approve, suspend, delay, or administer any program, policy,
contract, personnel action, budgetary decision, clinical
decision, or operational activity of the Department. The
Commission shall serve solely in an advisory capacity to
Congress and to the Department on matters expressly authorized
under laws administered by the Secretary.
``(g) Powers of Commission.--
``(1) In general.--The Commission may--
``(A) employ and fix the compensation:
``(i) of an Executive Director (at a rate
of pay not greater than that provided for level
III of the Executive Schedule under section
5314 of title 5) who is confirmed by two thirds
vote by members of the Commission; and
``(ii) other such personnel as may be
necessary to carry out the duties of the
Commission, without regard to the provisions of
title 5 governing appointments in the
competitive service;
``(B) seek such assistance and support as may be
required in the performance of its duties from
appropriate departments and agencies of the United
States or departments or agencies of a State;
``(C) enter into a contract or conduct original
research only upon a written determination by the Chair
and Vice Chair that comparable information is
unavailable, insufficient, or outdated;
``(D) make advance, progress, and other payments
that relate to the work of the Commission;
``(E) provide transportation and subsistence for
individuals serving the Commission without
compensation; and
``(F) prescribe such rules and regulations as the
Commission determines necessary with respect to the
internal organization and operation of the Commission.
``(2) Data collection.--In order to carry out its
functions, the Commission shall--
``(A) utilize existing information, both published
and unpublished, if possible, collected and assessed
either by its own staff or under other arrangements
made in accordance with this section;
``(B) to the maximum extent practicable, rely on
existing data, reports, audits, evaluations, and
assessments prepared by the Department, the Inspector
General of the Department, the Government
Accountability Office, the Congressional Research
Service, the Congressional Budget Office, and other
relevant Federal entities before entering into any
contract or conducting original research; and
``(C) adopt procedures allowing any interested
party to submit information for use by the Commission
in making reports and recommendations.
``(3) Information from federal agencies.--
``(A) In general.--The Commission may secure
directly from any relevant department or agency of the
United States health care information the Chairman
determines would be helpful to enable the Commission to
carry out this section.
``(B) Timing.--Upon request of the Chairman, the
head of a department or agency of the United States
shall furnish information requested under subparagraph
(A) to the Commission on an agreed upon schedule or not
later than 180 days after the date of the request.
``(h) Compensation.--
``(1) Members.--
``(A) In general.--While conducting the business of
the Commission (including travel time), a member of the
Commission shall be entitled to compensation at the per
diem equivalent of the rate provided for level IV of
the Executive Schedule under section 5315 of title 5.
``(B) Travel expenses.--While conducting the
business of the Commission away from home and the
regular place of business of the member, a member may
be allowed travel expenses, as authorized by the
Chairman.
``(2) Physician comparability allowance for personnel.--The
Commission may provide a physician comparability allowance to
physicians serving as personnel of the Commission in the same
manner as physicians of the Federal Government may be provided
such an allowance by an agency under section 5948 of title 5,
and for such purpose, subsection (i) of such section shall
apply to the Commission in the same manner as it applies to the
Tennessee Valley Authority.
``(3) Treatment of personnel.--For purposes of pay (other
than pay of members of the Commission) and employment benefits,
rights, and privileges, all personnel of the Commission shall
be treated as if they were employees of the United States
Senate.
``(i) Detail of Federal Employees.--An employee of the Federal
Government may be detailed to the Commission without reimbursement and
without interruption or loss of civil service status or privileges.
``(j) Access of Congressional Support Agencies to Information.--The
Commission shall provide to the Comptroller General, the Congressional
Research Service, and the Congressional Budget Office unrestricted
access to all deliberations, records, and nonproprietary data of the
Commission not later than 30 days after such access is requested.
``(k) Authorization of Appropriations.--The Commission shall submit
requests for appropriations in the same manner as the Comptroller
General submits requests for appropriations, but amounts appropriated
for the Commission shall be separate from amounts appropriated for the
Comptroller General.
``(l) Termination.--
``(1) The Commission shall terminate on September 30, 2032.
``(2) Not later than 1 year before the date of termination
under paragraph (1), the Commission shall submit to the
Committees on Veterans' Affairs of the House of Representatives
and the Senate a final assessment on whether the Commission
should be continued, modified, or allowed to terminate.
``(3) A member of the Commission shall be appointed under
subsection (b)(1) for a term of 5 years, except that the
Comptroller General shall designate staggered terms for the
members first appointed.
``(4) No funds may be obligated by the Commission after the
date of termination under paragraph (1), except for activities
necessary to close out the operations of the Commission.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
119 the following new item:
``120. Veterans Health Administration Policy Advisory Commission.''.
(c) Initial Appointment.--Not later than 280 days after the date on
which amounts are first appropriated to the Veterans Health
Administration Policy Advisory Commission established under section 120
of title 38, United States Code, as added by subsection (a), the
Comptroller General of the United States shall make initial
appointments of members to the Commission under subsection (b)(1) of
such section.
SEC. 327. ACCESS TO HEALTH CARE.
(a) Connection to Veterans Health Administration When a Disability
Claim Related to Military Sexual Trauma Is Submitted to Veterans
Benefits Administration.--Section 2 of the MST Claims Coordination Act
(Public Law 117-303; 38 U.S.C. 1166 note) is amended--
(1) in subsection (a)(1)--
(A) in subparagraph (C), by striking ``; and'' and
inserting a semicolon; and
(B) by striking subparagraph (D) and inserting the
following:
``(D) the contact information for the nearest
military sexual trauma coordinator for the veteran at
the Veterans Benefits Administration and a description
of the assistance such coordinator can provide;
``(E) the contact information for the nearest
military sexual trauma coordinator for the veteran at
the Veterans Health Administration and a description of
the assistance such coordinator can provide;
``(F) the types of services that individuals who
have experienced military sexual trauma are eligible to
receive from the Department of Veterans Affairs, such
as mental health counseling from providers trained in
military sexual trauma issues and peer support
services, including the nearest locations where such
services are furnished, including the nearest
Readjustment Counseling Service location, and the
contact information for the providers of such services;
and
``(G) such other information on services, care, or
resources for military sexual trauma as the Secretary
determines appropriate.''; and
(2) in subsection (d)--
(A) in paragraph (3)--
(i) in subparagraph (B), by striking ``;
and'' and inserting a semicolon;
(ii) in subparagraph (C), by striking the
period and inserting ``; and''; and
(iii) by adding at the end the following:
``(D) submitting a claim for disability
compensation to the Veterans Benefits Administration
for a disability relating to military sexual trauma.'';
and
(B) by amending paragraph (5) to read as follows:
``(5) The term `military sexual trauma' with respect to
eligibility for health care, has the meaning given such term in
section 1166(d)(2) of title 38, United States Code.''.
(b) Care Relating to Military Sexual Trauma for Individuals Who
Withdraw From or Otherwise Do Not Complete Service at Service
Academies.--
(1) In general.--The Secretary of Veterans Affairs, in
coordination with the Secretary of Defense, the Secretary of
Homeland Security, and the Secretary of Transportation, shall
ensure that each individual who withdraws from, or otherwise
does not complete service at, a service academy is provided--
(A) information on the potential eligibility of
such individual for care and counseling relating to
military sexual trauma provided through the Department
of Veterans Affairs; and
(B) the option to receive copies of--
(i) the individual's service treatment
records or military personnel records that
document military sexual trauma;
(ii) reporting forms of the Department of
Defense, the Department of Homeland Security,
or the Department of Transportation on sexual
assault or sexual harassment for which the
individual was the victim; and
(iii) any investigative reports into
military sexual trauma that occurred during the
individual's service in the Armed Forces and
for which the individual was the victim, which
are in the possession of the Department of
Defense, the Department of Homeland Security,
or the Department of Transportation.
(2) Definitions.--In this subsection:
(A) Military sexual trauma.--The term ``military
sexual trauma'' has the meaning given such term in
section 1166(d)(2) of title 38, United States Code.--
(B) Service academy.--The term ``service academy''
means any of the following:
(i) The United States Military Academy.
(ii) The United States Naval Academy.
(iii) The United States Air Force Academy.
(iv) The United States Coast Guard Academy.
(v) The United States Merchant Marine
Academy.
SEC. 328. RESEARCH ON HEALTH CONDITIONS OF DESCENDANTS OF TOXIC-EXPOSED
VETERANS.
(a) Research on Diagnosis and Treatment of Health Conditions of
Descendants of Individuals Exposed to Toxic Substances While Serving in
Armed Forces.--
(1) Contract or agreement.--The Secretary of Veterans
Affairs shall enter into a contract or interagency agreement
with the Agency for Toxic Substances and Disease Registry (in
this section referred to as the ``Agency'') to perform the
services covered by this section.
(2) Services.--Under a contract or agreement between the
Secretary and the Agency under this section, the Agency shall--
(A) conduct a literature review on the health
effects on descendants of toxic-exposed veterans and
toxic-exposed members of the Armed Forces from their
toxic exposure and identify any gaps in knowledge or
research on such topic;
(B) not later than 180 days after completing the
literature review under subparagraph (A) establish and
maintain a publicly available report with information
on--
(i) the findings of the Agency with respect
to such literature review; and
(ii) the ongoing research and activities
directed by the Agency, including a review of
all relevant data to determine the strength of
evidence for a positive association between a
health condition researched and a toxic
exposure based on the categories set forth
under section 1173(c)(2) of title 38, United
States Code; and
(C) not later than 30 days after the date on which
the first review is published under subparagraph (B)
and not less frequently than once every year
thereafter, publish a new report containing the
information made available under clause (ii) of such
subparagraph.
(3) Sunset.--On the date that is 7 years after the date of
enactment of this Act.
(4) Literature review.--
(A) In general.--In carrying out the literature
review under paragraph (2)(A), the Agency shall review
available literature to determine the association
between military toxic exposures and the incidence or
prevalence of birth defects among the descendants of
toxic-exposed veterans and toxic-exposed members of the
Armed Forces.
(B) Report.--Not later than one year after the date
of the enactment of this Act, the Agency shall submit
to the Secretary, the Committee on Veterans' Affairs of
the Senate, and the Committee on Veterans' Affairs of
the House of Representatives a report containing the
findings of the Agency with respect to the activities
of the Agency under paragraph (2)(A).
(C) Plan.--
(i) In general.--Not later than 180 days
after the date of the enactment of this Act,
the Agency shall submit to the Secretary and to
the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs
of the House of Representatives a plan
describing the Agency's proposed approach to
carrying out the literature review under
paragraph (2)(A).
(ii) Contents.--The plan submitted pursuant
to clause (i) shall include--
(I) the scope and key research
questions to be addressed; and
(II) the methodology to be used in
identifying, evaluating, and
synthesizing relevant scientific and
medical literature.
(5) Consultation.--The Agency shall carry out the services
covered by this subsection in consultation with such Federal,
State, and research partners as the Agency and the Secretary
jointly consider appropriate.
(6) Prohibition on expansion of services.--Nothing in this
section shall be construed to authorize the expansion of
compensation or healthcare benefits furnished by the Department
to the descendants of members of the Armed Forces.
(b) Program for Monitoring Health of Descendants of Veterans and
Members of the Armed Forces Subjected to Toxic Exposure in the Armed
Forces.--
(1) In general.--The Secretary of Veterans Affairs shall
use the results of the literature review conducted under
subsection (a)(2)(A) to establish a health monitoring or
screening program for descendants of toxic-exposed veterans and
toxic-exposed members of the Armed Forces, to assist in
identifying potential patterns or signals, supporting public
health surveillance, and facilitating epidemiologic and
clinical research related to birth defects.
(2) Requirements.--In carrying out the program required by
paragraph (1), the Secretary shall--
(A) leverage Government data sets to improve the
program;
(B) recruit additional descendants;
(C) consult with relevant stakeholders to develop a
strategy to coordinate collection of information under
the program; and
(D) ensure data from the program is used to inform
basic research, translational research, and
epidemiological studies to help address data and
knowledge gaps identified in the literature review
conducted under subsection (a)(2)(A).
(3) Mechanisms for administration.--The Secretary may
administer the program required by paragraph (1) either
directly or through such mechanisms as the Secretary considers
appropriate, such as through the award of a grant or
cooperative agreement.
(4) Collection of information.--In administering the health
monitoring program required by paragraph (1), the Secretary may
collect, process, maintain, and consolidate information on
birth defects among descendants of toxic-exposed veterans and
toxic-exposed members of the Armed Forces, including biological
samples, environmental factors, and personal and social
factors.
(5) Consultation.--The Secretary shall carry out the
services covered by this section in consultation with such
Federal, State, and research partners as the Department
considers appropriate.
(6) Sunset.--On the date that is 7 years after the date of
enactment of this Act.
(7) Prohibition on expansion of services.--No information
collected by this program shall be used to inform the expansion
of compensation or healthcare benefits furnished by the
Department to the descendants of members of the Armed Forces,
unless otherwise authorized by another Act of Congress on a
date after the passage of this legislation.
(c) Definitions.--In this subsection:
(1) Active military, naval, air, or space service.--The
term ``active military, naval, air, or space service'' has the
meaning given such term in section 101 of title 38, United
States Code.
(2) Relevant stakeholders.--The term ``relevant
stakeholders'' means--
(A) public health experts with experience in
developing and maintaining registries;
(B) epidemiologists with experience in studying
health effects of toxic exposure on the descendants of
toxic-exposed veterans;
(C) descendants of toxic-exposed veterans; and
(D) veterans service organizations.
(3) Toxic-exposed member of the armed forces.--The term
``toxic-exposed member of the Armed Forces'' means a member of
the Armed Forces who was subject to a toxic exposure in line of
duty in the active military, naval, air, or space service.
(4) Toxic-exposed veteran.--The term ``toxic-exposed
veteran'' means a veteran who was subject to a toxic exposure
in line of duty in the active military, naval, air, or space
service.
(5) Toxic exposure.--The terms ``toxic exposure'' and
``toxic-exposed veteran'' have the meanings given such terms in
section 101 of title 38, United States Code.
SEC. 329. VETERANS SPINAL TRAUMA ACCESS TO NEW DEVICES ACT.
Section 1706 of title 38, United States Code, is amended by adding
at the end the following new subsection:
``(d)(1) In managing the provision of hospital care and medical
services under section 1710(a) of this title, the Secretary shall
furnish (through direct provision of service, referral, or a telehealth
program operated by the Department) a preventative health evaluation
annually to any veteran with a spinal cord injury or disorder who
elects to undergo the evaluation.
``(2) The evaluation described in paragraph (1) shall include the
following:
``(A) An assessment of any circumstance or condition the
veteran is experiencing that indicates a risk for any health
complication related to the spinal cord injury or disorder,
including a risk of comorbidities.
``(B) An assessment regarding chronic pain and, if
applicable, the management of chronic pain.
``(C) An assessment regarding dietary management and weight
management.
``(D) An assessment regarding prosthetic equipment,
including which prosthetic equipment the veteran needs, how
well any existing prosthetic equipment is functioning
considering the needs of the veteran, and any safety concerns
regarding the prosthetic equipment in use by or recommended to
the veteran.
``(E) An assessment with respect to the provision of
assistive technology, including spinal cord neuromodulation
technology (such as non-invasive transcutaneous spinal
stimulation), that could help maximize the veteran's voluntary
motor or autonomic function, independence, or mobility,
including suitability for home use and need for training,
programming, and remote follow-up.
``(3)(A) In maintaining, prescribing, or amending any guidance,
rules, or regulations issued by the Department regarding the
requirements set out in this subsection, the Secretary shall consult
with--
``(i) the spinal cord injury and disorder program managers
of the Department;
``(ii) clinicians employed by the Department as specialists
in spinal cord injuries and disorders;
``(iii) clinicians and technologists with demonstrated
expertise in spinal cord neuromodulation therapies, including
non-invasive transcutaneous approaches; and
``(iv) representatives of organizations recognzied under
section 5902 of this title.
``(B) Before issuing any guidance, rules, or regulations regarding
the requirements set out in this subsection, the Secretary shall
consult with manufacturers of assistive technologies and other entities
relevant to the provision of assistive technologies if the guidance,
rules, or regulations would directly affect such manufacturers or
entities.
``(C) The Secretary shall ensure, to the extent possible, that any
veteran known by the Secretary to have a spinal cord injury or disorder
receives information annually about the evaluation available under this
subsection and the benefits to the veteran of choosing to undergo the
evaluation.
``(4) As the Secretary determines clinically appropriate, the
Secretary may provide training, programming, remote monitoring, and
follow-up for assistive technologies through telehealth.
``(5) Not later than one year after the date of the enactment of
the Take Care of America's Veterans Act, and every two years
thereafter, the Secretary shall submit to the Committees on Veterans'
Affairs of the Senate and the House of Representatives a report that
includes the following:
``(A) For the period covered by the report--
``(i) the number of veterans who--
``(I) received medical care or hospital
services from the Department and used an
assistive technology;
``(II) received medical care or hospital
services from the Department and were assessed
for the provision of an assistive technology;
and
``(III) received medical care or hospital
services from the Department and were
prescribed an assistive technology.
``(ii) for any assistive technology prescribed, an
identification of the category of such technology,
including spinal cord neuromodulation, and a summary of
functional outcomes associated with the prescription of
such technology, if available.
``(B) The year-to-year change (for the period covered by
the report, including the two years immediately prior to year
the report is submitted) in the percent of veterans with a
spinal cord injury or disorder who received an evaluation under
this subsection.
``(6) In reviewing the performance metrics of a Veterans Integrated
Service Network for any year beginning after the date that is one year
after the date of the enactment of the Veterans Spinal Trauma Access to
New Devices Act, the Secretary shall consider the provision of
evaluations under paragraph (1).
``(7) In this subsection, the term `assistive technology' means a
powered medical device or electronic tool used to treat or alleviate
symptoms or conditions caused by a spinal cord injury or disorder,
including the following:
``(A) A personal mobility device, including a powered
exoskeleton device.
``(B) A speech generating device.
``(C) A spinal cord neuromodulation technology, including
non-invasive transcutaneous spinal stimulation using sensory
(afferent) pathways, intended to improve voluntary motor
function, autonomic function, independence, or quality of life.
``(D) Where clinically appropriate, and consistent with the
prosthetic and sensory aids policies of the Department, an
implantable spinal cord stimulation system that is approved by
the Food and Drug Administration.''.
SEC. 330. DEPARTMENT OF VETERANS AFFAIRS PILOT PROGRAM TO AWARD GRANTS
FOR THE PROVISION OF SERVICE DOGS TO VETERANS.
(a) In General.--
(1) Pilot program required.--Not later than 24 months after
the date of the enactment of this Act, the Secretary of
Veterans Affairs shall establish a pilot program under which
the Secretary shall award grants, on a competitive basis based
on the application elements listed in subsection (b)(2), to
nonprofit entities to provide service dogs to eligible
veterans.
(2) Duration.--The Secretary shall carry out the pilot
program during the three-year period beginning on the date on
which the first grant is awarded under this section.
(b) Applications.--
(1) In general.--To be eligible to receive a grant under
this section, a nonprofit entity shall submit an application to
the Secretary at such time and in such manner as the Secretary
may require.
(2) Elements.--An application submitted by a nonprofit
entity under paragraph (1) shall include the following:
(A) A proposal for the provision of service dogs to
eligible veterans, including how the nonprofit entity
will communicate with the Secretary to ensure an
increasing number of service dogs are provided to
veterans.
(B) A description of the following services or
commitments to be provided by the nonprofit entity:
(i) The training that will be provided to
eligible veterans.
(ii) The training of dogs that will serve
as service dogs.
(iii) Any additional support or services
that will be provided for such dogs and
eligible veterans.
(iv) The plan for publicizing the
availability of such service dogs through a
marketing campaign that targets eligible
veterans.
(v) The commitment to have humane standards
for animals.
(vi) The demonstrated experience of the
nonprofit entity in training service dogs in
compliance with the requirements of the
Americans with Disabilities Act of 1990 (42
U.S.C. 12101 et seq.).
(c) Award of Grants.--
(1) In general.--The Secretary shall award a grant to each
nonprofit entity for which the Secretary has approved an
application submitted under subsection (b)(1).
(2) Agreement required.--Before the provision of any grant
amounts to a nonprofit entity selected to receive a grant under
this section, the Secretary shall enter into an agreement,
containing such terms, conditions, and limitations as the
Secretary determines appropriate, with such entity.
(3) Maximum grant amount.--Except as provided in
subparagraph (B), a grant awarded to a nonprofit entity under
this section may not exceed $2,000,000 in a fiscal year.
(4) Payments.--The Secretary shall establish intervals of
payment for the administration of each grant awarded under this
section.
(d) Use of Funds.--
(1) In general.--
(A) Requirement.--A recipient of a grant under this
section shall use the grant amounts to plan, develop,
implement, and manage one or more covered programs.
(B) Covered program defined.--In this paragraph,
the term ``covered program'' means a program under
which--
(i) service dogs are provided to
participants in the program; and
(ii) only eligible veterans are allowed to
participate in the program.
(2) Administrative expenses.--The Secretary may establish a
maximum amount for each grant awarded under this section that
may be used by the recipient of the grant to cover
administrative expenses.
(3) Other conditions and limitations.--The Secretary may
establish other conditions or limitations on the use of grant
amounts under this section.
(e) Requirements for Grant Recipients.--
(1) Notifications and information.--A recipient of a grant
under this section shall--
(A) notify each veteran who receives a service dog
through such grant that the service dog is being paid
for, in whole or in part, by the Department of Veterans
Affairs; and
(B) inform each such veteran of the benefits and
services available from the Secretary for the veteran
and the service dog.
(2) Prohibition on certain fees.--A recipient of a grant
under this section may not charge a fee to a veteran receiving
a service dog through such grant.
(f) Veterinary Insurance.--
(1) In general.--The Secretary shall provide to each
veteran who receives a service dog through a grant under this
section a commercially available veterinary insurance policy
for the service dog.
(2) Continuation.--If the Secretary provides a veterinary
insurance policy to a veteran under paragraph (1), the
Secretary shall continue to provide the policy to the veteran
without regard to the continuation or termination of the pilot
program.
(g) Training and Technical Assistance.--The Secretary may provide
training and technical assistance regarding grant application and
administration to recipients of grants under this section.
(h) Oversight and Monitoring.--The Secretary--
(1) may require each recipient of a grant under this
section to provide, in such form as may be prescribed by the
Secretary, such reports or answers in writing to specific
questions, surveys, or questionnaires as the Secretary
determines necessary to carry out the pilot program;
(2) shall establish such oversight and monitoring
requirement as the Secretary determines appropriate to ensure
that grant amounts awarded under this section are used
appropriately; and
(3) may take such actions as the Secretary determines
necessary and according to the terms of the grant agreement to
address any issues identified through the enforcement of such
requirements.
(i) Definitions.--In this section:
(1) Eligible veteran.--The term ``eligible veteran'' means
a veteran (as defined in section 101 of title 38, United States
Code) who--
(A) as determined by a physician, has one or more
disabilities, conditions, or diagnoses described in
paragraph (2); and
(B) is enrolled in the system of annual patient
enrollment of the Department of Veterans Affairs
established and operated under section 1705(a) of title
38, United States Code, or is otherwise entitled to
receive such care and services under subsection (c)(2)
of such section.
(2) Disability, condition, diagnosis described.--A
disability, condition, or diagnosis described in this
subparagraph is any of the following:
(A) Blindness or visual impairment.
(B) Loss of use of a limb, paralysis, or other
significant mobility issue.
(C) Loss of hearing.
(D) Post-traumatic stress disorder.
(E) Traumatic brain injury.
(F) Any other disability, condition, or diagnosis
for which the Secretary determines, based on medical
judgment, that it is optimal for the veteran to manage
the disability, condition, or diagnosis and live
independently through the assistance of a service dog.
(3) Pilot program.--The term ``pilot program'' means the
pilot program required by subsection (a)(1).
(4) Service dog.--The term ``service dog'' means any dog
that is individually trained to do work or perform tasks that
are--
(A) for the benefit of a veteran with a disability,
condition, or diagnosis described in paragraph (2); and
(B) directly related to the disability, condition,
or diagnosis of the veteran.
(j) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $10,000,000 for each of the
three consecutive fiscal years beginning the fiscal year in which the
pilot program is established under subsection (a).
(k) Termination.--
(1) The authority to carry out a pilot program under this
section shall terminate on September 30, 2029.
(2) No funds may be obligated by the Secretary to carry out
a pilot program under this section after the date of
termination in paragraph (1), except for activities necessary
to close operations of such pilot program.
SEC. 331. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECT OF DEPARTMENT
OF VETERANS AFFAIRS FOR FISCAL YEAR 2027 IN MANCHESTER,
NEW HAMPSHIRE.
(a) Authorization of Major Medical Facility Project of Department
of Veterans Affairs for Fiscal Year 2027 in Manchester, New
Hampshire.--
(1) In general.--The Secretary of Veterans Affairs shall
carry out a major medical facility project for the replacement
of a medical center, a new central utility plant, a community
living center, a residential rehabilitation treatment facility,
associated parking, and demolition of existing buildings in
Manchester, New Hampshire.
(2) Non-department federal entity waiver.--In order to
reduce cost and expedite timelines, the Secretary may waive the
requirements under section 8103(e) of title 38, United States
Code, and section 1096 of the National Defense Authorization
Act for Fiscal Year 2016 (Public Law 114-92; 38 U.S.C. 8103
note) for a non-Department Federal entity to be engaged in
project management and other activities for the project under
paragraph (1).
(3) Notification.--Not later than 60 days after making a
waiver, modification, or substitution relating to the project
under subsection (a), including a waiver under paragraph (2),
the Secretary shall submit to the appropriate committees of
Congress a notification describing the waiver, modification, or
substitution and the reason for such waiver, modification, or
substitution.
(4) Authorization of appropriations.--There is authorized
to be appropriated to the Secretary of Veterans Affairs for the
Construction, Major Projects account $1,180,000,000 for the
project under paragraph (1), to remain available until
expended.
(5) Appropriate committees of congress defined.--In this
section the term ``appropriate committees of Congress'' means--
(A) the Committee on Veterans' Affairs and the
Committee on Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the
Committee on Appropriations of the House of
Representatives.
(b) Access to Information for Medical Facility Construction
Projects and Leases.--
(1) In general.--Subchapter I of chapter 81 of title 38,
United States Code, is amended by inserting after section 8106
the following:
``Sec. 8107. Access to information for medical facility construction
projects and leases
``(a) In General.--For any major construction project, lease, or
enhanced-use lease for a medical facility of the Department, the
Secretary shall ensure that the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives are provided timely access to all information, records,
documents, data, analyses, communications, contracts, agreements,
project schedules, cost estimates, memoranda, briefings, reports, and
other materials relating to the project or lease.
``(b) Prohibition on Withholding Information.--The Secretary may
not withhold information under subsection (a) from the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives solely on the basis that the
information is predecisional, deliberative, advisory, procurement-
sensitive, or subject to an internal policy or directive of the
Department.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 8106 the following new item:
``8107. Access to information for medical facility construction
projects and leases.''.
SEC. 332. BOWEL AND BLADDER CARE PROGRAM OF DEPARTMENT OF VETERANS
AFFAIRS.
(a) Findings; Sense of Congress.--
(1) Findings.--Congress finds the following:
(A) Bowel care and bladder care are supportive and
necessary medical services for veterans with spinal
cord injuries and disorders when they are unable to
manage their bowel and bladder functions independently.
(B) Inadequate care will lead to complications and
problems such as autonomic dysreflexia that can be
potentially life-threatening and result in illness and
hospitalization.
(C) Bowel care and bladder care are essential to
support veterans with spinal cord injuries and
disorders in non-institutional settings, improve
quality of life, optimize health, and prevent
complications from neurogenic bowel and bladder.
(D) Family caregivers and individually employed
caregivers provide life-sustaining care for the bowel
and bladder care needs of veterans that allow them to
live in their communities.
(2) Sense of congress.--It is the sense of Congress that--
(A) family caregivers and individually employed
caregivers should not be subjected to self-employment
taxes and treated as vendors or contractors for the
veterans to whom they provide care;
(B) veterans should not be forced to finish their
bowel and bladder care needs in a set period of time
that does not consider their individual needs; and
(C) veterans should not be subjected to ongoing
clinical determinations regarding their bowel and
bladder care needs absent a decision by their medical
care provider that such care is no longer needed.
(b) In General.--The Secretary of Veterans Affairs shall establish
a program to address the bowel and bladder care needs of covered
veterans (in this section referred to as the ``program'').
(c) Provision of Care.--
(1) Clinical need.--The Secretary shall provide bowel and
bladder care under the program to covered veterans based on
clinical need, which may include covered veterans receiving aid
and attendance benefits from the Department of Veterans
Affairs.
(2) Caregiver or agency.--A covered veteran may receive
bowel and bladder care under the program through a qualified
family member, an individually employed caregiver, or a
contracted home health agency.
(3) Individualized assessment.--The Secretary shall conduct
an individualized assessment with respect to a covered veteran
to determine the number of hours of bowel and bladder care
needed by such veteran under the program.
(4) Denial of care.--Before denying bowel and bladder care
for any covered veteran under the program, the Secretary shall
first obtain review of and concurrence with respect to such
denial from a designated Spinal Cord Injuries and Disorders
Center of the Department.
(d) Coordination of Care and Benefits.--The Secretary shall ensure
the program is coordinated with other programs and benefits of the
Department for which the covered veteran is eligible to ensure that
covered veterans and caregivers receive appropriate support without
duplicating benefits or services.
(e) Supportive Medical Training and Qualifications.--
(1) In general.--The Secretary shall provide to each family
member or individually employed caregiver providing care to a
covered veteran under the program necessary supportive medical
training to participate in and receive payment by the Secretary
for the provision of such care.
(2) Qualifications.--The Secretary shall establish such
requirements, conditions, and qualifications for providers of
care under the program as necessary to provide clinically
appropriate bowel and bladder care to covered veterans and to
ensure the financial and administrative integrity of the
program.
(f) Payment.--
(1) In general.--The Secretary shall provide a monthly
stipend to family members and individually employed caregivers
and payment to contracted home health agencies for care
provided to covered veterans under the program.
(2) Limitation.--
(A) Family members and individually employed
caregivers.--The stipend for a family member or
individually employed caregiver for care provided to a
covered veteran under the program--
(i) shall be determined by the Secretary;
(ii) shall be based on the amount and
degree of assistance provided; and
(iii) may not exceed the fifth step of the
applicable grade of the General Schedule hourly
rate paid to nursing assistants who provide
such care at the medical facility of the
Department that is nearest to the residence of
such veteran.
(B) Home health agencies.--Payment to a home health
agency for care provided to a covered veteran under the
program may not exceed the payment rates of the
Department under section 17.4035 of title 38, Code of
Federal Regulations (relating to payment rates and
methodologies), or successor regulations.
(g) Submission of Documentation.--Family members and individually
employed caregivers providing care to covered veterans under the
program shall provide such documentation and information in such format
and under such terms as the Secretary may require as a condition of
receiving payment under the program.
(h) Continued Participation in Program.--If a covered veteran has
been medically determined to require care under the program for a
continuous period of three years or more, the veteran is deemed to
require such care for life or until such time as the medical provider
for such veteran determines the service is no longer needed.
(i) Not Vendors or Contractors.--Family members and individually
employed caregivers providing care to covered veterans under the
program shall not be considered vendors or contractors for purposes of
the program.
(j) Limitation.--Care may not be provided under the program to a
veteran who can perform the bowel and bladder functions of the veteran
without assistance.
(k) Covered Veteran Defined.--In this section, the term ``covered
veteran'' means a veteran who--
(1) is enrolled in the system of annual patient enrollment
of the Department of Veterans Affairs established and operated
under section 1705(a) of title 38, United States Code;
(2) has a spinal cord injury or disorder; and
(3) is dependent upon others for bowel and bladder care
while residing in non-institutional settings.
TITLE IV--ORGANIZATION
SEC. 401. AUTHORIZATION OF APPROPRIATIONS TO THE OFFICE OF INFORMATION
AND TECHNOLOGY OF THE DEPARTMENT OF VETERANS AFFAIRS FOR
CERTAIN PURPOSES.
(a) Authorization of Appropriations.--There is authorized to be
appropriated, and there is appropriated, to the Secretary of Veterans
Affairs $500,000,000 for fiscal year 2026, to remain available until
September 30, 2031, for deposit into the accounts of the Office of
Information and Technology of the Department of Veterans Affairs for
the purposes described in subsection (b).
(b) Use of Funds.--Funds shall be allocated and expended only as
follows:
(1) $150,000,000 for Enterprise Logistics and Supply Chain
Visibility -- To develop and deploy integrated, real-time
enterprise-wide logistics systems, inventory visibility,
pharmaceutical tracking, and medical supply chain resiliency
capabilities. These systems shall support both routine veteran
care operations and 4th Mission medical surge, patient
movement, and emergency distribution requirements in
consultation with DoD, FEMA, and other agencies.
(2) $200,000,000 for Cybersecurity and Operational
Resiliency -- For zero trust architecture implementation,
threat detection, secure cloud hardening, endpoint protection,
continuity of operations (COOP) platforms, and protection of
mission-essential systems against cyber and physical
disruptions. Funds shall prioritize high-risk legacy systems
and medical device security.
(3) $150,000,000 for Resilient Communications and Digital
Records Modernization -- For interoperable, survivable
communications infrastructure and targeted digitization/
automation of high-volume paper-based workflows (claims,
correspondence, administrative records) to reduce fraud risk
and improve continuity during degraded or emergency
environments. Funds shall not be used for broad Electronic
Health Record Modernization expansion.
(c) Oversight and Protection of Sensitive Information.--
(1) The Secretary may obligate and expend amounts under
this section in classified, controlled, or protected
environments consistent with applicable law.
(2) Not later than 90 days after the date of enactment of
this Act, and annually thereafter until September 30, 2031, the
Secretary shall provide to the Committees on Veterans' Affairs
of the House of Representatives and the Senate a briefing and
report on--
(A) activities carried out using funds made
available under this section;
(B) progress on improving cybersecurity,
resiliency, continuity, logistics, communications,
digitization, and mission assurance capabilities; and
(C) coordination with other Federal agencies, as
appropriate. Such reports may include a classified
annex.
(3) Detailed implementation plan and quarterly briefings.--
(A) Not later than 90 days after the date of
enactment of this Act, the Secretary, acting through
the Office of Information and Technology, shall submit
to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a comprehensive
implementation plan. The plan shall include--
(i) specific milestones, deliverables, and
performance metrics for each category of
activities in subsection (b);
(ii) a zero trust architecture strategy
with timelines and technical requirements;
(iii) a detailed expenditure plan by fiscal
quarter and by activity category; and(iv) any
proposed interagency or private-sector
partnerships.
(B) Not later than 30 days after the end of each
fiscal quarter through September 30, 2031, the
Secretary shall provide the Committees a briefing and
written report on--
(i) obligations and expenditures to date,
by category;
(ii) progress against the implementation
plan;
(iii) any deviations from the plan and
corrective actions; and
(iv) updated projections for remaining
funds. The initial briefing shall be in person;
subsequent briefings may be virtual unless
otherwise requested by the Committees. Reports
may include a classified annex.
(d) Limitation.--Funds made available under this section may not be
used for any purpose unrelated to information technology modernization,
cybersecurity, operational resilience, logistics modernization,
communications modernization, digitization, or fraud prevention
activities of the Department.
(e) Supplement, Not Supplant.--Amounts made available under this
section shall supplement and not supplant other amounts otherwise
authorized to be appropriated for the Office of Information and
Technology of the Department of Veterans Affairs.
(f) Rule of Construction.--Nothing in this section shall be
construed to require the public disclosure of classified information,
controlled unclassified information, operational details, cybersecurity
architecture, contingency planning information, mission-essential
system design, or information otherwise protected from disclosure under
Federal law or Executive Order.
(g) Reauthorization and Sunset.--
(1) Reauthorization required.--The authority provided under
this section to obligate or expend amounts appropriated
pursuant to subsection (a) shall terminate on September 30,
2031, unless subsequently reauthorized by law.
(2) Limitation on new obligations after sunset.--Beginning
on October 1, 2031, the Secretary may not initiate, award,
enter into, renew, extend, or otherwise obligate funds for any
new program, project, activity, contract, task order, or
operational capability carried out pursuant to this section
unless expressly authorized by a subsequent Act of Congress.
(3) Continuation of existing activities.--Nothing in
paragraph (2) shall be construed to prohibit the Secretary
from--
(A) maintaining, sustaining, securing, operating,
completing, or supporting any program, project,
activity, contract, system, platform, infrastructure
capability, or operational activity lawfully initiated
using amounts obligated before September 30, 2031; or
(B) carrying out similar information technology
modernization, cybersecurity, continuity of operations,
logistics modernization, communications modernization,
operational resiliency, or mission assurance activities
using amounts otherwise authorized and appropriated
under any other provision of law.
(h) Use of Existing Contracting Authorities.--The Secretary shall
carry out the activities authorized under this section, to the maximum
extent practicable, through contracts, task orders, delivery orders,
interagency agreements, cooperative agreements, or other agreements
entered into under existing authorities of title 38, United States
Code, as applicable. Amounts made available under this section shall
not be used to establish a new full-time equivalent position, hire
additional employees of the Department, or otherwise increase the
number of full-time equivalent employees of the Department, except to
the extent the Secretary determines that such personnel are necessary
for the oversight, management, cybersecurity supervision, acquisition
administration, or operational integration of activities carried out
under this section.
SEC. 402. ESTABLISHMENT OF UNDER SECRETARY FOR MANAGEMENT AND CHIEF
FINANCIAL OFFICER.
(a) Chief Financial Officer; Office of Budget.--Section 309 of
title 38, United States Code, is amended to read as follows:
``Sec. 309. Under Secretary for Management and Chief Financial Officer
``(a) Under Secretary for Management and Chief Financial Officer.--
``(1) The Under Secretary for Management and Chief
Financial Officer shall be the principal management and
financial officer of the Department.
``(2) The Under Secretary shall report directly to the
Secretary.
``(3) The Under Secretary shall serve as the Chief
Financial Officer of the Department for purposes of chapter 9
of title 31.
``(4) The Under Secretary shall exercise authority,
direction, and control over the Office of Budget and such other
offices as may be assigned by law or by the Secretary.
``(b) Duties.--The duties of the Under Secretary include the
following:
``(1) To advise the Secretary on financial management of
the Department.
``(2) To formulate, justify, execute, oversee, and certify
the budget of the Department.
``(3) To control, account for, audit, and report on the
finances of the Department.
``(4) To coordinate and assist the Chief Acquisition
Officer with the life cycle of major acquisition programs of
the Department.
``(5) To exercise the authority and carry out the functions
specified in section 902 of title 31.
``(6) To ensure compliance with sections 1341, 1342, 1349,
1350, and 1511 through 1519 of title 31.
``(7) To provide to Congress, or a congressional committee
upon request, information regarding the budget, finances, and
fiscal condition of the Department.
``(8) To serve as the head of the Office of Budget of the
Department.
``(9) To establish and oversee Department-wide financial
management policies, accounting systems, internal controls,
enterprise risk management programs, strategic planning
processes, and capital planning activities.
``(10) To oversee infrastructure investment planning,
financial systems modernization, and business transformation
initiatives of the Department.
``(c) Deputy Assistant Secretary.--(1) There is in the Department a
Deputy Assistant Secretary for Infrastructure and Construction.
``(2) Such Deputy Assistant Secretary shall be a career appointee
(as that term is defined in section 3132(a) of title 5) within the
Senior Executive Service of the Department.
``(d) Office of Infrastructure and Construction.--There is an
Office of Infrastructure and Construction in the Department.
``(e) Budget and Appropriations Affairs Office.--(1) There is
within the Office of Management a Budget and Appropriations Affairs
Office (in this subsection referred to as the `BAA office'). The
Undersecretary shall appoint a head of the BAA Office who shall report
exclusively to the Undersecretary.
``(2) The sole function of the BAA Office is to provide to Congress
(or a congressional committee), accurate, timely, and certified
information regarding the finances and budget of the Department.
``(3) Congress or a congressional committee may submit a request
for information described in paragraph (2) directly to the BAA Office.
``(4) Paragraphs (2) and (3) notwithstanding, the Assistant
Secretary for Congressional and Legislative Affairs may facilitate and
transmit responses to requests described in paragraph (3) that are
submitted to the BAA Office. Any response containing information
described in paragraph (2) shall be prepared and certified by the BAA
Office and may not be altered, delayed, withheld, edited, or modified
by any other officer or employee of the Department prior to
transmission to Congress or a congressional committee.
``(5) Not more than six full-time equivalent employees, including
supervisors, may be assigned to the BAA Office.
``(f) Limitation on Authority to Appoint.--The Secretary may not
establish an employee position--
``(1) that performs a function substantially similar to the
function of the Budget and Appropriations Affairs Office
established under section 309(e); and
``(2) that is not within the Office of Management.
``(g) Transfer of Functions.--(1) All functions, powers, duties,
authorities, responsibilities, personnel, property, records, contracts,
delegations, directives, regulations, administrative actions, and
unobligated balances of appropriations relating to the Chief Financial
Officer of the Department immediately before the effective date of this
Act are transferred to the Under Secretary for Management and Chief
Financial Officer.
``(2) Any delegation, determination, rule, regulation, order,
permit, contract, agreement, certification, or other administrative
action in effect immediately before the effective date of this Act
shall continue in effect according to its terms until modified,
superseded, terminated, or revoked.
``(h) References.--Any reference in any law, regulation, rule,
directive, delegation, contract, agreement, determination, record, or
other official document of the United States to the Chief Financial
Officer of the Department shall be deemed to refer to the Under
Secretary for Management and Chief Financial Officer.''.
(b) Technical and Conforming Amendments.--
(1) The table of sections for chapter 3 of title 38, United
States Code, is amended accordingly.
(2) The Secretary shall make such additional technical and
conforming amendments to regulations, directives, delegations,
organizational charters, manuals, and internal guidance as may
be necessary to carry out this Act.
SEC. 403. DEPARTMENT OF VETERANS AFFAIRS ACQUISITION REFORM AND COST
ASSESSMENT.
(a) Department of Veterans Affairs Acquisition Organization.--
(1) Definitions.--Chapter 81 of title 38, United States
Code, is amended by inserting after subchapter VI the following
new subchapter:
``SUBCHAPTER VII--ACQUISITION ORGANIZATION, COST ASSESSMENT, AND
PROGRAM EVALUATION
``Sec. 8181. Definition of major acquisition program
``In this subchapter, the term `major acquisition program' means a
program of the Department to acquire services, supplies, technology,
systems, or a combination thereof, with an estimated total program
cost, estimated by the Secretary, that exceeds--
``(1) $1,000,000,000 (adjusted pursuant to section 1908 of
title 41) for the total life cycle cost of the program; or
``(2) $200,000,000 (adjusted pursuant to section 1908 of
title 41) annually.''.
(2) Assistant secretary for acquisition.--Section 308 of
such title is amended--
(A) in subsection (a)(1), by striking ``seven'' and
inserting ``eight''; and
(B) in subsection (b)(10), by striking
``Procurement functions'' and inserting ``Acquisition
functions''.
(3) Acquisition organization.--Subchapter VII of chapter 81
of such title, as added by paragraph (1), is amended by adding
at the end the following new section:
``Sec. 8182. Acquisition organization
``(a) Assistant Secretary for Acquisition; Chief Acquisition
Officer.--(1) The Secretary shall designate one of the Assistant
Secretaries specified in subsection (a)(1) of section 308 of this title
as the Assistant Secretary of Veterans Affairs for Acquisition, who
shall focus solely on the administration of functions specified in
subsection (b)(10) of such section.
``(2) Pursuant to section 1702(a) of title 41, the Secretary shall
designate the Assistant Secretary of Veterans Affairs for Acquisition
as the Chief Acquisition Officer of the Department.
``(b) Office of Acquisition.--(1) There is in the Department an
Office of Acquisition.
``(2) The head of the Office of Acquisition shall be the Assistant
Secretary of Veterans Affairs for Acquisition designated pursuant to
subsection (a).
``(3) The Secretary shall take such actions as may be necessary to
ensure that major acquisition program offices of the Department align
under the Office of Acquisition and report directly to the Assistant
Secretary of Veterans Affairs for Acquisition.
``(4) The budget of the Office of Acquisition, including budgets
for major acquisition programs, shall be established in the budget
justification materials submitted to Congress in support of the budget
of the Department (as submitted with the budget of the President under
section 1105(a) of title 31).
``(c) Deputy Assistant Secretary for Logistics.--(1) Pursuant to
section 308(d) of this title, the Secretary shall appoint a Deputy
Assistant Secretary of Veterans Affairs for Logistics, who shall report
to the Assistant Secretary for Acquisition.
``(2) The Deputy Assistant Secretary of Veterans Affairs for
Logistics shall be responsible for administration of logistics and
supply chain operations of the Department.
``(d) Deputy Assistant Secretary for Procurement.--(1) Pursuant to
section 308(d) of this title, the Secretary shall appoint a Deputy
Assistant Secretary of Veterans Affairs for Procurement, who shall
report to the Assistant Secretary for Acquisition.
``(2) The Deputy Assistant Secretary of Veterans Affairs for
Procurement shall be responsible for all procurement and contracting
organizations of the Department.
``(e) Deputy Assistant Secretary for Acquisition, Program
Management, and Performance.--(1) Pursuant to section 308(d) of this
title, the Secretary shall appoint a Deputy Assistant Secretary of
Veterans Affairs for Acquisition, Program Management, and Performance,
who shall report to the Assistant Secretary for Acquisition.
``(2) The Deputy Assistant Secretary for Acquisition, Program
Management, and Performance shall be responsible for the following:
``(A) Lifecycle management.
``(B) Requirements planning.
``(C) Programming and budgeting.
``(D) Policy.
``(E) Performance standards.
``(F) Governance.
``(G) Enhancing the capabilities of the acquisition
workforce.
``(f) Program Executive Officers.--(1) The Assistant Secretary for
Acquisition shall appoint no fewer than four Program Executive
Officers, each responsible for overseeing major acquisition programs in
one of the following areas:
``(A) Medical.
``(B) Information technology.
``(C) Professional services.
``(D) Other areas not included in subparagraphs (A) through
(C).
``(2) Each Program Executive Officer shall report directly to the
Assistant Secretary for Acquisition and shall supervise the managers of
major acquisition programs within their respective area, as appointed
under section 8183 of this title.
``(3) Each Program Executive Officer shall be--
``(A) certified in project management at level three by--
``(i) the Department;
``(ii) the Federal Acquisition Institute pursuant
to section 1201 of title 41; or
``(iii) the Department of Defense pursuant to
section 1701a of title 10; or
``(B) hold an equivalent certification by a private sector
project management certification organization, as determined
appropriate by the Secretary.''.
(b) Department of Veterans Affairs Major Acquisition Program
Managers.--Subchapter VII of chapter 81 of title 38, United States
Code, as added by subsection (a), is amended by adding at the end the
following new section:
``Sec. 8183. Major acquisition program managers
``(a) Appointments.--Not later than 30 days after any date on which
the Secretary approves a major acquisition program to commence, the
applicable Program Executive Officer shall appoint a manager to be
responsible for administering such program.
``(b) Qualifications.--Each manager appointed pursuant to
subsection (a) shall be--
``(1) certified in project management at level three by--
``(A) the Department;
``(B) the Federal Acquisition Institute pursuant to
section 1201 of title 41; or
``(C) the Department of Defense pursuant to section
1701a of title 10; or
``(2) hold an equivalent certification by a private sector
project management certification organization, as determined
appropriate by the Secretary.
``(c) Duties.--Each manager appointed pursuant to subsection (a)
for a major acquisition program shall--
``(1) report to the Assistant Secretary for Acquisition
through the Program Executive Officer responsible for the major
acquisition program; and
``(2) shall be responsible for, with respect to the major
acquisition program--
``(A) developing, in coordination with the Program
Executive Officer, a plan to administer major
acquisition program, which shall be known as the
`program baseline' for the major acquisition program,
that includes--
``(i) a description of each acquisition
phase of the major acquisition program;
``(ii) for each such acquisition phase,
requirements for advancing the major
acquisition program to a subsequent acquisition
phase; and
``(iii) estimates of the cost, schedule,
and performance of the major acquisition
program that account for the entire life cycle
of the major acquisition program;
``(B) ensuring the major acquisition program is in
compliance with such requirements and providing all
program documentation, including program baseline
documentation, cost, schedule, performance and risk
assessments, and other relevant materials, to
designated officials and relevant governance boards;
``(C) developing resource requests and
justifications necessary to satisfy such requirements;
and
``(D) on a continuous basis, assessing and managing
risks to satisfying the requirements of such program
baseline relating to cost and schedule.
``(d) Program Decision Authority.--The Secretary shall ensure
that--
``(1) program decision authority for oversight of a major
acquisition program is the Assistant Secretary for Acquisition;
and
``(2) program management offices for major acquisition
programs are independent of the Veterans Benefits
Administration, the Veterans Health Administration, the
National Cemetery Administration, and staff offices of the
Department by reporting directly to the Assistant Secretary for
Acquisition.
``(e) Program Decision Authority Notification Required.--Not later
than 30 days after any date on which a major acquisition program
concludes an acquisition phase, the manager of such program appointed
pursuant to subsection (a) shall notify the program decision authority
under subsection (c).''.
(c) Department of Veterans Affairs Acquisition and Procurement
Reorganization Matters.--
(1) Organizational consolidation.--Not later than one year
after the date of the enactment of this Act, the Secretary of
Veterans Affairs shall organizationally consolidate under the
Assistant Secretary of Veterans Affairs for Acquisition every
activity of the Department of Veterans Affairs, including the
Veterans Benefits Administration, the Veterans Health
Administration, and the National Cemetery Administration, that
relates to--
(A) acquisition;
(B) procurement and contracting; or
(C) logistics and supply chain.
(2) Relocation.--Paragraph (1) shall not be construed to
require the physical relocation of employees of the Department.
(3) Plan and briefing.--
(A) In general.--Not later than 90 days after
commencing organizational consolidation under
subsection (a), the Secretary shall--
(i) submit to the Committee on Veterans'
Affairs of the Senate and the Committee on
Veterans' Affairs of the House of
Representatives a written plan to carry out
such organizational consolidation; and
(ii) provide such committees a briefing on
such plan.
(B) Contents.--The plan submitted pursuant to
subparagraph (A)(i) shall include the following:
(i) A timeline.
(ii) A plan for communication and training
activities for relevant Department personnel.
(iii) A plan for modification of relevant
Department policy and guidance.
(iv) Such other matters as the Secretary
considers relevant and appropriate.
(d) Independent Verification and Validation of Major Acquisition
Programs of Department of Veterans Affairs.--
(1) Contracting authority.--Not later than 120 days after
the date of the enactment of this Act, the Secretary of
Veterans Affairs shall seek to enter into one or more contracts
using competitive procedures with one or more entities to carry
out the functions described in paragraph (3).
(2) Eligibility.--
(A) In general.--An entity is not eligible to be
awarded a contract under this section unless the Chief
Acquisition Officer of the Department of Veterans
Affairs determines, at the time of evaluation of offers
submitted under paragraph (1), that the entity is
currently performing or has performed, during the
preceding three-year period, not fewer than three prime
contracts from either governmental or commercial health
care organizations for--
(i) the independent verification and
validation services or equivalent services,
including systems engineering and technical
advisory (SETA) support of major acquisition
programs; or
(ii) the independent verification and
validation or systems engineering and technical
advisory (SETA) support of the development or
acquisition of major acquisition programs or
defense systems, in accordance with guidance of
the Department of Defense relating to such
acquisition programs or such business systems.
(B) Past performance.--For any contract used to
demonstrate eligibility under subparagraph (A), an
entity must have performed the work at a satisfactory
or better level as indicated by the past performance
information in the Contractor Performance Assessment
Reporting System, or successor system.
(C) Demonstration of lack of conflict of
interest.--The Secretary shall revoke the eligibility
of an entity under this subsection if an entity does
not demonstrate clear and unmitigable evidence that the
entity does not have a conflict of interest with
respect to the effective performance of functions under
paragraph (3).
(D) No mitigation plans acceptable.--The Secretary
may not accept from an entity a plan to mitigate a
conflict of interest in order to ameliorate any
limitation or prohibition under this subsection.
(3) Functions.--The functions specified in this subsection
are the following:
(A) The independent verification and validation of
each major acquisition program project--
(i) when such major acquisition program is
initiated, with respect to its design and the
development of its requirements and
acquisition;
(ii) at the conclusion of such program; and
(iii) at any other intervals during such
program selected by the Chief Acquisition
Officer of the Department.
(B) The independent verification and validation of
other programs or projects of the Department selected
by the Chief Acquisition Officer of the Department, at
intervals selected by the Chief Acquisition Officer.
(4) Funding.--The Chief Financial Officer of the Department
shall ensure that each organizational subdivision of the
Department that enters into a contract under paragraph (1)
proportionally contributes amounts to fund each such contract.
(5) Definitions.--In this section:
(A) Covered contract.--The term ``covered
contract'' means any prime or subcontract with the
Department, including--
(i) information technology support or
software or system design, development,
sustainment, or maintenance services;
(ii) professional or management consulting
services; or
(iii) advisory and assistance services.
(B) Independent verification validation.--The term
``independent verification and validation'' means a
comprehensive inspection, a review, analysis, and
testing, or an assessment of systems, software, or
hardware, as applicable, performed by an entity awarded
a contract under paragraph (1)--
(i) to verify that the requirements of a
program, project or system, or a development
phase of such a program or project, are
correctly defined; and
(ii) to validate cost, schedule, and
performance baselines of current programs and
measure program effectiveness.
(e) Department of Veterans Affairs Cost Assessment and Program
Evaluation.--
(1) In general.--Subchapter VII of chapter 81 of title 38,
United States Code, as added by subsection (a) and amended by
subsection (b), is further amended by adding at the end the
following new section:
``Sec. 8184. Cost assessment and program evaluation
``(a) Director of Cost Assessment and Program Evaluation.--There is
in the Department a Director of Cost Assessment and Program Evaluation,
who shall report directly to the Secretary.
``(b) Responsibilities.--The responsibilities of the Director are
as follows:
``(1) To develop policies and procedures for cost
estimation and analysis of major acquisition programs of the
Department.
``(2) To conduct independent cost estimates and analyses
for major acquisition programs to support acquisition
decisions, or any other acquisitions as directed by the
Secretary,
``(3) To provide an independent cost estimate to the
Assistant Secretary for Acquisition in advance of a decision to
proceed with full-scale acquisition for a major acquisition
program or any other program as directed by the Director.
``(4) To evaluate the effectiveness of major acquisition
programs in meeting Department objectives.
``(5) Not less frequently than once each year, to submit to
the Secretary and the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives an annual report on cost estimation and program
evaluation activities, including recommendations to improve
acquisition efficiency. Such report shall include a list of all
acquisitions where the independent cost estimate for a major
acquisition program exceeded the budget request for the program
by more than 5 percent.
``(c) Support and Resources.--The Chief Financial Officer of the
Department shall provide to the Secretary such support and resources as
may be necessary for the Secretary to ensure the effective
establishment and functioning of the Director of Cost Assessment and
Program Evaluation.''.
(2) Report on monitoring of operating and support costs for
major acquisition programs.--
(A) Report to secretary of veterans affairs.--Not
later than one year after the date of the enactment of
this Act, and not less frequently than once each year
thereafter until December 31, 2028, the Director of
Cost Assessment and Program Evaluation of the
Department of Veterans Affairs shall submit to the
Secretary of Veterans Affairs a report on systems and
methods for tracking and assessing operating and
support costs of major acquisition programs (as defined
in section 8181 of title 38, United States Code, as
added by subsection (a)), including recommendations for
establishing cost baselines.
(B) Transmittal to congress.--Not later than 30
days after receiving a report pursuant to subparagraph
(A), the Secretary shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives the
report received by the Secretary.
(f) Improvements to Hiring of Entry-level Acquisition Positions in
Department of Veterans Affairs.--
(1) Priority use of internship programs for hiring into
entry-level positions in acquisitions.--The Secretary of
Veterans Affairs shall prioritize the use of acquisition
internship programs to hire employees to entry-level positions
relating to acquisition in the Department of Veterans Affairs.
(2) Annual number of participants in acquisition internship
programs.--
(A) In general.--Not later than September 30 of the
first fiscal year beginning after the date of the
enactment of this Act, the Secretary shall take such
actions as may be necessary to ensure that the annual
number of participants in acquisition internship
programs of the Department is--
(i) not fewer than twice the number of
participants in such programs during fiscal
year 2025; and
(ii) not more than 4 times the number of
participants in such programs during such
fiscal year.
(B) Termination.--The requirements of subparagraph
(A) shall terminate on the date on which the Secretary
certifies to the appropriate committees of Congress
that the projected number of graduates of acquisition
internship programs is sufficient to satisfy the human
capital needs of the Department with respect to
acquisition, taking into account the rate of attrition
and projected retirements of personnel.
(C) Appropriate committees of congress defined.--In
this subsection, the term ``appropriate committees of
Congress'' means the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of
the House of Representatives.
(g) Independent Analysis of Acquisition Process of Department of
Veterans Affairs.--
(1) Systems engineering analysis.--Not later than one year
after the date of the enactment of this Act, the Secretary of
Veterans' Affairs shall enter into a memorandum of
understanding with the Executive Director of the Acquisition
Research Center of the Department of Defense to conduct a
systems engineering analysis of the acquisition process of the
Department of Veterans Affairs.
(2) Report.--Not later than one year after the date in
which the Secretary enters into the memorandum of understanding
required by paragraph (1), the Secretary shall submit to
Committee on Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives a report
on the findings of the Executive Director with respect to the
analysis conducted under such subsection.
(h) Requirements Development Process.--
(1) In general.--Subchapter VII of chapter 81 of title 38,
United States Code, as added by subsection (a) and amended by
subsections (b) and (e), is further amended by adding at the
end the following new section:
``Sec. 8185. Requirements development process
``(a) Establishment of Process.--(1) The Secretary shall establish
a standardized requirements development process for major acquisition
programs.
``(2) The process established pursuant to paragraph (1) shall--
``(A) define and validate mission-driven requirements for
major acquisition programs exceeding $200,000,000 annually or
$1,000,000,000 in lifecycle costs, in coordination with the
Assistant Secretary for Acquisition;
``(B) incorporate data-driven needs assessments,
stakeholder input from relevant administrations, staff offices,
and other elements of the Department, and alignment with
statutory mandates, such as section 8121 of this title; and
``(C) ensure iterative validation of requirements through
independent verification and validation, as described in
section 8185 of this title, to confirm cost, schedule, and
performance baselines.
``(b) Limitation on Personnel.--The Secretary shall implement the
process established pursuant to subsection (a) using staff within the
Office of Acquisition and other relevant offices of the Department, as
established under section 8182 of this title, without creating new
positions, unless a subsequent cost-benefit analysis, validated by the
Director of Cost Assessment and Program Evaluation, justifies
additional resources.''.
(2) Report.--Not later than 180 days after 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 detailing the
requirements process established pursuant to section 8187 of
such title, as added by paragraph (1) and a plan for
implementation of such process, including timelines for
integration with major acquisition program baselines.
(i) Conforming Amendments.--Subchapter VI of chapter 81 of title
38, United States Code, is amended--
(1) in section 8171, by striking paragraphs (5) and (6);
and
(2) by striking section 8172.
(j) Clerical Amendments.--The table of sections at the beginning of
chapter 81 of title 38, United States Code, is amended--
(1) by striking the item relating to section 8172; and
(2) by adding at the end the following:
``subchapter vii--acquisition review, cost assessment, and program
evaluation
``8181. Definition of major acquisition program.
``8182. Acquisition reorganization.
``8183. Major acquisition program managers.
``8184. Cost assessment and program evaluation.
``8185. Requirements development process.''.
SEC. 404. IMPROVEMENT OF TELEPHONE COMMUNICATION BY DEPARTMENT OF
VETERANS AFFAIRS.
(a) In General.--Chapter 63 of title 38, United States Code, is
amended by adding at the end the following new section:
``Sec. 6321. Telephone communication
``(a) Calls Associated With Department.--Not later than one year
after the date of the enactment of the Take Care of America's Veterans
Act, the Secretary shall ensure, to the extent practicable and
feasible, that any call made to a veteran, beneficiary, claimant, or
other relevant individual by an employee or contractor of the
Department regarding services or benefits furnished by the Department--
``(1) is made from a single, well-known telephone number;
and
``(2) uses caller identification branding that indicates to
the individual that the call is from or on behalf of the
Department.
``(b) Call Centers for Health Care Appointments and Referrals.--
``(1) In general.--Not later than one year after the date
of the enactment of the Take Care of America's Veterans Act,
the Secretary shall ensure that the Veterans Health
Administration has at least one call center in each of the time
zones specified in paragraph (3) to address concerns regarding
appointments and referrals for health care under the laws
administered by the Secretary.
``(2) Existing efforts and call centers.--In carrying out
paragraph (1), the Secretary--
``(A) shall ensure coordination with existing
efforts of the Department to improve call center
operations; and
``(B) may use existing call centers to meet the
requirements of such paragraph.
``(3) Time zones specified.--The time zones specified in
this paragraph are the following:
``(A) Eastern time.
``(B) Central time.
``(C) Mountain time.
``(D) Pacific time.
``(E) Alaska time.
``(F) Hawaii time.
``(4) Clarification.--The Secretary is not required to
ensure that the Veterans Health Administration has a call
center in any location generally within a time zone specified
in paragraph (3) that does not follow daylight saving time.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 63 of such title is amended by adding at the end the following
new item:
``6321. Telephone communication.''.
(c) Report.--Not later than 180 days after enactment, and annually
for three years thereafter, the Secretary shall submit to the
Committees on Veterans' Affairs a report on implementation, including
call-answer rates, abandoned-call rates, average wait times, veteran
complaints, spoofing or fraud-prevention measures, and any exceptions
granted.
SEC. 405. ADVANCING DEPARTMENT OF VETERANS AFFAIRS EMERGENCY RESPONSE
TO CRISIS.
(a) Report on Emergency Management Roles for Department of Veterans
Affairs.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report outlining the roles and
responsibilities of all offices of the Department of Veterans
Affairs involved with emergency management.
(2) Consultation.--In preparing the report required by
paragraph (1), the Secretary of Veterans Affairs shall consult
with the Comptroller General of the United States, the
Inspector General of the Department of Veterans Affairs, the
Secretary of Homeland Security, the Secretary of Defense, and
such other Federal agencies as the Secretary of Veterans
Affairs considers relevant, to obtain insights from their
experience and trends that they have found, and such
recommendations as they may have with respect to the management
by the Department of Veterans Affairs of emergency management
functions.
(3) Contents.--The report submitted pursuant to paragraph
(1) shall include the following:
(A) A description of the organizational structure
of each office, both during normal operations and
during emergency or disaster operations.
(B) The roles and responsibilities of each office.
(C) A detailed description of roles and
responsibilities that are shared by both the Office of
Emergency Management of the Department and the Office
of Operations, Security, and Preparedness of the
Department, including an analysis of how each office
plays a part in emergency management functions.
(D) Recommendations for improving the structure and
alignment of relevant offices to better prepare the
Department for emergencies, remove redundancies, and
improve accountability.
(E) An analysis of the feasibility and advisability
of consolidating relevant offices into one centralized
emergency management office to improve communication
and streamline emergency preparedness and response
efforts of the Department.
(b) Plan to Allow Fuel Sharing and Increased Coordination Between
the Federal Emergency Management Agency and the Department of Veterans
Affairs.--Not later than 90 days after the date of the enactment of
this Act, the Secretary of Veterans Affairs shall, after consulting
with the Administrator of the Federal Emergency Management Agency,
submit to the Committee on Veterans' Affairs of the Senate, the
Committee on Veterans' Affairs of the House of Representatives, the
Committee on Homeland Security and Government Affairs of the Senate,
and the Committee on Homeland Security of the House of Representatives
a report regarding--
(1) the current limitations preventing the Federal
Emergency Management Agency from providing fuel or other
resources to the Department of Veterans Affairs during
emergencies;
(2) whether the Department requires action by Congress to
allow such resource provision to occur;
(3) whether the Secretary has been unable to coordinate
with the Administrator during prior emergencies or Fourth
Mission activations due to a lack of authority for such
coordination;
(4) whether the Secretary requires action by Congress to
address any of the issues mentioned under paragraph (3); and
(5) whether the Secretary requires action by Congress to
address the issue of Department employees or responders being
unable to use Department-purchased fuel.
SEC. 406. MEMBERSHIP OF DEPARTMENT OF VETERANS AFFAIRS GERIATRICS AND
GERONTOLOGY ADVISORY COMMITTEE.
Section 7315 of title 38, United States Code, is amended, in
subsection (a)--
(1) in the second sentence, by striking ``and at least one
representative of a national veterans service organization''
and inserting ``, at least one individual who represents a
national veterans service organization, at least one individual
who has served veterans or families of veterans in a State
home, and at least one individual who holds a professional
license in nursing home administration''; and
(2) by designating the first, second, and third sentences
as paragraphs (1) through (3), respectively (and adjusting the
margins accordingly).
SEC. 407. SCHEDULING OF APPOINTMENTS UNDER THE VETERANS COMMUNITY CARE
PROGRAM.
(a) In General.--
(1) Electronic process.--Subsection (d) of section 3101 of
the Johnny Isakson and David P. Roe, M.D. Veterans Health Care
and Benefits Improvement Act of 2020 (Public Law 116-315; 38
U.S.C. 1701 note) is amended to read as follows:
``(d) Electronic Process.--(1) The Secretary shall implement an
electronic process through which a scheduler of the Department, using
an information technology system, may schedule an appointment for
health care furnished by the Department or through the Veterans
Community Care Program, under section 1703 of this title, by a non-
Department health care provider.
``(2) The electronic process under this subsection shall allow a
scheduler, with regards to appointments described in--
``(A) either clause of subparagraph (A) of subsection
(a)(1), to view, search, and sort such appointments by type of
care, location, and date; and
``(B) clause (ii) of such subparagraph--
``(i) to schedule such an appointment;
``(ii) to provide referral and authorization
documents directly to a non-Department provider; and
``(iii) to perform any other function the Secretary
determines necessary.
``(3) The Secretary shall ensure that the electronic process allows
a scheduler to schedule an appointment for health care furnished by the
Secretary through a health care provider of the Department.
``(4) The Secretary shall implement the electronic process through
an existing agreement if practicable.
``(5) The Secretary shall submit to the Committees on Veterans'
Affairs of the Senate and House of Representatives the following
regarding the electronic process:
``(A) Not later than 90 days after the Secretary makes a
determination under subparagraph (B)(iii) of paragraph (2), a
briefing regarding the functions the Secretary has determined
necessary.
``(B) Not later than six months after the date of the
enactment of Take Care of America's Veterans Act, and
semiannually thereafter during the following three years, a
report regarding operation of the electronic process during
both the semiannual period preceding the date of the report and
the cumulative period since the date of the enactment of such
Act. Such a report shall include the following for each such
period:
``(i) The number of non-Department health care
providers that participated in such electronic process,
disaggregated by--
``(I) category of hospital care or medical
services provided; and
``(II) medical center of the Department;
``(ii) The number of appointments scheduled
pursuant to the electronic process, disaggregated by--
``(I) category of hospital care or medical
services provided;
``(II) medical center of the Department;
and
``(III) month.
``(iii) A comparison of the average wait time for
appointments scheduled through the electronic process
and through non-electronic methods, disaggregated by
medical center of the Department.
``(iv) The rates at which veterans cancelled
appointments scheduled through the electronic process.
``(v) The rates at which veterans did not appear
for appointments scheduled through the electronic
process.''.
(2) Implementation.--
(A) Date.--The Secretary of Veterans Affairs shall
implement the electronic process under subsection (d)
of section 1703H of such title, as added by this
section, not later than two years after the date of the
enactment of this Act.
(B) Guidelines.--Not later than 90 days after the
date of the enactment of this Act, the Secretary of
Veterans Affairs shall establish guidelines. Such
guidelines shall include the following:
(i) Procedures for schedulers and other
employees of the Department involved in the
scheduling of appointments described in such
section.
(ii) A directive that employees described
in clause (i) use the electronic process to the
extent practicable.
(iii) A directive that employees described
in clause (i), when scheduling an appointment
for a covered veteran (as such term is used in
section 1703 of such title) for health care
furnished by the Secretary, inform such covered
veteran of available appointments though
providers of the Department and through
providers under the Veterans Community Care
Program when eligible.
(iv) Procedures for engaging with non-
Department health care providers in specialized
cases.
(v) Standards regarding timeliness and
accuracy.
(vi) Escalation protocols for scheduling
failures or delays.
(C) Training.--Not later than 180 days after the
date of the enactment of this Act, the Secretary shall
implement a mandatory training program for employees
described in subparagraph (B) regarding the guidelines
under subparagraph (B).
(D) Evaluation.--Not later than 60 days after the
date of the enactment of this Act, the Secretary shall
prescribe performance benchmarks and outcome-based
metrics for the electronic process under such section,
including--
(i) time between a referral and a scheduled
appointment;
(ii) patient satisfaction; and
(iii) the percentage of appointments
scheduled exclusively through the electronic
process.
(E) Outreach.--Not later than 90 days after the
date of the enactment of this Act, the Secretary shall
plan and carry out an outreach strategy to encourage
non-Department of Veterans Affairs health care
providers that participate in the Veterans Community
Care Program to participate in the electronic process
under such subsection. Such outreach shall--
(i) include contacting each such provider
during such 90 days;
(ii) include seeking to enter into an
agreement with each such provider under which
the provider shall participate in the
electronic process;
(iii) include collaborating with State
hospital associations and rural health
associations to promote such participation;
(iv) focus on providers in specialties or
underserved areas, as determined by the
Secretary; and
(v) include the publication, on a publicly
accessible website of the Department, of
information regarding--
(I) details of the electronic
process;
(II) how a provider may elect to
participate in the electronic process;
and
(III) a point of contact in the
Department regarding the electronic
process.
(F) Oversight.--The Secretary shall submit to the
Committees on Veterans' Affairs of the Senate and House
of Representatives, with regards to the electronic
process under such subsection, the following:
(i) Not later than 30 days after the
Secretary establishes guidelines under
subparagraph (B) of this paragraph, a copy of
such guidelines.
(ii) Not later than 30 days after the
Secretary formulates the plan under
subparagraph (E) of this paragraph, a briefing
on the outreach strategy under such paragraph.
(iii) Not later than 180 days after the
date of the enactment of this Act, the
benchmarks and metrics prescribed under
subparagraph (D).
(3) Expansion.--Not later than 90 days after the date of
the enactment of this Act, the Secretary shall submit to the
Committees on Veterans' Affairs of the Senate and House of
Representatives a plan to integrate the scheduling of
appointments for health care furnished through health care
providers of the Department of Veterans Affairs into the
electronic process under subsection (d) of section 1703H of
such title. Such plan shall include the following elements:
(A) A timeline to implement such plan.
(B) Estimated costs to carry out such plan.
(C) Changes to policies and procedures of the
Department the Secretary determines necessary to
implement such plan.
(4) Codification.--
(A) In general.--Section 3101 of such Act, as
amended by paragraph (1), is transferred to subchapter
I of chapter 17 of title 38, United States Code,
inserted after section 1703G, and redesignated as
section 1703H.
(B) Conforming amendments.--Section 1703H of such
title, as transferred and redesignated by this
subsection, is amended--
(i) by striking any heading that is not a
section heading or subsection heading and
conforming the margins accordingly;
(ii) by striking ``of title 38, United
States Code'' both places it appears and
inserting ``of this title'';
(iii) in subsection (b)(1), by striking
``Not later than one year after the date of the
enactment of this Act, the Secretary'' and
inserting ``The Secretary'';
(iv) in subsection (c)--
(I) in paragraph (1), in the matter
preceding subparagraph (A), by striking
``Not later than 180 days after the
date of the enactment of this Act, the
Secretary'' and inserting ``The
Secretary''; and
(II) in paragraph (2), by striking
subparagraphs (A) and (B) and inserting
``The Secretary shall require each
medical facility of the Department to
use the method or tool described in
paragraph (1).'';
(v) in the section enumerator, by striking
``sec.'' and inserting ``Sec. ''; and
(vi) in the section heading--
(I) by striking ``process and
requirements for scheduling
appointments for health care from
department of veterans affairs and non-
department health care.'' and inserting
``scheduling of appointments''; and
(II) by conforming the typeface and
typestyle, including capitalization, to
the typeface and typestyle used in the
section heading of section 1703G of
such title.
(C) Table of sections.--The table of sections at
the beginning of such chapter is amended by inserting,
after the item relating to section 1703G, the following
new item:
``1703H. Scheduling of appointments.''.
TITLE V--MEMORIAL AFFAIRS
SEC. 501. EXPANSION OF ELIGIBILITY FOR DEPARTMENT OF VETERANS AFFAIRS
MEMORIAL HEADSTONE OR MARKER FOR CERTAIN INDIVIDUALS.
Section 2306(b)(2) of title 38, United States Code, is amended in
subparagraphs (B) and (C) by striking ``who dies on or after November
11, 1998,'' each place it appears.
SEC. 502. DEPARTMENT OF VETERANS AFFAIRS PROVISION OF ADDITIONAL BURIAL
BENEFITS WHEN AN URN OR COMMEMORATIVE PLAQUE IS
FURNISHED.
(a) In General.--Paragraph (2) of section 2306(h) of title 38,
United States Code, is amended to read as follows:
``(2) If the Secretary furnishes an urn or commemorative plaque for
an individual under paragraph (1), the Secretary may not provide for
such individual a headstone or marker under this section, or any
interment benefit under section 2402 of this title, unless--
``(A) in the case of a request for a headstone or marker
under this section--
``(i) such request is made at the same time as a
request for placement of a headstone or marker for
another individual who is eligible to have such a
headstone or marker placed in a national cemetery, a
veterans' cemetery in receipt of a grant made under
section 2408 of this title, or a post cemetery; and
``(ii) the Secretary furnishes one headstone or
marker inscribed for both individuals; or
``(B) in the case of a request for interment, the
individual is interred at the same time and in the same
gravesite as the interment of another individual eligible for
interment in a national cemetery under section 2402(a) of this
title.''.
(b) Applicability.--The amendment made by subsection (a) shall
apply with respect to an individual who dies on or after January 5,
2021.
SEC. 503. FALLEN SERVICEMEMBERS RELIGIOUS HERITAGE RESTORATION PROGRAM.
(a) Findings.--Congress finds the following:
(1) An estimated 900 American-Jewish servicemembers of the
Armed Forces, killed in World War I and World War II and buried
overseas in United States military cemeteries were, for various
reasons, mistakenly buried under Latin Crosses. In most
instances, those mistakes were made inadvertently.
(2) In 2022, more than 2,000,000 people visited the United
States World War I and World War II cemeteries in foreign
countries.
(3) American-Jewish servicemembers played a vital role in
the Allied victories in World War I and World War II.
(4) American-Jewish servicemembers who fought and died for
the United States must have their heritage properly recognized
and honored.
(5) The United States Government has a solemn
responsibility to ensure that every American servicemember
killed in action and buried overseas is properly honored.
(6) The work of properly identifying American-Jewish
servicemembers buried overseas is vital and integral to the
responsibility of the American Battle Monuments Commission to
ensure that past mistakes in honoring those servicemembers who
died in the line of duty are corrected.
(b) Fallen Servicemembers Religious Heritage Restoration Program.--
(1) Establishment.--The American Battle Monuments
Commission shall establish a program to identify covered
members and to contact survivors and descendants of such
covered members. Such program shall be known as the ``Fallen
Servicemembers Religious Heritage Restoration Program''.
(2) Duration.--The Commission shall carry out the Fallen
Servicemembers Religious Heritage Restoration Program during
the first five fiscal years that begin after the date of the
enactment of this Act.
(3) Contracts.--
(A) Authority.--During each fiscal year described
in subsection (b), the Commission shall seek to enter
into a contract with a nonprofit organization under
which such nonprofit organization shall carry out the
purpose described in subsection (a).
(B) Term; amount.--Each contract under this
subsection shall be for one year and in the amount of
$500,000 to the nonprofit organization.
(C) Priority.--In awarding a contract under this
subsection, the Commission shall give priority to a
nonprofit organization that has demonstrated capability
and expertise in carrying out the purpose described in
subsection (a).
(4) Definitions.--In this section:
(A) The term ``covered member'' means a deceased
member of the Armed Forces who was Jewish and buried--
(i) in a United States military cemetery
located outside the United States; and
(ii) under a marker that indicates such
member was not Jewish.
(B) The term ``nonprofit organization'' means an
organization described in section 501(c)(3) of the
Internal Revenue Code of 1986 and exempt from taxation
under section 501(a) of such Code.
TITLE VI--VETERANS' ASSURING CRITICAL CARE EXPANSIONS TO SUPPORT
SERVICEMEMBERS
Subtitle A--Improvement of Veterans Community Care Program
SEC. 601. CODIFICATION OF REQUIREMENTS FOR ELIGIBILITY STANDARDS FOR
ACCESS TO COMMUNITY CARE FROM DEPARTMENT OF VETERANS
AFFAIRS.
(a) Eligibility Access Standards.--Section 1703B of title 38,
United States Code, is amended--
(1) by striking subsections (a) through (e) and inserting
the following:
``(a) Access Standards for Community Care.--(1) For purposes of
section 1703(d)(1)(D) of this title, the eligibility access standards
for hospital care, medical services, or non-institutional extended care
services, are as follows:
``(A) With respect to primary care, mental health care, or
non-institutional extended care services, the Secretary must
schedule an appointment for the covered veteran with a health
care provider of the Department who can provide the needed
service--
``(i) within 30 minutes average driving time from
the residence of the veteran unless a longer average
driving time has been agreed to by the veteran in
consultation with a health care provider of the
veteran; and
``(ii) within 20 days of either the date of request
for such an appointment or a later date agreed to by
the veteran in consultation with a health care provider
of the veteran.
``(B) With respect to specialty care, the Secretary must
schedule an appointment for the covered veteran with a health
care provider of the Department who can provide the needed
service--
``(i) within 60 minutes average driving time from
the residence of the veteran unless a longer average
driving time has been agreed to by the veteran in
consultation with a health care provider of the
veteran; and
``(ii) within 28 days of either the date of request
for such an appointment or a later date agreed to by
the veteran in consultation with a health care provider
of the veteran.
``(C) With respect to a covered treatment program, the
Secretary must--
``(i) provide to a covered veteran a screening not
later than 48 hours after the date on which the
veteran, or a relevant health care provider, makes a
documented request for the veteran to be admitted to a
covered treatment program; and
``(ii) if the veteran is determined eligible for
priority admission to a covered treatment program--
``(I) admit the veteran to a covered
treatment program not later than 48 hours after
the date of such determination or give the
veteran the option of seeking care at a non-
Department facility pursuant to section 1792(e)
of this title; or
``(II) give the veteran the option of
seeking care at a non-Department facility
pursuant to section 1792(e) of this title.
``(2) For the purposes of determining the ability of the Secretary
to schedule an appointment for a covered veteran with a health care
provider of the Department under paragraph (1), the Secretary shall not
take into consideration the availability of telehealth appointments
from the Department.
``(3) In the case of a covered veteran who has had an appointment
with a health care provider of the Department canceled by the
Department for a reason other than either the request of the veteran or
the failure of the veteran to appear as scheduled, in calculating a
wait time for a subsequent appointment under the eligibility access
standards established under paragraph (1), the Secretary shall
calculate such wait time from the date of the request for the original,
canceled appointment.
``(4) If a veteran agrees to a longer average drive time or a later
date under paragraph (1), the Secretary shall document the agreement to
such longer average drive time or later date in the electronic health
record of the veteran and provide the veteran a copy of such
documentation. Such copy may be provided electronically.
``(5) Paragraph (1)(C) shall not be construed to affect a covered
veteran in a covered treatment program pursuant to a determination made
on or before the date of the enactment of the Take Care of America's
Veterans Act.
``(6)(A) Subject to the provisions of this paragraph, subparagraphs
(A) and (B) of paragraph (1) shall terminate on the date that is eight
years after the date of the enactment of the Take Care of America's
Veterans Act.
``(B) Not later than seven years after the date of the enactment of
the Take Care of America's Veterans 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 containing--
``(i) an assessment of the effects of the codification of
eligibility access standards for primary care, mental health
care, non-institutional extended care services, and specialty
care under this subsection on the management and oversight of
the Veterans Community Care Program under section 1703 of this
title; and
``(ii) the recommendation of the Secretary for continued
codification of such standards along with a justification for
such recommendation.
``(C) On and after the date that is eight years after the date of
the enactment of the Take Care of America's Veterans Act, the Secretary
may not establish access standards for care and services described in
subparagraph (A) or (B) of paragraph (1) that are different from the
standards set forth in those subparagraphs unless, not later than 180
days before establishing such different standards--
``(i) the Secretary submits to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs of
the House of Representatives notification of the intent of the
Secretary to establish such different standards, including a
description of the changes the Secretary intends to make and
the justification for such changes; and
``(ii) a joint resolution of approval is enacted that
approves such different standards.
``(D) For purposes of this subsection, the term `joint resolution
of approval' means only a joint resolution the matter after the
resolving clause of which is as follows: `That Congress approves the
access standards established by the Secretary submitted on __ relating
to __.', with the first blank space filled by the appropriate date and
the second blank space filled with a description of the access
standards.
``(E) A joint resolution of approval shall be considered under the
expedited procedures outlined in section 802 of title 5 to the same
extent as a joint resolution described in subsection (a) of that
section is considered.
``(b) Application.--The Secretary shall ensure that the eligibility
access standards established under subsection (a) apply--
``(1) to all care and services within the medical benefits
package of the Department to which a covered veteran is
eligible under section 1703 of this title; and
``(2) to all covered veterans, regardless of whether a
veteran is a new or established patient.
``(c) Periodic Review of Access Standards.--(1) Not later than
three years after the date of the enactment of the Take Care of
America's Veterans Act, and not less frequently than once every three
years thereafter, the Secretary shall--
``(A) conduct a review of the eligibility access standards
under subsection (a) in consultation with--
``(i) such Federal entities as the Secretary
considers appropriate, including the Department of
Defense, the Department of Health and Human Services,
and the Centers for Medicare & Medicaid Services;
``(ii) entities and individuals in the private
sector, including--
``(I) veteran patients;
``(II) representatives of veterans,
including individual veterans and participants
from veteran stakeholder organizations selected
through an open and transparent process; and
``(III) health care providers participating
in the Veterans Community Care Program under
section 1703 of this title; and
``(iii) other entities that are not part of the
Federal Government; and
``(B) submit to the appropriate committees of Congress a
report on--
``(i) the findings of the Secretary with respect to
the review conducted under paragraph (1); and
``(ii) such recommendations as the Secretary may
have with respect to the eligibility access standards
under subsection (a).
``(2) Chapter 10 of title 5 shall not apply to the consultation
required by paragraph (1)(A).'';
(2) by striking subsection (g);
(3) by redesignating subsections (f), (h), and (i) as
subsections (d), (e), and (f), respectively;
(4) in subsection (d), as redesignated by paragraph (3)--
(A) by striking ``established'' each place it
appears; and
(B) in paragraph (1), by striking ``(1) Subject
to'' and inserting ``Compliance by Community Care
Providers With Access Standards.--(1) Subject to'';
(5) in subsection (e), as so redesignated--
(A) in paragraph (1)--
(i) by striking ``(1) Consistent with'' and
inserting ``Determination Regarding
Eligibility.--(1) Consistent with''; and
(ii) by striking ``designated access
standards established under this section'' and
inserting ``eligibility access standards under
subsection (a)''; and
(B) in paragraph (2)(B), by striking ``designated
access standards established under this section'' and
inserting ``eligibility access standards under
subsection (a)''; and
(6) in subsection (f), as redesignated by paragraph (2)--
(A) in the matter preceding paragraph (1), by
striking ``In this section'' and inserting
``Definitions.--In this section''; and
(B) in paragraph (2)--
(i) by striking ``covered veterans'' and
inserting ``covered veteran'';
(ii) by striking ``veterans described'' and
inserting ``a veteran described'';
(iii) by redesignating paragraphs (3) and
(4) as paragraphs (4) and (5), respectively;
and
(iv) by inserting after paragraph (2) the
following new paragraph (3):
``(3) The term `covered treatment program' has the meaning
given such term in section 1791 of this title.''.
(b) Conforming Amendments.--Section 1703(d) of such title is
amended--
(1) in paragraph (1)(D), by striking ``designated access
standards developed by the Secretary under section 1703B of
this title'' and inserting ``eligibility access standards under
section 1703B(a) of this title'';
(2) in paragraph (3), by striking ``designated access
standards developed by the Secretary under section 1703B of
this title'' and inserting ``eligibility access standards under
section 1703B(a) of this title''; and
(3) in paragraph (4), by striking ``designated access
standards developed by the Secretary under section 1703B of
this title'' and inserting ``eligibility access standards under
section 1703B(a) of this title''.
SEC. 602. REQUIREMENT THAT SECRETARY NOTIFY VETERANS OF ELIGIBILITY FOR
CARE OR DENIAL OF REQUEST FOR CARE UNDER VETERANS
COMMUNITY CARE PROGRAM.
(a) In General.--Section 1703(a) of title 38, United States Code,
is amended by adding at the end the following new paragraph:
``(5)(A)(i) Except as provided in clause (iii), the Secretary shall
notify each covered veteran in writing of the eligibility of such
veteran for care or services under this section as soon as possible but
not later than five days after the date on which the Secretary is aware
that the veteran is seeking care or services and is eligible for such
care or services under this section.
``(ii) The Secretary is required to notify a covered veteran under
clause (i) only at the start of an episode of care for such veteran.
``(iii) The Secretary shall allow a covered veteran to opt out of
receiving notification under clause (i).
``(B) With respect to each covered veteran eligible for care or
services under subsection (d), and consistent with subparagraph (A),
the Secretary shall provide such veteran periodic reminders, as
applicable and as the Secretary determines appropriate, of their
ongoing eligibility under such subsection.
``(C) Any notification or reminder under this paragraph may be
provided electronically.
``(6)(A) If a request by a veteran for the Secretary to authorize
care or services under this section is denied, except as provided in
subparagraph (C), the Secretary shall notify the veteran in writing as
soon as possible but not later than five days after the denial is
made--
``(i) of the reason for the denial; and
``(ii) with instructions on how to appeal such denial using
the clinical appeals process of the Veterans Health
Administration.
``(B) If a denial under subparagraph (A) is due to the Secretary
meeting the eligibility access standards under section 1703B(a) of this
title, notice under such subparagraph shall include an explanation of
how the Secretary met such standards.
``(C) The Secretary shall allow a covered veteran to opt out of
receiving notification under subparagraph (A).
``(D) Any notification under this paragraph may be provided
electronically.''.
(b) Reports to Congress.-- Not later than one year after the date
of the enactment of this Act, and not less frequently than annually
thereafter for a period of five years, 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 implementation of the amendments made
by subsection (a), including--
(1) an assessment of the timeliness of the notifications
required by those amendments;
(2) a description of barriers to increasing the timeliness
of those notifications; and
(3) the number of veterans who opt out of receiving those
notifications.
SEC. 603. CONSIDERATION UNDER VETERANS COMMUNITY CARE PROGRAM OF
CONTINUITY OF CARE AND NEED FOR CAREGIVER OR ATTENDANT.
Section 1703(d) of title 38, United States Code, is amended--
(1) in paragraph (2), by adding at the end the following
new subparagraphs:
``(F) The potential for improved continuity of care,
including if a veteran has an established relationship with a
non-Department provider and the likelihood of the covered
veteran to seek and complete recommended care, including if the
veteran would abstain from seeking such care if required to
seek such care at a facility of the Department.
``(G) Whether the covered veteran needs an attendant to
provide required aid or assistance to the veteran, including
for the veteran to travel to a facility of the Department.'';
and
(2) by adding at the end the following new paragraph:
``(5) The Secretary shall ensure that consideration of the factors
specified in paragraph (2) includes consideration of all relevant
factors, is driven by clinical need, and that no single factor is
required to be determinative when considering the best medical interest
of a covered veteran.''.
SEC. 604. DISCUSSION OF TELEHEALTH OPTIONS UNDER VETERANS COMMUNITY
CARE PROGRAM.
Section 1703 of title 38, United States Code, is amended--
(1) by redesignating subsection (q) as subsection (r); and
(2) by inserting after subsection (p) the following new
subsection (q):
``(q) Discussion of Options for Telehealth.--(1) When discussing
options for care or services for a covered veteran under this section,
the Secretary shall ensure that the veteran is informed of the ability
of the veteran to seek care or services via telehealth, either through
a medical facility of the Department or through a non-Department
provider, if--
``(A) telehealth is--
``(i) available to the veteran;
``(ii) appropriate for the type of care or services
the veteran is seeking, as determined by the Secretary;
and
``(iii) is acceptable to the veteran; or
``(B) the care or services the veteran is seeking is only
or primarily available through telehealth.
``(2) Nothing in paragraph (1) shall be construed to prohibit a
health care provider specified in subsection (c) from furnishing
hospital care, medical services, or extended care services under this
section via telehealth.''.
SEC. 605. EXTENSION OF DEADLINE FOR SUBMITTAL OF CLAIMS BY HEALTH CARE
ENTITIES AND PROVIDERS UNDER PROMPT PAYMENT STANDARD.
Section 1703D of title 38, United States Code, is amended--
(1) in subsection (a)(2), by striking ``the reason for
denying the claim and what, if any, additional information is
required to process the claim'' and inserting ``the reason for
denying the claim and request additional missing information,
if any, that is required to process the claim'';
(2) by amending subsection (b) to read as follows:
``(b) Submittal of Claims by Health Care Entities and Providers.--
(1) A health care entity or provider that furnishes hospital care, a
medical service, or an extended care services under this chapter
pursuant to a contract, agreement, or other arrangement shall submit to
the Secretary a claim for payment for furnishing the hospital care,
medical service, or extended care service not later than one year after
the date on which the entity or provider furnished the hospital care,
medical service, or extended care service.
``(2) No health care entity or provider may seek payment from a
patient if the health care entity or provider failed to comply with the
timely filing requirement set forth in paragraph (1).''; and
(3) in subsection (c), by adding at the end the following
new paragraph:
``(3)(A) If the Secretary determines, based on reliable evidence,
that a health care entity or provider has submitted or caused to be
submitted a fraudulent claim for payment under this chapter, the
Secretary may suspend such entity or provider from furnishing hospital
care, medical services, or extended care services under this chapter.
``(B) Before imposing a suspension under subparagraph (A) with
respect to an entity or provider, the Secretary shall--
``(i) provide written notice to the entity or provider
identifying the basis for the proposed suspension;
``(ii) afford the entity or provider an opportunity to
respond within a period of 30 days; and
``(iii) consider any evidence or explanation submitted by
the entity or provider.
``(C)(i) The Secretary shall take all necessary actions to resolve
a suspension under subparagraph (A) as soon as possible but not longer
than within one year of the date of the beginning of the suspension,
unless the Secretary determines and provides a written determination
that an extension beyond one year is strictly necessary to protect the
interests of veterans and taxpayers and to preserve the integrity of
the health care delivery system of the Department.
``(ii) Any extension under clause (i) of a suspension shall--
``(I) be for an additional period of not longer than one
year; and
``(II) shall be reported to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs of
the House of Representatives.
``(D) The Secretary shall establish procedures for reinstatement of
an entity or provider suspended under subparagraph (A) following the
resolution of any fraud-related investigation or proceeding.
``(E) The Secretary shall coordinate actions under this paragraph
with the Office of Inspector General of the Department.
``(F) The Secretary shall prescribe regulations to carry out this
paragraph, including standards of evidence, notice, and appeal
procedures.
``(G)(i) Not less frequently than quarterly, 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
written notification of the suspensions entered into, if any, during
the preceding quarter that includes--
``(I) the identity of the suspended entity or provider;
``(II) the statutory or regulatory basis for the
suspension;
``(III) a summary of the factual findings or evidence
supporting the action; and
``(IV) the status of any related investigation of or
referral to the Office of Inspector General of the Department
or any other appropriate Federal agency.
``(ii) The Secretary shall provide to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs of the
House of Representatives, upon request, all records, memoranda, and
communications relevant to any suspension or reinstatement action taken
under this paragraph, in accordance with applicable laws related to
privacy, ongoing investigations, or sensitive law enforcement
information.
``(iii) Failure by the Secretary to provide notice under clause (i)
shall be treated as a failure to comply with a statutory reporting
requirement.''.
SEC. 606. AUDIT OF REPRESENTATIVE SAMPLE OF VETERANS RECEIVING CARE AND
SERVICES UNDER VETERANS COMMUNITY CARE PROGRAM.
Not later than one year after the date of the enactment of this
Act, and not less frequently than annually thereafter for the following
five years, the Secretary of Veterans Affairs shall--
(1) conduct an audit, for the one-year period preceding the
audit, of--
(A) the number of veterans eligible for care or
services under section 1703 of title 38, United States
Code, and the reasons for such eligibility, including
multiple such reasons for veterans eligible under more
than one eligibility criteria;
(B) of those veterans eligible for care or services
under section 1703 of title 38, United States Code, the
number of veterans who are informed of such
eligibility;
(C) the number of veterans who opt to seek care or
services under such section;
(D) the number of veterans who do not opt to seek
care or services under such section;
(E) the timeliness of referrals for care or
services under such section and the timeliness of
receipt of such care or services, including whether
care or services received by the veteran through a non-
Department of Veterans Affairs provider had a shorter
wait time than the average wait time for such care or
services at a facility of the Department;
(F) the number of requests for an appeal of a
denial of care or services under such section using the
clinical appeals process of the Veterans Health
Administration;
(G) the timeliness of each such appeal; and
(H) the outcome of each such appeal; and
(2) 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 audit conducted under paragraph
(1).
SEC. 607. INFORMATION ON WAIT TIME AND DRIVE TIME OPTIONS FOR RECEIPT
OF CARE BY VETERANS.
(a) In General.--To the greatest extent practicable, the Secretary
of Veterans Affairs shall ensure that veterans are informed in writing,
for each episode of care provided under the laws administered by the
Secretary, of current wait time and average drive time options for such
episode of care disaggregated by care provided--
(1) in person at a facility of the Department of Veterans
Affairs;
(2) via telehealth through a provider of the Department.
(3) in person through the nearest suitable non-Department
facility with which the Department has a provider agreement or
other arrangement for non-Department care pursuant to section
1703 of title 38, United States Code; and
(4) via telehealth through a non-Department provider with
which the Department has a provider agreement or other
arrangement for non-Department care pursuant to such section
with the shortest wait time.
(b) Form of Information.--Information provided under subsection
(a)--
(1) may be provided electronically; and
(2) shall be documented in the health record of the
veteran.
(c) Opt Out.--The Secretary shall permit a veteran to opt out of
receiving information under subsection (a).
SEC. 608. ESTABLISHMENT OF PERIOD DURING WHICH A REFERRAL UNDER
VETERANS COMMUNITY CARE PROGRAM REMAINS VALID.
Section 1703(a) of title 38, United States Code, as amended by
section 602(a), is further amended by adding at the end the following
new paragraph:
``(7) When authorizing care or services under this section, the
Secretary shall ensure that the period during which such care or
services may be performed by a health care provider specified in
subsection (c) begins on the date that the covered veteran has the
first appointment with such provider.''.
SEC. 609. UPDATES TO CONTRACTING REQUIREMENTS UNDER VETERANS COMMUNITY
CARE PROGRAM.
Section 1703(h) of title 38, United States Code, is amended--
(1) in paragraph (3)--
(A) by amending subparagraph (A) to read as
follows:
``(A) The Secretary may terminate a contract with an entity entered
into under paragraph (1) at such time and upon such notice to the
entity as the Secretary may specify for purposes of this section, if
the Secretary notifies the appropriate committees of Congress that, at
a minimum--
``(i) the entity failed to comply substantially with the
provisions of the contract or with the provisions of this
section and the regulations prescribed under this section,
including with respect to access, quality, training, and
medical documentation;
``(ii) it is reasonable to terminate the contract based on
the health care needs of veterans; or
``(iii) it is reasonable to terminate the contract based on
coverage provided by contracts or sharing agreements entered
into under authorities other than this section.'';
(B) by redesignating subparagraph (B) as
subparagraph (D);
(C) by inserting after subparagraph (A) the
following new subparagraphs:
``(B)(i) The Secretary shall terminate a contract with an entity
entered into under paragraph (1) at such a time and upon such notice to
the entity as the Secretary may specify for the purposes of this
section, if the entity--
``(I) is excluded from participation in a Federal health
care program (as defined in section 1128B(f) of the Social
Security Act (42 U.S.C. 1320a-7b(f))) under section 1128 or
1128A of the Social Security Act (42 U.S.C. 1320a-7 and 1320a-
7a);
``(II) has been convicted of a felony or other serious
offense under Federal or State law and the continued
participation of the entity would be detrimental to the best
interests of veterans or the Department; or
``(III) is identified as an excluded source on the list
maintained in the System for Award Management, or any successor
system.
``(ii) The Secretary may issue a waiver for entities subject to
clause (i) for a one-year period, and such a waiver shall be reported
to Congress not later than 30 days after such waiver is issued.
``(C) Any entities ineligible to enter into contracts with the
Department due to one or more reasons specified in this paragraph may
be listed on a publicly available website of the Department or
appropriate third party administrator.'';
(D) in subparagraph (D), as redesignated by
subparagraph (B) of this paragraph, by striking ``in
subparagraph (A)'' and inserting ``in this paragraph'';
and
(2) by adding at the end the following new paragraph:
``(7) Any contract or agreement between the Department and a third
party administrator or between a third party administrator and a health
care provider specified in subsection (c) that is made with respect to
care or services provided under this section shall include--
``(A) notice of obligations to comply with Federal laws and
the consequences for failure to comply with those laws,
including specific information regarding claims for payment and
consequences for any false claims, statements, or documents, or
concealment of a material fact;
``(B) confirmation by the health care provider that they
are accredited to provide any specialized services subject to
the contract or agreement and that they will only use qualified
staff to provide those services; and
``(C) confirmation that the health care provider will
identify any individuals providing specialized services or
treatments included in the contract or agreement and provide
proof of the licensure of those individuals to the
Department.''.
SEC. 610. PUBLICATION OF COMMUNITY CARE NETWORK SUFFICIENCY AND PAYMENT
WAIVER REQUESTS AND APPROVALS.
Not later than one year after the date of the enactment of this
Act, and not less frequently than annually thereafter, the Secretary of
Veterans Affairs shall publish on a publicly available and user-
friendly website--
(1) the information contained in the most recent report
required by section 1703(p) of title 38, United States Code;
and
(2) an overview, disaggregated by region, of the waivers
requested, approved, and denied under section 1703B(f)(3) of
such title.
SEC. 611. REQUIREMENTS RELATING TO QUALITY OF COMMUNITY CARE PROVIDERS.
(a) Monthly Checks Against List of Excluded Individuals or
Entities.--The Secretary of Veterans Affairs shall ensure that third
party administrators under the Veterans Community Care Program perform
automated monthly checks for all community care providers against the
list of excluded individuals or entities set forth by the Office of
Inspector General of the Department of Health and Human Services using
national provider identifier records or other unique identifiers.
(b) Revision of Provider Exclusion Standard Operating Procedures.--
Not later than 90 days after the date of the enactment of this Act, the
Secretary shall ensure that the Office of Integrated Veteran Care or
successor office revises its provider exclusion standard operating
procedures to require automated matching of community care providers in
the provider profile management system of the Department of Veterans
Affairs to the system for award management exclusions of the General
Services Administration using both taxpayer identification number and
national provider identifier as identifiers.
(c) Process to Identify Department Providers Terminated or
Resigning From Employment.--Not later than 90 days after the date of
the enactment of this Act, the Secretary shall ensure that the Under
Secretary for Health of the Department of Veterans Affairs develops a
process to identify health care providers that are terminated, retire,
or resign from employment with the Department for quality of care
concerns or while under investigation for quality of care concerns so
those health care providers can be prevented from participating in the
Veterans Community Care Program.
(d) Update of Information on Providers.--Not later than one year
after the date of the enactment of this Act, the Secretary, through the
Office of Integrated Veteran Care or successor office, shall develop a
process to ensure that third party administrators regularly, not less
frequently than quarterly--
(1) update their lists of community care providers to
reflect accurate provider contact information;
(2) annotate providers that are not currently accepting
patients under the Veterans Community Care Program; and
(3) remove providers from the provider profile management
system that--
(A) are on the list of excluded individuals or
entities set forth by the Office of Inspector General
of the Department of Health and Human Services;
(B) are in the system for award management
exclusions of the General Services Administration; or
(C) have been terminated from employment with the
Department of Veterans Affairs due to quality of care
concerns or left such employment voluntarily, through
resignation, or through retirement, while under
investigation for quality of care concerns.
(e) Definitions.--In this section:
(1) Community care provider.--The term ``community care
provider'' means a health care provider specified under section
1703(c) of title 38, United States Code.
(2) Veterans community care program.--The term ``Veterans
Community Care Program'' means the Veterans Community Care
Program under section 1703 of title 38, United States Code.
SEC. 612. PROVIDER TRAINING.
(a) Development of Plan.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs shall
develop a comprehensive plan to better align training and incentive
requirements applicable to community care providers participating in
the Veterans Community Care Program and health care providers,
residents, and trainees of the Department of Veterans Affairs.
(b) Elements.--The plan required under subsection (a) shall--
(1) identify existing training requirements or incentives
applicable to health care providers of the Department;
(2) identify existing training requirements or incentives
applicable to health care trainees or residents of the
Department;
(3) identify existing training requirements or incentives
applicable to community care providers;
(4) assess gaps between training requirements and
incentives for health care providers of the Department,
trainees or residents of the Department, and community care
providers;
(5) establish standardized baseline training requirements
to ensure consistency in the quality of care furnished through
the Department from health care providers of the Department,
trainees or residents of the Department, and community care
providers; and
(6) provide a strategy, assessment of barriers, and
timeline for implementing such baseline training requirements,
including--
(A) through online modules and continuing medical
education programs; and
(B) within such strategy--
(i) metrics to measure the effectiveness of
baseline training requirements in improving
clinical quality, satisfaction of veterans, and
health outcomes for veterans;
(ii) a mechanism to account for non-
Department training that is equivalent or
substantially similar to the Department
training in length, scope, and content, as
determined by the Secretary;
(iii) a mechanism to regularly communicate,
including through direct outreach and
publication online and in provider handbooks of
third party administrators under the Veterans
Community Care Program, requirements and
expectations with respect to training;
(iv) a mechanism to track, report, and
address non-compliance, to include corrective
actions, which may include suspending or
barring providers who are routinely non-
compliant; and
(v) a mechanism to designate community care
providers who routinely meet or exceed baseline
training requirements as preferred providers or
part of the high performing provider program of
the Department, as the Secretary considers
appropriate.
(c) Implementation.--Not later than one year after submission of
the report required under subsection (d), the Secretary shall begin
implementing the plan required under subsection (a).
(d) Report to Congress.--Not later than 180 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 containing--
(1) the plan required under subsection (a);
(2) a description of identified gaps between training or
incentives for providers of the Department, trainees or
residents of the Department, and community care providers;
(3) the estimated costs associated with implementation of
the plan; and
(4) a description of any legislative or regulatory changes
necessary to carry out the plan.
(e) Annual Updates.--Not later than one year after the submission
of the report required by subsection (d), and annually thereafter for
the following two years, 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--
(1) describing progress in implementing the plan required
under subsection (a);
(2) assessing any measurable impacts of such implementation
on quality of care; and
(3) assessing any improvements in rates of compliance with
training requirements among health care providers, trainees,
and residents of the Department and community care providers.
(f) Definitions.--In this section:
(1) Community care provider.--The term ``community care
provider'' means a health care provider specified under section
1703(c) of title 38, United States Code.
(2) Training.--The term ``training'' includes training
relating to--
(A) veteran-specific cultural competency;
(B) health conditions related to military service,
including toxic exposures, post-traumatic stress
disorder, traumatic brain injury, and military sexual
trauma;
(C) suicide prevention;
(D) pain management and opioid safety; and
(E) any other matter the Secretary determines
appropriate.
(3) Veterans community care program.--The term ``Veterans
Community Care Program'' means the Veterans Community Care
Program under section 1703 of title 38, United States Code.
SEC. 613. OVERSIGHT AUTHORITY OVER COMMUNITY CARE.
(a) In General.--The Secretary of Veterans Affairs shall include in
each contract or agreement used to provide care or services through the
Veterans Community Care Program provisions requiring the contractor and
any subcontractor or participating provider to provide government
officials, including the Office of the Inspector General of the
Department of Veterans Affairs, access, within a reasonable time and
manner, to records, materials, documents, data, and personnel necessary
to conduct audits, inspections, evaluations, or investigations related
to such care or services.
(b) Third Party Administrators.--
(1) Requirement.--The Secretary shall require third party
administrators under the Veterans Community Care Program to
include provisions in agreements with participating providers
that are equivalent to the provisions required under subsection
(a).
(2) Notification.--Notification of the requirements under
this section and any other related information as the Secretary
determines appropriate shall be included in the provider
handbooks of third party administrators under the Veterans
Community Care Program.
(c) Standard Contract Language.--The Secretary shall establish
standard contract language under this section in consultation with the
Inspector General of the Department of Veterans Affairs.
(d) Veterans Community Care Program Defined.--In this section, the
term ``Veterans Community Care Program'' means the Veterans Community
Care Program under section 1703 of title 38, United States Code.
Subtitle B--Mental Health Treatment Programs
SEC. 621. VETERAN PARTICIPATION IN CERTAIN MENTAL HEALTH PROGRAMS.
(a) Establishment.--Chapter 17 of title 38, United States Code, is
amended by adding at the end the following new subchapter:
``SUBCHAPTER IX--PARTICIPATION BY VETERANS IN CERTAIN MENTAL HEALTH
TREATMENT PROGRAMS
``Sec. 1791. Definitions
``In this subchapter:
``(1) Activities of daily living.--The term `activities of
daily living' means specific personal care activities that are
required for basic daily maintenance and sustenance, to include
eating, toileting, bathing, grooming, dressing and undressing,
and mobility.
``(2) Covered treatment program.--
``(A) In general.--The term `covered treatment
program'--
``(i) means--
``(I) a mental health residential
rehabilitation treatment program of the
Department; or
``(II) a program of the Department
for residential care for mental health
and substance use disorders;
``(ii) includes--
``(I) the programs designated as of
the date of the enactment of the Take
Care of America's Veterans Act as
domiciliary residential rehabilitation
treatment programs; and
``(II) any programs designated as
domiciliary residential rehabilitation
treatment programs on or after such
date of enactment; and
``(iii) does not include--
``(I) Compensated Work Therapy
Transition Residence programs of the
Department; or
``(II) Department or non-Department
programs in which more than 20 percent
of the care provided is provided
through telehealth.
``(B) Accreditation.--A program described in
subparagraph (A) must maintain accreditation by the
Commission on Accreditation of Rehabilitation
Facilities and the Joint Commission.
``(3) Covered veteran.--The term `covered veteran' means a
veteran described in section 1703(b) of this title.
``(4) Evidence-based treatment.--The term `evidence-based
treatment' means treatment provided in accordance with the
Department of Veterans Affairs/Department of Defense Clinical
Practice Guidelines for Mental Health and Substance Use
Disorder, or any successor similar guidelines.
``(5) Social support systems.--The term `social support
systems', with respect to a covered veteran--
``(A) means--
``(i) a member of the family of the covered
veteran, including a parent, spouse, child,
step-family member, or extended family member;
or
``(ii) an individual who lives with the
veteran but is not a member of the family of
the veteran; and
``(B) does not include a facility-organized peer
support program.
``Sec. 1792. Standardized process to determine eligibility of covered
veterans for participation in certain mental health
treatment programs
``(a) Standardized Screening Process.--Not later than one year
after the date of the enactment of the Take Care of America's Veterans
Act, the Secretary shall establish a standardized screening process to
determine, based on clinical need, whether a covered veteran satisfies
criteria for priority or routine admission to a covered treatment
program.
``(b) Eligibility Criteria for Priority Admission.--
``(1) In general.--Under the standardized screening process
required by subsection (a), a covered veteran shall be eligible
for priority admission to a covered treatment program if the
covered veteran meets criteria established by the Secretary
that shall include any of the following:
``(A) A clinical assessment of the symptoms of the
veteran, including symptoms that--
``(i) significantly affect activities of
daily life; and
``(ii) increase the risk of adverse
outcomes, such as overdose, suicide, self-harm,
or an unsafe living situation.
``(B) The lack of availability and applicability of
other treatment options.
``(C) Whether the veteran has a recent suicide or
overdose attempt.
``(D) Whether the veteran is determined to be a
high risk for suicide or overdose.
``(E) Whether the veteran has a demonstrated
history of non-responsiveness, relapse, or inability to
find recovery from two other completed courses of
treatment, such as outpatient or intensive outpatient
treatment, through a program that--
``(i) is licensed by a State;
``(ii) is accredited by the Commission on
Accreditation of Rehabilitation Facilities or
the Joint Commission; and
``(iii) provides evidence-based treatment.
``(F) Such other criteria as the Secretary
determines appropriate, in consultation with Congress.
``(2) Consideration.--In making a determination that a
covered veteran meets criteria established by the Secretary
under paragraph (1) for priority admission to a covered
treatment program, the Secretary shall--
``(A) consider any referral of a health care
provider of a covered veteran; and
``(B) ensure that consideration of such criteria
includes consideration of all relevant factors, is
driven by clinical need, and that no single factor is
required to be determinative when considering the best
medical interest of a covered veteran.
``(3) Provision of higher-level care.--The Secretary shall
provide immediate and clinically necessary care under other
authorities available to the Secretary to any covered veteran
who is not clinically recommended for admission to a covered
treatment program based on the need for a higher level of care,
such as being at a high acute risk for suicide.
``(c) Screening for Traumatic Brain Injury.--Under the standardized
screening process required by subsection (a), the Secretary shall
ensure a covered veteran is screened at an appropriate time for
potential mild, moderate, or severe traumatic brain injury.
``(d) Considerations.--In making placement decisions in a covered
treatment program for veterans who meet criteria for priority or
routine admission, the Secretary shall--
``(1) consider the input of the covered veteran with
respect to the--
``(A) program specialty, subtype, and treatment
track offered to the covered veteran; and
``(B) geographic placement of the covered veteran,
including proximity to the current residence, time
zone, or geographic region of the covered veteran;
``(2) maximize the proximity of the covered veteran to
social support systems; and
``(3) to the greatest extent practicable, place the veteran
in a covered treatment program located within the same time
zone and geographic region as the residence of the veteran at
the time of admission.
``(e) Conditions Under Which Care Shall Be Furnished Through Non-
Department Providers.--
``(1) Priority admission.--If the Secretary determines a
covered veteran is eligible for priority admission to a covered
treatment program pursuant to the standardized screening
process required by subsection (a) and the Secretary is unable
to admit such covered veteran to a covered treatment program at
a facility of the Department in a manner that complies with the
requirements under subsection (d) and section 1703B(a)(1)(C) of
this title, the Secretary shall offer the covered veteran the
option to receive care at a non-Department facility that--
``(A) can admit the covered veteran within the
period required by section 1703B(a)(1)(C)(ii)(I) of
this title;
``(B) is party to a contract or agreement with the
Department or enters into such a contract or agreement
under which the Department furnishes a program that is
equivalent to a covered treatment program to a veteran
through such non-Department facility;
``(C) is licensed by a State;
``(D) is accredited by the Commission on
Accreditation of Rehabilitation Facilities or the Joint
Commission; and
``(E) provides evidence-based treatment.
``(2) Routine admission.--If the Secretary determines a
covered veteran is eligible for routine admission to a covered
treatment program pursuant to the standardized screening
process required by subsection (a) and the Secretary is unable
to admit such covered veteran to a covered treatment program at
a facility of the Department in a manner that complies with the
requirements under section 1703B(a)(1)(C) of this title with
respect to routine admission, the Secretary shall offer the
covered veteran the option to receive care at a non-Department
facility that--
``(A) is party to a contract or agreement with the
Department or enters into such a contract or agreement
under which the Department furnishes a program that is
equivalent to a covered treatment program to a veteran
through such non-Department facility;
``(B) is licensed by a State;
``(C) is accredited by the Commission on
Accreditation of Rehabilitation Facilities or the Joint
Commission; and
``(D) provides evidence-based treatment.
``(3) Rule of construction.--This subsection shall not be
construed to affect a covered veteran in a covered treatment
program pursuant to a determination made on or before the date
of the Take Care of America's Veterans Act.
``Sec. 1793. Improvements to Department of Veterans Affairs mental
health residential rehabilitation treatment program
``(a) Performance Metrics.--
``(1) In general.--The Secretary shall develop metrics to
track, and shall subsequently track, the performance of medical
facilities of the Department, Veterans Integrated Service
Networks, and non-Department facilities in meeting the
requirements for--
``(A) screening, under section 1792 of this title,
for a covered treatment program;
``(B) timely admission, under section 1792 of this
title, to a covered treatment program pursuant to such
screening; and
``(C) adherence to evidence-based treatment
standards developed by the Secretary in consultation
with appropriate governmental and non-governmental
professional organizations with a demonstrated history
of providing or accrediting programs that are
substantially similar to covered treatment programs, or
made of professionals who provide for such programs,
including by--
``(i) using placement criteria established
by the American Society of Addiction Medicine;
and
``(ii) maintaining standards to meet
accreditation by the Commission on
Accreditation of Rehabilitation Facilities or
the Joint Commission.
``(2) Elements.--The metrics developed under paragraph (1)
shall include metrics for tracking the performance of medical
facilities of the Department, Veterans Integrated Service
Networks, and non-Department facilities with respect to routine
and priority admission under a covered treatment program as
well as adherence to evidence-based treatment standards.
``(3) Consultation.--In developing metrics under paragraph
(1), the Secretary shall consult with mental health and
substance use disorder providers, including providers employed
by the Department and those employed by non-Department
entities, and ensure adherence to industry standards.
``(4) Report.--Not later than one year after the date of
the enactment of the Take Care of America's Veterans Act, the
Secretary shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the House
a report describing the consultation and performance metrics
required under this subsection.
``(b) Oversight.--
``(1) In general.--The Secretary shall develop a process
for systematically assessing at the facility, network, and
regional level, as the Secretary considers appropriate, the
quality of care delivered by facilities of the Department and
non-Department facilities treating covered veterans under this
section as well as a process for rectifying any identified
concerns.
``(2) Elements.--The processes required under paragraph (1)
shall include assessments of--
``(A) the extent to which providers at the facility
deliver evidence-based treatments to covered veterans;
``(B) clinical outcomes for covered veterans,
including those outcomes assessment pursuant to a
subsequent clinical screening under subsection
(g)(3)(E);
``(C) the ratio of licensed independent
practitioners per resident;
``(D) the rate of completion of training under
section 1795 of this title by licensed independent
practitioners;
``(E) whether non-Department facilities and
providers generally meet the criteria outlined in
section 1792(e) of this title;
``(F) the timeliness, completeness, and rate of
transmission, if applicable, of medical records during
and following treatment of covered veterans; and
``(G) potentially wasteful, fraudulent, or
inappropriate referral or billing practices.
``(3) Consultation.--In developing the processes required
under paragraph (1), the Secretary shall consult with relevant
stakeholders, including mental health and substance use
disorder providers employed by the Department and those
employed by non-Department entities, and ensure adherence to
industry standards.
``(4) Report.--Not later than one year after the date of
the enactment of the Take Care of America's Veterans Act, the
Secretary shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the House
a report describing the consultation and oversight processes
required by this subsection.
``(c) Placement; Transportation.--
``(1) Locations.--If the Secretary determines that a
covered veteran is in need of residential care under a covered
treatment program, the Secretary shall provide to the covered
veteran a list of locations at which such covered veteran can
receive such residential care that meets--
``(A) the standards for screening under section
1792 of this title; and
``(B) the care needs of the covered veteran,
including applicable treatment tracks.
``(2) Transportation coverage.--
``(A) In general.--Notwithstanding any other
provision of law regarding the transportation of
individuals under this title, or any other law
administered by the Secretary, and except as provided
in subparagraph (B), the Secretary shall provide
transportation, pay for, or reimburse the costs of
transportation for any covered veteran who is admitted
into a covered treatment program and needs
transportation assistance--
``(i) from the residence of the covered
veteran or a facility of the Department or
authorized non-Department facility that does
not provide such care to another Department or
non-Department facility that provides
residential care covered under a covered
treatment program; and
``(ii) back to the residence of the covered
veteran or to a facility of the Department or
an authorized non-Department facility after the
conclusion of a covered treatment program, if
applicable.
``(B) Limitations.--
``(i) Costs incurred by veterans.--The
Secretary shall provide reimbursement under
subparagraph (A) directly to a covered veteran
only for costs directly incurred by the covered
veteran and pre-approved by the Department.
``(ii) No coverage of transportation
provided by covered treatment program.--The
Secretary shall not reimburse a covered veteran
for transportation provided to the covered
veteran by a covered treatment program, unless
for a purpose and amount approved by the
Secretary.
``(d) Appeals.--
``(1) In general.--The Secretary shall develop a national
policy and associated procedures, in accordance with the
existing clinical appeals process of the Veterans Health
Administration, under which a covered veteran, a representative
of a covered veteran, or a provider who requests a covered
veteran be admitted to a covered treatment program, including a
provider of the Department or a non-Department provider, may
file a clinical appeal pursuant to this subsection if the
covered veteran is--
``(A) denied admission into a covered treatment
program; or
``(B) accepted into a covered treatment program but
is not offered bed placement in a timely manner.
``(2) Timeliness standards for review.--
``(A) In general.--The national policy and
procedures developed under paragraph (1) for appeals
described in such paragraph shall include timeliness
standards for the Department to review and make a
decision on such an appeal.
``(B) Decision.--The Secretary shall review and
respond to any appeal under paragraph (1) not later
than 72 hours after the Secretary receives such appeal.
``(3) Public guidance.--The Secretary shall develop, and
make available to the public, guidance on how a covered
veteran, a representative of the covered veteran, or a provider
of the covered veteran can file a clinical appeal pursuant to
this subsection--
``(A) if the covered veteran is denied admission
into a covered treatment program;
``(B) if the first date on which the covered
veteran may enter a covered treatment program does not
comply with the eligibility access standards under
section 1703B(a) of this title for care at a covered
treatment program; or
``(C) with respect to such other factors as the
Secretary may specify.
``(4) Rule of construction.--Nothing in this subsection may
be construed as granting a covered veteran, a representative of
a covered veteran, or a provider who requests a covered veteran
be admitted to a covered treatment program, including a
provider of the Department or a non-Department provider, the
right to appeal a decision of the Secretary with respect to
admission to a covered treatment program to the Board of
Veterans' Appeals under chapter 71 of this title.
``(e) Tracking of Availability and Wait Times.--
``(1) In general.--The Secretary, to the extent
practicable, shall create a method for tracking availability
and wait times under a covered treatment program across all
facilities of the Department, Veterans Integrated Service
Networks, and non-Department providers throughout the United
States.
``(2) Availability of information.--The Secretary shall
make the information tracked under paragraph (1) available, in
real time to--
``(A) the mental health treatment coordinators at
each facility of the Department;
``(B) the leadership of each medical center of the
Department;
``(C) the leadership of each Veterans Integrated
Service Network; and
``(D) the Office of the Under Secretary for Health
of the Department.
``(3) Publication of information.--Not less frequently than
monthly, the Secretary shall publish the information tracked
under paragraph (1) on a publicly accessible website of the
Department.
``(f) Staffing Matters.--
``(1) Training.--
``(A) In general.--The Secretary shall update and
implement training for staff of the Department directly
involved in a covered treatment program regarding
referrals, screening, admission, placement decisions,
and appeals for such program, including all changes to
processes and guidance under such program required by
this section and section 1792.
``(B) Covered veterans awaiting admission.--The
training under subparagraph (A) shall include
procedures for the care of covered veterans awaiting
admission into a covered treatment program and
communication with such covered veterans and the
providers of such covered veterans.
``(C) Timing of training.--
``(i) In general.--The Secretary shall
require the training under subparagraph (A) to
be completed by staff required to complete such
training--
``(I) not later than 60 days after
beginning employment at the Department
in a position that includes work
directly involving a covered treatment
program; and
``(II) not less frequently than
annually.
``(ii) Tracking.--The Secretary shall track
completion of training required under clause
(i) by staff required to complete such
training.
``(2) Oversight standards.--The Secretary shall review and
revise oversight standards for the leadership of the Veterans
Integrated Service Networks and the Veterans Health
Administration to ensure that facilities and staff of the
Department are adhering to the policy on access to care of each
covered treatment program.
``(3) Staff coverage.--The Secretary shall not require
staff of a covered treatment program to act as coverage for any
other team, service, or project unrelated to the covered
treatment program for a period of greater than three days per
month unless such coverage is for purposes of the fourth
mission of the Department or under an emergency declaration.
``(g) Care Coordination and Follow-up Care.--
``(1) Continuity of care.--The Secretary shall ensure each
covered veteran who is screened for admission to a covered
treatment program is offered, and provided if agreed upon, care
options during the period between screening of the covered
veteran and admission of the covered veteran to such program to
ensure the covered veteran does not experience any lapse in
care.
``(2) Care coordination for substance use disorder.--For a
covered veteran being treated for substance use disorder, the
Secretary shall--
``(A) ensure there is a care plan in place during
the period between any detoxification services or
inpatient care received by the covered veteran and
admission of the covered veteran to a covered treatment
program; and
``(B) communicate that care plan to the covered
veteran, the primary care provider of the covered
veteran, and the facility where the covered veteran is
or will be residing under such program.
``(3) Care planning and clinical screening.--
``(A) In general.--A covered treatment program, in
consultation with the covered veteran and the treating
providers of the covered veteran in the covered
treatment program, shall ensure the completion of a
care plan and a clinical screening upon admittance to
the covered treatment program and prior to discharge
from the covered treatment program, which shall include
an assessment of, with respect to the covered veteran--
``(i) overall mental health;
``(ii) risk for suicide;
``(iii) risk for overdose;
``(iv) housing insecurity;
``(v) food insecurity;
``(vi) employment;
``(vii) complex medical needs and
diagnoses; and
``(viii) any other factors the Secretary
determines necessary.
``(B) Matters to be included.--The care plan
required under subparagraph (A) for a covered veteran
shall include details on the course of treatment for
the covered veteran following completion of treatment
under the covered treatment program, including
recommended length of stay and any necessary follow-up
care and the results of any screening conducted under
such subparagraph.
``(C) Length of stay.--
``(i) In general.--Covered treatment
programs at non-Department facilities shall
submit the care plan under subparagraph (A) for
a covered veteran, including the requested or
recommended length of stay for the covered
veteran, to the Department not later than 72
hours after the veteran is admitted to the
covered treatment program.
``(ii) Approval required.--Any length of
stay of a covered veteran at a covered
treatment program longer than 30 days or
extensions of length of stay greater than a
total of 30 days shall require approval by the
Secretary. The Secretary shall respond to any
such requests for approval within 72 hours. Any
such requests that have not received a response
within 72 hours shall be automatically approved
on a daily basis until the Secretary responds.
``(D) Sharing of care plan.--The care plan required
under subparagraph (A) shall be shared with the covered
veteran, the primary care provider of the covered
veteran, and any other providers with which the covered
veteran consents to sharing the plan.
``(E) Discharge from non-department facility.--Upon
discharge of a covered veteran under a covered
treatment program from a non-Department facility, and
not later than 30 days after discharge, the facility
shall share with the Department all care records
maintained by the facility with respect to the covered
veteran and shall work in consultation with the
Department on the care plan of the covered veteran
required under subparagraph (A).
``(F) Subsequent clinical screening.--Not later
than 180 days after the end of treatment of a covered
veteran in a covered treatment program, the covered
treatment program or a Department or non-Department
provider shall conduct a subsequent clinical screening,
which shall include an assessment of the factors
specified in clauses (i) through (viii) of subparagraph
(A) and recommendations for follow-up care as the
Secretary considers appropriate.
``(G) Complex medical needs.--Before, during, and
after treatment in a covered treatment program, the
Secretary shall provide greater engagement,
coordination, and monitoring of care for covered
veterans with--
``(i) complex medical diagnoses, including
diagnoses of dementia, spinal cord injury or
disorder, epilepsy, Parkinson's, anemia, severe
mental illness, multiple sclerosis,
incontinence of the bladder or bowel, mobility
limitations, or impaired vision; or
``(ii) complex medical needs, including
chemotherapy or other oncology care, dialysis,
recurring blood transfusions, or physical or
occupational therapy.
``(h) Data Collection.--The Secretary shall consult with the Office
of Research and Development of the Department, or any successor office,
regarding any data the Department should consider requesting or
requiring from non-Department facilities to assist with research
studies and projects in which the Department is participating relating
to mental health residential rehabilitation treatment programs.
``(i) Reports to Congress.--
``(1) Report on modifications to programs.--
``(A) In general.--Not later than two years after
the date of the enactment of the Take Care of America's
Veterans 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 modifications made to the
guidance, operation, and oversight of covered treatment
programs to fulfill the requirements of this section.
``(B) Elements.--The report required by
subparagraph (A) shall include--
``(i) an assessment of whether costs of
covered treatment programs, including for
residential care provided through facilities of
the Department and non-Department facilities,
serve as a disincentive to placement in the
such a program;
``(ii) a description of actions taken by
the Department to address the findings and
recommendations by the Secretary contained in
the report under section 503(c) of the STRONG
Veterans Act of 2022 (division V of Public Law
117-328; 136 Stat. 5515), including--
``(I) such actions with respect
to--
``(aa) any new locations
added for covered treatment
programs;
``(bb) any beds added at
existing facilities of such
programs; and
``(cc) any additional
treatment tracks or sex-
specific programs created or
added at facilities of the
Department; and
``(II) a breakdown of the number
and percentage of covered veterans who
are determined eligible for priority
placement into a covered treatment
program and the number and percentage
of covered veterans who are determined
eligible for routine placement into a
covered treatment program; and
``(iii) such recommendations as the
Secretary may have for legislative or
administrative action to address any funding
constraints or disincentives for use of a
covered treatment program.
``(2) Annual report on operation of programs.--
``(A) In general.--Not later than one year after
the submission of the report under paragraph (1), and
not less frequently than annually thereafter for the
following five years, 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 operation of covered
treatment programs.
``(B) Elements.--Subject to subparagraph (C), each
report required by subparagraph (A) shall include the
following:
``(i) The number of covered veterans served
by a covered treatment program, disaggregated
by--
``(I) Veterans Integrated Service
Network in which the covered veteran
receives care;
``(II) facility, including
facilities of the Department and non-
Department facilities, at which the
covered veteran receives care;
``(III) type of residential
rehabilitation treatment care received
by the covered veteran under such
program;
``(IV) sex of the covered veteran;
and
``(V) race or ethnicity of the
covered veteran.
``(ii) Wait times under a covered treatment
program for the most recent year data is
available, disaggregated by--
``(I) treatment track or
specificity of residential
rehabilitation treatment care sought by
the covered veteran;
``(II) sex of the covered veteran;
``(III) State or territory in which
the covered veteran is located;
``(IV) Veterans Integrated Service
Network in which the covered veteran is
located; and
``(V) facility of the Department at
which the covered veteran seeks care.
``(iii) A list of all locations of a
covered treatment program and number of bed
spaces at each such location, disaggregated by
residential rehabilitation treatment care or
treatment track provided under such program at
such location.
``(iv) A list of any new locations of
covered treatment programs added or removed and
any bed spaces added or removed during the one-
year period preceding the date of the report.
``(v) Average cost of a stay under a
covered treatment program, including total stay
average and daily average, at facilities of the
Department compared to non-Department
facilities.
``(vi) A review of staffing needs and gaps
with respect to covered treatment programs that
is data-driven and aligned with industry
benchmarks and standards, including--
``(I) a list of facilities that had
unstaffed beds or closed beds due to
lack of staffing at any point in the
previous year;
``(II) the number of additional
staff needed to staff those beds;
``(III) the number of beds at each
facility;
``(IV) the average wait-times for
the covered treatment program,
disaggregated by month, during the
periods of bed closures; and
``(V) a list of facilities that
required staff of covered treatment
programs to perform duties unrelated to
covered treatment programs for a period
of greater than three days.
``(vii) An overview of data collected
pursuant to a subsequent clinical screening
under subsection (g)(3)(F).
``(viii) A list of health care systems
without a covered treatment program and an
assessment of the feasibility and advisability
of opening a covered treatment program at such
health care system that is aligned and
justified by patient demand and market factors.
``(ix) A list of health care systems that
offer a covered treatment program aligned with
patient demand and market factors and that have
an average wait time of more than 20 days and
an assessment of the feasibility and
advisability of expanding such covered
treatment program to lower such average wait
time.
``(x) Any recommendations for changes to
the operation of covered treatment programs,
including any policy changes, guidance changes,
training changes, or other changes.
``(C) Anonymity.--To ensure that the data provided
under this paragraph, or some portion of that data,
will not undermine the anonymity of a veteran, the
Secretary shall provide such data pursuant to
applicable Federal law and in a manner that is wholly
consistent with applicable Federal privacy and
confidentiality laws, including--
``(i) section 552a of title 5 (commonly
known as the `Privacy Act of 1974');
``(ii) the Health Insurance Portability and
Accountability Act of 1996 (Public Law 104-
191);
``(iii) parts 160 and 164 of title 45, Code
of Federal Regulations, or successor
regulations; and
``(iv) sections 5701, 5705, and 7332 of
this title.
``(3) Notification to congress of beds not available due to
lack of staffing.--The Secretary shall notify Congress of any
covered treatment programs of the Department with more than
five beds or more than ten percent of beds unavailable, closed,
or reassigned due to lack of staffing, including--
``(A) information on the staff needed to reopen
beds that are closed;
``(B) plans to recruit and retain staff;
``(C) the total number of beds closed or expected
to be closed;
``(D) the estimated length of time until those
closed beds are made available; and
``(E) the current wait time for access to those
beds.
``(j) Third-party Assessment.--
``(1) In general.--Not later than two years after the date
of the enactment of the Take Care of America's Veterans Act,
the Secretary shall seek to enter into a contract with an
appropriate entity to conduct a study of the care provided
under covered treatment programs through facilities of the
Department and non-Department facilities.
``(2) Elements.--The study required under paragraph (1)
shall include a review of--
``(A) whether facilities are meeting requirements
of the Department pursuant to law, regulation, or
policy;
``(B) staffing models used by facilities and level
of adherence to those models;
``(C) success rates of covered treatment programs
in preventing readmittance to a covered treatment
program or death by suicide or overdose within a year
of discharge from the program;
``(D) adherence of non-Department facilities to
timelines for claim submission and record returns to
the Department; and
``(E) any other factors the Secretary or the
appropriate entity determines relevant or appropriate
to include.
``(3) Completion of study.--The contract sought under
paragraph (1) shall include a requirement that the appropriate
entity, not later than four years after the date of the
enactment of the Take Care of America's Veterans Act, complete
the study required under such paragraph and submit to the
Secretary a report on the study.
``(4) Action plan and commentary.--Not later than five
years after the date of the enactment of the Take Care of
America's Veterans 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, and
publish on a publicly accessible website of the Department, a
report containing--
``(A) the results of the study required under
paragraph (1);
``(B) action plans for improvement based on the
results of the study; and
``(C) general commentary and feedback on the
results of the study.
``(5) Appropriate entity defined.--In this subsection, the
term `appropriate entity' means--
``(A) a nongovernmental entity with experience in
assessing programs that deliver services provided under
covered treatment programs on a large scale; or
``(B) a federally funded research and development
center.
``(k) Revision of Guidance.--The Secretary shall update the
guidance of the Department on the operation of covered treatment
programs to reflect each of the requirements under this section.
``(l) Deadline.--Unless otherwise specified, the Secretary shall
carry out each requirement under this section by not later than one
year after the date of the enactment of the Take Care of America's
Veterans Act.
``(m) Comptroller General Review.--
``(1) In general.--Not later than two years after the date
of the enactment of the Take Care of America's Veterans Act,
the Comptroller General of the United States shall review
access to care under a covered treatment program for covered
veterans in need of residential mental health care and
substance use disorder care.
``(2) Elements.--The review required by paragraph (1) shall
include the following:
``(A) A review of wait times for covered veterans
under a covered treatment program, disaggregated by--
``(i) treatment track or specificity of
residential rehabilitation treatment care
needed;
``(ii) sex of the covered veteran;
``(iii) home State of the covered veteran;
``(iv) home Veterans Integrated Service
Network of the covered veteran; and
``(v) wait times for--
``(I) facilities of the Department;
and
``(II) non-Department facilities.
``(B) A review of policy and training of the
Department on screening, admission, and placement under
a covered treatment program.
``(C) A review of the rights of covered veterans
and providers to appeal admission decisions under a
covered treatment program and how the Department
adjudicates appeals.
``(D) When determining the facility at which a
covered veteran admitted to a covered treatment program
will be placed in such program, a review of how the
input of the covered veteran is taken into
consideration with respect to--
``(i) program specialty, subtype, or
treatment track offered to the covered veteran;
and
``(ii) the geographic placement of the
covered veteran, including family- or
occupation-related preferences or
circumstances.
``(E) A review of staffing and staffing needs and
gaps of covered treatment programs, including with
respect to--
``(i) mental health providers and
coordinators at the facility level;
``(ii) staff of facilities of such
programs;
``(iii) staff of Veterans Integrated
Service Networks; and
``(iv) overall administration of such
programs at the national level.
``(F) A review of outcomes from Department and non-
Department covered treatment programs based at least in
part on the subsequent clinical screenings required
under subsection (g)(3)(E).
``(G) Recommendations for improvement of access by
covered veterans to care under a covered treatment
program, including with respect to--
``(i) any new sites or types of programs
needed or in development;
``(ii) changes in training or policy;
``(iii) changes in communications with
covered veterans; and
``(iv) oversight of covered treatment
programs by the Department.
``Sec. 1794. Fee schedule
``(a) In General.--Not later than 180 days after the date of the
enactment of the Take Care of America's Veterans Act, the Secretary
shall make publicly available on an appropriate website of the
Department a fee schedule for each covered treatment program provided
by a non-Department provider through which the Secretary furnishes care
and services under section 1710 of this title.
``(b) Elements.--The fee schedule required under subsection (a) for
a covered treatment program shall--
``(1) reflect reasonable charges for the services provided;
``(2) be based on the amounts customarily paid for similar
services under the Medicaid program under title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.) and by commercial
health insurance providers;
``(3) to the greatest extent practicable, be consistent
with payment rates under section 1703(i) of this title;
``(4) be comprehensive to include a variety of possible
types of care, services, and charges; and
``(5) be sufficient to ensure a robust network of qualified
community providers able to provide services under a covered
treatment program to covered veterans.
``(c) Coordination of Payment Rates.--After the date of the initial
publication of the fee schedule under subsection (a), the rate paid by
the Department for residential substance use disorder treatment shall
be the rate provided in the fee schedule required under such
subsection.
``(d) Recoupment of Amounts.--
``(1) In general.--The Secretary shall recoup from a non-
Department entity, including a third party administrator, any
amount paid to such entity that exceeds the amount specified
under the fee schedule under subsection (a) for the care or
services provided.
``(2) Limitation.--A non-Department entity shall not bill a
veteran for any charges recouped under paragraph (1).
``Sec. 1795. Training
``(a) In General.--Not later than one year after the date of the
enactment of the Take Care of America's Veterans Act, the Secretary
shall--
``(1) develop and implement a plan to ensure that health
care providers caring for veterans under covered treatment
programs receive and complete relevant training aligned with
industry standards and practices; and
``(2) submit that plan to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs of
the House of Representatives.
``(b) Elements of Training.--Training required under subsection (a)
shall--
``(1) be easily accessible, no-cost, and offered in such a
manner as to qualify for or fulfill continuing education
requirements for health care professionals;
``(2) include course modules related to military culture,
post-traumatic stress disorder, the evaluation and management
of suicide, traumatic brain injury, and opioid safety, or
comparable course modules, as determined by the Secretary; and
``(3) be offered through Department and non-Department
entities or organizations.
``(c) Elements of Plan.--The plan required under subsection (a)
shall--
``(1) allow for Department or non-Department providers to
receive credit for non-Department training that is equivalent
or substantially similar to training required under subsection
(a); and
``(2) include details regarding consequences for non-
compliance with training required under such plan, which may
include removal from a network of providers under the Veterans
Community Care Program under section 1703 of this title for a
specified period of time.
``(d) Consultation.--The Secretary shall consult with relevant
professional organizations with respect to the content of relevant
training required under subsection (a).''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by adding at the end the following new items:
``subchapter ix--participation by veterans in certain mental health
treatment programs
``1791. Definitions.
``1792. Standardized process to determine eligibility of covered
veterans for participation in certain
mental health treatment programs.
``1793. Improvements to Department of Veterans Affairs mental health
residential rehabilitation treatment
program.
``1794. Fee schedule.
``1795. Training.''.
SEC. 622. ACCESS TO MENTAL HEALTH RESIDENTIAL REHABILITATION TREATMENT
PROGRAMS FOR VETERANS WITH SPINAL CORD INJURY OR
DISORDER.
(a) Plan.--
(1) In general.--Not later than 90 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a plan to ensure access to mental health
residential treatment programs for veterans with a spinal cord
injury or disorder.
(2) Elements.--The plan required under paragraph (1) shall
include--
(A) a staffing plan, which shall include a plan for
how the Department will--
(i) incorporate staff from other facilities
to support the pilot program required under
subsection (b); and
(ii) ensure adequate staffing to support
the needs of veterans with a spinal cord injury
or disorder;
(B) an assessment of medical equipment needs; and
(C) an assessment of the best location to deliver
treatment and health care under mental health
residential treatment programs, including through the
use of spinal cord injury or disorder centers, spinal
cord injury or disorder spokes, and community care
providers.
(b) Pilot Program.--
(1) In general.--Commencing not later than 120 days after
the date of the enactment of this Act, the Secretary shall
carry out a pilot program to provide improved access to mental
health residential treatment programs of the Department of
Veterans Affairs for veterans with a spinal cord injury or
disorder at not fewer than three medical facilities of the
Department.
(2) Selection of locations.--In selecting sites for the
pilot program under paragraph (1), the Secretary shall
prioritize sites in the following areas:
(A) Areas with geographic diversity, including
areas that serve veterans residing in rural or highly
rural areas.
(B) Areas with a significant number of veterans
with spinal cord injury or disorder.
(c) Report.--Not later than one year 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--
(1) the implementation of the plan required under
subsection (a);
(2) the initial results from the pilot program under
subsection (b), including the number of unique veterans who
participated in the pilot program, the cost of the pilot
program, and an assessment of the effectiveness of the pilot
program in increasing access to, and improving outcomes for,
participants in the pilot program;
(3) plans, if any, to expand or extend the pilot program to
address demand for the highly specialized treatment provided
under the mental health residential treatment programs of the
Department for veterans with a spinal cord injury or disorder;
and
(4) Such other matters as the Secretary considers
appropriate.
Subtitle C--Staffing Matters
SEC. 631. TREATMENT OF PSYCHOLOGISTS.
(a) Treatment as Title 38 Employees.--Section 7401 of title 38,
United States Code, is amended--
(1) in paragraph (1), by inserting ``psychologists,'' after
``chiropractors,''; and
(2) in paragraph (3), by striking ``psychologists,''.
(b) Inclusion in Contracts for Scarce Medical Specialist
Services.--Section 7409(a) of title 38, United States Code, is amended
by inserting ``psychologists,'' after ``chiropractors,''.
SEC. 632. MENTORSHIP PROGRAM FOR EXECUTIVE LEADERSHIP TEAMS AT MEDICAL
CENTERS OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--The Secretary of Veterans Affairs may establish a
program to connect covered individuals (in this section referred to as
``mentees'') with peer mentors to facilitate sharing of best practices
and leadership experiences and to foster opportunities to develop
knowledge and skills required to lead successfully at medical
facilities of the Department (in this section referred to as the
``mentorship program'').
(b) Covered Individual Defined.--In this section, the term
``covered individual'' means--
(1) an individual in the position of Facility Director,
Chief of Staff, Associate Director of Patient Care Services,
Associate Director, Assistant Director, or Deputy Director at a
medical center of the Department; or
(2) any other employee of the Department who is determined
by the Secretary to be an executive leader at a medical center
of the Department.
(c) Eligibility.--The following employees of the Department are
eligible for participation as mentees in the mentorship program:
(1) An employee appointed to a position as a covered
individual who has been in that position for less than one
year.
(2) A covered individual employed at a medical center of
the Department (regardless of appointment commencement date)
that meets one or more of the following criteria:
(A) Reports poor performance, as defined by the
Secretary, on the Strategic Analytics for Improvement
and Learning Value Model of the Department, or
successor similar model.
(B) Reports data under section 1703C(a)(3) of title
38, United States Code, as published on the Access to
Care website of the Department, or successor similar
website, that--
(i) does not consistently meet the level
reported in the community surrounding such
medical center, as determined by the Secretary;
or
(ii) does not meet a threshold level
determined by the Secretary.
(C) Has one or more recommendations from a report
by the Office of Inspector General of the Department of
Veterans Affairs that is still open more than one year
after the report was published.
(3) A covered individual employed at a medical center of
the Department (regardless of appointment commencement date)
who is recommended by the regional leadership overseeing such
medical center.
(d) Criteria for Peer Mentors.--Each peer mentor to be paired with
a mentee under subsection (a) shall meet each of the following
criteria:
(1) Previous or current employment in the same position
title as the mentee.
(2) Employment in that position for not less than two
years.
(3) Employment at a medical center of the Department that
reports--
(A) above average performance, as defined by the
Secretary, on the Strategic Analytics for Improvement
and Learning Value Model of the Department, or
successor similar model; and
(B) data under section 1703C(a)(3) of title 38,
United States Code, as published on the Access to Care
website of the Department, or successor similar
website, that exceeds the level reported in the
community surrounding such medical center, as
determined by the Secretary.
(e) Report.--Not later than one year after the date of the
enactment of this Act, and annually thereafter for an additional three
years, 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 mentorship program, including--
(1) the number of mentees and peer mentors participating in
the mentorship program, disaggregated by medical center of the
Department;
(2) the number of mentor-mentee pairings initiated under
each of the eligibility criteria outlined in paragraphs (1),
(2), and (3) of subsection (c), including information on any
circumstances in which multiple criteria under such paragraphs
were met;
(3) a description of the actions taken by the Department to
encourage communication between mentees and peer mentors;
(4) aggregated feedback from participants in the mentorship
program; and
(5) the turnover rate for mentee participants in the
mentorship program.
(f) Termination.--The authority under this section shall terminate
on September 30, 2030.
SEC. 633. REQUIREMENT FOR EQUIVALENT ROLE POSTINGS FOR VACANT POSITIONS
AT DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Whenever possible and practicable, if the
Secretary of Veterans Affairs is issuing a posting for vacant positions
at the Department of Veterans Affairs that may be filled by more than
one type of professional or clinician, the Secretary shall issue
postings for all possible clinicians or professionals who could fill
the position.
(b) Application to Certain Positions.--The Secretary shall consider
the requirement under subsection (a) in particular with respect to
hard-to-recruit, hard-to-retain, primary care, and mental health care
positions.
SEC. 634. IMPROVEMENTS TO DEPARTMENT OF VETERANS AFFAIRS HIRING
PROCESSES.
(a) In General.--Subchapter I of chapter 7 of title 38, United
States Code, is amended by inserting after section 701 the following
new section:
``Sec. 702. Hiring processes
``(a) Standardized Approval Process for Filling Vacant Positions.--
``(1) Process required.--
``(A) In general.--The Secretary shall establish a
standardized, nationwide approval process for filling
vacant employment positions within the Department.
``(B) Variability.--The process required by
subparagraph (A) may be different for each type of
employment position in the Department.
``(C) Approval windows.--The process required by
subparagraph (A) shall include a standardized approval
window for each approval step.
``(2) Delegation.--If the approval authority for a step in
the hiring process established under paragraph (1) is vacant,
on leave, or otherwise unable to respond to requests for
approval in an appropriate timeframe, such authority for
approval shall be delegated to the extent practicable to the
supervisor of such approval authority or such other designee as
may be specified in the chain of command.
``(3) Time to fill goal.--Each window of time allotted for
each approval step under paragraph (1)(C) when added together
shall not exceed the goal of the Department to fill window for
that employment position.
``(b) Process for Tentative Offers of Employment.--The Secretary
shall develop a standardized process for issuing tentative offers of
employment with the Department and such process shall require that each
such offer includes a specified rate of basic pay when possible and
practicable.
``(c) Third-party Contracts.--The Secretary may conduct laboratory
testing, background clearances, and other candidate approval and
vetting procedures through a contract with a third party if the
Secretary determines that the contract would ensure equal or better
quality or timeliness.
``(d) Electronic Signatures.--
``(1) Authority.--The Secretary shall allow electronic
signatures on any hiring, recruitment, retention, or other
employment documents once a standardized process for such
signatures is developed and implemented under paragraph (2).
``(2) Standardized process.--The Secretary shall develop a
standardized process for use of electronic signatures as
described in paragraph (1), which shall include exceptions and
limitations as the Secretary considers appropriate and that
allows for use of electronic signatures for employment
documents, including SF 1152 and related successor forms, SF
2823 and related successor forms, and SF 3102-FERS and related
successor forms.
``(e) Employee Community Building Program.--The Secretary shall, to
the extent practicable, establish an employee community building
program that connects employees in similar positions, offices, and
programs to connect with each other nationwide.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 7 of such title is amended by inserting after the item relating
to section 701 the following new item:
``702. Hiring processes.''.
SEC. 635. DEPARTMENT OF VETERANS AFFAIRS TELEWORK POLICY.
(a) Policy Required.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall, in
accordance with the requirements of this section and the requirements
of section 6502 of title 5, United States Code, establish a policy for
the use of telework within the Department of Veterans Affairs.
(b) Locations.--The policy established under subsection (a) may be
different for different locations, specialties, and categories of
employees, as determined appropriate by the Secretary.
(c) Assessment.--In developing the policy required by subsection
(a), the Secretary shall assess the following for each category of
employees at the Department--
(1) staffing levels and trends over the last 5 years;
(2) exit survey data related to telework;
(3) the availability of dedicated work space at facilities
of the Department to enable onsite work at a duty station;
(4) a comparison of productivity levels when duties are
performed on site or through telework;
(5) telework flexibilities for comparable categories of
employees in the private sector and in other Federal agencies;
and
(6) particular duties that necessitate on site work.
(d) Notice and Reporting.--
(1) In general.--For any change made to the policy
established pursuant to subsection (a), the Secretary shall--
(A) notify all affected employees of the Department
of the changes; and
(B) 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 changes.
(2) Report contents.--For each report submitted to Congress
under paragraph (1)(B), the Secretary shall include the
analyses for each category conducted in subsection (c) and the
role of those analyses in the telework policy for each
category.
(3) Deadline.--A report submitted under paragraph (1)(B)
regarding a change to the policy established under subsection
(a) shall be made not fewer than 90 days before the change goes
into effect.
(e) Report on Budgetary Impact.--Not later than 1 year after the
date on which the policy established pursuant to subsection (a) goes
into effect, the Secretary shall submit to the Committee on Veterans'
Affairs and the Committee on Appropriations of the Senate and the
Committee on Veterans' Affairs and the Committee on Appropriations of
the House of Representatives a report on the annual budgetary impact of
such policy.
(f) Effective Date and Changes.--
(1) Effective date of initial policy.--The initial policy
established by pursuant to subsection (a) shall go into effect
not later than 180 days after the date on which the policy is
established.
(2) Effective date of subsequent changes.--Any change made
to the policy established pursuant to subsection (a) after the
effective date set forth in paragraph (1) shall take effect not
less than 90 days after the date on which the change is made.
(3) Notice.--For any change made to the policy established
pursuant to subsection (a) after the effective date set forth
in paragraph (1), the Secretary shall--
(A) notify all affected employees of the Department
of the changes; and
(B) 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 changes.
SEC. 636. EXPANSION OF REIMBURSEMENT OF CONTINUING PROFESSIONAL
EDUCATION EXPENSES.
(a) In General.--Section 7411 of title 38, United States Code, is
amended to read as follows:
``Sec. 7411. Reimbursement of continuing professional education
expenses
``(a) Required Reimbursement.--The Secretary shall reimburse any
full-time physician, dentist, podiatrist, chiropractor, optometrist,
psychologist, registered nurse (including any advanced practice
registered nurse), or physician assistant appointed under section
7401(1) of this title not more than $1,000 per year for each such
individual for expenses incurred for continuing professional education
directly related to the duties and responsibilities of the position of
the employee or related to the duties and responsibilities of the
position or positions of the employees overseen by the employee.
``(b) Authorized Reimbursement.--The Secretary may reimburse any
full-time licensed practical or vocational nurse (including any nurse
practitioner), medical technologist, pharmacist, pharmacy technician,
diagnostic radiologic technologist, or social worker appointed under
section 7401(3) of this title, not more than $1,000 per year for each
such individual for expenses incurred for continuing professional
education directly related to the duties and responsibilities of the
position of the employee or related to the duties and responsibilities
of the position or positions of the employees overseen by the employee.
``(c) Maximum Number of Individuals Reimbursed.--The total number
of individuals who may be reimbursed under this section may not exceed
50,000 per year.
``(d) Priority Reimbursements.--In providing reimbursement under
subsection (a), the Secretary shall prioritize reimbursement for
individuals providing direct patient care or individuals who are
decision-makers for direct patient care.
``(e) Report Required.--
``(1) In general.--Not less frequently than annually after
the end of the first fiscal year following the date of the
enactment of the Take Care of America's Veterans 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 information on utilization of reimbursement
under this section, including--
``(A) locations at which reimbursement is claimed;
``(B) position title and specialty of the
individual claiming reimbursement;
``(C) average amount claimed per position and
specialty; and
``(D) percent utilization by each position and
specialty overall.
``(2) Authority to include in existing report.--The
information required under paragraph (1) may be submitted
independently or included in another annual report to
Congress.''.
(b) Clerical Amendment.--The table of sections at the beginning of
subchapter I of chapter 74 of title 38, United States Code, is amended
by striking the item relating to section 7411 and inserting the
following new item:
``7411. Reimbursement of continuing professional education expenses.''.
SEC. 637. DEPARTMENT OF VETERANS AFFAIRS PERSONNEL TRANSPARENCY.
(a) In General.--Section 505 of the John S. McCain III, Daniel K.
Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and
Strengthening Integrated Outside Networks Act of 2018 (Public Law 115-
182; 38 U.S.C. 301 note) is amended--
(1) in subsection (a)--
(A) in paragraph (1)--
(i) in the matter before subparagraph (A),
by striking ``information,'' and all that
follows through ``facility:'' and inserting
``information:'';
(ii) in subparagraph (B)--
(I) by inserting ``(i)'' before
``The number''; and
(II) by adding at the end the
following new clause:
``(ii) Information made available under this
subparagraph shall be updated not less frequently than
once each quarter to account for delays in data
processing and shall reflect the most recently
available data.'';
(iii) in subparagraph (C), by striking
``vacancies, by occupation.'' and inserting
``positions currently undergoing a recruitment
action, disaggregated by occupation and by
stage of recruitment.'';
(iv) in subparagraph (E)(iii), by striking
``potential hires or''; and
(v) by adding at the end the following new
subparagraph:
``(F) The number of positions vacated during the
quarter for which the Department has not initiated a
recruitment action or is not planning to initiate a
recruitment action.'';
(B) by redesignating paragraph (5) as paragraph
(6);
(C) by inserting after paragraph (4) the following
new paragraph (5):
``(5) Display of information.--The display of information
made publicly available on a website of the Department pursuant
to paragraph (1) shall be disaggregated--
``(A) by departmental component;
``(B) in the case of information relating to
Veterans Health Administration positions, by medical
facility; and
``(C) in the case of information relating to
Veterans Benefits Administration positions, by regional
office.''; and
(D) in paragraph (6), as redesignated by
subparagraph (B), by striking ``shall'' and all that
follows and inserting the following: ``shall--
``(A) review the administration of the website
required under paragraph (1);
``(B) develop recommendations relating to the
improvement of such administration; and
``(C) submit to the Committee on Veterans' Affairs
of the Senate and the Committee on Veterans' Affairs of
the House of Representatives a report containing--
``(i) the findings of the Inspector General
with respect to the most recent review
conducted under subparagraph (A); and
``(ii) the recommendations most recently
developed under subparagraph (B).''; and
(2) by amending subsection (b) to read as follows:
``(b) Annual Report.--Each year, the Secretary shall submit to
Congress an annual report that includes the following:
``(1) A description of the steps the Department is taking
to achieve full staffing capacity.
``(2) A description of the actions the Department is taking
to improve the onboard timeline for facilities of the
Department, including--
``(A) in the case of facilities of the Veterans
Health Administration, for facilities for which the
duration of the onboarding process exceeds the metrics
laid out in the Time to Hire Model of the Veterans
Health Administration, or successor model; and
``(B) in the case of the Veterans Benefits
Administration, for regional offices that exceed the
time-to-hire target of the Office of Personnel
Management.
``(3) The amount of additional funds necessary to enable
the Department to reach full staffing capacity.
``(4) Such recommendations for legislative or
administrative action as the Secretary may have in order to
achieve full staffing capacity at the Department.''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on the date of the enactment of this Act and shall apply
with respect to the second update under section 505(a)(3) of such Act
beginning after the date of the enactment of this Act and each update
thereafter.
SEC. 638. MODIFICATION OF AUTHORITY OF LICENSURE OF HEALTH CARE
PROFESSIONALS PROVIDING TREATMENT VIA TELEMEDICINE.
Section 1730C of title 38, United States Code, is amended--
(1) by amending subsection (a) to read as follows:
``(a) In General.--Notwithstanding any provision of law regarding
the licensure of health care professionals or the prescribing of
controlled substances, a covered health care professional may practice
the health care profession of the health care professional and
prescribe controlled substances at any location in any State or any of
the Freely Associated States (as defined in section 1724(f) of this
title), regardless of where the covered health care professional or the
patient is located, if the covered health care professional is using
telemedicine to provide treatment or prescribe controlled substances to
an individual under this chapter.'';
(2) in subsection (b), by adding at the end the following
new paragraph:
``(4) A health care professional who is a contractor of the
Department acting in the scope of a contract with the
Department to furnish care in a facility or clinic of the
Department and who has an active, current, full, and
unrestricted license, registration, or certification in a State
to practice the health care profession of the health care
professional, excluding the following:
``(A) A health care professional located outside a
facility or clinic of the Department providing care
through the Veterans Community Care Program under
section 1703 of this title or a similar authority under
the laws administered by the Secretary.
``(B) A health care professional conducting
disability compensation evaluations pursuant to a
contract with the Department.'';
(3) in subsection (d)--
(A) by redesignating paragraph (2) as paragraph
(3); and
(B) by inserting after paragraph (1) the following
new paragraph (2):
``(2) State laws that may be inconsistent under paragraph (1)
include--
``(A) the laws of--
``(i) the State of licensure, certification, or
registration of the covered health care professional;
``(ii) the State of practice of the covered health
care professional;
``(iii) the State in which the patient is located;
or
``(iv) the State of residence of the patient; and
``(B) such laws specified under subparagraph (A) as
incorporated by the Controlled Substances Act (21 U.S.C. 801 et
seq.).''; and
(4) in subsection (e), striking ``Nothing'' and inserting
``Except as provided in subsections (a) and (d), nothing.''.
SEC. 639. PROVISION OF DATA ON EDUCATIONAL ASSISTANCE PROGRAMS OF
VETERANS HEALTH ADMINISTRATION.
(a) In General.--Beginning not later than 180 days after the date
of the enactment of this Act, the Secretary of Veterans Affairs shall
provide to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of Representatives data on
graduate medical education programs, health profession scholarship
programs, and any other educational assistance programs within the
Veterans Health Administration.
(b) Elements.--The data required to be provided under subsection
(a) shall include, for each program, the following:
(1) The number of active participants, broken down by
position or expected future position or licensure.
(2) The amount of funds spent each fiscal year.
(3) The number of participants who have completed their
education and are currently completing their service
requirements at the Department of Veterans Affairs.
(4) The number of participants who were previously active
in the program but left the program before completing their
education or service requirement during the year preceding the
date on which the data is provided.
(5) An overview of outreach by the Department to
prospective participants in the program.
(6) Such other information as the Secretary considers
appropriate.
(c) Update and Submittal of Data.--The data required to be provided
under subsection (a)--
(1) shall be updated not less frequently than annually; and
(2) may be submitted to the Committee on Veterans' Affairs
of the Senate and the Committee on Veterans' Affairs of the
House of Representatives as part of another report required by
law.
(d) Initial Data.--With the first iteration of data provided under
subsection (a), the Secretary shall provide 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
pilot program under section 246 of the Military Construction, Veterans
Affairs, and Related Agencies Appropriations Act, 2018 (division J of
Public Law 115-141; 38 U.S.C. 7601 note), including the current status
of the pilot program and a timeline of the status of the pilot program
since its initial implementation.
Subtitle D--Optimization of Workforce
SEC. 641. DEPARTMENT OF VETERANS AFFAIRS STRATEGIC HUMAN CAPITAL PLAN.
(a) In General.--Subchapter I of chapter 7 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 729. Strategic human capital plan
``(a) Plan Development.--(1) Not later than September 30, 2027, the
Secretary shall develop and submit to the appropriate committees of
Congress a five-year strategic human capital plan to support the
mission and responsibilities of the Department, disaggregated by the
Veterans Health Administration, the Veterans Benefits Administration,
the National Cemetery Administration, and such other administrative
components of the Department as the Secretary considers necessary to
carry out the mission of the Department.
``(2) Not later than September 30, 2028, and each September 30
thereafter, the Secretary shall update the plan developed pursuant to
paragraph (1) and extend the plan so that it covers the next period of
five fiscal years commencing immediately after the date of the update.
``(b) Requirements.--(1) In developing the plan required by
subsection (a), the Secretary shall take into account and document
current and future projected demand for benefits and services
administered by the Department, disaggregated for each component by
facility location, facility type, region, administration, program
office, the type of benefit or service, and such other categories as
the Secretary determines appropriate.
``(2) The Secretary shall develop and update the plan under
subsection (a) in consultation with veterans service organizations and
such other stakeholders as the Secretary considers appropriate.
``(c) Contents.--The strategic human capital plan required by
subsection (a) shall incorporate leading practices, including the
following:
``(1) A workforce gap analysis, including an assessment
of--
``(A) the staffing levels of each employee position
needed to deliver high quality, accessible, and timely
health care, benefits, and other services the Secretary
considers appropriate, disaggregated by employee
position, facility location, facility type, region,
administration, program office, the type of benefit or
service, and such other categories as the Secretary
determines appropriate;
``(B) how the staffing levels described in
subparagraph (A) align with industry best practices in
each employee position for the anticipated demand for
health care, benefits, and other services described in
subsection (b); and
``(C) core competencies, as defined by the
Secretary, and the staffing levels needed in each of
these core competencies, disaggregated by employee
position, facility location, facility type, region,
administration, program office, the type of benefit or
service and such other categories as the Secretary
considers appropriate.
``(2) An implementation plan that includes the following:
``(A) Specific recruitment and retention goals to
fulfill the staffing needs identified in the strategic
human capital plan and the strategy of the Department
to achieve such goals.
``(B) Specific strategies--
``(i) to improve workforce productivity
using technological, organizational,
behavioral, and such other approaches as the
Secretary determines appropriate and
productivity measures that are specific to
employee positions and the benefits or services
they provide; and
``(ii) that are informed by applicable
industry best practices.
``(C) Specific strategies for recruiting and
retaining veterans, spouses of veterans and members of
the Armed Forces, family members of veterans and
members of the Armed Forces, caregivers of veterans,
and survivors of members of the Armed Forces as
employees of the Department.
``(D) Specific goals to reduce the time to hire and
onboard employees of the Department and a strategy to
achieve such goals, including draft legislative
language for any legislative action necessary to
achieve such goals, without degradation of--
``(i) necessary background checks; and
``(ii) measures to protect Department
customer and employee safety.
``(d) Annual Updates.--Not later than September 30, 2028, and
September 30 of each of year thereafter, the Secretary shall submit to
the appropriate committees of Congress an update on the implementation
of the strategic human capital plan developed pursuant to subsection
(a), including an assessment by the Secretary of--
``(1) the progress of the Department in implementing the
strategic human capital plan;
``(2) the progress of the Department in improving outcomes
for veterans and their spouses, dependents, and caregivers
through the delivery of high quality, accessible, and timely
health care, benefits, and other services the Secretary
considers appropriate using results based performance measures;
``(3) changes to projected demand for benefits and services
based on new legislative action or other factors, disaggregated
for each component by facility location, facility type, region,
administration, program office and the type of benefit or
service;
``(4) changes to the staffing levels included in the
strategic human capital plan, including justifications for such
changes, disaggregated by employee position, facility location,
facility type, region, administration, program office, the type
of benefit or service and such other categories as the
Secretary determines appropriate;
``(5) any differentiation between the staffing levels
included in the strategic human capital plan and those included
in the budget justification materials most recently submitted
to Congress in support of the budget of the Department (as
submitted with the budget of the President under section
1105(a) of title 31); and
``(6) any differentiation from the Quadrennial Veterans
Health Administration review required by section 7330C of this
title.
``(e) Comptroller General of the United States Biennial Reviews.--
Not later than 180 days after the date on which the human capital plan
is submitted to the appropriate committees of Congress pursuant to
subsection (a), and not less frequently than once every 2 years
thereafter, the Comptroller General of the United States shall--
``(1) review the strategic human capital plan developed
pursuant to subsection (a) and updated pursuant to subsection
(d), as the case may be, particularly with respect to the
adequacy of the plan to fulfill the mission and
responsibilities of the Department; and
``(2) submit to Congress the findings of the Comptroller
General with respect to the review conducted pursuant to
paragraph (1).
``(f) Definitions.--In this section:
``(1) The term `appropriate committees of Congress' means--
``(A) the Committee on Veterans' Affairs and the
Committee on Appropriations of the Senate; and
``(B) the Committee on Veterans' Affairs and the
Committee on Appropriations of the House of
Representatives.
``(2) The term `veterans service organization' means any
organization recognized by the Secretary under section 5902 of
this title.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 7 of such title is amended by inserting after the item relating
to section 728 the following new item:
``729. Strategic human capital plan.''.
SEC. 642. DEPARTMENT OF VETERANS AFFAIRS REDUCTION IN FORCE NOTICE
REQUIREMENT.
(a) In General.--Subchapter I of chapter 7 of title 38, United
States Code, as amended by section 641(a), is further amended by
inserting after section 729 the following new section:
``Sec. 729A. Reductions in force
``(a) Notice Required.--In any case in which the Secretary plans to
carry out a reduction in force, the Secretary shall, not later than the
date that is 60 days before the date on which the Secretary commences
carrying out such reduction in force, submit to the appropriate
committees of Congress and the employees of the Department who will be
affected by the reduction in force notice of the intention of the
Secretary to carry out such reduction in force.
``(b) Limitation.--Notwithstanding any other provision of law, the
Secretary may not carry out any reduction in force with respect to any
employee who has not received the notice required under subsection (a)
in the manner and within the time required by such subsection.
``(c) Contents.--Notice regarding plans to carry out a reduction in
force submitted pursuant to subsection (a) shall include the following:
``(1) The total number of employees of the Department who
will be affected by the reduction.
``(2) The offices of the Department that will be affected
by the reduction, including, for each such office, the
following:
``(A) The location of the office.
``(B) The program of the Department carried out by
the office.
``(C) The total number of employees of the office
before and after the reduction in force.
``(D) The services provided by the office.
``(3) A justification for the reduction in force, including
how--
``(A) the new staffing levels resulting from the
reduction in force align with the current and future
projected demand for benefits and services administered
by the Department, disaggregated for each component by
facility location, facility type, region,
administration, program office, the type of benefit or
service, and such other categories as the Secretary
determines appropriate; and
``(B) the reduction in force aligns with the
strategic human capital plan required by section 729 of
this title.
``(4) Budgetary effects of the reduction in force.
``(5) An assessment of the anticipated impact of the
reduction in force on the delivery of benefits and services
furnished by the Department and the actions the Secretary plans
to take to mitigate any adverse impacts.
``(d) Equal Content.--A notice regarding a reduction in force sent
to an employee pursuant to subsection (a) shall be the same as the
notice submitted under such subsection to Congress for the same
reduction in force.
``(e) Administrative Remedy.--Effect of Noncompliance. A reduction
in force carried out with respect to an employee in violation of
subsection (b) shall have no force or effect with respect to such
employee until the Secretary complies with subsection (a).
``(f) Definitions.--In this section:
``(1) The term `appropriate committees of Congress' means--
``(A) the Committee on Veterans' Affairs and the
Committee on Appropriations of the Senate; and
``(B) the Committee on Veterans' Affairs and the
Committee on Appropriations of the House of
Representatives.
``(2) The term `reduction in force' means any action that
would have required notice under part 351 of title 5, Code of
Federal Regulations, as in effect on January 1,2026.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 7 of such title, as amended by section 2(b), is further amended
by inserting after the item relating to section 729 the following new
item:
``729A. Reductions in force.''.
SEC. 643. DETAILED PLANS AND JUSTIFICATIONS FOR REORGANIZATION OF
OFFICES.
Section 510 of title 38, United States Code, is amended--
(1) in subsection (f)(2)--
(A) in subparagraph (D), by inserting ``in
improving outcomes for veterans and their spouses,
dependents, and caregivers through the delivery of high
quality, accessible, and timely health care, benefits,
and other services the Secretary considers
appropriate'' before the period at the end; and
(B) by adding at the end the following new
subparagraphs:
``(G) A description of how the Secretary will
analyze success of the reorganization using results
based performance metrics that are derived from the
justification for the reorganization.
``(H) A risk mitigation plan identifying
significant operational, workforce, financial,
information technology, patient care, and service-
delivery risks reasonably anticipated by the Secretary
and the actions planned to mitigate such risks.'';
(2) by redesignating subsections (e) and (f) as subsections
(f) and (g), respectively; and
(3) by inserting after subsection (d) the following new
subsection (e):
``(e) Not later than 180 days after the date on which the Secretary
completes an administrative reorganization for which the Secretary
submitted under subsection (b) a report containing a detailed plan and
justification for the administrative reorganization, and not less
frequently than once every 180 days thereafter until the date that is
two years after the date of the completion of such administrative
reorganization, 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 assessing the administrative
reorganization using the performance metrics described in the detailed
plan and justification pursuant to subsection (g)(2)(G).''.
SEC. 644. RULE OF CONSTRUCTION.
Nothing in this subtitle or an amendment made by this subtitle
shall be construed to have any effect on any provision of law in effect
before the date of the enactment of this Act.
Subtitle E--Veterans Infrastructure and Transformation
SEC. 651. SHORT TITLE.
This subtitle may be cited as the ``Veterans Infrastructure and
Transformation Act of 2026'' or the ``VITAL Act of 2026''.
SEC. 652. MODIFICATION OF AUTHORITY FOR SHARING OF HEALTH-CARE
RESOURCES OF DEPARTMENT OF VETERANS AFFAIRS TO INCLUDE
FLEXIBLE SPACE UTILIZATION AND STREAMLINED SERVICE
AGREEMENTS.
Section 8153 of title 38, United States Code, is amended--
(1) in subsection (a)(3)--
(A) in subparagraph (A), by inserting ``physical''
before ``space'';
(B) in subparagraph (B)(i), by inserting
``physical'' before ``space'';
(C) by striking subparagraph (E);
(D) by redesignating subparagraphs (C) and (D) as
subparagraphs (D) and (E), respectively;
(E) by inserting after subparagraph (B) the
following new subparagraph (C):
``(C) If the health-care resource required is physical
space or common services with respect to existing buildings and
is to be acquired from an institution affiliated with the
Department in accordance with section 7302 of this title or
another entity, the Secretary may enter into contracts or
agreements for the acquisition of the space or service--
``(i) without regard to any law or regulation
(including any Executive order, circular, or other
administrative policy) that would otherwise require the
use of competitive procedures for acquiring the
resource; and
``(ii) if all obligations are funded through
available appropriations or borne by the institution or
entity, without regard to any limitations applicable to
leases of the Department, if, in the case of a multi-
year space-sharing agreement, the agreement--
``(I) requires that payments for each
fiscal year be made only from appropriated
funds and available that year; and
``(II) includes a provision that the
Government's obligations for future years is
contingent upon availability of
appropriations.'';
(F) in subparagraph (D), as redesignated by
subparagraph (D) of this paragraph, by striking
``subparagraph (A) or (B)'' and inserting
``subparagraph (A), (B), or (C)'';
(2) by adding at the end the following:
``(h) In this section:
``(1) The term `commercial service' means a service that is
offered and sold competitively in the commercial marketplace,
is performed under standard commercial terms and conditions,
and is procured using firm-fixed price contracts.
``(2) The term `common service' means a commercial service
necessary to maintain or operate existing physical space,
including maintenance, heating, ventilation, air conditioning,
electricity, energy, water, wastewater, landscaping, security,
laundry, or any other service as determined by the Secretary.
``(3) The term `physical space' means a portion of a
building or parking facilities.''.
SEC. 653. USE OF COMMERCIAL CONSTRUCTION AND FACILITIES CODE AND
STANDARDS.
(a) In General.--The Secretary of Veterans Affairs may use
commercial codes and standards instead of or in addition to Federal
codes and standards in the construction or alteration of facilities of
the Department of Veterans Affairs, where such commercial codes and
standards do not conflict with statutory and regulatory requirements.
(b) Pilot Projects.--The Secretary shall under take not fewer than
three pilot projects during each of fiscal years 2027, 2028, 2029,
2030, and 2031 utilizing commercial codes and standards instead of
Federal codes and standards to lease or construct facilities of the
Department for major construction, minor construction, or major lease
projects.
(c) Reports.--The Secretary shall submit a report to the Committee
on Veterans' Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives not later than 90 days after
the end of each of fiscal years 2027, 2028, 2029, 2030, and 2031
detailing the use by the Secretary of the authority provided by
subsection (a) and conduct of each pilot project required by subsection
(b) that was initiated, ongoing, or completed during the fiscal year.
(d) Definitions.--In this section:
(1) Commercial codes and standards.--The term ``commercial
codes and standards'' means building codes or standards of the
following:
(A) The National Fire Protection Association.
(B) The International Code Council.
(C) The American Society for Testing and Materials.
(D) The American Society of Civil Engineers.
(E) Any other building code or standard, other than
those described in (2), determined by the Secretary.
(2) Federal codes and standards.--The term ``Federal codes
and standards'' means the following:
(A) Building codes or standards specific to one or
more Federal agencies.
(B) Building codes or standards specific to the
Department, including the Technical Information
Library.
(C) Standards of the Federal Guidelines Institute.
SEC. 654. FEASIBILITY STUDY FOR FULL-SERVICE HOSPITAL OF DEPARTMENT OF
VETERANS AFFAIRS IN CERTAIN STATES.
(a) In General.--The Secretary of Veterans Affairs shall conduct a
study on the feasibility of establishing a full-service hospital of the
Department of Veterans Affairs in Alaska and Hawaii.
(b) Publication.--Not later than one year after the date of the
enactment of this title, the Secretary shall publish on a publicly
available website of the Department the findings of the Secretary with
respect to the study conducted under subsection (a).
SEC. 655. REPORT ON STRATEGIC PLAN FOR INFRASTRUCTURE AND CAPITAL
ASSETS OF DEPARTMENT OF VETERANS AFFAIRS.
(a) Report.--Not later than one year after the date of the
enactment of this title, 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
strategic plan for infrastructure and capital assets of the Department
of Veterans Affairs, which summarizes a facility lifecycle strategy
targeting modernization of owned and leased facilities and
infrastructure required to mitigate increasing systemic failures,
veteran and staff safety, benefits delivery interruptions, and funding
associated to address emergency repairs.
(b) Elements.--The report required by subsection (a) shall cover
known and projected requirements over a period of not less than 10
years for the following:
(1) Land acquisition.
(2) Operations and maintenance of facilities of the
existing capital asset portfolio of the Department.
(3) Operations and maintenance of the planned future
capital asset portfolio of the Department.
(4) New construction, disaggregated by type of new
construction, including the following types of construction:
(A) Major construction.
(B) Minor construction.
(C) Nonrecurring maintenance.
(5) Leasing.
(6) Alternative acquisition methods, such as partnerships
and donations.
(7) Activation of space.
(8) Disposal, reuse, and remediation.
(9) Facility lifecycle strategy process supporting the
planning, programming delivery, management, and maintenance of
the current and future capital asset portfolio of the
Department.
(10) A discussion of the negative effect of the lack of
stable and predictable capital asset funding on the ability of
the Department to plan, staff, and execute effective capital
asset management.
(11) Overview of the strategy being utilized in the
approach of the Secretary to capital investment, across all the
capital and leasing programs, including the approach of repair
versus recapitalization, use of leasing, and other relevant
strategies as deemed appropriate by the Secretary.
(12) Such other matters as the Secretary considers
appropriate, including with respect to legislative or
administrative action, if such actions are subject to the
availability of appropriated funds.
(c) Rule of Construction.--Nothing in this section or a report
submitted under this section shall be construed to create or imply any
financial or operational obligation beyond the availability of
appropriated funds.
SEC. 656. PERMANENT EXTENSION OF PILOT PROGRAM ON ACCEPTANCE BY THE
DEPARTMENT OF VETERANS AFFAIRS OF DONATED FACILITIES AND
RELATED IMPROVEMENTS.
(a) In General.--Section 2 of the Communities Helping Invest
through Property and Improvements Needed for Veterans Act of 2016
(Public Law 114-294; 38 U.S.C. 8103 note) is amended--
(1) in the section heading, by striking ``pilot'';
(2) in subsection (a), in the subsection heading, by
striking ``Pilot'';
(3) by striking ``pilot'' each place it appears;
(4) by striking subsection (i); and
(5) by redesignating subsection (j) as subsection (i).
(b) Modification of Acceptance of Property.--Paragraph (1) of
subsection (b) of such section is amended to read as follows:
``(1) the donation aligns with--
``(A) a need identified in a Strategic Capital
Investment Planning process priority list, a five-year
development plan, a facility master plan, or an annual
capital needs inventory of the Department; or
``(B) any component or phase of a need described in
paragraph (1); and''.
SEC. 657. AUTHORITY TO ACCEPT DONATIONS OF CONSTRUCTION SERVICES, MINOR
CONSTRUCTION OR NONRECURRING MAINTENANCE PROJECTS, AND
TARGETED CONTRIBUTIONS.
(a) Authority.--Notwithstanding any other provision of law, the
Secretary of Veterans Affairs may accept donations comprising the total
cost or a portion of the cost of--
(1) minor construction projects;
(2) nonrecurring maintenance projects; or
(3) construction services relating--
(A) to minor construction projects;
(B) to nonrecurring maintenance projects;
(C) to an existing facility of the Department; or
(D) to a new facility or portion thereof of the
Department.
(b) Alignment to Needs.--The Secretary may accept a donation under
this section only if--
(1) the donation aligns with--
(A) a need identified in a Strategic Capital
Investment Planning process priority list, a five-year
development plan, a facility master plan, or an annual
capital needs inventory of the Department; or
(B) any component or phase of a need described in
subparagraph (A);
(2) the donation is from an entity described in section
2(a)(2) of the Communities Helping Invest through Property and
Improvements Needed for Veterans Act of 2016 (Public Law 114-
294; 38 U.S.C. 8103 note);
(3) the Secretary determines such donation would--
(A) accelerate project completion;
(B) reduce the expense to the Department;
(C) improve facility condition; or
(D) otherwise benefit veterans;
(4) the donor enters into a formal agreement with the
Secretary that includes--
(A) provisions for the Department's oversight
during performance;
(B) compliance with applicable construction codes
and standards, and applicable laws and regulations;
(C) donor-provided insurance, warranties, and
liability protections;
(D) the amount of the donation and the amount of
the Department's funding contribution, if any;
(E) that the donation shall not increase the cost
to the Federal Government of completing such project
described in subsection (a) (excluding activation and
sustainment of such facility); and
(F) such other terms as the Secretary determines
necessary.
(c) Streamlined Requirements.--For donations under this section
that do not involve transfer of real property title--
(1) the donor shall enter into an agreement with the
Department that determines who is responsible to ensure
environmental or historic preservation due diligence is
completed;
(2) the donor shall obtain all federally required
construction and facility related permits; and
(3) agreements may be simplified relative to those under
section 2 of the Communities Helping Invest through Property
and Improvements Needed for Veterans Act of 2016 (Public Law
114-294; 38 U.S.C. 8103 note) to reflect the nature of services
or targeted contributions.
(d) Reporting.--The Secretary shall include information on
donations accepted under this section in the reports required under
section 2(g) of the Communities Helping Invest through Property and
Improvements Needed for Veterans Act of 2016 (Public Law 114-294; 38
U.S.C. 8103 note), with separate tracking for donations under this
section.
SEC. 658. REPORT ON USE OF ADDITIONAL AUTHORITIES RELATING TO
RECRUITMENT AND RETENTION OF PERSONNEL.
(a) Report Required.--Not later than 90 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit
to the appropriate committees of Congress a report detailing how the
Secretary will use the authorities of section 706 of title 38, United
States Code, to increase the size and performance of the acquisition
workforce of the Department of Veterans Affairs.
(b) Definitions.--In this section:
(1) Acquisition workforce of the department.--The term
``acquisition workforce of the Department of Veterans Affairs''
means personnel of the Department of Veterans Affairs occupying
positions within occupational series, as defined by the
Director of the Office of Personnel Management, responsible for
acquisition functions, as determined by the Secretary.
(2) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives.
SEC. 659. REPORTS ON KEY CAPITAL ASSET INVESTMENTS, ACTIVITIES, AND
PERFORMANCE OF DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Section 8120 of title 38, United States Code, is
amended to read as follows:
``Sec. 8120. Reports on key capital asset investments, activities, and
performance
``(a) Capital Asset Investment, Activities, and Performance.--
``(1) In general.--Not later than 30 days after the end of
each fiscal year, and every 60 days thereafter until the end of
the subsequent fiscal year, the Secretary shall submit to the
appropriate committees of Congress a report on key capital
asset investments, activities, and performance of the
Department.
``(2) Elements.--
``(A) First report in each fiscal year.--The first
report under paragraph (1) in each fiscal year shall
include the following:
``(i) A brief summary of work that was
completed on each capital asset project that
was completed in the previous fiscal year.
``(ii) A brief summary of the
accomplishments, impediments, and challenges
experienced by the Department with respect to
capital asset projects in the previous fiscal
year and a description of efforts made to
address any such impediments and challenges.
``(iii) With respect to each capital asset
project completed in such year, the following:
``(I) The type of project (major
construction, minor construction,
nonrecurring maintenance, leases, or
other category, including disposals).
``(II) The estimated total cost and
the actual total cost of the project.
``(III) A description of the
project.
``(IV) The location and facility
with respect to which the project was
carried out.
``(V) The fiscal quarter the
project was expected to begin, the
fiscal quarter the project began, the
month and year the project was
completed, and the fiscal quarter the
facility in connection to such project
was in use by veterans, employees of
the Department, or other relevant
users, as the case may be.
``(iv) In the case of any capital asset
project completed during the previous fiscal
year with respect to which the final cost of
the project (or any increment of the project)
was more than 10 percent greater than the
estimated cost of the project (or increment) or
the completion of such project (or increment)
was more than 180 days later than the planned
schedule for such project (or increment)--
``(I) the reason for any such
overage or delay; and
``(II) actions being taken to
prevent any such overage or delay in
future projects.
``(v) A list of any capital asset projects
cancelled during the previous fiscal year,
including any projects in the design phase and
including the reason for the cancellation.
``(vi) A summary of total actual
obligations for capital asset projects for the
previous fiscal year, broken out by major
construction, minor construction, nonrecurring
maintenance, and leases from the medical
facilities appropriation account of the
Department.
``(vii) A projected list of capital asset
projects, broken out by type of project under
subclause (I), that are expected to be
initiated during the current fiscal year and
those that are expected to be completed during
the current fiscal year, which shall include
the following:
``(I) The type of project (major
construction, minor construction,
nonrecurring maintenance, leases, or
other category, including disposals).
``(II) The estimated total cost of
the project.
``(III) A description of the
project.
``(IV) The location and facility
with respect to which the project was
carried out or is expected to be
carried out.
``(V) The fiscal quarter the
project is expected to begin, the
fiscal quarter the project is expected
to be completed, and the fiscal quarter
the facility in connection to such
project is expected to be in use by
veterans, employees of the Department,
or other relevant users, as the case
may be.
``(viii) Projected total obligations for
capital asset projects for the current fiscal
year, broken out by major construction, minor
construction, nonrecurring maintenance, and
leases, from the medical facilities
appropriation account of the Department.
``(ix) Such observations of best practices,
impediments, and accomplishments related to the
capital asset management and performance of the
Department, including any legislative or
administrative action, as the Secretary
considers appropriate with respect to such
practices, impediments, and accomplishments.
``(x) Meaningful metrics that show the
progress of the Department toward meeting
relevant goals of the Department relating to
capital asset management.
``(xi) Such other matters as the Secretary
considers appropriate.
``(B) Subsequent reports.--Each report in a fiscal
year after the first report shall include, at a
minimum, relevant updates on any capital asset projects
that are ongoing during that fiscal year, including any
updates to information provided with respect to such
projects under subparagraph (A).
``(3) Matters relating to reporting costs.--In each report
under paragraph (1), when reporting on costs for capital asset
projects, the Secretary may include information regarding
Federal requirements, including those specific to the
Department, that may not exist in the non-Federal construction
sector that may increase costs for capital asset projects.
``(b) Super Construction Projects.--
``(1) In general.--Not later than 30 days after the end of
each fiscal year, and every 60 days thereafter until the end of
that fiscal year, the Secretary shall submit to the appropriate
committees of Congress a report on the super construction
projects carried out by the appropriate non-Department Federal
entity described in section 8103(e)(1) of this title during
such year.
``(2) Elements.--Each report required under paragraph (1)
shall include, for each project described in such paragraph--
``(A) the budgetary and scheduling status of the
project, as of the last day of the most recent fiscal
quarter ending before the date on which the report is
required to be submitted; and
``(B) the actual cost and schedule variances of the
project, as of such day, compared to the planned cost
and schedules for the project.
``(c) Definitions.--In this section:
``(1) Appropriate committees of congress.--The term
`appropriate committees of Congress' means--
``(A) the Committee on Appropriations and the
Committee on Veterans' Affairs of the Senate; and
``(B) the Committee on Appropriations and the
Committee on Veterans' Affairs of the House of
Representatives.
``(2) Capital asset project.--The term `capital asset
project' means a capital asset investment or activity of the
Department.
``(3) Super construction project.--The term `super
construction project' has the meaning given such term in
section 8103(e)(3) of this title.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 81 of title 38, United States Code, is amended by striking the
item relating to section 8120 and inserting the following new item:
``8120. Reports on key capital asset investments, activities, and
performance.''.
SEC. 660. DEVELOPMENT OF STREAMLINED PROCUREMENT MODEL; REPORT.
Not later than 180 days after the date of enactment of this Act,
the Secretary of Veterans Affairs, in consultation with the Comptroller
General of the United States, the Director of the Office of Management
and Budget, and private sector stakeholders, shall develop a revised
process for the procurement of major medical facility leases under
chapter 81 of title 38, United States Code, and submit to the
Committees on Veterans' Affairs of the House of Representatives and the
Senate a report that includes a description of such revised process.
SEC. 661. SUBMISSION AND NOTIFICATION OF COST ESTIMATES FOR MEDICAL
FACILITY LEASES.
(a) Submission of Cost Estimates for Major Medical Facility Leases
With Presidential Budget Request.--Subchapter I of chapter 81 of title
38, United States Code, is amended by inserting after section 8104 the
following new section:
``Sec. 8104A. Submission of cost estimates for major medical facility
leases with president's budget request
``(a) In General.--For each major medical facility lease or
prospectus-level lease for which the Secretary seeks authorization,
appropriations, or prospectus approval, the Secretary shall include in
the budget justification materials submitted to Congress in connection
with the budget of the Department for the applicable fiscal year (as
submitted with the budget of the President under section 1105(a) of
title 31) a market-based cost estimate and full life-cycle cost
estimate for such lease.
``(b) Market-based Cost Estimate.--Each market-based cost estimate
required under subsection (a) shall include an evaluation of--
``(1) local land values;
``(2) applicable construction costs; and
``(3) other cost factors the Secretary determines relevant
to build-to-suit facilities.
``(c) Standardized Methodology.--
``(1) In general.--The Secretary shall adopt and apply a
standardized methodology for estimating under subsection (a)
the full life-cycle cost of major medical facility leases and
prospectus-level leases.
``(2) Required elements.--The methodology required under
paragraph (1) shall include, at a minimum--
``(A) base rent projections over the full lease
term;
``(B) tenant improvement and buildout costs based
on current medical facility standards;
``(C) estimated operating expenses, including
utilities, maintenance, and security;
``(D) annual escalation factors tied to
construction cost indices, labor rates, and market
trends;
``(E) cost assumptions for option periods or
potential renewal terms; and
``(F) geographic adjustments using current regional
market data to reflect location-specific construction
and leasing conditions.
``(d) Annual Adjustment.--
``(1) In general.--To reflect inflation and market
escalation, the Secretary shall annually adjust each cost
estimate for a lease submitted to Congress for authorization,
appropriations, or prospectus approval during the period
beginning on the date on which the Secretary first includes
such cost estimate in the budget justification materials
described in subsection (a) and ending on the projected award
date for the lease.
``(2) Indices.--In adjusting a cost estimate under
paragraph (1), the Secretary shall use such medical
construction or real estate indices as the Secretary determines
appropriate.
``(e) Rules of Construction.--
``(1) Budgetary treatment.--Nothing in this section shall
be construed to alter, supersede, waive, or otherwise affect
the application of the scorekeeping guidelines, including the
budgetary treatment of leases under Office of Management and
Budget Circular A-11 or any successor guidance.
``(2) Preservation of existing budget authority
requirements.--Nothing in this section shall be construed to
authorize the Secretary to enter into a lease, incur an
obligation, or make an expenditure except to the extent and in
the amount provided in advance in appropriations Acts.
``(f) Definitions.--In this section, the term `major medical
facility lease' has the meaning given that term in section
8104(a)(3)(B) of this title.''.
(b) Congressional Notification and Plan Required for Cost Estimates
Exceeding Approved Prospectus Amounts.--Subchapter I of such chapter is
further amended by inserting after section 8104A the following new
section:
``Sec. 8104B. Congressional notification and plan required for cost
estimates exceeding approved prospectus amounts
``(a) Price Estimates Required During Solicitation Phase.--As part
of the request for lease proposals (or equivalent formal solicitation)
for a major medical facility lease, the Secretary shall require
offerors to provide detailed price proposals, including the cost of
land (if applicable), to enable evaluation against the authorized
prospectus amount.
``(b) Notification Required.--If the lowest responsive offer for a
major medical facility lease exceeds the unserviced shell rent
authorized in the approved prospectus by more than 10 percent, the
Secretary shall notify the Committee on Veterans' Affairs of the Senate
and the Committee on Veterans' Affairs of the House of Representatives
not later than 45 days after the date on which the Secretary determines
that such offer exceeds such authorized amount.
``(c) Plan Required.--
``(1) In general.--Not later than 60 days after
notification under subsection (b) with respect to a major
medical facility lease, 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 to
address the cost discrepancy for such lease, which may include
scope adjustment, value engineering, requesting additional
authority, or other appropriate measures.
``(2) Limitation on award.--The Secretary shall not award a
major medical facility lease until the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs of
the House of Representatives have received the plan required
under paragraph (1) with respect to such lease.
``(d) Limitation on Further Action.--If the Secretary is required
to submit a notification under subsection (b), the Secretary may not
issue a request for lease proposals for the applicable major medical
facility lease until the date on which the Secretary submits the plan
required under subsection (c).
``(e) Rule of Construction.--Nothing in this section shall be
construed to authorize the Secretary to exceed any amount authorized in
an approved prospectus or any amount provided in advance in an
appropriations Act.''.
(c) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
8104 the following new items:
``8104A. Submission of cost estimates for major medical facility leases
with President's budget request
``8104B. Congressional notification and plan required for cost
estimates exceeding approved prospectus
amounts''.
SEC. 662. REPORT ON CAPITAL ASSET AND INFORMATION TECHNOLOGY NEEDS OF
THE RESEARCH AND DEVELOPMENT PROGRAM OF DEPARTMENT OF
VETERANS AFFAIRS.
(a) Report Required.--Not later than two years after the date of
the enactment of this Act, the Secretary of Veterans Affairs shall
submit to Congress a report on the capital asset and information
technology needs of the research and development program of the
Department of Veterans Affairs.
(b) Contents.--
(1) In general.--The report required by subsection (a)
shall include the following:
(A) A comprehensive summary of new facilities,
renovations of existing facilities, leasing of
facilities, and any other such facilities or physical
infrastructure the Department requires to effectively
perform its research and development functions,
including projected functions.
(B) Detailed information on the information
technology resources, projects, equipment, and related
information technology needs, disaggregated by type of
information technology funding categories, such as
development or operations and maintenance, the
Department requires in order to make the research and
development program and activities of the Department
functional and high-performing in the short-, medium-,
and long-term, and those needed to enable employees of
the Department to perform their research and
development activities in an effective and efficient
manner.
(C) Such matters as the Secretary determines
relevant to maintain and further improve and advance
the research and development functions of the
Department through improved capital asset and
information technology support.
(2) Requirements.--
(A) Facilities.--
(i) Summaries by project.--In providing
information under paragraph (1)(A), the
Secretary shall provide estimated summaries for
each project with cost data as well as a
realistic multi-year plan to design and deliver
the capital asset projects, assuming required
funding is provided.
(ii) Identification of projects.--The
Secretary shall identify each project under
paragraph (1)(A) by its project type, such as
major construction, minor construction,
nonrecurring maintenance, major lease, minor
lease, or such other category as the Secretary
determines may be appropriate.
(B) Information technology.--In providing
information under paragraph (1)(B), the Secretary shall
provide estimated summaries for each project or
investment with individual and total cost data as well
as a realistic multi-year plan to develop relevant
requirements and acquire and deploy the relevant
information technology services, projects, equipment,
and related matters.
(C) Scope.--The scope of the report submitted under
subsection (a) is on the capital asset, information
technology, and other related critical support
functions, excluding human capital related needs,
needed for the Department to perform research and
development in an effective and efficient manner.
(c) Considerations.--In preparing the report required by subsection
(a), the Secretary may consider the following:
(1) The findings of the 2012 final report of the Research
Infrastructure Program of the Department.
(2) Current and updated data providing the most accurate
and holistic presentation of the physical infrastructure,
information technology, and other relevant support function
needs of the research and development program of the
Department.
(3) Such other matters as the Secretary considers
appropriate.
SEC. 663. IMPROVING PREVENTION, DETECTION, AND REPORTING OF WASTE,
FRAUD, AND ABUSE IN DEPARTMENT OF VETERANS AFFAIRS
CAPITAL ASSET PROJECTS AND ACTIVITIES.
(a) Report Required.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit
to the appropriate committees of Congress a report on actions the
Department of Veterans Affairs is taking or plans to take to enhance
the ability of the Department to prevent, detect, and report waste,
fraud, and abuse occurring in capital asset projects of the Department,
whether by employees, contractors, or other relevant persons or
entities involved with the Department.
(b) Elements.--The report required by subsection (a) shall include
the following:
(1) An assessment of whether new training or enhancements
to existing training should be undertaken to improve the
prevention, detection, and reporting of waste, fraud, and
abuse.
(2) Recommendations for such legislative and administrative
action as the Secretary determines appropriate to improve the
prevention, detection, and reporting of waste, fraud, and
abuse.
(3) Such other matters as the Secretary considers
appropriate.
(c) Consultation.--In carrying out subsection (a), the Secretary--
(1) shall consult with the Inspector General of the
Department of Veterans Affairs and the Comptroller General of
the United States on matters relating to best practices and
strategies to improve detection and prevention by the
Department of waste, fraud, and abuse in capital asset projects
and management; and
(2) may consult with such other persons and entities on
such matters as the Secretary considers appropriate.
SEC. 664. REPORT ON LONG-TERM CARE PHYSICAL INFRASTRUCTURE NEEDS OF
DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit
to the appropriate committees of Congress a report, disaggregated by
medical center or other relevant health care facility of the Department
of Veterans Affairs, identifying the physical infrastructure needs of
the Department to support current and future anticipated long-term care
needs and models of care for veterans, including--
(1) infrastructure needed to support the delivery of long-
term care for women veterans, veterans with spinal cord
injuries and diseases, veterans with traumatic brain injury,
veterans with unique behavioral health needs, veterans with
memory loss, and other population groups with unique needs or
projected future needs;
(2) information regarding the plans of the Department to
provide such care as the Department builds internal capacity
but space is not yet available to meet the demand for such
care; and
(3) with respect to any projects needed to provide the
infrastructure specified under paragraph (1)--
(A) the estimated individual project cost and total
cost to accomplish those projects; and
(B) the estimated individual project timeline to
accomplish each such project upon receipt of
appropriate funding.
(b) Inclusion of Information Regarding Prioritization of Certain
Projects.--The Secretary shall include in the report required under
subsection (a) information regarding how the infrastructure
prioritization processes of the Department, such as the Strategic
Capital Investment Planning process, or successor process, could be
modified to include higher prioritization of projects that support the
provision of a health care service that is not widely available, or is
not available in compliance with appropriate quality or access
standards, from non-Department providers.
(c) Development of Report.--In developing the report required under
subsection (a), the Secretary shall consult with relevant regional and
national program offices of the Veterans Health Administration with
responsibility for managing the various health care services covered by
the report, including long-term care and care relating to spinal cord
injuries and diseases, to ensure that the report contains a holistic,
comprehensive, and integrated plan to address the capital asset and
other space needs for the population of veterans who require those
services.
(d) Indication of Types of Projects.--In the report required under
subsection (a), the Secretary shall indicate the projects that can be
most efficiently and effectively accomplished through smaller
individual infrastructure projects or through a larger medical facility
replacement or new site of care, as determined by the Secretary.
Subtitle F--Other Health Care Matters
SEC. 671. PRESCRIPTION, DELIVERY, DISTRIBUTION, AND DISPENSATION OF
CONTROLLED SUBSTANCE MEDICATIONS BY COVERED HEALTH CARE
PROFESSIONALS OF DEPARTMENT OF VETERANS AFFAIRS VIA
TELEMEDICINE.
(a) In General.--Subchapter III of chapter 17 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 1730D. Prescription, delivery, distribution, and dispensation of
controlled substance medications via telemedicine
``(a) In General.--Notwithstanding sections 102(54) and 309(e) of
the Controlled Substances Act (21 U.S.C. 802(54) and 829(e)), a covered
health care professional may prescribe, deliver, distribute, and
dispense a controlled substance if the covered health care professional
is using telemedicine through the use of an interactive
telecommunications system, including an audio-only telecommunications
system when necessary, to prescribe, deliver, distribute, or dispense
to a patient eligible to receive hospital care or medical services
under this chapter a controlled substance that is a prescription drug
as determined under the Federal Food, Drug, and Cosmetic Act (21 U.S.C.
301 et seq.), regardless of whether such covered health care
professional has conducted an in-person medical examination of such
patient, if--
``(1) such covered health care professional--
``(A) is acting in the usual course of professional
practice;
``(B) is registered pursuant to section 303(g) of
the Controlled Substances Act (21 U.S.C. 823(g)) in any
State or is utilizing the registration of a facility of
the Department registered pursuant to section 303(f) of
such Act (21 U.S.C. 823(f));
``(C) has access to medical documentation from an
in-person medical evaluation of such patient in the
past two years by--
``(i) a covered health care professional;
``(ii) a health care professional who
furnished care and services under the Veterans
Community Care Program under section 1703 of
this title; or
``(iii) a health care professional of the
Department of Defense; and
``(D) at the time of the telemedicine visit of the
patient--
``(i) has reviewed the prescription data of
the individual from the electronic health
record database of the Department and data from
the prescription drug monitoring program for
the State in which the patient is located at
the time of the telemedicine encounter (if such
a program exists) for at least the one-year
period preceding the date of the visit or, if
less than one year of data is available, for
the entire period available; and
``(ii) provides documentation of--
``(I) such review;
``(II) all successful attempts to
access such databases and program; and
``(III) all unsuccessful attempts
to access such databases and program
that resulted in the prescription of a
limited supply under subsection (b);
and
``(2) such substance is delivered, distributed, or
dispensed for a legitimate medical purpose.
``(b) Authority for Limited Supply.--
``(1) In general.--If the databases and program described
in subsection (a)(1)(D) are unavailable or inaccessible at the
time of a telemedicine encounter conducted by a covered health
care professional, the covered health care professional may not
prescribe, deliver, distribute, or dispense more than a seven-
day supply of a controlled substance until the covered health
care professional is able to review such databases and program.
``(2) Databases unavailable or inaccessible.--If a database
or program required to be reviewed under subsection (a)(1)(D)
is unavailable or inaccessible for an extended period, as
determined by the Secretary, a covered health care professional
may provide additional seven-day supplies of a controlled
substance until such database or program is accessible.
``(c) Maximum Supply.--The authority under this section may be used
to supply a controlled substance for not more than a six-month period.
``(d) Use of Authority.--The Secretary shall ensure that the
authority under this section is used to prevent interruptions to
patient care and not as a replacement for routine in-person patient
care.
``(e) Regulations.--
``(1) In general.--The Secretary shall establish in
regulations guidelines and a process for the prescription,
delivery, distribution, and dispensation of a controlled
substance pursuant to subsection (a).
``(2) Elements.--The Secretary shall ensure the guidelines
and process described in paragraph (1)--
``(A) do not restrict access of a patient to in-
person care; and
``(B) provide for the collection and analysis of
data to determine if an individual has evidence of a
prior in-person medical evaluation by a health care
professional described in subsection (a)(1)(C) who
would reasonably be expected to have prescribing
authority based on their credential or organizational
role.
``(3) Initiating treatment.--
``(A) In general.--The guidelines established by
paragraph (1) shall prohibit a covered health care
professional from initiating treatment with an opioid
medication listed in schedule II or III under section
202 of the Controlled Substances Act (21 U.S.C. 812)
unless the covered health care professional is
providing treatment--
``(i) for opioid use disorder;
``(ii) for a patient receiving palliative
care or enrolled in hospice care; or
``(iii) for a patient who is physically
located in a medical facility where the patient
is receiving in-person care.
``(B) Exception.--The prohibition under
subparagraph (A) shall not apply to renewal or
maintenance of a previously prescribed medication
described in such subparagraph.
``(f) Reporting.--
``(1) In general.--Not later than one year after the date
of the enactment of the Take Care of America's Veterans Act,
and not less frequently than annually thereafter until the
termination date under subsection (g), 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 addresses the use of the
authority under this section during the fiscal year preceding
the date of submission of the report in each Veterans
Integrated Service Network.
``(2) Elements.--Each report under paragraph (1) shall
indicate, at a minimum--
``(A) how many patients received prescriptions for
controlled substance medications through telemedicine
under this section;
``(B) which controlled substances are being
prescribed under this section and how many
prescriptions were written for each such substance;
``(C) the number of individuals who received a
controlled substance medication that was prescribed,
delivered, distributed, or dispensed under this section
without evidence of an in-person medical evaluation
within the previous two years by a health care
professional described in subsection (a)(1)(C); and
``(D) the barriers that exist to reviewing
prescription drug monitoring programs of States and how
often those barriers occur.
``(g) Duration.--The authority under this section shall terminate
on September 30, 2031.
``(h) Definitions.-- In this section:
``(1) The terms `controlled substance', `deliver',
`dispense', and `distribute' have the meanings given those
terms in section 102 of the Controlled Substances Act (21
U.S.C. 802).
``(2) The term `covered health care professional' means--
``(A) a health care professional who--
``(i) is--
``(I) an employee of the Department
appointed under section 7306, 7401,
7405, 7406, or 7408 of this title or
under title 5; or
``(II) operating from a facility of
the Department, including a clinic of
the Department;
``(ii) is authorized by the Secretary to
provide health care under this chapter;
``(iii) is required to adhere to all
standards for quality relating to the provision
of health care in accordance with applicable
policies of the Department;
``(iv) has an active, current, full, and
unrestricted license, registration, or
certification or meets qualification standards
set forth by the Secretary within a specified
time frame; and
``(v) with respect to a health care
profession listed under section 7402(b) of this
title, has the qualifications for such
profession as set forth by the Secretary; and
``(B) a health professions trainee who--
``(i) is appointed under section 7405 of
this title; and
``(ii) is under the clinical supervision of
a health care professional described in
subparagraph (A).''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
1730C the following new item:
``1730D. Prescription, delivery, distribution, and dispensation of
controlled substance medications via
telemedicine.''.
SEC. 672. COPAYMENTS FOR LIMITED SUPPLIES OF MEDICATIONS.
Paragraph (4) of section 1722A(a) of title 38, United States Code,
is amended to read as follows:
``(4) Paragraph (1) does not apply--
``(A) to opioid antagonists furnished under this chapter to
a veteran who is at high risk for overdose of a specific
medication or substance in order to reverse the effect of such
an overdose; and
``(B) to any limited supply prescription for medication, up
to a 30-day supply of such medication, under section 1730D(b)
of this title if the covered health care professional would
have prescribed, delivered, distributed, or dispensed a supply
for more than seven days if not for the restrictions under such
section.''.
SEC. 673. PLAN ON ESTABLISHMENT OF INTERACTIVE, ONLINE SELF-SERVICE
MODULE FOR CARE.
(a) In General.--The Secretary of Veterans Affairs shall develop
and implement a plan to establish, to the greatest extent practicable,
an interactive, online self-service module--
(1) to allow veterans enrolled in the system of annual
patient enrollment of the Department of Veterans Affairs
established and operated under section 1705(a) of title 38,
United States Code--
(A) to request appointments, track referrals for
health care under the laws administered by the
Secretary, whether at a facility of the Department of
Veterans Affairs or through a non-Department provider,
and receive appointment reminders;
(B) to appeal and track decisions relating to--
(i) denials of requests for authorization
for care or services under section 1703 of
title 38, United States Code; or
(ii) denials of requests for care or
services at facilities of the Department,
including under section 1710 of such title;
(C) to compare the average wait times for
appointments for the type of care sought by the veteran
at facilities of the Department and with non-Department
facilities and providers through which the Secretary
furnishes care and services under section 1703 of such
title;
(D) to compare average driving times between their
residence and the nearest facility of the Department
that provides the care they are seeking and between
their residence and the closest non-Department provider
that provides the care they are seeking and through
which the Secretary furnishes care and services under
section 1703 of such title; and
(E) to view a provider directory, information
regarding pending medical claims, and explanations of
benefits; and
(2) to implement such other matters as determined
appropriate by the Secretary.
(b) Submittal of Plan.--
(1) Initial plan.--Not later than 180 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 the plan
developed under subsection (a).
(2) Biannual update.--Not less frequently than once every
180 days during the two-year period beginning on the submittal
of the plan under paragraph (1), the Secretary shall brief the
Committee on Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives on any
updates on the implementation of such plan.
SEC. 674. MODIFICATION OF REQUIREMENTS FOR CENTER FOR INNOVATION FOR
CARE AND PAYMENT OF THE DEPARTMENT OF VETERANS AFFAIRS
AND TRANSFER OF AUTHORITY.
(a) In General.--Chapter 3 of title 38, United States Code, is
amended by adding at the end the following new section:
``Sec. 326. Center for Innovation
``(a) Establishment.--There is established within the Department a
Center for Innovation (in this section referred to as the `Center').
``(b) Purpose.--The purpose of the Center is to test innovative
payment and service delivery models to reduce program expenditures of
the Department under chapter 17 of this title while preserving or
enhancing the quality of care furnished to veterans and other eligible
individuals.
``(c) Identification and Testing of Models.--
``(1) In general.--The Center shall--
``(A) identify and test health care payment and
service delivery models under this title, including
care from non-Department providers under subchapter I
of chapter 17 of this title, that have the potential
to--
``(i) reduce program expenditures; and
``(ii) preserve or enhance the quality of
care furnished to veterans;
``(B) give preference to models that improve the
coordination, quality, and efficiency of health care
services furnished under this title; and
``(C) evaluate the effect of applying such models
on program expenditures and quality outcomes under this
title.
``(2) Included models.--The models identified and tested
under paragraph (1) may include the following:
``(A) Bundled payment arrangements.
``(B) Preventive care initiatives.
``(C) Chronic care coordination models.
``(d) Selection of Models.--
``(1) In general.--The Secretary, acting through the
Center, shall select models to be tested under subsection (b)
from among those that--
``(A) address a defined population for which there
are demonstrated deficits in care leading to poor
clinical outcomes or potentially avoidable
expenditures; and
``(B) are expected to reduce program costs while
preserving or enhancing the quality of care furnished
to veterans.
``(2) Criteria.--In selecting models under paragraph (1),
the Secretary shall apply criteria consistent with the model
selection framework used in evidence-based criteria that the
Secretary determines appropriate.
``(e) Testing and Evaluation.--
``(1) In general.--The Secretary shall design and test each
model under this section in a manner that allows for the
evaluation of--
``(A) changes in program expenditures;
``(B) changes in quality and outcomes of care for
veterans; and
``(C) other factors the Secretary determines
relevant to care coordination, access, and equity.
``(2) Evaluation.--The Secretary shall evaluate each model
under this section using scientifically valid methodologies,
including control or comparison groups if practicable.
``(f) Reporting.--
``(1) Annual report.--Not less frequently than annually,
the Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs of
the House of Representatives a report on models being tested
under this section and their preliminary results, including--
``(A) a brief narrative description of the model
explaining its intent and the proposed manner in which
it is supposed to reduce expenditures and increase
quality of or access to care for veterans;
``(B) the number of veterans and providers
participating in the model, broken down by demographics
such as age, race or ethnicity, geographic location,
and other characteristics as chosen by the Secretary;
``(C) gross and net savings or increases to the
medical services account of the Department, including
in comparison to baseline budgetary assumptions in the
absence of the model;
``(D) an assessment of the utilization of the
model, including the proportion of providers choosing
to participate in the model and the proportion of
veterans choosing to participate in the model, as the
case may be;
``(E) an assessment of quality of care and patient
outcome as measured by discrete objective metrics,
including changes to morbidity and mortality, changes
to admission rates, changes to readmission rates,
changes to population health metrics such as average
blood pressure, A1C levels, body mass index, or other
relevant health metrics, or other relevant clinical
outcome metrics;
``(F) a description of provider, stakeholder, and
veteran experiences; and
``(G) such other matters as the Secretary may
consider relevant.
``(2) Final report on models.--Not later than 180 days
after completing each model 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 final report on such model, including--
``(A) findings from the evaluation of such model;
``(B) updated findings under paragraph (1) with
respect to such model;
``(C) an assessment of the fiscal impact of such
model; and
``(D) recommendations for expansion or termination
of the use of such model.
``(g) Expansion of Successful Models.--
``(1) In general.--Except as provided in paragraph (2), the
Secretary may, through rulemaking, expand the duration and
scope of a model tested under this section to the extent that--
``(A) the Secretary determines such expansion is
expected to--
``(i) reduce program expenditures without
reducing quality of care; or
``(ii) improve quality of care without
increasing program expenditures; and
``(B) the Chief Financial Officer of the Department
certifies that such expansion will maintain budget
neutrality.
``(2) Limitation.--The Secretary shall not expand a model
unless the results of the evaluation of the model under
subsection (e) demonstrate that the requirements of paragraph
(1) are satisfied.
``(h) Cost Neutrality and Funding.--
``(1) In general.--Implementation or expansion of any model
under this section shall be conducted in a manner that is cost-
neutral to the Department over the duration of the use of the
model, including administrative costs.
``(2) Use of available amounts.--The Secretary shall ensure
that expenditures under this section are made from amounts
otherwise available to the Department for medical services,
community care, or medical support and compliance.
``(i) Rule of Construction.--Nothing in this section shall be
construed to authorize the Secretary to reduce the scope or amount of
benefits under this title, or to impose additional eligibility
requirements, except as may be necessary to carry out an approved model
under this section.''.
(b) Conforming and Clerical Amendments.--
(1) Conforming repeal.--Section 1703E of title 38, United
States Code, is repealed.
(2) Conforming amendments.--
(A) Pilot program to improve administration of care
under veterans community care program.--Section 105(a)
of the Senator Elizabeth Dole 21st Century Veterans
Healthcare and Benefits Improvement Act (Public Law
118-210; 38 U.S.C. 1703 note) is amended, in the matter
preceding paragraph (1), by striking ``Pursuant to
section 1703E of title 38, United States Code, the
Secretary of Veterans Affairs, acting through the
Center for Innovation for Care and Payment'' and
inserting ``Pursuant to section 326 of title 38, United
States Code, the Secretary of Veterans Affairs, acting
through the Center for Innovation''.
(B) Pilot program on consolidating approval process
of department of veterans affairs for covered dental
care.--Section 106(a) of the Senator Elizabeth Dole
21st Century Veterans Healthcare and Benefits
Improvement Act (Public Law 118-210; 38 U.S.C. 1703
note) is amended, in the matter preceding paragraph
(1), by striking ``the Center for Innovation for Care
and Payment established under section 1703E of title
38, United States Code'' and inserting ``the Center for
Innovation established under section 326 of title 38,
United States Code''.
(C) Strategic plan on value-based health care
system for veterans health administration; pilot
program.--Section 107 of the Senator Elizabeth Dole
21st Century Veterans Healthcare and Benefits
Improvement Act (Public Law 118-210; 38 U.S.C. 1701
note) is amended--
(i) in subsection (a)(2)(A)(viii), by
striking ``the Center for Innovation for Care
and Payment of the Department under section
1703E of title 38, United States Code'' and
inserting ``the Center for Innovation under
section 326 of title 38, United States Code'';
and
(ii) in subsection (c)(1), by striking
``the Center for Innovation for Care and
Payment established under section 1703E of
title 38, United States Code'' and inserting
````the Center for Innovation under section 326
of title 38, United States Code''.
(3) Clerical amendments.--
(A) Chapter 17.--The table of sections at the
beginning of chapter 17 of title 38, United States
Code, is amended by striking the item relating to
section 1703E.
(B) Chapter 3.--The table of sections at the
beginning of chapter 3 of such title is amended by
adding at the end the following new item:
``326. Center for Innovation.''.
(c) Comptroller General Report.--Not later than 18 months after the
date of the enactment of this Act, the Comptroller General of the
United States shall submit to Congress a report--
(1) on the efforts of the Center for Innovation of the
Department of Veterans Affairs in fulfilling the objectives and
requirements under section 326 of title 38, United States Code,
as added by subsection (a); and
(2) containing such recommendations as the Comptroller
General considers appropriate.
(d) Review of Veterans Community Care Program.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs,
acting through the Office of Management of the Department of
Veterans Affairs, shall conduct a review of all aspects of the
Veterans Community Care Program.
(2) Elements.--The review required by paragraph (1) shall--
(A) identify proven management and payment best
practices of the Federal Government used under the
Medicare program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.), the Medicaid
program under title XIX of such Act (42 U.S.C. 1396 et
seq.), and the TRICARE program (as defined in section
1072 of title 10, United States Code);
(B) determine what best practices, if any,
identified under subparagraph (A) should be adopted and
implemented by the Secretary, including those practices
that would require legislative action before adoption
and implementation;
(C) determine how the Secretary can improve access
to care through the Veterans Community Care Program for
veterans eligible for such care;
(D) identify solutions to ease administrative,
legislative, and regulatory burdens and improve
efficiency in the Veterans Community Care Program;
(E) identify improvements to the Veterans Community
Care Program that can enhance the experience of
veterans and participating entities and providers
furnishing hospital care, medical services, and
extended care services under the Veterans Community
Care Program;
(F) review how the Secretary--
(i) identifies eligibility for and reviews,
processes, and approves referrals for care
under the Veterans Community Care Program;
(ii) authorizes the furnishing of services
under the Veterans Community Care Program; and
(iii) receives, reviews, processes, and
approves requests for payment from
participating entities and providers furnishing
services under the Veterans Community Care
Program.
(G) assess such other factors as determined
appropriate by the Secretary in consultation with
Congress.
(3) Briefing and report.--
(A) Briefing.--Periodically throughout the duration
of the review required under paragraph (1), but not
less frequently than quarterly, the Secretary shall
brief the Committee on Veterans' Affairs of the Senate
and the Committee on Veterans' Affairs of the House of
Representatives on the status and preliminary findings
of such review.
(B) Report.--Not later than 30 days after the
conclusion of the review required under paragraph (1),
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
written report containing--
(i) a complete and unredacted list of all
findings and recommendations from the review;
and
(ii) any legislative, administrative,
regulatory, policy, or other changes sought by
the Secretary as a result of such findings.
(4) Veterans community care program defined.--In this
subsection, the term ``Veterans Community Care Program'' means
the Veterans Community Care Program under section 1703 of title
38, United States Code.
(e) Pilot Programs.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall commence carrying out the pilot programs described in
paragraph (2) through the Center for Innovation established by
section 326 of title 38, United States Code, as added by
subsection (a), and the Office of Management of the Department
of Veterans Affairs.
(2) Pilot programs described.--The Secretary shall carry
out the following pilot programs:
(A) A pilot program to test innovative payment
models for the furnishing of preventive health
services, as such term is defined in section 1701 of
title 38, United States Code.
(B) A pilot program to test innovative payment
models involving payment bundling for integrated care
during an episode of care authorized under the Veterans
Community Care Program under section 1703 of title 38,
United States Code, to improve the coordination,
quality, and efficiency of health care delivery under
such program.
(f) Modification of Independent Assessments of Health Care Delivery
Systems and Management Processes.--Subsection 1704A of title 38, United
States Code, is amended--
(1) in subsection (a)(2)(I), by adding at the end the
following new clause:
``(vi) To identify proven management and payment
best practices of the Federal Government used under the
Medicare program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.), the Medicaid
program under title XIX of such Act (42 U.S.C. 1396 et
seq.), and the TRICARE program (as defined in section
1072 of title 10).''; and
(2) in subsection (d), by inserting ``or federally funded
research and development center'' after ``private entity''.
SEC. 675. REPORT ON IMPROVEMENTS TO CLINICAL APPEALS PROCESS.
(a) In General.--Not later than two years after the date of the
enactment of this Act, the Secretary of Veterans Affairs, in
consultation with veterans service organizations, veterans, caregivers
of veterans, employees of the Department of Veterans Affairs, and other
stakeholders as determined by 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 containing
recommendations for legislative or administrative action to improve the
clinical appeals process of the Department with respect to timeliness,
transparency, objectivity, consistency, and fairness.
(b) Inapplicability of Requirements Relating to Federal Advisory
Committees.--Chapter 10 of title 5, United States Code, shall not apply
to the consultation required by subsection (a).
(c) Veterans Service Organization Defined.--In this section, the
term ``veterans service organization'' means any organization
recognized by the Secretary under section 5902 of title 38, United
States Code.
SEC. 676. PLAN ON INCREASING ACCESSIBILITY OF CARE FOR VETERANS WITH
SPINAL CORD INJURY OR DISORDER.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit
to the Committee on Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives a plan on
improving disability-related access to care from facilities of the
Department and from non-Department facilities and providers through
which the Secretary furnishes care and services under section 1703 of
title 38, United States Code, for veterans with spinal cord injury or
disorder.
(b) Consultation.--In developing the plan required under subsection
(a), the Secretary shall consult with relevant stakeholders, including
veterans service organizations who serve veterans with spinal cord
injury or disorder.
(c) Elements.--The plan required under subsection (a) shall include
an assessment of disability-related barriers to care at medical
facilities of the Department of Veterans Affairs and through community
care networks of non-Department providers for veterans with spinal cord
injury or disorder and a description of the actions needed to overcome
such barriers, including cost estimates, timelines for corrective
action, and requests for legislative action, if any.
(d) Veterans Service Organization Defined.--In this section, the
term ``veterans service organization'' means any organization
recognized by the Secretary under section 5902 of title 38, United
States Code.
Calendar No. 433
119th CONGRESS
2d Session
S. 4744
_______________________________________________________________________
A BILL
To amend titles 10 and 38, United States Code, and other Federal laws,
to improve benefits for veterans and the administration of the
Department of Veterans Affairs.
_______________________________________________________________________
June 11, 2026
Read the second time and placed on the calendar