(a) Short title.—This Act may be cited as the “Caring for our Veterans Act of 2017”.

(b) Table of contents.—The table of contents for this Act is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. References to title 38, United States Code.

Except as otherwise expressly provided, whenever in this Act an amendment or repeal is expressed in terms of an amendment to, or repeal of, a section or other provision, the reference shall be considered to be made to a section or other provision of title 38, United States Code.

(a) Establishment of program.—

(1) IN GENERAL.—Section 1703 is amended to read as follows:

(2) CLERICAL AMENDMENT.—The table of sections at the beginning of chapter 17 is amended by striking the item relating to section 1703 and inserting the following new item:

“1703. Veterans Community Care Program.”.

(b) Effective date.—Section 1703 of title 38, United States Code, as amended by subsection (a), shall take effect on the later of—

(1) the date that is 30 days after the date on which the Secretary of Veterans Affairs submits the report required under section 101(q)(2) of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note); or

(2) the date on which the Secretary promulgates regulations pursuant to subsection (c).

(c) Regulations.—Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall promulgate regulations to carry out section 1703 of title 38, United States Code, as amended by subsection (a) of this section.

(d) Continuity of existing agreements.—

(1) IN GENERAL.—Notwithstanding section 1703 of title 38, United States Code, as amended by subsection (a), the Secretary of Veterans Affairs shall continue all contracts, memorandums of understanding, memorandums of agreements, and other arrangements that were in effect on the day before the date of the enactment of this Act between the Department of Veterans Affairs and the American Indian and Alaska Native health care systems as established under the terms of the Department of Veterans Affairs and Indian Health Service Memorandum of Understanding, signed October 1, 2010, the National Reimbursement Agreement, signed December 5, 2012, and agreements entered into under sections 102 and 103 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146).

(2) MODIFICATIONS.—Paragraph (1) shall not be construed to prohibit the Secretary and the parties to the contracts, memorandums of understanding, memorandums of agreements, and other arrangements described in such paragraph from making such changes to such contracts, memorandums of understanding, memorandums of agreements, and other arrangements as may be otherwise authorized pursuant to other provisions of law or the terms of the contracts, memorandums of understanding, memorandums of agreements, and other arrangements.

(a) In general.—Subchapter I of chapter 17 is amended by inserting after section 1703 the following new section:

(b) Clerical Amendment.—The table of sections at the beginning of such chapter is amended by inserting after the item related to section 1703 the following new item:

“1703A. Agreements with eligible entities or providers; certification processes.”.

(a) In general.—Section 1745(a) is amended—

(1) in paragraph (1), by striking “(or agreement under section 1720(c)(1) of this title)” and inserting “(or an agreement)”; and

(2) by adding at the end the following new paragraph:

“(4) (A) An agreement under this section may be authorized by the Secretary or any Department official authorized by the Secretary, and any such action is not an award for purposes of such laws that would otherwise require the use of competitive procedures for the furnishing of hospital care, medical services, and extended care services.

“(B) (i) Except as provided in clause (ii), and unless otherwise provided in this section or regulations prescribed pursuant to this section, a State home that enters into an agreement under this section is not subject to, in the carrying out of the agreement, any provision of law to which providers of services and suppliers under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) are not subject.

“(ii) A State home that enters into an agreement under this section is subject to—

“(I) all provisions of law regarding integrity, ethics, or fraud, or that subject a person to civil or criminal penalties; and

“(II) all provisions of law that protect against employment discrimination or that otherwise ensure equal employment opportunities.

“(iii) Notwithstanding subparagraph (B)(ii)(I), a State home that enters into an agreement under this section may not be treated as a Federal contractor or subcontractor for purposes of chapter 67 of title 41 (known as the ‘McNamara-O’Hara Service Contract Act of 1965’).”.

(b) Effective date.—The amendment made by subsection (a) shall apply to care provided on or after the effective date of regulations issued by the Secretary of Veterans Affairs to carry out this section.

(a) In general.—Subchapter I of chapter 17, as amended by section 102, is further amended by inserting after section 1703A the following new sections:

(b) Clerical amendment.—The table of sections at the beginning of chapter 17, as amended by section 102, is further amended by inserting after the item relating to section 1703A the following new items:

“1703B. Access guidelines.
“1703C. Standards for quality.”.

(a) In general.—Chapter 17 is amended by inserting after section 1725 the following new section:

(b) Effective date.—Section 1725A of title 38, United States Code, as added by subsection (a) shall take effect on the date upon which final regulations implementing such section take effect.

(c) Clerical amendment.—The table of sections at the beginning of such chapter is amended by inserting after the item related to section 1725 the following new item:

“§1725A. Access to walk-in care.”.

(a) Market area assessments.—

(1) IN GENERAL.—Not less frequently than every four years, the Secretary of Veterans Affairs shall perform market area assessments regarding the health care services furnished under the laws administered by the Secretary.

(2) ELEMENTS.—Each market area assessment established under paragraph (1) shall include the following:

(A) An assessment of the demand for health care from the Department, disaggregated by geographic market areas as determined by the Secretary, including the number of requests for health care services under the laws administered by the Secretary.

(B) An inventory of the health care capacity of the Department of Veterans Affairs across the Department’s system of facilities.

(C) An assessment of the health care capacity to be provided through contracted community care providers and providers who entered into a provider agreement with the Department under section 1703A of title 38, United States Code, as added by section 102(a), including the number of providers, the geographic location of the providers, and categories or types of health care services provided by the providers.

(D) An assessment obtained from other Federal direct delivery systems of their capacity to provide health care to veterans.

(E) An assessment of the health care capacity of non-contracted providers where there is insufficient network supply.

(F) An assessment of the health care capacity of academic affiliates and other collaborations of the Department as it relates to providing health care to veterans.

(G) An assessment of the effects on health care capacity by the access guidelines and standards for quality established under section 1703(h) of title 38, United States Code, as amended by section 101(a)(1).

(H) The number of appointments for health care services under the laws administered by the Secretary, disaggregated by—

(i) appointments at facilities of the Department of Veterans Affairs; and

(ii) appointments with non-Department health care providers.

(3) SUBMITTAL TO CONGRESS.—The Secretary shall submit to the appropriate committees of Congress the market area assessments established in paragraph (1).

(4) USE OF MARKET AREA ASSESSMENTS FOR INTEGRATED HEALTH CARE DELIVERY.—

(A) IN GENERAL.—The Secretary shall use the market area assessments established under paragraph (1) in determining the capacity of the health care provider networks established under section 1703(j) of title 38, United States Code, as amended by section 101(a)(1).

(B) BUDGET.—The Secretary shall ensure that the Department budget for any fiscal year (as submitted with the budget of the President under section 1105(a) of title 31, United States Code) reflects the findings of the Secretary with respect to the most recent market area assessments under paragraph (1).

(5) EFFECTIVE DATE.—The amendments made by subsection (a) shall take effect on September 30, 2018.

(b) Strategic plan To meet health care demand.—

(1) IN GENERAL.—Not later than one year after the date of the enactment of this Act and not less frequently than once every four years thereafter, the Secretary shall submit to the appropriate committees of Congress a strategic plan that specifies a four-year forecast of—

(A) the demand for health care from the Department, disaggregated by geographic area as determined by the Secretary;

(B) the health care capacity to be provided at each medical center of the Department; and

(C) the health care capacity to be provided through community care providers.

(2) ELEMENTS.—In preparing the strategic plan under paragraph (1), the Secretary shall—

(A) consider the access guidelines and standards for quality established under section 1703(h) of title 38, United States Code, as amended by section 101(a)(1);

(B) consider the market area assessments established under subsection (a);

(C) consider the needs of the Department based on identified services that provide management of conditions or disorders related to military service for which there is limited experience or access in the national market, the overall health of veterans throughout their lifespan, or other services as the Secretary determines appropriate;

(D) consult with key stakeholders within the Department, the heads of other Federal agencies, and other relevant governmental and nongovernmental entities, including State, local, and tribal government officials, members of Congress, veterans service organizations, private sector representatives, academics, and other policy experts;

(E) identify emerging issues, trends, problems, and opportunities that could affect health care services furnished under the laws administered by the Secretary;

(F) develop recommendations regarding both short- and long-term priorities for health care services furnished under the laws administered by the Secretary;

(G) after consultation with veterans service organizations and other key stakeholders on survey development or modification of an existing survey, consider a survey of veterans who have used hospital care, medical services, or extended care services furnished by the Veterans Health Administration during the most recent two-year period to assess the satisfaction of the veterans with service and quality of care; and

(H) consider such other matters as the Secretary considers appropriate.

(c) Appropriate committees of congress defined.—In this section, the term “appropriate committees of Congress” means—

(1) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and

(2) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.

(a) In general.—Notwithstanding the treatment of certain laws under subsection (i) of section 1703A of title 38, United States Code, as added by section 102 of this Act, Directive 2014–01 of the Office of Federal Contract Compliance Programs of the Department of Labor (effective as of May 7, 2014) shall apply to any entity entering into an agreement under such section 1703A or section 1745 of such title, as amended by section 103, in the same manner as such directive applies to subcontractors under the TRICARE program for the duration of the moratorium provided under such directive.

(b) Applicability period.—The directive described in subsection (a), and the moratorium provided under such directive, shall not be altered or rescinded before May 7, 2019.

(c) TRICARE program defined.—In this section, the term “TRICARE program” has the meaning given that term in section 1072 of title 10, United States Code.

(a) In general.—On and after the date that is one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall deny or revoke the eligibility of a health care provider to provide non-Department health care services to veterans if the Secretary determines that the health care provider—

(1) was removed from employment with the Department of Veterans Affairs due to conduct that violated a policy of the Department relating to the delivery of safe and appropriate health care; or

(2) violated the requirements of a medical license of the health care provider that resulted in the loss of such medical license.

(b) Permissive action.—On and after the date that is one year after the date of the enactment of this Act, the Secretary may deny, revoke, or suspend the eligibility of a health care provider to provide non-Department health care services if the Secretary determines such action is necessary to immediately protect the health, safety, or welfare of veterans and the health care provider is under investigation by the medical licensing board of a State in which the health care provider is licensed or practices.

(c) Suspension.—The Secretary shall suspend the eligibility of a health care provider to provide non-Department health care services to veterans if the health care provider is suspended from serving as a health care provider of the Department.

(d) Comptroller General report.—Not later than two years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the implementation by the Secretary of this section, including the following:

(1) The aggregate number of health care providers denied or suspended under this section from participation in providing non-Department health care services.

(2) An evaluation of any impact on access to health care for patients or staffing shortages in programs of the Department providing non-Department health care services.

(3) An explanation of the coordination of the Department with the medical licensing boards of States in implementing this section, the amount of involvement of such boards in such implementation, and efforts by the Department to address any concerns raised by such boards with respect to such implementation.

(4) Such recommendations as the Comptroller General considers appropriate regarding harmonizing eligibility criteria between health care providers of the Department and health care providers eligible to provide non-Department health care services.

(e) Non-Department health care services defined.—In this section, the term “non-Department health care services” means services—

(1) provided under subchapter I of chapter 17 of title 38, United States Code, at non-Department facilities (as defined in section 1701 of such title);

(2) provided under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note);

(3) purchased through the Medical Community Care account of the Department; or

(4) purchased with amounts deposited in the Veterans Choice Fund under section 802 of the Veterans Access, Choice, and Accountability Act of 2014.

(a) In general.—Subchapter I of chapter 17 is amended by inserting after section 1703C, as added by section 104 of this Act, the following new section:

(b) Clerical amendment.—The table of sections at the beginning of such chapter is amended by inserting after the item related to section 1703C, as added by section 104 of this Act, the following new item:

“1703D. Prompt payment standard.”.

(a) In general.—Subchapter IV of chapter 81 is amended by adding at the end the following new section:

(b) Clerical amendment.—The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 8158 the following new item:

“8159. Authority to pay for services authorized but not subject to an agreement.”.

(a) Broadening scope of applicability.—Section 1729 is amended—

(1) in subsection (a)—

(A) in paragraph (2)(A)—

(i) by striking “the veteran’s” and inserting “the individual’s”; and

(ii) by striking “the veteran” and inserting “the individual”; and

(B) in paragraph (3)—

(i) in the matter preceding subparagraph (A), by striking “the veteran” and inserting “the individual”; and

(ii) in subparagraph (A), by striking “the veteran’s” and inserting “the individual’s”;

(2) in subsection (b)—

(A) in paragraph (1)—

(i) by striking “the veteran” and inserting “the individual”; and

(ii) by striking “the veteran’s” and inserting “the individual’s”; and

(B) in paragraph (2)—

(i) in subparagraph (A)—

(I) by striking “the veteran” and inserting “the individual”; and

(II) by striking “the veteran’s” and inserting “the individual’s”; and

(ii) in subparagraph (B)—

(I) in clause (i), by striking “the veteran” and inserting “the individual”; and

(II) in clause (ii)—

(aa) by striking “the veteran” and inserting “the individual”; and

(bb) by striking “the veteran’s” each place it appears and inserting “the individual’s”;

(3) in subsection (e), by striking “A veteran” and inserting “An individual”; and

(4) in subsection (h)—

(A) in paragraph (1)—

(i) in the matter preceding subparagraph (A), by striking “a veteran” and inserting “an individual”;

(ii) in subparagraph (A), by striking “the veteran” and inserting “the individual”; and

(iii) in subparagraph (B), by striking “the veteran” and inserting “the individual”; and

(B) in paragraph (2)—

(i) by striking “A veteran” and inserting “An individual”;

(ii) by striking “a veteran” and inserting “an individual”; and

(iii) by striking “the veteran” and inserting “the individual”.

(b) Modification of authority.—Subsection (a)(1) of such section is amended by striking “(1) Subject” and all that follows through the period and inserting the following: “(1) Subject to the provisions of this section, in any case in which the United States is required by law to furnish or pay for care or services under this chapter for a non-service-connected disability described in paragraph (2) of this subsection, the United States has the right to recover or collect from a third party the reasonable charges of care or services so furnished or paid for to the extent that the recipient or provider of the care or services would be eligible to receive payment for such care or services from such third party if the care or services had not been furnished or paid for by a department or agency of the United States.”

(c) Modification of eligible individuals.—Subparagraph (D) of subsection (a)(2) of such section is amended to read as follows:

“(D) that is incurred by an individual who is entitled to care (or payment of the expenses of care) under a health-plan contract.”.

The Secretary of Veterans Affairs may enter into an agreement with a third-party entity to process, through the use of an electronic interface, claims for reimbursement for health care provided under the laws administered by the Secretary.

(a) In general.—The Secretary of Veterans Affairs shall develop and administer an education program that teaches veterans about their health care options through the Department of Veterans Affairs.

(b) Elements.—The program under subsection (a) shall—

(1) teach veterans about—

(A) eligibility criteria for care from the Department set forth under sections 1703, as amended by section 101 of this Act, and 1710 of title 38, United States Code;

(B) priority groups for enrollment in the system of annual patient enrollment under section 1705(a) of such title;

(C) the copayments and other financial obligations, if any, required of certain individuals for certain services; and

(D) how to utilize the access guidelines and standards for quality established under sections 1703B and 1703C of such title.

(2) teach veterans about the interaction between health insurance (including private insurance, Medicare, Medicaid, the TRICARE program, the Indian Health Service, tribal health programs, and other forms of insurance) and health care from the Department; and

(3) provide veterans with information on what to do when they have a complaint about health care received from the Department (whether about the provider, the Department, or any other type of complaint).

(c) Accessibility.—In developing the education program under this section, the Secretary shall ensure that materials under such program are accessible —

(1) to veterans who may not have access to the Internet; and

(2) to veterans in a manner that complies with the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.).

(d) Annual evaluation and report.—

(1) EVALUATION.—The Secretary shall develop a method to evaluate the effectiveness of the education program under this section and evaluate the program using the method not less frequently than once each year.

(2) REPORT.—Not less frequently than once each year, the Secretary shall submit to Congress a report on the findings of the Secretary with respect to the most recent evaluation conducted by the Secretary under paragraph (1).

(e) Definitions.—In this section:

(1) MEDICAID.—The term “Medicaid” means the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).

(2) MEDICARE.—The term “Medicare” means the Medicare program under title XVIII of such Act (42 U.S.C. 1395 et seq.).

(3) TRICARE PROGRAM.—The term “TRICARE program” has the meaning given that term in section 1072 of title 10, United States Code.

(a) Establishment of program.—The Secretary of Veterans Affairs shall develop and implement a training program to train employees and contractors of the Department of Veterans Affairs on how to administer non-Department health care programs, including the following:

(1) Reimbursement for non-Department emergency room care.

(2) The Veterans Community Care Program under section 1703 of such title, as amended by section 101.

(3) Management of prescriptions pursuant to improvements under section 131.

(b) Annual evaluation and report.—The Secretary shall—

(1) develop a method to evaluate the effectiveness of the training program developed and implemented under subsection (a);

(2) evaluate such program not less frequently than once each year; and

(3) not less frequently than once each year, submit to Congress the findings of the Secretary with respect to the most recent evaluation carried out under paragraph (2).

(a) Establishment of program.—

(1) IN GENERAL.—The Secretary of Veterans Affairs shall establish a program to provide continuing medical education material to non-Department medical professionals.

(2) EDUCATION PROVIDED.—The program established under paragraph (1) shall include education on the following:

(A) Identifying and treating common mental and physical conditions of veterans and family members of veterans.

(B) The health care system of the Department of Veterans Affairs.

(C) Such other matters as the Secretary considers appropriate.

(b) Material provided.—The continuing medical education material provided to non-Department medical professionals under the program established under subsection (a) shall be the same material provided to medical professionals of the Department to ensure that all medical professionals treating veterans have access to the same materials, which supports core competencies throughout the community.

(c) Administration of program.—

(1) IN GENERAL.—The Secretary shall administer the program established under subsection (a) to participating non-Department medical professionals through an Internet website of the Department of Veterans Affairs.

(2) CURRICULUM AND CREDIT PROVIDED.—The Secretary shall determine the curriculum of the program and the number of hours of credit to provide to participating non-Department medical professionals for continuing medical education.

(3) ACCREDITATION.—The Secretary shall ensure that the program is accredited in as many States as practicable.

(4) CONSISTENCY WITH EXISTING RULES.—The Secretary shall ensure that the program is consistent with the rules and regulations of the following:

(A) The medical licensing agency of each State in which the program is accredited.

(B) Such medical credentialing organizations as the Secretary considers appropriate.

(5) USER COST.—The Secretary shall carry out the program at no cost to participating non-Department medical professionals.

(6) MONITORING, EVALUATION, AND REPORT.—The Secretary shall monitor the utilization of the program established under subsection (a), evaluate its effectiveness, and report to Congress on utilization and effectiveness not less frequently than once each year.

(d) Non-Department medical professional defined.—In this section, the term “non-Department medical professional” means any individual who is licensed by an appropriate medical authority in the United States and is in good standing, is not an employee of the Department of Veterans Affairs, and provides care to veterans or family members of veterans under the laws administered by the Secretary of Veterans Affairs.

(a) Receipt and review of guidelines.—The Secretary of Veterans Affairs shall ensure that all covered health care providers are provided a copy of and certify that they have reviewed the evidence-based guidelines for prescribing opioids set forth by the Opioid Safety Initiative of the Department of Veterans Affairs under sections 911(a)(2) and 912(c) of the Jason Simcakoski Memorial and Promise Act (Public Law 114–198; 38 U.S.C. 1701 note) before first providing care under the laws administered by the Secretary and at any time when those guidelines are modified thereafter.

(b) Inclusion of medical history and current medications.—The Secretary shall implement a process to ensure that, if care of a veteran by a covered health care provider is authorized under the laws administered by the Secretary, the document authorizing such care includes the relevant medical history of the veteran and a list of all medications prescribed to the veteran.

(c) Submittal of prescriptions.—

(1) IN GENERAL.—Except as provided in paragraph (3), the Secretary shall require, to the maximum extent practicable, each non-Department health care provider to submit prescriptions for opioids—

(A) to the Department for prior authorization for the prescribing of a limited amount of opioids under contracts the Department has with retail pharmacies; or

(B) directly to a pharmacy of the Department for dispensing of the prescriptions.

(2) RESPONSIBILITY OF DEPARTMENT FOR RECORDING AND MONITORING.—In carrying out paragraph (1) and upon the receipt by the Department of the prescription for opioids to veterans under laws administered by the Secretary, the Secretary shall—

(A) ensure the Department is responsible for the recording of the prescription in the electronic health record of the veteran; and

(B) enable other monitoring of the prescription as outlined in the Opioid Safety Initiative of the Department.

(3) EXCEPTION.—

(A) IN GENERAL.—A covered health care provider is not required under paragraph (1)(B) to submit an opioid prescription directly to a pharmacy of the Department if—

(i) the health care provider determines that there is an immediate medical need for the prescription, including an urgent or emergent prescription or a prescription dispensed as part of an opioid treatment program that provides office-based medications; and

(ii) (I) following an inquiry into the matter, a pharmacy of the Department notifies the health care provider that it cannot fill the prescription in a timely manner; or

(II) the health care provider determines that the requirement under paragraph (1)(B) would impose an undue hardship on the veteran, including with respect to travel distances, as determined by the Secretary.

(B) NOTIFICATION TO DEPARTMENT.—If a covered health care provider uses an exception under subparagraph (A) with respect to an opioid prescription for a veteran, the health care provider shall, on the same day the prescription is written, submit to the Secretary for inclusion in the electronic health record of the veteran a notice, in such form as the Secretary may establish, providing information about the prescription and describing the reason for the exception.

(C) REPORT.—

(i) IN GENERAL.—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 report evaluating the compliance of covered health care providers with the requirements under this paragraph and setting forth data on the use by health care providers of exceptions under subparagraph (A) and notices under subparagraph (B).

(ii) ELEMENTS.—Each report required by clause (i) shall include the following with respect to the quarter covered by the report:

(I) The number of exceptions used under subparagraph (A) and notices received under subparagraph (B).

(II) The rate of compliance by the Department with the requirement under subparagraph (B) to include such notices in the health records of veterans.

(III) The identification of any covered health care providers that, based on criteria prescribed by the Secretary, are determined by the Secretary to be statistical outliers regarding the use of exceptions under subparagraph (A).

(d) Use of Opioid Safety Initiative guidelines.—

(1) IN GENERAL.—If a director of a medical center of the Department or a Veterans Integrated Service Network determines that the opioid prescribing practices of a covered health care provider conflicts with or is otherwise inconsistent with the standards of appropriate and safe care, as that term is used in section 913(d) of the Jason Simcakoski Memorial and Promise Act (Public Law 114–198; 38 U.S.C. 1701 note), the director shall take such action as the director considers appropriate to ensure the safety of all veterans receiving care from that health care provider, including removing or directing the removal of any such health care provider from provider networks or otherwise refusing to authorize care of veterans by such health care provider in any program authorized under the laws administered by the Secretary.

(2) INCLUSION IN CONTRACTS.—The Secretary shall ensure that any contracts entered into by the Secretary with third parties involved in administering programs that provide care in the community to veterans under the laws administered by the Secretary specifically grant the authority set forth in paragraph (1) to such third parties and to the directors described in that paragraph, as the case may be.

(e) Denial or revocation of eligibility of non-Department providers.—The Secretary shall deny or revoke the eligibility of a non-Department health care provider to provide health care to veterans under the laws administered by the Secretary if the Secretary determines that the opioid prescribing practices of the provider—

(1) violate the requirements of a medical license of the health care provider; or

(2) detract from the ability of the health care provider to deliver safe and appropriate health care.

(f) Covered health care provider defined.—In this section, the term “covered health care provider” means a non-Department of Veterans Affairs health care provider who provides health care to veterans under the laws administered by the Secretary of Veterans Affairs.

Section 7332(b)(2) is amended by striking subparagraph (H) and inserting the following new subparagraphs:

“(H) (i) To a non-Department entity (including private entities and other Federal agencies) for purposes of providing health care, including hospital care, medical services, and extended care services, to patients.

“(ii) An entity to which a record is disclosed under this subparagraph may not disclose or use such record for a purpose other than that for which the disclosure was made.

“(I) To a third party in order to recover or collect reasonable charges for care furnished to, or paid on behalf of, a patient in connection with a non-service connected disability as permitted by section 1729 of this title or for a condition for which recovery is authorized or with respect to which the United States is deemed to be a third party beneficiary under the Act entitled ‘An Act to provide for the recovery from tortiously liable third persons of the cost of hospital and medical care and treatment furnished by the United States’ (Public Law 87–693; 42 U.S.C. 2651 et seq.; commonly known as the ‘Federal Medical Care Recovery Act’).”.

(a) Establishment of standards and requirements.—The Secretary of Veterans Affairs shall establish standards and requirements for the provision of care by non-Department of Veterans Affairs health care providers in clinical areas for which the Department of Veterans Affairs has special expertise, including post-traumatic stress disorder, military sexual trauma-related conditions, and traumatic brain injuries.

(b) Condition for eligibility to participate in Veterans Choice Program.—Each non-Department of Veterans Affairs health care provider shall meet the standards and requirements established pursuant to subsection (a) before entering into a contact with the Department of Veterans Affairs to participate in the Veterans Choice Program under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note). Non-Department of Veterans Affairs health care providers participating in the Veterans Choice Program shall fulfill training requirements established by the Secretary on how to deliver evidence-based treatments in the clinical areas for which the Department of Veterans Affairs has special expertise.

Whenever the Secretary submits to Congress a request for supplemental appropriations or any other appropriation outside the standard budget process to address a budgetary issue affecting the Department of Veterans Affairs, the Secretary shall, not later than 45 days before the date on which such budgetary issue would start affecting a program or service, submit to Congress a justification for the request, including a plan that details how the Secretary intends to use the requested appropriation and how long the requested appropriation is expected to meet the needs of the Department and certification that the request was made using an updated and sound actuarial analysis.

Section 802 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note) is amended—

(1) in subsection (c)—

(A) in paragraph (1), by striking “by paragraph (3)” and inserting “in paragraphs (3) and (4)”; and

(B) by adding at the end the following new paragraph:

“(4) PERMANENT AUTHORITY FOR OTHER USES.—Beginning in fiscal year 2019, amounts remaining in the Veterans Choice Fund may be used to furnish hospital care, medical services, and extended care services to individuals pursuant to chapter 17 of title 38, United States Code, at non-Department facilities, including pursuant to non-Department provider programs other than the program established by section 101. Such amounts shall be available in addition to amounts available in other appropriations accounts for such purposes.”; and

(2) in subsection (d)(1), by striking “to subsection (c)(3)” and inserting “to paragraphs (3) and (4) of subsection (c)”.

Subsection (p) of section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note) is amended to read as follows:

“(p) Authority To furnish care and services.—The Secretary may not use the authority under this section to furnish care and services after December 31, 2018.”.

(a) In general.—

(1) TITLE 38.—Title 38, United States Code, is amended—

(A) in section 1712(a)—

(i) in paragraph (3), by striking “under clause (1), (2), or (5) of section 1703(a) of this title” and inserting “or entered an agreement”; and

(ii) in paragraph (4)(A), by striking “under the provisions of this subsection and section 1703 of this title”;

(B) in section 1712A(e)(1)—

(i) by inserting “or agreements” after “contracts”; and

(ii) by striking “(under sections 1703(a)(2) and 1710(a)(1)(B) of this title)”; and

(C) in section 2303(a)(2)(B)(i), by striking “with section 1703” and inserting “with sections 1703A, 8111, and 8153”.

(2) SOCIAL SECURITY ACT.—Section 1866(a)(1)(L) of the Social Security Act (42 U.S.C. 1395cc(a)(1)(L)) is amended by striking “under section 1703” and inserting “under chapter 17”.

(3) VETERANS' BENEFITS IMPROVEMENTS ACT OF 1994.—Section 104(a)(4)(A) of the Veterans' Benefits Improvements Act of 1994 (Public Law 103–446; 38 U.S.C. 1117 note) is amended by striking “in section 1703” and inserting “in sections 1703A, 8111, and 8153”.

(b) Effective date.—The amendments made by subsection (a) shall take effect on the date described in section 101(b).

(a) In general.—Chapter 17 is amended by inserting after section 1730A the following new section:

(b) Clerical amendment.—The table of sections at the beginning of chapter 17 of such title is amended by inserting after the item relating to section 1730A the following new item:

“1730B. Licensure of health care professionals providing treatment via telemedicine.”.

(c) Report on telemedicine.—

(1) IN GENERAL.—Not later than one year after the earlier of the date on which services provided under section 1730B of title 38, United States Code, as added by subsection (a), first occur or regulations are promulgated to carry out such section, 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 effectiveness of the use of telemedicine by the Department of Veterans Affairs.

(2) ELEMENTS.—The report required by paragraph (1) shall include an assessment of the following:

(A) The satisfaction of veterans with telemedicine furnished by the Department.

(B) The satisfaction of health care providers in providing telemedicine furnished by the Department.

(C) The effect of telemedicine furnished by the Department on the following:

(i) The ability of veterans to access health care, whether from the Department or from non-Department health care providers.

(ii) The frequency of use by veterans of telemedicine.

(iii) The productivity of health care providers.

(iv) Wait times for an appointment for the receipt of health care from the Department.

(v) The use by veterans of in-person services at Department facilities and non-Department facilities.

(D) The types of appointments for the receipt of telemedicine furnished by the Department that were provided during the one-year period preceding the submittal of the report.

(E) The number of appointments for the receipt of telemedicine furnished by the Department that were requested during such period, disaggregated by medical facility.

(F) Savings by the Department, if any, including travel costs, from furnishing health care through the use of telemedicine during such period.

(a) Inclusion as physician.—

(1) IN GENERAL.—Subchapter I of chapter 74 is amended by adding at the end the following new section:

(2) CLERICAL AMENDMENT.—The table of sections at the beginning of chapter 74 is amended by inserting after the item relating to section 7412 the following new item:

“7413. Treatment of podiatrists; clinical oversight standards.”.

(b) Modification and clarification of pay grade.—

(1) GRADE.—The list in section 7404(b) of such title is amended—

(A) by striking “PHYSICIAN AND DENTIST SCHEDULE” and inserting “PHYSICIAN AND SURGEON (MD/DO), PODIATRIC SURGEON (DPM), AND DENTIST AND ORAL SURGEON (DDS, DMD) SCHEDULE”;

(B) by striking, “Physician grade” and inserting “Physician and surgeon grade”; and

(C) by striking “PODIATRIST, CHIROPRACTOR, AND” and inserting “CHIROPRACTOR AND”.

(2) APPLICATION.—The amendments made by paragraph (1) shall apply with respect to a pay period of the Department of Veterans Affairs beginning on or after the date that is 30 days after the date of the enactment of this Act.

(a) Appointment.—Section 7401(1) is amended by inserting “certified clinical perfusionists,” after “physician assistants,”.

(b) Increases in rates of basic pay.—Section 7455(c)(1) is amended by inserting “certified clinical perfusionists,” after “pharmacists,”.

Section 7309(b)(2) is amended—

(1) in subparagraph (B), by striking “in the Readjustment Counseling Service”; and

(2) in subparagraph (C), by striking “in the Readjustment Counseling Service”.

Section 7404(d) is amended by striking “Except” and inserting “Except for positions described in section 7401(4) of this title and except”.

(a) In general.—Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall identify and fully staff—

(1) all mental health vacancies within the Department of Veterans Affairs; and

(2) all primary care and mental health vacancies in Patient Aligned Care Teams of the Department.

(b) Report.—Not later than 210 days after the date of the enactment of this Act, the Secretary shall submit to Congress a report that specifies—

(1) whether the Department has complied with the requirements under subsection (a); and

(2) if the Secretary has not complied with such requirements—

(A) how many vacancies described in subsection (a) remain; and

(B) why the Department was unable to fill such vacancies.

(a) Publication of staffing and vacancies.—

(1) WEBSITE REQUIRED.—Not later than 30 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall make publicly available on an Internet website of the Department of Veterans Affairs the following information, which shall be displayed by departmental component or, in the case of information relating to Veterans Health Administration positions, by medical facility:

(A) The number of personnel encumbering positions.

(B) The number of accessions and de-accessions of personnel during the month preceding the date of the publication of the information.

(C) The number of vacancies, by occupation.

(D) The number of active job postings that have been filled during the 30-day period ending on the date of publication of the information, including the length of time for which each position was posted prior to being filled.

(2) UPDATE OF INFORMATION.—The Secretary shall update the information on the website required under paragraph (1) on a monthly basis.

(3) TREATMENT OF CONTRACTOR POSITIONS.—Any Department of Veterans Affairs position that is filled through a contractor employee may not be treated as a Department position for purposes of the information required to be published under paragraph (1).

(4) INSPECTOR GENERAL REVIEW.—On a semi-annual basis, the Inspector General of the Department shall review the administration of the website required under paragraph (1) and make recommendations relating to the improvement of such administration.

(b) Report to Congress.—The Secretary of Veterans Affairs shall submit to Congress an annual report on the steps the Department is taking to achieve full staffing capacity. Each such report shall include the amount of additional funds necessary to enable the Department to reach full staffing capacity.

(a) Program required.—The Secretary of Veterans Affairs shall carry out a program to establish not fewer than two peer specialists in patient aligned care teams at medical centers of the Department of Veterans Affairs to promote the use and integration of services for mental health, substance use disorder, and behavior health in a primary care setting.

(b) Timeframe for establishment of program.—The Secretary shall carry out the program at medical centers of the Department as follows:

(1) Not later than December 31, 2018, at not fewer than 25 medical centers of the Department.

(2) Not later than December 31, 2019, at not fewer than 50 medical centers of the Department.

(c) Selection of locations.—

(1) IN GENERAL.—The Secretary shall select medical centers for the program as follows:

(A) Not fewer than five shall be medical centers of the Department that are designated by the Secretary as polytrauma centers.

(B) Not fewer than ten shall be medical centers of the Department that are not designated by the Secretary as polytrauma centers.

(2) CONSIDERATIONS.—In selecting medical centers for the program under paragraph (1), the Secretary shall consider the feasibility and advisability of selecting medical centers in the following areas:

(A) Rural areas and other areas that are underserved by the Department.

(B) Areas that are not in close proximity to an active duty military installation.

(C) Areas representing different geographic locations, such as census tracts established by the Bureau of the Census.

(d) Gender-Specific services.—In carrying out the program at each location selected under subsection (c), the Secretary shall ensure that—

(1) the needs of female veterans are specifically considered and addressed; and

(2) female peer specialists are made available to female veterans who are treated at each location.

(e) Engagement with community providers.—At each location selected under subsection (c), the Secretary shall consider ways in which peer specialists can conduct outreach to health care providers in the community who are known to be serving veterans to engage with those providers and veterans served by those providers.

(f) Reports.—

(1) PERIODIC REPORTS.—

(A) IN GENERAL.—Not later than 180 days after the date of the enactment of this Act, and not less frequently than once every 180 days thereafter until the Secretary determines that the program is being carried out at the last location to be selected under subsection (c), the Secretary shall submit to Congress a report on the program.

(B) ELEMENTS.—Each report required by subparagraph (A) shall, with respect to the 180-day period preceding the submittal of the report, include the following:

(i) The findings and conclusions of the Secretary with respect to the program.

(ii) An assessment of the benefits of the program to veterans and family members of veterans.

(iii) An assessment of the effectiveness of peer specialists in engaging under subsection (e) with health care providers in the community and veterans served by those providers.

(2) FINAL REPORT.—Not later than 180 days after the Secretary determines that the program is being carried out at the last location to be selected under subsection (c), the Secretary shall submit to Congress a report detailing the recommendations of the Secretary as to the feasibility and advisability of expanding the program to additional locations.

(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 pilot program to increase the use of medical scribes to maximize the efficiency of physicians at medical facilities of the Department of Veterans Affairs.

(b) Duration.—The Secretary shall carry out the pilot program during the 18-month period beginning on the date of the commencement of the pilot program.

(c) Locations.—The Secretary shall carry out the pilot program at not fewer than five medical facilities of the Department—

(1) at which the Secretary has determined there is a high volume of patients; or

(2) that are located in rural areas and at which the Secretary has determined there is a shortage of physicians and each physician has a high caseload.

(d) Contracts.—

(1) IN GENERAL.—In carrying out the pilot program, the Secretary shall enter into a contract with one or more appropriate nongovernmental entities described in paragraph (2).

(2) APPROPRIATE NONGOVERNMENTAL ENTITIES DESCRIBED.—An appropriate nongovernmental entity described in this paragraph is an entity that trains and employs professional medical scribes who specialize in the collection of medical data and data entry into electronic health records.

(e) Collection of data.—

(1) IN GENERAL.—The Secretary shall collect data on the pilot program to determine the effectiveness of the pilot program in increasing the efficiency of physicians at medical facilities of the Department.

(2) ELEMENTS.—The data collected under paragraph (1) shall include the following with respect to each medical facility participating in the pilot program:

(A) The average wait time for a veteran to receive care from a physician at such medical facility before implementation of the pilot program.

(B) The average wait time for a veteran to receive care from such a physician after implementation of the pilot program.

(C) The average number of patients that such a physician is able to see on a daily basis before implementation of the pilot program.

(D) The average number of patients that such a physician is able to see on a daily basis after implementation of the pilot program.

(E) The average amount of time such a physician spends on documentation on a daily basis before implementation of the pilot program.

(F) The average amount of time such a physician spends on documentation on a daily basis after implementation of the pilot program.

(G) The satisfaction and retention scores of each such physician before implementation of the pilot program.

(H) The satisfaction and retention scores of each such physician after implementation of the pilot program.

(I) The patient satisfaction scores for each such physician before implementation of the pilot program.

(J) The patient satisfaction scores for each such physician after implementation of the pilot program.

(K) The patient satisfaction scores for their health care experience before implementation of the pilot program.

(L) The patient satisfaction scores for their health care experience after implementation of the pilot program.

(f) Report.—

(1) IN GENERAL.—Not later than 180 days after the commencement of the pilot program, and not less frequently than once every 180 days thereafter for the duration of the pilot program, the Secretary shall submit to Congress a report on the pilot program.

(2) ELEMENTS.—Each report required by paragraph (1) shall include the following:

(A) The number of medical facilities of the Department that are participating in the pilot program.

(B) With respect to each such medical facility, an assessment of the effects that participation in the pilot program has had on the following—

(i) Maximizing the efficiency of physicians at such medical facility.

(ii) Reducing average wait times for appointments.

(iii) Improving access of patients to electronic medical records.

(iv) Mitigating physician shortages by increasing the productivity of physicians.

(C) All data collected under subsection (e).

(D) Such recommendations as the Secretary may have with respect to the extension or expansion of the pilot program.

(g) Medical scribe defined.—In this section, the term “medical scribe” means a member of the medical team hired and trained specifically and exclusively to perform documentation in an electronic health record to maximize the productivity of a physician.

(a) Findings.—Congress makes the following findings:

(1) The Department of Veterans Affairs needs to fill at least 35,000 positions.

(2) Prolonged personnel vacancies in the Department result in staffing shortages that cause veterans to receive delayed benefits and services.

(b) Sense of Congress.—It is the sense of Congress that the Department should make the resolution of staffing shortages a top priority.

(a) Increase in number of graduate medical education residency positions.—

(1) IN GENERAL.—The Secretary of Veterans Affairs shall increase the number of graduate medical education residency positions at covered facilities by up to 1,500 positions in the 10-year period beginning on the date of the enactment of this Act.

(2) COVERED FACILITIES.—For purposes of this section, a covered facility is any of the following:

(A) A facility of the Department of Veterans Affairs.

(B) A facility operated by an Indian tribe or a tribal organization, as those terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304).

(C) A facility operated by the Indian Health Service.

(D) A Federally-qualified health center, as defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B)).

(E) A community health center.

(F) A facility operated by the Department of Defense.

(G) Such other health care facility as the Secretary considers appropriate for purposes of this section.

(3) STIPENDS AND BENEFITS.—The Secretary may pay stipends and provide benefits for residents in positions under paragraph (1), regardless of whether they have been assigned in a Department facility.

(4) PARAMETERS FOR LOCATION, AFFILIATE SPONSOR, AND DURATION.—When determining characteristics of residency positions under paragraph (1), the Secretary shall consider the extent to which there is a clinical need for providers, as determined by the following:

(A) The ratio of veterans to health care providers of the Department for a standardized geographic area surrounding a facility, including a separate ratio for general practitioners and specialists.

(B) Whether the local community is medically underserved.

(C) Whether the facility is located in a rural or remote area.

(D) Such other criteria as the Secretary considers important in determining which facilities are not adequately serving area veterans.

(5) PARAMETERS FOR TYPES OF SPECIALTIES.—When determining the types of specialties to be included in residency positions under paragraph (1), the Secretary shall consider the following:

(A) The types of specialties that improve the quality and coverage of medical services provided to veterans.

(B) The range of clinical specialties covered by providers in standardized geographic areas surrounding facilities.

(C) Whether the specialty is included in the most recent staffing shortage determination of the Department under section 7412 of title 38, United States Code.

(b) Application To participate.—To participate as a resident in one of the positions increased under subsection (a)(1), an individual shall submit to the Secretary an application therefor together with an agreement described in subsection (d) under which the participant agrees to serve a period of obligated service in the Veterans Health Administration as provided in the agreement in return for payment of stipend and benefit support as provided in the agreement.

(c) Selection.—

(1) IN GENERAL.—An individual becomes a participant in a residency program under this section upon the Secretary's approval of the individual's application under subsection (b) and the Secretary's acceptance of the agreement under subsection (d) (if required).

(2) NOTICE.—Upon the Secretary's approval of an individual's participation in the program under paragraph (1), the Secretary shall promptly notify the individual of that approval. Such notice shall be in writing.

(d) Agreement.—

(1) IN GENERAL.—An agreement between the Secretary and a resident in a position under subsection (a)(1) shall be in writing and shall be signed by the resident containing such terms as the Secretary may specify.

(2) REQUIREMENTS.—The agreement must specify the terms of the service obligation resulting from participating as a resident under this section, including by requiring a service obligation equal to the number of years of stipend and benefit support.

(e) Conditions of employment.—The Secretary may prescribe the conditions of employment of individuals appointed to positions under subsection (a)(1), including necessary training, and the customary amount and terms of pay for such positions during the period of such employment and training.

(f) Obligated service.—

(1) IN GENERAL.—Each individual appointed to a position under subsection (a)(1) shall provide service as a full-time employee of the Department for the period of obligated service provided in the agreement of the participant entered into under subsection (d). Such service shall be provided in the full-time clinical practice of such participant's profession or in another health care position in an assignment or location determined by the Secretary.

(2) COMMENCEMENT DATE.—Not later than 60 days before the date on which an individual commences serving in a position under subsection (a)(1), the Secretary shall notify the individual of such date. Such date shall be the first day of the individual's period of obligated service.

(g) Breach of agreement: liability.—

(1) PENALTY.—An individual appointed under this section to a position under subsection (a)(1) (other than an individual who is liable under paragraph (2)) who fails to accept payment, or instructs the educational institution in which the individual is enrolled not to accept payment, in whole or in part, for a residency under the agreement entered into under subsection (d) of this title shall be liable to the United States for liquidated damages in the amount of $1,500. Such liability is in addition to any period of obligated service or other obligation or liability under the agreement.

(2) LIABILITY.—

(A) IN GENERAL.—An individual appointed to a position under subsection (a)(1) shall be liable to the United States for the amount which has been paid to or on behalf of the individual under the agreement if any of the following occurs:

(i) The individual is dismissed from the position for disciplinary reasons.

(ii) The individual voluntarily terminates the residency before the completion of such course of training.

(iii) The individual loses the individual's license, registration, or certification to practice the individual's health care profession in a State.

(B) LIABILITY SUPPLANTS SERVICE OBLIGATION.—Liability under this paragraph is in lieu of any service obligation arising under the individual's agreement under subsection (d).

(h) Recovery.—

(1) IN GENERAL.—If an individual breaches the individuals's agreement under subsection (d) by failing (for any reason) to complete such individual's period of obligated service, the United States shall be entitled to recover from the individual an amount equal to the product of—

(A) three;

(B) the sum of—

(i) the amounts paid under this section to or on behalf of the individual; and

(ii) the interest on such amounts that would be payable if at the time the amounts were paid they were loans bearing interest at the maximum legal prevailing rate, as determined by the Treasurer of the United States; and

(C) the quotient of—

(i) the difference between—

(I) the total number of months in the individual's period of obligated service; and

(II) the number of months of such period served by the individual; and

(ii) the total number of months in the individual's period of obligated service.

(2) PERIOD OF RECOVERY.—Any amount which the United States is entitled to recover under this subsection shall be paid to the United States not later than the date that is one year after the date of the breach of the agreement.

(i) Annual report.—

(1) IN GENERAL.—Not later than one year after the date of the enactment of this Act and not less frequently than once each year thereafter, the Secretary shall submit to the appropriate committees of Congress a report on the implementation of this section during the previous year.

(2) CONTENTS.—Each report submitted under paragraph (1) shall include, for the period covered by the report, the following:

(A) The number of positions described in subsection (a) that were filled.

(B) The location of each such position.

(C) The academic affiliate associated with each such position.

(D) A description of the challenges faced in filling the positions described in subsection (a) and the actions the Secretary has taken to address such challenges.

(3) APPROPRIATE COMMITTEES OF CONGRESS DEFINED.—In this subsection, the term “appropriate committees of Congress” means—

(A) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and

(B) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.

(a) Pilot program required.—The Secretary of Veterans Affairs, in consultation with the Director of the Indian Health Service and such other persons as the Secretary considers appropriate, shall carry out a pilot program—

(1) to establish graduate medical education residency training programs at covered facilities; or

(2) to affiliate with established programs described in paragraph (1).

(b) Covered facilities.—For purposes of the pilot program, a covered facility is any facility—

(1) (A) described in subparagraph (B) or (C) of section 211(a)(2); or

(B) with an agreement with the Department described in section 101(d)(1); and

(2) located in a rural or remote area.

(c) Locations.—

(1) IN GENERAL.—The Secretary shall carry out the pilot program at not more than five covered facilities that have been selected by the Secretary for purposes of the pilot program.

(2) CRITERIA.—The Secretary shall establish criteria for selecting covered facilities under paragraph (1).

(d) Duration.—The Secretary shall carry out the pilot program during the eight-year period beginning on the date that is 180 days after the date of the enactment of this Act.

(e) Reimbursement of costs.—The Secretary shall reimburse each covered facility participating in the pilot program for the following costs associated with the pilot program:

(1) Curriculum development.

(2) Recruitment, training, supervision, and retention of residents and faculty.

(3) Accreditation of programs of education under the pilot program by the Accreditation Council for Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA).

(4) The portion of faculty salaries attributable to activities relating to carrying out the pilot program.

(5) Payment for expenses relating to providing medical education under the pilot program.

(6) Stipends and benefits.

(f) Period of obligated service.—

(1) IN GENERAL.—The Secretary shall enter into an agreement with each individual who participates in the pilot program under which such individual agrees to serve under the same terms as established under section 211.

(2) LOAN REPAYMENT.—During the period of obligated service of an individual under paragraph (1), the individual—

(A) shall be deemed to be an eligible individual under subsection (b) of section 108 of the Indian Health Care Improvement Act (25 U.S.C. 1616a) for purposes of participation in the Indian Health Service Loan Repayment Program under such section during the portion of such period that the individual serves at a covered facility; and

(B) shall be deemed to be an eligible individual under section 7682(a) of title 38, United States Code, for purposes of participation in the Department of Veterans Affairs Education Debt Reduction Program under subchapter VII of chapter 76 of such title during the portion of such period that the individual serves at a facility of the Department.

(3) CONCURRENT SERVICE.—Any period of obligated service required of an individual under paragraph (1) shall be served—

(A) with respect to service at a covered facility, concurrently with any period of obligated service required of the individual by the Indian Health Service; and

(B) with respect to service at a facility of the Department of Veterans Affairs, concurrently with any period of obligated service required of the individual by the Department.

(g) Treatment of participants.—A residency position into which a participant in the pilot program is placed as part of the pilot program shall be considered a position referred to in section 211(a)(1) for purposes of the limitation on number of new positions authorized under such section.

(h) Report.—Not later than three years before the date on which the pilot program terminates, 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 feasibility and advisability of—

(1) expanding the pilot program to additional locations; and

(2) making the pilot program or any aspect of the pilot program permanent.

(a) In general.—Section 7411 is amended to read as follows:

(b) Clerical amendment.—The table of sections at the beginning of chapter 74 is amended by striking the item relating to section 7411 and inserting the following new item:

“7411. Reimbursement of continuing professional education expenses.”.

(a) Increase in amount.—Section 7683(d)(1) is amended—

(1) by striking “$120,000” and inserting “$240,000”; and

(2) by striking “$24,000” and inserting “$48,000”.

(b) Study.—

(1) IN GENERAL.—Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall—

(A) conduct a study on the demand for education debt reduction under subchapter VII of chapter 76 of title 38, United States Code; 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 findings of the Secretary with respect to the study carried out under subparagraph (A).

(2) CONSIDERATIONS.—In carrying out the study required by paragraph (1)(A), the Secretary shall consider the following:

(A) The total number of vacancies within the Veterans Health Administration whose applicants are eligible to participate in the Education Debt Reduction Program pursuant to section 7682(a) of such title.

(B) The types of medical professionals in greatest demand in the United States.

(C) Projections by the Secretary of the numbers and types of medical professions that meet the needs of veterans.

(a) Demonstration program authorized.—The Secretary of Veterans Affairs may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to increase access to dental health care services for veterans who are entitled to such services from the Department of Veterans Affairs and reside in rural and other underserved communities.

(b) Priority.—The Secretary shall prioritize the establishment of programs under the demonstration program under this section in States that do not have a facility of the Department that offers on-site dental services.

(c) Telehealth.—For purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care, dental services provided under the demonstration program under this section may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible.

(d) Authorization of appropriations.—There are authorized to be appropriated to the Secretary such sums as are necessary to carry out the demonstration program under this section.

(e) Alternative dental health care providers defined.—In this section, the term “alternative dental health care providers” has the meaning given that term in section 340G–1(a)(2) of the Public Health Service Act (42 U.S.C. 256g–1(a)(2)).

Section 705(a) of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 703 note) is amended, in the matter preceding paragraph (1), by inserting “other than recruitment, relocation, or retention incentives,” after “title 38, United States Code,”.

(a) In general.—Chapter 7 is amended by adding at the end the following new section:

(b) Clerical amendment.—The table of sections at the beginning of chapter 7 is amended by inserting after the item relating to section 725 the following new item:

“726. Annual report on performance awards and bonuses awarded to certain high-level employees.”.

Section 7454 is amended by adding at the end the following new subsection:

“(d) In this section, the term ‘compensation’ includes all compensation earned by employees when performing duties authorized by the Secretary or when the employee is approved to use annual, sick, family medical, military, or court leave or during any other paid absence for which pay is not already regulated.”.

Paragraph (2) of section 7451(c) is amended to read as follows:

“(2) (A) The maximum rate of basic pay for any grade for health-care personnel positions referred to in paragraphs (1) and (3) of section 7401 of this title (other than the positions of physician, dentist, and registered nurse) may not exceed the rate of basic pay established for positions in level IV of the Executive Schedule under section 5315 of title 5.

“(B) Pursuant to an adjustment under subsection (d), the maximum rate of basic pay for a registered nurse serving as a nurse executive or a grade for the position of certified registered nurse anesthetist may exceed the rate of basic pay established for positions in level IV of the Executive Schedule under section 5315 of title 5 but may not exceed the rate of basic pay established for positions in level I of the Executive Schedule under section 5312 of title 5.

“(C) Pursuant to an adjustment under subsection (d), the maximum rate of basic pay for all registered nurses not described in subparagraph (B) may exceed the rate of basic pay established for positions in level IV of the Executive Schedule under section 5315 of title 5 but may not exceed the rate of basic pay established for positions in level III of the Executive Schedule under section 5314 of title 5.”.

(a) In general.—Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall develop criteria to designate medical centers, ambulatory care facilities, and community based outpatient clinics of the Department of Veterans Affairs as underserved facilities.

(b) Consideration.—Criteria developed under subsection (a) shall include consideration of the following with respect to a facility:

(1) The ratio of veterans to health care providers of the Department of Veterans Affairs for a standardized geographic area surrounding the facility, including a separate ratio for general practitioners and specialists.

(2) The range of clinical specialties covered by such providers in such area.

(3) Whether the local community is medically underserved.

(4) The type, number, and age of open consults.

(5) Whether the facility is meeting the wait-time goals of the Department.

(6) Such other criteria as the Secretary considers important in determining which facilities are not adequately serving area veterans.

(c) Analysis of facilities.—Not less frequently than annually, directors of Veterans Integrated Service Networks of the Department shall perform an analysis to determine which facilities within that Veterans Integrated Service Network qualify as underserved facilities pursuant to criteria developed under subsection (a).

(d) Annual plan To address underserved facilities.—

(1) PLAN REQUIRED.—Not later than one year after the date of the enactment of this Act and not less frequently than once each year, the Secretary shall submit to Congress a plan to address the problem of underserved facilities of the Department, as designated pursuant to criteria developed under subsection (a).

(2) CONTENTS.—Each plan submitted under paragraph (1) shall address the following:

(A) Increasing personnel or temporary personnel assistance, including mobile deployment teams furnished under section 233.

(B) Providing special hiring incentives, including under the Education Debt Reduction Program under subchapter VII of chapter 76 of title 38, United States Code, and recruitment, relocation, and retention incentives.

(C) Using direct hiring authority.

(D) Improving training opportunities for staff.

(E) Such other actions as the Secretary considers appropriate.

(a) In general.—Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall commence a pilot program to assess the feasibility and advisability of providing incentives to individuals to work at underserved facilities of the Veterans Health Administration by providing tuition reimbursement and loan repayment to medical students and health care providers who commit to serving in underserved facilities selected under subsection (c).

(b) Duration.—The Secretary shall carry out the pilot program during the six-year period beginning on the date of the commencement of the pilot program.

(c) Selection of locations.—

(1) IN GENERAL.—The Secretary shall select not fewer than three medical centers and seven ambulatory care facilities or community based outpatient clinics of the Department to participate in the pilot program.

(2) RURAL AND HIGHLY RURAL AREAS.—Not fewer than two of the medical centers and five of the ambulatory care facilities or community based outpatient clinics selected under paragraph (1) shall be in States or United States territories that are among the ten States or United States territories with—

(A) the highest percentage of land designated as highly rural pursuant to the rural-urban commuting area codes set forth by the Department of Agriculture; or

(B) the highest percentage of enrolled veterans living in rural, highly rural, or insular island areas.

(3) STATES.—Facilities selected under paragraph (1) shall be located in not fewer than eight different States.

(d) Use of amounts.—Of the amounts used to provide tuition reimbursement or loan repayment under the pilot program—

(1) one-half shall be used to provide tuition reimbursement or loan repayment for individuals practicing in a general practice position; and

(2) one-half shall be used to provide tuition reimbursement or loan repayment for individuals practicing—

(A) in a specialist position; or

(B) in an occupation, other than a position described in paragraph (1), included in the most recent staffing shortage determination of the Department under section 7412 of title 38, United States Code.

(e) Tuition reimbursement.—Under the pilot program, the Secretary may provide to an individual attending medical school and seeking a degree as a Doctor of Medicine or a Doctor of Osteopathic Medicine full tuition reimbursement in exchange for a five-year commitment to serve at an underserved facility selected under subsection (c).

(f) Student loan repayment.—Under the pilot program, in exchange for a three-year commitment to serve at an underserved facility selected under subsection (c), the Secretary may provide—

(1) to an individual currently serving as a health care provider at an underserved facility, an amount not to exceed $30,000 to apply to any remaining student loan debt of the individual; and

(2) to an individual other than an individual described in paragraph (1), an amount not to exceed $50,000 to apply to any remaining student loan debt of the individual.

(g) Breach.—An individual who participates in the pilot program and fails to satisfy a period of obligated service under subsection (d) or (e) shall be liable to the United States, in lieu of such obligated service, for the amount that has been paid or is payable to or on behalf of the individual under the pilot program, reduced by the proportion that the number of days served for completion of the period of obligated service bears to the total number of days in the period of obligated service of such individual.

(h) Expedited hiring.—The Secretary shall ensure that the hiring of individuals to serve in the Department under the pilot program is conducted in an expedited manner.

(i) Continuation in pilot program.—An individual participating in the pilot program in an occupation included in a staffing shortage determination of the Department under section 7412 of title 38, United States Code, may continue participating in the pilot program notwithstanding that the occupation is no longer included in such determination under such section.

(j) Annual report.—

(1) IN GENERAL.—Not later than one year after the date of the enactment of this Act and not less frequently than once each year thereafter, the Secretary shall submit to Congress a report on the pilot program.

(2) CONTENTS.—Each report submitted under paragraph (1) shall include the following:

(A) The number of participants, including number receiving tuition reimbursement and student loan repayment.

(B) The number of facilities where participants are located.

(C) The number of individuals who have applied to participate in the pilot program.

(D) A list of the five most common occupations of the participants in the pilot program, other than general practice.

(k) Definitions.—In this section:

(1) ENROLLED VETERAN.—The term “enrolled veteran” means a veteran who is enrolled in the system of annual patient enrollment established and operated under section 1705(a) of title 38, United States Code.

(2) UNDERSERVED FACILITY.—The term “underserved facility” means a medical center, ambulatory care facility, or community based outpatient clinic of the Department of Veterans Affairs designated by the Secretary of Veterans Affairs pursuant to criteria developed under section 231.

(a) In general.—The Secretary of Veterans Affairs shall establish a program to furnish mobile deployment teams of medical personnel to underserved facilities.

(b) Elements.—In furnishing mobile deployment teams under subsection (a), the Secretary shall consider the following elements:

(1) The medical positions of greatest need at underserved facilities.

(2) The size and composition of teams to be deployed.

(3) Such other elements as the Secretary considers necessary for effective oversight of the program established under subsection (a).

(c) Use of annual analysis.—The Secretary shall use the results of the annual analysis conducted under section 231(c) to form mobile deployment teams under subsection (a) that are composed of the most needed medical personnel for underserved facilities.

(d) Underserved facility defined.—In this section, the term “underserved facility” means a medical center, ambulatory care facility, or community based outpatient clinic of the Department of Veterans Affairs designated by the Secretary of Veterans Affairs pursuant to criteria developed under section 231.

(a) In general.—The Secretary of Veterans Affairs shall ensure that clinical staff working at Vet Centers are eligible to participate in the education debt reduction program of the Department of Veterans Affairs under subchapter VII of chapter 76 of title 38, United States Code.

(b) 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 the number of participants in the education debt reduction program of the Department under such subchapter who work at Vet Centers.

(c) Vet Center defined.—In this section, the term “Vet Center” has the meaning given that term in section 1712A(h) of title 38, United States Code.

(a) Modification of definition of medical facility.—Section 8101(3) is amended by striking “Secretary” and all that follows through “nursing home,” and inserting “Secretary, or as otherwise authorized by law, for the provision of health-care services (including hospital, outpatient clinic, nursing home,”.

(b) Modification of definitions of major medical facility project and major medical facility lease.—Paragraph (3) of section 8104(a) is amended to read as follows:

“(3) For purposes of this subsection:

“(A) The term ‘major medical facility project’ means a project for the construction, alteration, or acquisition of a medical facility involving a total expenditure of more than $20,000,000, but such term does not include an acquisition by exchange, non-recurring maintenance projects of the Department, or the construction, alteration, or acquisition of a shared Federal medical facility for which the Department’s estimated share of the project costs does not exceed $20,000,000.

“(B) The term ‘major medical facility lease’ means a lease for space for use as a new medical facility at an average annual rental equal to or greater than the dollar threshold for leases procured through the General Services Administration under section 3307(a)(2) of title 40, which shall be subject to annual adjustment in accordance with section 3307(h) of such title.”.

(a) In general.—Subchapter I of chapter 81 is amended by inserting after section 8111A the following new section:

(b) Clerical amendment.—The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 8111A the following new item:

“8111B. Authority to plan, design, construct, or lease a shared medical facility.”.

Section 8162(b)(6) is amended to read as follows:

“(6) The Office of Management and Budget shall review each enhanced-use lease before the lease goes into effect to determine whether the lease is in compliance with paragraph (5).”.

(a) Authorization.—The Secretary of Veterans Affairs may carry out the following major medical facility project, to be carried out in an amount not to exceed the amount specified for that project: Construction of the new East Bay Community Based Outpatient Clinic and all associated site work, utilities, parking, and landscaping, construction of the Central Valley Engineering and Logistics support facility, and enhanced flood plain mitigation at the Central Valley and East Bay Community Based Outpatient Clinics as part of the realignment of medical facilities in Livermore, California, in an amount not to exceed $117,300,000.

(b) Authorization of appropriations for construction.—There is authorized to be appropriated to the Secretary of Veterans Affairs for fiscal year 2018 or the year in which funds are appropriated for the Construction, Major Projects account, $117,300,000 for the project authorized in subsection (a).

(c) Submittal of information.—Not later than 90 days after the date of the enactment of this Act, for the project authorized in section (a), 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 the following information:

(1) A line item accounting of expenditures relating to construction management carried out by the Department of Veterans Affairs for such project.

(2) The future amounts that are budgeted to be obligated for construction management carried out by the Department for such project.

(3) A justification for the expenditures described in paragraph (1) and the future amounts described in paragraph (2).

(4) Any agreement entered into by the Secretary regarding a non-Department of Veterans Affairs Federal entity providing management services relating to such project, including reimbursement agreements and the costs to the Department for such services.

(a) Program required.—

(1) IN GENERAL.—The Secretary of Veterans Affairs shall carry out a program through the award of grants to public or private nonprofit entities to assess the feasibility and advisability of using wellness programs to complement the provision of mental health care to veterans and family members eligible for counseling under section 1712A(a)(1)(C) of title 38, United States Code.

(2) MATTERS TO BE ADDRESSED.—The program shall be carried out so as to assess the following:

(A) Means of improving coordination between Federal, State, local, and community providers of health care in the provision of mental health care to veterans and family members described in paragraph (1).

(B) Means of enhancing outreach, and coordination of outreach, by and among providers of health care referred to in subparagraph (A) on the mental health care services available to veterans and family members described in paragraph (1).

(C) Means of using wellness programs of providers of health care referred to in subparagraph (A) as complements to the provision by the Department of Veterans Affairs of mental health care to veterans and family members described in paragraph (1).

(D) Whether wellness programs described in subparagraph (C) are effective in enhancing the quality of life and well-being of veterans and family members described in paragraph (1).

(E) Whether wellness programs described in subparagraph (C) are effective in increasing the adherence of veterans described in paragraph (1) to the primary mental health services provided such veterans by the Department.

(F) Whether wellness programs described in subparagraph (C) have an impact on the sense of wellbeing of veterans described in paragraph (1) who receive primary mental health services from the Department.

(G) Whether wellness programs described in subparagraph (C) are effective in encouraging veterans receiving health care from the Department to adopt a more healthy lifestyle.

(b) Duration.—The Secretary shall carry out the program for a period of three years beginning on the date that is one year after the date of the enactment of this Act.

(c) Locations.—The Secretary shall carry out the program at facilities of the Department providing mental health care services to veterans and family members described in subsection (a)(1).

(d) Grant proposals.—

(1) IN GENERAL.—A public or private nonprofit entity seeking the award of a grant under this section shall submit an application therefor to the Secretary in such form and in such manner as the Secretary may require.

(2) APPLICATION CONTENTS.—Each application submitted under paragraph (1) shall include the following:

(A) A plan to coordinate activities under the program, to the extent possible, with Federal, State, and local providers of services for veterans to enhance the following:

(i) Awareness by veterans of benefits and health care services provided by the Department.

(ii) Outreach efforts to increase the use by veterans of services provided by the Department.

(iii) Educational efforts to inform veterans of the benefits of a healthy and active lifestyle.

(B) A statement of understanding from the entity submitting the application that, if selected, such entity will be required to report to the Secretary periodically on standardized data and other performance data necessary to evaluate individual outcomes and to facilitate evaluations among entities participating in the program.

(C) Other requirements that the Secretary may prescribe.

(e) Grant uses.—

(1) IN GENERAL.—A public or private nonprofit entity awarded a grant under this section shall use the award for purposes prescribed by the Secretary.

(2) ELIGIBLE VETERANS AND FAMILY.—In carrying out the purposes prescribed by the Secretary in paragraph (1), a public or private nonprofit entity awarded a grant under this section shall use the award to furnish services only to individuals specified in section 1712A(a)(1)(C) of title 38, United States Code.

(f) Reports.—

(1) PERIODIC REPORTS.—

(A) IN GENERAL.—Not later than 180 days after the date of the commencement of the program, and every 180 days thereafter, the Secretary shall submit to Congress a report on the program.

(B) REPORT ELEMENTS.—Each report required by subparagraph (A) shall include the following:

(i) The findings and conclusions of the Secretary with respect to the program during the 180-day period preceding the report.

(ii) An assessment of the benefits of the program to veterans and their family members during the 180-day period preceding the report.

(2) FINAL REPORT.—Not later than 180 days after the end of the program, the Secretary shall submit to Congress a report detailing the recommendations of the Secretary as to the advisability of continuing or expanding the program.

(g) Wellness defined.—In this section, the term “wellness” has the meaning given that term in regulations prescribed by the Secretary.

(a) In general.—Subchapter VIII of chapter 17 is amended by adding at the end the following new section:

(b) Clerical amendment.—The table of sections at the beginning of chapter 17 is amended by inserting after the item relating to section 1787 the following new item:

“1788. Transplant procedures with live donors and related services.”.

It is the sense of the Senate that—

(1) a strong and fully resourced Veterans Health Administration is necessary to effectively serve our veterans community;

(2) veterans overwhelmingly report that they are satisfied with the care they receive at facilities operated by the Administration;

(3) research has shown that the Administration produces as good or better outcomes for its patients than private health care systems; and

(4) the Senate opposes any effort that would weaken the Administration or put the Administration on a path toward privatization.

(a) Family caregiver program.—

(1) EXPANSION OF ELIGIBILITY.—

(A) IN GENERAL.—Subparagraph (B) of subsection (a)(2) of section 1720G is amended to read as follows:

“(B) for assistance provided under this subsection—

“(i) before the date on which the Secretary submits to Congress a certification that the Department has fully implemented the information technology system required by section 302(a) of the Caring for our Veterans Act of 2017, has a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service on or after September 11, 2001;

“(ii) during the two-year period beginning on the date on which the Secretary submitted to Congress the certification described in clause (i), has a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service—

“(I) on or before May 7, 1975; or

“(II) on or after September 11, 2001; or

“(iii) after the date that is two years after the date on which the Secretary submits to Congress the certification described in clause (i), has a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service; and”.

(B) PUBLICATION IN FEDERAL REGISTER.—Not later than 30 days after the date on which the Secretary of Veterans Affairs submits to Congress the certification described in subsection (a)(2)(B)(i) of section 1720G of such title, as amended by subparagraph (A) of this paragraph, the Secretary shall publish the date specified in such subsection in the Federal Register.

(2) EXPANSION OF NEEDED SERVICES IN ELIGIBILITY CRITERIA.—Subsection (a)(2)(C) of such section is amended—

(A) in clause (ii), by striking “; or” and inserting a semicolon;

(B) by redesignating clause (iii) as clause (iv); and

(C) by inserting after clause (ii) the following new clause (iii):

“(iii) a need for regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired; or”.

(3) EXPANSION OF SERVICES PROVIDED.—Subsection (a)(3)(A)(ii) of such section is amended—

(A) in subclause (IV), by striking “; and” and inserting a semicolon;

(B) in subclause (V), by striking the period at the end and inserting “; and”; and

(C) by adding at the end the following new subclause:

“(VI) through the use of contracts with, or the provision of grants to, public or private entities—

“(aa) financial planning services relating to the needs of injured veterans and their caregivers; and

“(bb) legal services, including legal advice and consultation, relating to the needs of injured veterans and their caregivers.”.

(4) MODIFICATION OF STIPEND CALCULATION.—Subsection (a)(3)(C) of such section is amended—

(A) by redesignating clause (iii) as clause (iv); and

(B) by inserting after clause (ii) the following new clause (iii):

“(iii) In determining the amount and degree of personal care services provided under clause (i) with respect to an eligible veteran whose need for personal care services is based in whole or in part on a need for supervision or protection under paragraph (2)(C)(ii) or regular instruction or supervision under paragraph (2)(C)(iii), the Secretary shall take into account the following:

“(I) The assessment by the family caregiver of the needs and limitations of the veteran.

“(II) The extent to which the veteran can function safely and independently in the absence of such supervision, protection, or instruction.

“(III) The amount of time required for the family caregiver to provide such supervision, protection, or instruction to the veteran.”.

(5) PERIODIC EVALUATION OF NEED FOR CERTAIN SERVICES.—Subsection (a)(3) of such section is amended by adding at the end the following new subparagraph:

“(D) In providing instruction, preparation, and training under subparagraph (A)(i)(I) and technical support under subparagraph (A)(i)(II) to each family caregiver who is approved as a provider of personal care services for an eligible veteran under paragraph (6), the Secretary shall periodically evaluate the needs of the eligible veteran and the skills of the family caregiver of such veteran to determine if additional instruction, preparation, training, or technical support under those subparagraphs is necessary.”.

(6) USE OF PRIMARY CARE TEAMS.—Subsection (a)(5) of such section is amended, in the matter preceding subparagraph (A), by inserting “(in collaboration with the primary care team for the eligible veteran to the maximum extent practicable)” after “evaluate”.

(7) ASSISTANCE FOR FAMILY CAREGIVERS.—Subsection (a) of such section is amended by adding at the end the following new paragraph:

“(11) (A) In providing assistance under this subsection to family caregivers of eligible veterans, the Secretary may enter into contracts, provider agreements, and memoranda of understanding with Federal agencies, States, and private, nonprofit, and other entities to provide such assistance to such family caregivers.

“(B) The Secretary may provide assistance under this paragraph only if such assistance is reasonably accessible to the family caregiver and is substantially equivalent or better in quality to similar services provided by the Department.

“(C) The Secretary may provide fair compensation to Federal agencies, States, and other entities that provide assistance under this paragraph.”.

(b) Modification of definition of personal care services.—Subsection (d)(4) of such section is amended—

(1) in subparagraph (A), by striking “independent”;

(2) by redesignating subparagraph (B) as subparagraph (D); and

(3) by inserting after subparagraph (A) the following new subparagraphs:

“(B) Supervision or protection based on symptoms or residuals of neurological or other impairment or injury.

“(C) Regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired.”.

(a) Implementation of new system.—

(1) IN GENERAL.—Not later than June 1, 2018, the Secretary of Veterans Affairs shall implement an information technology system that fully supports the Program and allows for data assessment and comprehensive monitoring of the Program.

(2) ELEMENTS OF SYSTEM.—The information technology system required to be implemented under paragraph (1) shall include the following:

(A) The ability to easily retrieve data that will allow all aspects of the Program (at the medical center and aggregate levels) and the workload trends for the Program to be assessed and comprehensively monitored.

(B) The ability to manage data with respect to a number of caregivers that is more than the number of caregivers that the Secretary expects to apply for the Program.

(C) The ability to integrate the system with other relevant information technology systems of the Veterans Health Administration.

(b) Assessment of Program.—Not later than 180 days after implementing the system described in subsection (a), the Secretary shall, through the Under Secretary for Health, use data from the system and other relevant data to conduct an assessment of how key aspects of the Program are structured and carried out.

(c) Ongoing monitoring of and modifications to Program.—

(1) MONITORING.—The Secretary shall use the system implemented under subsection (a) to monitor and assess the workload of the Program, including monitoring and assessment of data on—

(A) the status of applications, appeals, and home visits in connection with the Program; and

(B) the use by caregivers participating in the Program of other support services under the Program such as respite care.

(2) MODIFICATIONS.—Based on the monitoring and assessment conducted under paragraph (1), the Secretary shall identify and implement such modifications to the Program as the Secretary considers necessary to ensure the Program is functioning as intended and providing veterans and caregivers participating in the Program with services in a timely manner.

(d) Reports.—

(1) INITIAL REPORT.—

(A) IN GENERAL.—Not later than 90 days after the date of the enactment of this Act, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate, the Committee on Veterans' Affairs of the House of Representatives, and the Comptroller General of the United States a report that includes—

(i) the status of the planning, development, and deployment of the system required to be implemented under subsection (a), including any changes in the timeline for the implementation of the system; and

(ii) an assessment of the needs of family caregivers of veterans described in subparagraph (B), the resources needed for the inclusion of such family caregivers in the Program, and such changes to the Program as the Secretary considers necessary to ensure the successful expansion of the Program to include such family caregivers.

(B) VETERANS DESCRIBED.—Veterans described in this subparagraph are veterans who are eligible for the Program under clause (ii) or (iii) of section 1720G(a)(2)(B) of title 38, United States Code, as amended by section 301(a)(1) of this Act, solely due to a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service before September 11, 2001.

(2) NOTIFICATION BY COMPTROLLER GENERAL.—The Comptroller General shall review the report submitted under paragraph (1) and notify the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives with respect to the progress of the Secretary in—

(A) fully implementing the system required under subsection (a); and

(B) implementing a process for using such system to monitor and assess the Program under subsection (c)(1) and modify the Program as considered necessary under subsection (c)(2).

(3) FINAL REPORT.—

(A) IN GENERAL.—Not later than June 1, 2019, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate, the Committee on Veterans’ Affairs of the House of Representatives, and the Comptroller General a report on the implementation of subsections (a) through (c).

(B) ELEMENTS.—The report required by subparagraph (A) shall include the following:

(i) A certification by the Secretary with respect to whether the information technology system described in subsection (a) has been implemented.

(ii) A description of how the Secretary has implemented such system.

(iii) A description of the modifications to the Program, if any, that were identified and implemented under subsection (c)(2).

(iv) A description of how the Secretary is using such system to monitor the workload of the Program.

(e) Definitions.—In this section:

(1) ACTIVE MILITARY, NAVAL, OR AIR SERVICE.—The term “active military, naval, or air service” has the meaning given that term in section 101 of title 38, United States Code.

(2) PROGRAM.—The term “Program” means the program of comprehensive assistance for family caregivers under section 1720G(a) of title 38, United States Code, as amended by section 301 of this Act.

(a) Barriers to care and services.—Subparagraph (A)(iv) of section 101(c)(2) of the Caregivers and Veterans Omnibus Health Services Act of 2010 (Public Law 111–163; 38 U.S.C. 1720G note) is amended by inserting “, including a description of any barriers to accessing and receiving care and services under such programs” before the semicolon.

(b) Sufficiency of training for family caregiver program.—Subparagraph (B) of such section is amended—

(1) in clause (i), by striking “; and” and inserting a semicolon;

(2) in clause (ii), by striking the period at the end and inserting “; and”; and

(3) by adding at the end the following new clause:

“(iii) an evaluation of the sufficiency and consistency of the training provided to family caregivers under such program in preparing family caregivers to provide care to veterans under such program.”.

(a) In general.—There is authorized to be appropriated, and is appropriated, to the Secretary of Veterans Affairs, out of any funds in the Treasury not otherwise appropriated, $1,000,000,000 to carry out subsection (c).

(b) Availability of amounts.—The amount appropriated under subsection (a) shall be available for obligation or expenditure without fiscal year limitation.

(c) Use of amounts.—The amount appropriated under subsection (a) shall be used by the Secretary to carry out the following:

(1) Subchapters II and VII of chapter 76 of title 38, United States Code;

(2) The program to increase the number of graduate medical education residency positions of the Department under sections 211 and 212; and

(3) Section 221.

(d) Funding plan.—Not later than 60 days after the date of the enactment of this Act, the Secretary shall submit to the appropriate committees of Congress a funding plan describing how the Secretary intends to use the amount appropriated under subsection (a).

(e) Supplement not supplant.—Amounts appropriated under subsection (a) for purposes of carrying out subchapters II and VII of chapter 76 of title 38, United States Code, shall supplement, not supplant, amounts otherwise made available to the Secretary to carry out such subchapters.

(f) Report.—Not later than one year after the date of the enactment of this Act, the Secretary shall submit to the appropriate committees of Congress a report on how the Secretary has obligated the amount appropriated under subsection (a) as of the date of the submittal of the report.

(g) Appropriate committees of congress defined.—In this section, the term “appropriate committees of Congress” means—

(1) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and

(2) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.

(a) In general.—There is authorized to be appropriated, and is appropriated, to the Secretary of Veterans Affairs, out of any funds in the Treasury not otherwise appropriated, $4,000,000,000 to be deposited in the Veterans Choice Fund under section 802 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note).

(b) Availability.—The amount appropriated under subsection (a) shall remain available until expended pursuant to section 802(c)(4) of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note) as added by section 142.