TAKE CARE OF AMERICA'S VETERANS ACT

Quick facts

Record: House Floor
Section type: Floor speeches
Chamber: House
Date: July 16, 2026
Congress: 119th Congress
Why this source matters: This section came from the House floor portion of the record.

Linked context

People mentioned: Bost, Mike, Takano, Mark, Taylor, David J.
Bills and resolutions: H.Con.Res. 14 (119th Congress), H.Res. 1423 (119th Congress), S. 4744 (119th Congress)
Committees: Committee on Veterans' Affairs, Committee on Veterans' Affairs, Committee on Appropriations

Readable version of the official text

Mr. BOST. Mr. Speaker, pursuant to House Resolution 1423, I call up the bill (H.R. 9237) to amend titles 10 and 38, United States Code, and other Federal laws, to improve benefits for veterans and the administration of the Department of Veterans Affairs, and ask for its immediate consideration in the House.

The Clerk read the title of the bill.

The SPEAKER pro tempore. Pursuant to House Resolution 1423, the amendment printed in part B of House Report 119-749 is adopted, and the bill, as amended, is considered read.

The text of the bill, as amended, is as follows:

H.R. 9237

Be it enacted by the Senate and House of Representatives of

the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title.—This Act may be cited as the “Take Care

of America's Veterans Act”.

(b) Table of Contents.—The table of contents for this Act

is as follows:

Sec. 1. Short title; table of contents.

TITLE I—COMPENSATION

Sec. 101. Major Richard Star Act. Sec. 102. Love Lives On Act. Sec. 103. Extension of increased dependency and indemnity compensation

to surviving spouses of veterans who die from amyotrophic

lateral sclerosis. Sec. 104. Sharri Briley and Eric Edmundson Veterans Benefits Expansion

Act of 2026.
Sec. 105. Claims: prohibition on denial solely for certain reason;

improved efficiency of adjudications and appeals. Sec. 106. Annual report on causes of death among veterans. Sec. 107. Plan for use of automation tools to process claims under laws

administered by the Secretary of Veterans Affairs. Sec. 108. Reforms relating to Department of Veterans Affairs disability

ratings. Sec. 109. Improvements to temporary licensure requirements for contract

health care professionals who perform medical disability

examinations for the Department of Veterans Affairs.
Sec. 110. Disability examinations: study on access in rural areas;

review of training; review of inadequate or unnecessary

examinations. Sec. 111. Improvements to processing and outreach regarding claims

involving military sexual trauma. Sec. 112. Independent assessment of notices that the Secretary of

Veterans Affairs sends to claimants. Sec. 113. Independent assessment of forms that the Secretary of

Veterans Affairs sends to claimants.

TITLE II—EDUCATION AND ECONOMIC OPPORTUNITY

Sec. 201. Vets Opportunity Act. Sec. 202. Improvements to process for making payments to automobile

sellers for automobiles purchased for certain disabled

veterans. Sec. 203. Monthly housing stipend under the Post-9/11 Educational

Assistance Program for individuals who pursue summer

programs of education solely through distance learning. Sec. 204. Clarification regarding inclusion of medically necessary

automobile adaptations in Department of Veterans Affairs

definition of “medical services”.
Sec. 205. Digital communications: Solid Start program; educational

assistance. Sec. 206. Improvements to Transition Assistance Program and

Skillbridge. Sec. 207. Transition Assistance Program: presentation in preseparation

counseling to promote benefits available to veterans. Sec. 208. Elimination of requirement that on-campus educational and

vocational counseling is provided by certain Department

of Veterans Affairs employees. Sec. 209. Expansion of entitlement for payment for licensing or

certification tests for veterans entitled to educational

assistance. Sec. 210. Increase of amount of educational assistance paid by the

Secretary of Veterans Affairs for first year of a full-

time program of apprenticeship or other on-job training.
Sec. 211. Improving emerging technology opportunities for veterans.

TITLE III—HEALTH CARE

Sec. 301. Extension and modification of transportation grant program of

Department of Veterans Affairs. Sec. 302. Veteran Caregiver Reeducation, Reemployment, and Retirement

Act. Sec. 303. Veterans TBI Breakthrough Exploration of Adaptive Care

Opportunities Nationwide Act. Sec. 304. Department of Veterans Affairs assignment of traveling

physicians to serve territories and possessions. Sec. 305. Inclusion of adaptive prostheses and terminal devices for

sports and other recreational activities in medical

services furnished to eligible veterans by the Secretary

of Veterans Affairs. Sec. 306. Modifications to and reauthorization of Staff Sergeant Parker

Gordon Fox Suicide Prevention Grant Program of Department

of Veterans Affairs. Sec. 307. Reports on the use of hyperbaric oxygen therapy. Sec. 308. Department of Veterans Affairs pilot program to provide

grants to mental health care providers for the provision

of mental health care for veterans.

Sec. 309. Furnishing of certain health services to veterans in the

Freely Associated States.
Sec. 310. Modification of Precision Medicine for Veterans Initiative;

reporting on suicide by veterans and members of the Armed

Forces. Sec. 311. Establishment of the Blast Overpressure Task Force of the

Department of Veterans Affairs. Sec. 312. Extension of sharing of Department of Veterans Affairs and

Department of Defense Health Care Resources; resource

sharing oversight and implementation plan. Sec. 313. Timely reporting of the death of a veteran. Sec. 314. Expansion of access by veterans to critical access hospitals

and affiliated clinics under the Veterans Community Care

Program. Sec. 315. Pilot platform for services for veterans; collection from

veterans of information related to social determinants of

health. Sec. 316. Improvements to Department of Veterans Affairs prosthetic and

rehabilitative items and service. Sec. 317. Improvement of submission of medical documentation to the

Secretary of Veterans Affairs by community care

providers. Sec. 318. Implementation of and report on efforts of Department of

Veterans Affairs to improve health care appointment

scheduling. Sec. 319. Pilot program on coordination of care between Department of

Veterans Affairs and Medicare program. Sec. 320. Fisher House availability. Sec. 321. Agreements between medical facilities of Department of

Veterans Affairs and rural medical facilities. Sec. 322. Study on quality of care difference between mental health and

addiction therapy care provided by health care providers

of Department of Veterans Affairs compared to non-

Department providers. Sec. 323. Lactation spaces in medical centers of the Department of

Veterans Affairs. Sec. 324. Research related to menopause, perimenopause, and mid-life

women's health: report; plan. Sec. 325. Pilot program on provision of opioid rescue medications to

veterans. Sec. 326. Establishment of Veterans Health Administration Policy

Advisory Commission. Sec. 327. Access to health care. Sec. 328. Research on health conditions of descendants of toxic-exposed

veterans. Sec. 329. Veterans Spinal Trauma Access to New Devices Act. Sec. 330. Department of Veterans Affairs pilot program to award grants

for the provision of service dogs to veterans. Sec. 331. Authorization of major medical facility project of Department

of Veterans Affairs for fiscal year 2027 in Manchester,

New Hampshire. Sec. 332. Bowel and bladder care program of Department of Veterans

Affairs.

TITLE IV—ORGANIZATION

Sec. 401. Authorization of appropriations to the Office of Information

and Technology of the Department of Veterans Affairs for

certain purposes. Sec. 402. Establishment of Under Secretary for Management and Chief

Financial Officer. Sec. 403. Department of Veterans Affairs acquisition reform and cost

assessment. Sec. 404. Improvement of telephone communication by Department of

Veterans Affairs. Sec. 405. Advancing Department of Veterans Affairs emergency response

to crisis. Sec. 406. Membership of Department of Veterans Affairs Geriatrics and

Gerontology Advisory Committee. Sec. 407. Scheduling of appointments under the Veterans Community Care

Program.

TITLE V—MEMORIAL AFFAIRS

Sec. 501. Expansion of eligibility for Department of Veterans Affairs

memorial headstone or marker for certain individuals. Sec. 502. Department of Veterans Affairs provision of additional burial

benefits when an urn or commemorative plaque is

furnished.
Sec. 503. Fallen Servicemembers Religious Heritage Restoration Program.

TITLE VI—VETERANS' ASSURING CRITICAL CARE EXPANSIONS TO SUPPORT

SERVICEMEMBERS

Subtitle A—Improvement of Veterans Community Care Program

Sec. 601. Codification of requirements for eligibility standards for

access to community care from Department of Veterans

Affairs. Sec. 602. Requirement that Secretary notify veterans of eligibility for

care or denial of request for care under Veterans

Community Care Program. Sec. 603. Consideration under Veterans Community Care Program of

continuity of care and need for caregiver or attendant. Sec. 604. Discussion of telehealth options under Veterans Community

Care Program. Sec. 605. Extension of deadline for submittal of claims by health care

entities and providers under prompt payment standard. Sec. 606. Audit of representative sample of veterans receiving care and

services under Veterans Community Care Program. Sec. 607. Information on wait time and drive time options for receipt

of care by veterans. Sec. 608. Establishment of period during which a referral under

Veterans Community Care Program remains valid. Sec. 609. Updates to contracting requirements under Veterans Community

Care Program. Sec. 610. Publication of community care network sufficiency and payment

waiver requests and approvals.
Sec. 611. Requirements relating to quality of community care providers.
Sec. 612. Provider training.
Sec. 613. Oversight authority over community care.

Subtitle B—Mental Health Treatment Programs

Sec. 621. Veteran participation in certain mental health programs. Sec. 622. Access to mental health residential rehabilitation treatment

programs for veterans with spinal cord injury or

disorder.

Subtitle C—Staffing Matters

Sec. 631. Treatment of psychologists. Sec. 632. Mentorship program for executive leadership teams at medical

centers of the Department of Veterans Affairs. Sec. 633. Requirement for equivalent role postings for vacant positions

at Department of Veterans Affairs. Sec. 634. Improvements to Department of Veterans Affairs hiring

processes. Sec. 635. Department of Veterans Affairs telework policy. Sec. 636. Expansion of reimbursement of continuing professional

education expenses. Sec. 637. Department of Veterans Affairs personnel transparency. Sec. 638. Modification of authority of licensure of health care

professionals providing treatment via telemedicine. Sec. 639. Provision of data on educational assistance programs of

Veterans Health Administration.

Subtitle D—Optimization of Workforce

Sec. 641. Department of Veterans Affairs strategic human capital plan. Sec. 642. Department of Veterans Affairs reduction in force notice

requirement. Sec. 643. Detailed plans and justifications for reorganization of

offices.
Sec. 644. Rule of construction.

Subtitle E—Veterans Infrastructure and Transformation

Sec. 651. Short title. Sec. 652. Modification of authority for sharing of health-care

resources of Department of Veterans Affairs to include

flexible space utilization and streamlined service

agreements. Sec. 653. Use of commercial construction and facilities code and

standards. Sec. 654. Feasibility study for full-service hospital of Department of

Veterans Affairs in certain States. Sec. 655. Report on strategic plan for infrastructure and capital

assets of Department of Veterans Affairs. Sec. 656. Permanent extension of pilot program on acceptance by the

Department of Veterans affairs of donated facilities and

related improvements. Sec. 657. Authority to accept donations of construction services, minor

construction or nonrecurring maintenance projects, and

targeted contributions. Sec. 658. Report on use of additional authorities relating to

recruitment and retention of personnel. Sec. 659. Reports on key capital asset investments, activities, and

performance of Department of Veterans Affairs. Sec. 660. Development of streamlined procurement model; report. Sec. 661. Submission and notification of cost estimates for medical

facility leases.

Sec. 662. Report on capital asset and information technology needs of

the research and development program of Department of

Veterans Affairs. Sec. 663. Improving prevention, detection, and reporting of waste,

fraud, and abuse in Department of Veterans Affairs

capital asset projects and activities. Sec. 664. Report on long-term care physical infrastructure needs of

Department of Veterans Affairs.

Subtitle F—Other Health Care Matters

Sec. 671. Prescription, delivery, distribution, and dispensation of

controlled substance medications by covered health care

professionals of Department of Veterans Affairs via

telemedicine. Sec. 672. Copayments for limited supplies of medications. Sec. 673. Plan on establishment of interactive, online self-service

module for care. Sec. 674. Modification of requirements for Center for Innovation for

Care and Payment of the Department of Veterans Affairs

and transfer of authority. Sec. 675. Report on improvements to clinical appeals process. Sec. 676. Plan on increasing accessibility of care for veterans with

spinal cord injury or disorder.

TITLE I—COMPENSATION

SEC. 101. MAJOR RICHARD STAR ACT.

(a) Concurrent Receipt Generally.—Section 1414(b) of title

10, United States Code, is amended by striking paragraph (2)

and inserting the following new paragraphs:

“(2) Combat-related disability retirees.—

“(A) In general.—A member retired under chapter 61 of

this title with a combat-related disability who is entitled

for any month to retired pay under chapter 61 of this title

and is also entitled for that month to veterans' disability

compensation under title 38, is entitled to be paid both

without regard to sections 5304 and 5305 of title 38, as

provided by subparagraphs (B) and (C).

“(B) Career retirees.—In the case of a member retired

under chapter 61 of this title who has a combat-related

disability that is not a qualifying service-connected

disability (as defined in subsection (a)(2)) and who, at the

time of the member's retirement, had 20 years or more of

service otherwise creditable under section 1405 of this title

or at least 20 years of qualifying and equivalent service

computed under sections 12732 and 12733 of this title, the

member may receive, without regard to sections 5304 and 5305

of title 38, both—

“(i) the amount of retired pay to which the member would

have been entitled under any other provision of law based on

the member's service in the uniformed services if the member

had not been retired under chapter 61 of this title; and

“(ii) veterans' disability compensation under title 38.

“(C) Disability retirees with less than 20 years of

service.—In the case of a member retired under chapter 61 of

this title with a combat-related disability and who, at the

time of the member's retirement, had less than 20 years of

service otherwise creditable under section 1405 of this title

or less than 20 years of qualifying and equivalent service

computed under sections 12732 and 12733 of this title, the

member may receive, without regard to sections 5304 and 5305

of title 38, the lesser of—

“(i) both—

“(I) the retired pay for which the member is eligible

under chapter 61 of this title; and

“(II) veterans' disability compensation under title 38; or

“(ii) both—

“(I) an amount equal to the product of the retired pay

base computed under section 1406(b) or 1407 of this title and

the retired pay multiplier determined under section 1409 of

this title, as such base pay and multiplier would be computed

if the member had 20 years of service creditable under

section 1405 of this title; and

“(II) veterans' disability compensation under title 38.

“(D) Combat-related disability defined.—In this

paragraph, the term `combat-related disability' has the

meaning given that term in subsection (e) of section 1413a of

this title and as determined under the criteria and

procedures used for purposes of such section.

“(3) Exclusion of other retirees.—Subsection (a) does not

apply to a member retired under chapter 61 of this title if

the member is not covered by paragraph (1) or (2).”.

(b) Technical and Conforming Amendments.—

(1) Coordination with combat-related special compensation

program.—Section 1414(d) of title 10, United States Code, is

amended by striking “qualified retiree under this section”

and inserting “qualified retiree under subsection (a) or is

entitled to a payment under subsection (b)(2)”.

(2) Amendments reflecting end of concurrent receipt phase-

in period.—Section 1414 of title 10, United States Code, is

further amended—

(A) in subsection (a)(1)—

(i) by striking the second sentence; and

(ii) by striking subparagraphs (A) and (B);

(B) by striking subsection (c) and redesignating

subsections (d) and (e) as subsections (c) and (d),

respectively; and

paragraphs (3) and (4).

(3) Section heading.—The heading of section 1414 of such

title is amended to read as follows:

“Sec. 1414. Members eligible for retired pay who are also

eligible for veterans' disability compensation: concurrent

receipt”.

(4) Conforming amendment.—Section 1413a(f) of such title

is amended by striking “Subsection (d)” and inserting

“Subsection (c)”.

shall apply to payments for months beginning on or after the

date of the enactment of the Take Care of America's Veterans

Act.

SEC. 102. LOVE LIVES ON ACT.

(a) Modification of Entitlement to Veterans Dependency and

Indemnity Compensation for Surviving Spouses Who Remarry.—

Section 103(d) of title 38, United States Code, is amended—

(1) in paragraph (2)(B)—

(A) by inserting “(i)” before “The remarriage”;

(B) in clause (i), as designated by subparagraph (A), by

striking “Notwithstanding the previous sentence” and

inserting the following:

“(ii) Notwithstanding clause (i)”; and

“(iii) Notwithstanding clause (ii), the remarriage of a

surviving spouse shall not bar the furnishing of benefits

under section 1311 or 1562 of this title to the surviving

spouse of a veteran.”; and

(2) in paragraph (5)—

(A) by striking subparagraph (A); and

(B) by renumbering subparagraphs (B) through (E) as

subparagraphs (A) through (D), respectively.

(b) Continued Eligibility for Survivor Benefit Plan for

Surviving Spouses Who Remarry.—Section 1450 of title 10,

United States Code, is amended—

(1) in subsection (b)—

(A) in the section heading, by striking “, Remarriage

Before Age 55, etc.”;

(B) in paragraph (2)—

(i) in the paragraph heading, by striking “or remarriage

before age 55”; and

(ii) by striking “or, if the surviving spouse or former

spouse remarries before reaching age 55, until the surviving

spouse or former spouse remarries”; and

new paragraphs:

“(3) Effect of termination of subsequent marriage.—If the

surviving spouse or former spouse remarries and is also

entitled to an annuity under the Plan based upon the

subsequent marriage when the subsequent marriage is

terminated, the surviving spouse or former spouse may not

receive both annuities and shall elect which annuity to

receive.

“(4) Restoration of annuity for certain surviving

spouses.—In the case of a surviving spouse who remarried

before reaching age 55 and before the date of the enactment

of this paragraph, the Secretary shall resume payment of the

annuity to that surviving spouse—

“(A) except as provided by subparagraph (B), for each

month that begins on or after the date that is one year after

such date of enactment; or

“(B) on the first day of the first month beginning after

such date of enactment, in the case of a surviving spouse who

elected to transfer payment of that annuity to a surviving

child or children under the provisions of section

1448(d)(2)(B) of title 10, United States Code, as in effect

on December 31, 2019.”; and

(2) in subsection (k)(1)—

(A) in the paragraph heading, by striking “if beneficiary

55 years of age or more”;

(B) by striking “subsequently loses” and inserting

“lost”; and

the surviving spouse or former spouse is 55 years of age or

more” after “former spouse”.

Program to Include a Remarried Widow or Widower Whose

Subsequent Marriage Has Ended.—Section 1072(2) of title 10,

United States Code, is amended—

(1) in subparagraph (H), by striking “; and” and

inserting a semicolon;

(2) in subparagraph (I)(v), by striking the period at the

end and inserting “; and”; and

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

“(J) a remarried widow or widower whose subsequent

marriage has ended due to death, divorce, or annulment.”.

SEC. 103. EXTENSION OF INCREASED DEPENDENCY AND INDEMNITY

COMPENSATION TO SURVIVING SPOUSES OF VETERANS

WHO DIE FROM AMYOTROPHIC LATERAL SCLEROSIS.

(a) Extension.—Section 1311(a)(2) of title 38, United

States Code, is amended—

(1) by inserting “(A)” before “The rate”; and

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

“(B) A veteran whom the Secretary determines died from

amyotrophic lateral sclerosis shall be treated as a veteran

described in subparagraph (A) without regard for how long the

veteran had such disease prior to death.”.

(b) Applicability.—Subparagraph (B) of section 1311(a)(2)

of title 38, United States Code, as added by subsection (a),

shall apply to a veteran who dies from amyotrophic lateral

sclerosis on or after October 1, 2022.

SEC. 104. SHARRI BRILEY AND ERIC EDMUNDSON VETERANS BENEFITS

EXPANSION ACT OF 2026.

(a) Increase in Rates of Certain Disability Compensation

and Dependency and Indemnity Compensation Under Laws

Administered by Secretary of Veterans Affairs.—

(1) Increase to rates of wartime disability compensation.—

(A) In general.—Section 1114 of title 38, United States

Code, is amended by adding at the end the following new

subsection:

“(u) In the case of a veteran eligible for a monthly aid

and attendance allowance under subsection (r) or subsection

(t) of this section, the Secretary shall, in addition to the

total amount of compensation for which the veteran is

eligible under this section, pay the veteran a supplemental

monthly allowance at the rate of $833.33.”.

(B) Effective date; applicability.—Subsection (u) of such

section (as added by subparagraph (A)) shall take effect on

December 1, 2026, and shall apply to months beginning on or

after such date.

(2) Increase to rates of dependency and indemnity

compensation.—Section 5312 of such title is amended by

adding at the end the following new subsection:

“(d)(1) Whenever there is an increase in benefit amounts

payable under title II of the Social Security Act (42 U.S.C.

401 et seq.) as a result of a determination made under

section 215(i) of such Act (42 U.S.C. 415(i)), the Secretary

shall, except as provided in paragraph (2), effective on the

date of such increase in benefit amounts, increase the dollar

amounts in effect for the payment of dependency and indemnity

compensation by the Secretary under paragraph (1) and

paragraph (3) of section 1311(a) of this title, as such

amounts were in effect immediately before the date of such

increase in benefit amounts payable under title II of the

Social Security Act, by a percentage equal to the sum of—

“(A) the percentage by which such benefit amounts are

increased; and

“(B) one percent.

“(2) Whenever there is an increase under paragraph (1) in

amounts in effect for the payment of dependency and indemnity

compensation, the Secretary shall publish such amounts, as

increased pursuant to such paragraph, in the Federal Register

at the same time as the material required by section

215(i)(2)(D) of the Social Security Act (42 U.S.C.

415(i)(2)(D)) is published by reason of a determination under

section 215(i) of such Act (42 U.S.C. 415(i)).

“(3) The requirement to increase, pursuant to paragraph

(1), the amounts in effect for the payment of dependency and

indemnity compensation under paragraph (1) and paragraph (3)

of section 1311 (a) of this title by the Secretary shall—

“(A) take effect on December 1, 2026, and shall apply with

respect to months beginning on or after such date; and

“(B) terminate after the date on which the third increase

to such amounts pursuant to such paragraph occurs.”.

(b) Modification of Waivers of Fees Collected for Housing

Loans Guaranteed, Insured, or Made by the Secretary of

Veterans Affairs.—

(1) Modification.—Section 3729(b)(2) of such title is

amended, in the loan fee table—

(A) in subparagraph (E), by striking “0.50” both places

it appears and inserting “1.42”; and

(B) in subparagraph (I), by striking “0.50” each place it

appears and inserting “1.0”.

(2) Effective date.—The amendments made by paragraph (1)

shall take effect on October 1, 2026.

(1) Eligibility of certain members of the reserve

components and the national guard for guaranteed housing

loans.—

(A) Expanded definition of “active duty” for purposes of

housing loans.—Section 3701(b) of title 38, United States

Code, is amended by adding at the end the following new

paragraph:

“(9) The term `active duty' has the following meanings:

“(A) In the case of a member of the regular components of

the Armed Forces, the meaning given such term in section

101(21)(A) of this title.

“(B) In the case of members of the reserve components of

the Armed Forces—

“(i) service on active duty (as defined in section 101(d)

of title 10), inactive-duty training (as defined in section

101(d) of title 10), or annual training duty; or

“(ii) service on active duty under a call or order to

active duty under section 688, 12301(a), 12301(d), 12301(g),

12301(h), 12302, 12304, 12304a, or 12304b of title 10 or

section 713 of title 14, but not including inactive duty

training (as defined in section 101(d) of title 10) or annual

training duty.

“(C) In the case of a member of the Army National Guard of

the United States or Air National Guard of the United States,

in addition to service described in subparagraph (B)—

“(i) in the National Guard of a State for the purpose of

organizing, administering, recruiting, instructing, or

training the National Guard; or

“(ii) full-time National Guard duty (as defined in section

101 of title 32).”.

(B) Retroactive applicability to service performed.—The

amendments made by this subsection shall apply with respect

to any service performed on or after September 11, 2001.

(2) Expansion of eligibility for guaranteed housing loans

to certain additional personnel upon payment of additional

loan fee.—

(A) Expansion to individuals with at least 14 days of

service.—Section 3701(b) of title 38, United States Code, is

amended by inserting after paragraph (7) the following new

paragraph:

“(8) The term `veteran' also includes, for purposes of

home loans (subject to the additional loan fee in section

3729(b)(4)(J) of this title), an individual who—

“(A) is not otherwise eligible for the benefits of this

chapter;

“(B) has completed a total service of at least 14 days on

active duty under paragraph (B) or (C) of paragraph (9); and

“(C) following completion of such service, continued to

serve until the completion of entry level and skill training

(as defined in section 3301(3) of this title).”.

(B) Basic entitlement.—Section 3702(a)(2) of title 38,

United States Code, is amended by adding at the end the

following:

“(H) Each individual described in section 3701(b)(8) of

this title.”.

3729(b)(4) of title 38, United States Code, is amended by

adding at the end the following new subparagraph:

“(J) In the case of a housing loan in which the veteran

has eligibility under section 3701(b)(8) of this title and

does not otherwise have eligibility, the loan fee table in

paragraph (2) shall be applied to the veteran or other

obligor (as applicable) by adding 1.00 to the percentage in

the table.”.

(D) Notification to personnel.—The Secretary of Veterans

Affairs shall provide information about this benefit to the

Secretary of Defense to ensure that each member of a reserve

component or a member of the Army National Guard of the

United States or Air National Guard of the United States who

completes entry level and skill training (as defined in

section 3301(3) of title 38, United States Code) after the

date of the enactment of this Act is notified of their

eligibility for housing loan benefits under chapter 37 of

such title, including eligibility (subject to the additional

loan fee) under section 3701(b)(8) of such title.

SEC. 105. CLAIMS: PROHIBITION ON DENIAL SOLELY FOR CERTAIN

REASON; IMPROVED EFFICIENCY OF ADJUDICATIONS

AND APPEALS.

(a) Prohibition on Denial of Claims for Benefits Under Laws

Administered by Secretary of Veterans Affairs on Sole Basis

That Veteran Failed to Appear for Certain Medical

Examination.—Subsection (d) of section 5103A of title 38,

United States Code, is amended—

(1) in the heading, by striking “Compensation Claims” and

inserting “Claims for Benefits”;

(2) in paragraph (2), by striking “treat an examination or

opinion as being necessary to make a decision on a claim for

purposes of” and inserting “provide for a medical

examination or obtain a medical opinion under”; and

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

“(3) If a veteran fails to appear for a medical

examination provided by the Secretary in conjunction with a

claim for a benefit under a law administered by the

Secretary, the Secretary may not deny such claim on the sole

basis that such veteran failed to appear for such medical

examination.”.

(b) Improvements to Efficiency of Adjudications and Appeals

of Claims for Benefits Under Laws Administered by Secretary

of Veterans Affairs.—

(1) Annual report on length of adjudications.—

(A) In general.—Section 5109B of title 38, United States

Code, is amended—

(i) by striking “The Secretary” and inserting “(a) In

General.—The Secretary”; and

(ii) by adding at the end the following new subsection:

“(b) Annual Report.—The Secretary shall submit to the

Committees on Veterans' Affairs of the House of

Representatives and the Senate an annual report that

includes, with respect to the period covered by the report—

“(1) the average length of time a claim (or an issue

within a claim) that was remanded by the Board of Veterans'

Appeals was or has been pending before the Secretary after

such remand;

“(2) the number of cases that advanced on the docket by

reason of a motion that was filed under section 7107(b) of

this title and on which the Board ruled, disaggregated by—

“(A) whether a motion was granted or denied; and

“(B) the reason provided for the motion; and

“(3) the number of appeals dismissed by the Board,

disaggregated by—

“(A) whether or not the dismissal was by reason of the

death of the appellant; and

“(B) in the case of a dismissal by reason of the death of

the appellant, whether or not such death was a result of

suicide.”.

(B) Deadline.—The Secretary of Veterans Affairs shall

submit the first report required by subsection (b) of section

5109B of such title (as added by subparagraph (A)) by not

later than one year after the date of the enactment of this

Act.

(2) Guidelines for advancement of cases on docket of

board.—Not later than one year after the date of the

enactment of this

Act, the Secretary of Veterans Affairs, in consultation with

the Board of Veterans' Appeals and the General Counsel of the

Department of Veterans Affairs, shall prescribe guidelines

for the advancement of a case on the docket of the Board on a

motion for earlier consideration and determination under

section 7107(b)(3) of title 38, United States Code. Such

guidelines shall include the type of evidence that may be

submitted with the motion for the advancement of the case to

show grounds for such a motion.

(3) Requirement to track certain claims for benefits.—

(A) In general.—Chapter 51 of title 38, United States

Code, is amended by inserting after section 5109B the

following new section:

“Sec. 5109C. Requirement to track and maintain information

on certain claims for benefits; notice of certain

assignments

“(a) In General.—The Secretary shall use technology to

track and maintain information (including information with

respect to timeliness) on—

“(1) claims for benefits under the laws administered by

the Secretary (including issues within such claims) that

are—

“(A) continuously pursued in accordance with—

“(i) sections 5104C(a) and 5110(a)(2) of this title; or

“(ii) any other policy established by the Secretary;

“(B) filed in the National Work Queue (or any successor

system) but have not been assigned to an office of the

Veterans Benefits Administration for adjudication;

“(C) afforded expeditious treatment by the Veterans

Benefits Administration pursuant to section 5109B of this

title or any other policy established by the Secretary;

“(D) remanded by the Board of Veterans' Appeals to the

Secretary pursuant to section 7104 of this title; or

“(E) pending a hearing by the Board of Veterans' Appeals

under section 7107 of this title;

“(2) instances in which an adjudicator of the Veterans

Benefits Administration does not comply with a relevant

decision of the Board of Veterans' Appeals to remand a claim

for benefits under the laws administered by the Secretary (or

an issue within such a claim), including any such instance in

which the relevant decision concerned a failure on the part

of the agency of original jurisdiction to satisfy the duty of

the Secretary to assist under section 5103A of this title;

“(3) supplemental claims under section 5108 of this title

that are filed—

“(A) in accordance with section 5104C(a) and section

5110(a)(2) of this title; and

“(B) after the date of the applicable final decision of

the Secretary with respect to a claim for benefits under the

laws administered by the Secretary (or an issue within such a

claim); and

“(4) first notices submitted to the Secretary of the death

of individuals in receipt of benefits under the laws

administered by the Secretary, disaggregated by such

individuals who were—

“(A) assigned a fiduciary; and

“(B) not assigned a fiduciary.

“(b) Annual Report.—(1) The Secretary shall submit to the

Committees on Veterans' Affairs of the House of

Representatives and the Senate an annual report that includes

all information maintained and tracked pursuant to subsection

(a).

“(2) The first report required by paragraph (1) shall be

submitted by not later than one year after the date of the

enactment of the Take Care of America's Veterans Act.”.

(B) Clerical amendment.—The table of sections at the

beginning of such chapter is amended by inserting after the

item relating to section 5109B the following new item:

“5109C. Requirement to track and maintain information on certain

claims for benefits; notice of certain assignments.”.

(4) Improvements to board of veterans' appeals.—

(A) Authority to aggregate claims.—Section 7104(a) of

title 38, United States Code, is amended—

(i) by inserting “(1)” before the first sentence; and

(ii) by adding at the end the following new paragraphs:

“2(A) Subject to subparagraph (B), the Chairman of the

Board may aggregate appeals that the Chairman determines

involve a common question of law or fact to decide such

question.

“(B) The authority under subparagraph (A) shall be

effective during the period of three years beginning on the

day that is 90 days after the Secretary submits to the

Committees on Veterans' Affairs of the Senate and House of

Representatives a copy of policies and procedures pursuant to

section 105(b)(7)(D)(i)(II) of the Take Care of America's

Veterans Act.”.

(B) Requirement to ensure substantial compliance with

certain decisions.—Such section is further amended—

(i) by redesignating subsection (f) as subsection (g); and

(ii) by inserting after subsection (e) the following new

subsection (f):

“(f)(1) The Secretary, acting through a member of the

Board, shall ensure substantial compliance with any decision

of the Board to remand a claim.

“(2) The agency of original adjudication may waive the

requirement under paragraph (1) with respect to a decision of

the Board to remand a claim to the Secretary, if a member of

the Board determines—

“(A) evidence added to the evidentiary record after the

date of such decision is sufficient to resolve the issues

underlying such decision; or

“(B) such decision was unnecessary.

“(3) If the Secretary waives such requirement, the

applicable member of the Board shall include, pursuant to

subsection (d), a determination of such waiver in the

decision of the Board.”.

further amended by adding at the end the following new

subsections:

“(h) Not later than three years after the date on which

the Secretary of Veterans Affairs completes the development

of the policies and procedures required under paragraph

(7)(D)(i)(II), and every five years thereafter, the Secretary

shall submit to the Committees on Veterans' Affairs of the

Senate and House of Representatives a report on the

aggregation of claims by the Board under subsection (a). Each

such report shall include—

“(1) an identification of each instance in which the Board

aggregated appeals during the period covered by the report,

including, for each such instance, the number of appeals that

were aggregated;

“(2) an assessment of whether the aggregation of appeals

has contributed to improved efficiency at the Board with

issuing decisions on appeals; and

“(3) such other matters as the Secretary determines

appropriate.

“(i) In this section, the term `aggregate'—

“(1) means any practice or procedure to collect common

issues, claims, or appeals by multiple parties for the

purposes of resolving such issues, claims, or appeals; and

“(2) includes the use of joinder, consolidation,

intervention, class actions, and any other multiparty

proceedings.”.

(5) Expansion of jurisdiction of court of appeals for

veterans claims.—Section 7252 of title 38, United States

Code, is amended—

(A) by redesignating subsections (b) and (c) as subsections

(d) and (e), respectively; and

(B) by inserting after subsection (a) the following new

subsections:

“(b)(1) In an appeal over which the Court has jurisdiction

pursuant to section 7266 of this title, if the appellant

files a request for class certification pursuant to the rules

prescribed by the Court pursuant to section 7264 of this

title, the Court shall have supplemental jurisdiction over

any claim for benefits under the laws administered by the

Secretary—

“(A) filed by a claimant who satisfies the definition of

the class contained in such request (including a claimant who

has filed a claim for benefits under such laws that are

specified in such request); and

“(B) regarding which—

“(i) the agency of original jurisdiction has issued a

nonfinal decision; and

“(ii) the claimant has filed a notice of disagreement

under section 5104C(a) or section 7105 of this title,

including any case in which a claimant has filed a

supplemental claim within one year of a Board decision under

section 5110(a)(2)(D) and 5108 of this title following a

notice of disagreement and decision of the Board.

“(2) A claimant may submit a request for administrative

review of such a claim under section 5104C(a) of this title

during the period beginning on the date on which the named

claimant of the motion for class action review submits to the

Court a motion for class action review and ending on the date

that is 60 days after the later of the following dates:

“(A) The date on which the Court issues a final decision

with respect to such claim.

“(B) The date on which the Court issues a final decision

with respect to such motion for class action review.

“(3) In the case of a claimant whose claim is decided by

the Board during the period when the Court is reviewing the

motion for class action review the deadline for such claimant

to file an appeal to the Court with respect to the decision

of the Board shall be tolled if the Court denies the motion

for class action review.

“(c)(1) In the case of a claim for benefits under the laws

administered by the Secretary, the Court may remand a matter

to the Board of Veterans' Appeals for the limited purpose of

ordering the Board to address a question of law or fact if

the Court determines the Board failed to—

“(A) address, in the relevant decision of the Board, an

issue that—

“(i) the claimant or the representative of the claimant

raised; or

“(ii) was reasonably raised by the evidentiary record of

the claim; or

“(B) provide adequate reasons or bases for the decision of

the Board with respect to such question.

“(2) The Court shall issue Rules that provide for each of

the following:

“(A) When and how a party to an appeal (either the

appellant or the Secretary) may request that the Court issue

a limited remand.

“(B) The period of time within which the Board is required

to issue a decision on the relevant question identified in a

limited remand.

“(C) Guidelines for when the Court may grant a request for

a limited remand.

“(D) Guidelines for when the Court may decide sua sponte

to issue a limited remand without a request from any party.

“(E) A requirement that the parties to an appeal for which

a limited remand is issued provide notice to the Court when

the Board

issues its decision on the relevant question identified in

the limited remand.

“(3) With respect to any matter remanded to the Board

pursuant to paragraph (1), the Court shall—

“(A) retain jurisdiction over such matter; and

“(B) stay the proceedings of the Court on such matter

until the date on which the Board issues the decision

required by such remand.”.

(6) Study and report on common questions of law or fact

before board of veterans' appeals.—

(A) Study.—The Chairman of the Board of Veterans' Appeals

shall carry out a study to identify questions of law or fact

the Board commonly considers when reviewing appeals pursuant

to section 7104 of title 38, United States Code, for which

precedential guidance would assist the Board in issuing final

decisions on such appeals. The Chairman may use artificial

intelligence and other technology in carrying out such study.

(B) Report.—Not later than one year after the date of the

enactment of this Act, the Chairman of the Board of Veterans

Appeals shall submit to the Committees on Veterans Affairs of

the House of Representatives and the Senate a report that

includes the findings of the study required by subparagraph

(A).

(7) Independent assessment of potential modifications to

authority of board of veterans' appeals.—

(A) Agreement.—Not later than 30 days after the date of

the enactment of this Act, the Secretary of Veterans Affairs

shall seek to enter into an agreement with an FFRDC under

which the FFRDC shall conduct an assessment of the

feasibility of modifying the authority of the Board of

Veterans' Appeals established under chapter 71 of title 38,

United States Code, to permit the Board to issue precedential

decisions with respect to questions of law or fact arising in

matters before the Board.

(B) Report; briefings.—If the Secretary fails to finalize

an agreement with an FFRDC under subparagraph (A) before the

date that is 180 days after the date on which the Secretary

enters negotiations with respect to such agreement, the

Secretary shall—

(i) submit to the Committees on Veterans' Affairs of the

House of Representatives and the Senate a report that

includes—

(I) an explanation of the reasons the Secretary failed to

satisfy such requirement; and

(II) an estimate of the date on which the Secretary will

finalize the agreement under subparagraph (A); and

(ii) not less frequently than once every 60 days after the

date on which the Secretary failed to satisfy such

requirement, provide to the Committees on Veterans' Affairs

of the House of Representatives and the Senate a briefing on

the progress of the Secretary toward finalizing such

agreement.

under subparagraph (A) shall, in consultation with veterans

service organizations, veterans' and survivors' advocate

groups, relevant legal experts, and the Chair of the

Administrative Conference of the United States (or the

designee or designees of such Chair) submit to the Secretary

a written assessment that includes the following:

(i) The determination of the FFRDC of whether modifying the

authority of the Board to permit the Board to issue

precedential decisions with respect to questions of law or

fact arising in matters before the Board is feasible.

(ii) An assessment of the authority of the Board of

Veterans' Appeals to aggregate, for review, more than one

appeal under chapter 71 of such title that involves common

questions of law or fact pursuant to section 7104 of such

title, as amended by paragraph (4)(A).

(iii)(I) The recommendations of the FFRDC with respect to

rules or principles to which the Board should adhere when

aggregating appeals for review pursuant to section 7104(a) of

title 38, United States Code, as so amended, including—

(aa) whether the use of an opt-out system is appropriate in

a class certification described in section 7104(a) of title

38, United States Code, as amended;

(bb) whether aggregation described in clause (ii) is better

carried out by one member, or a panel of members, of the

Board;

(cc) whether such aggregation may be accomplished in

accordance with section 7107 of title 38, United States Code;

and

(dd) how an accredited representative, attorney, or

authorized agent may be selected to represent a class before

the Board.

(II) The recommendations shall include, but not be limited

to, the following:

(aa) How the Board should provide notice to claimants of

the Board's intent to aggregate their claim.

(bb) This shall include standards for ensuring that

information provided to claimants regarding aggregation is

written in plain language and clearly explains the potential

effects of aggregation on adjudication timelines, appeal

rights, and participation options.

(cc) The options the Board should provide to claimants to

opt out of participation in aggregation of their claim.

(dd) The rights of the claimants to appeal decisions that

arise out of aggregation of claims, and whether or not such

rights may be limited by existing statute, regulation, or

judicial decisions.

(ee) Safeguards to ensure that aggregation of appeals does

not diminish the requirement that each appeal be decided

based on the individual facts, evidence, and circumstances

specific to the claimant.

(ff) Recommendations regarding quality review procedures

and oversight mechanisms to monitor the impact of aggregation

on claim accuracy, consistency, timeliness, and claimant

outcomes.

(D) Report; implementation.—

(i) In general.—Not later than 90 days after the Secretary

receives the assessment under subparagraph (C), the Secretary

shall—

(I) submit to the Committees on Veterans' Affairs of the

Senate and House of Representatives a copy of such

assessment; and

(II) begin developing policies and procedures to implement

the recommendations in the assessment with respect to the

authority of the Board of Veterans' Appeals referred to in

subparagraph (C).

(ii) Deadline.—The Secretary shall complete the

development of the policies and procedures required under

clause (i)(II) and submit to the Committees on Veterans'

Affairs of the Senate and House of Representatives a copy of

such policies and procedures not later than six months after

the date on which the Secretary begins developing such

policies and procedures.

(E) Definitions.—In this paragraph:

(i) The term “FFRDC” means a federally funded research

and development center.

(ii) The term “veterans service organization” means an

organization recognized by the Secretary for the

representation of veterans under section 5902 of title 38,

United States Code.

Benefits Under Laws Administered by Secretary of Veterans

Affairs.—

(1) Program for quality assurance in decisions of board of

veterans' appeals; performance reviews.—

(A) In general.—Section 7101 of title 38, United States

Code, is amended by adding at the end the following new

subsection:

“(f)(1) The Chairman shall carry out a program to ensure

quality in the decisions of the Board. Under such program,

the Chairman shall—

“(A) develop policies and procedures for—

“(i) measuring quality in such decisions;

“(ii) maintaining data and identifying trends with respect

to—

“(I) errors in such decisions;

“(II) errors in decisions remanded or returned to the

Board by the Court of Appeals for Veterans Claims; and

“(III) specific members of the Board that issued decisions

that were subsequently vacated by the Court of Appeals for

Veterans Claims; and

“(iii) ensuring any such decision of the Board to remand a

claim for a benefit under a law administered by the Secretary

is necessary under any applicable law or regulation;

“(B) with respect to a claim for such a benefit that is

remanded to the Board by the Court of Appeals for Veterans

Claims—

“(i) inform any employee of the Board responsible for

drafting the decision of the Board with respect to such claim

that such decision was remanded;

“(ii) provide any such employee with a copy of the

relevant order of the Court of Appeals for Veterans Claims

(including a copy of any accompanying joint motion for

remand); and

“(iii) provide incentives to such employees to review such

relevant orders and joint motions for remand; and

“(C) ensure, to the maximum extent practicable, that any

error identified by the Board under such program is corrected

before the date on which the Board issues the final decision

associated with such error.

“(2) In developing policies and procedures to measure

quality in decisions of the Board pursuant to clause (i) of

subparagraph (A) of paragraph (1), the Chairman shall

consider the data and trends maintained and identified

pursuant to clause (ii) of such subparagraph.

“(3) The Chairman may use technology, including artificial

intelligence, to maintain such data and identify such trends.

“(4) The Secretary shall submit to the Committees on

Veterans' Affairs of the House of Representatives and the

Senate an annual report on the program required by this

subsection that includes, with respect to the period covered

by the report, an identification of—

“(A) elements, if any of the process of the Board for

reviewing an appeal under this chapter that lead to errors in

decisions of the Board; and

“(B) the most common reasons that a claim for a benefit

under a law administered by the Secretary was remanded to

such Board by the Court of Appeals for Veterans Claims.”.

(B) Deadline.—The Secretary shall submit the first report

required by paragraph (2) of such section (as added by

subparagraph (A)) by not later than one year after the date

of the enactment of this Act.

(2) Training program for certain employees of board of

veterans' appeals; performance reviews.—

(A) Training program.—

(i) In general.—Chapter 71 of such title (as amended by

paragraph (1)) is further amended by inserting after section

7101A the following new section:

“Sec. 7101B. Training program for members of Board on timely

and correct adjudication of appeals

“(a) In General.—The Secretary, in conjunction with the

Chairman of the Board of Veterans' Appeals, shall develop and

carry out a program to provide Members of the Board training

on timely and correct adjudication of appeals under this

chapter.

“(b) Required Considerations.—In carrying out the program

required by subsection (a), the Secretary shall consider the

following:

“(1) Feedback, if any, from members of the Board and

covered employees with respect to such program.

“(2) Data on errors in decisions of the Board maintained

pursuant to the program for quality assurance required by

subsection (f) of section 7101 of this title.

“(3) Any decision of the Court of Appeals for Veterans

Claims to remand a claim for benefits under the laws

administered by the Secretary to the Board for further

action, including a joint motion to remand such claim.

“(c) Assessments of Effectiveness.—The Secretary, in

conjunction with the Chairman of the Board of Veterans'

Appeals, shall develop a method to assess, on an annual

basis, the effectiveness of the training program under this

section. In developing such method, the Secretary shall

consider best practices for assessing the effectiveness of

training programs, including the Kirkpatrick evaluation

model.

“(d) Report.—The Secretary shall submit to the Committees

on Veterans' Affairs of the House of Representatives and the

Senate an annual report on the program required by subsection

(a) that includes, with respect to the period covered by the

report—

“(1) a statement of the topics of the training provided

pursuant to this section, disaggregated by—

“(A) mandatory training; and

“(B) non-mandatory training; and

“(2) the results of the assessment of the effectiveness of

such program required under subsection (c).

“(e) Covered Employee Defined.—In this section, the term

`covered employee' means an employee of the Board who is—

“(1) not a member of the Board; and

“(2) responsible for drafting decisions of the Board.”.

(ii) Clerical amendment.—The table of sections at the

beginning of such chapter is amended by inserting after the

item relating to section 7101A the following new item:

“7101B. Training program for Members of Board on timely and correct

adjudication of appeals.”.

(B) Performance reviews of members of the board.—Section

7101A of such title is amended—

(i) in subparagraph (B) of subsection (c)(1) by striking

“not less often than once every three years” and inserting

“not less often than annually”; and

(ii) by adding at the end the following new subsection:

“(h)(1) With respect to any performance review of a

covered employee, the Secretary may not consider the

timeliness or quality of work of any Member of the Board.

“(2) In this subsection, the term `covered employee' has

the meaning given such term in section 7101B of this

title.”.

(3) Decisions of board to remand.—

(A) Information relating to decisions to remand.—Section

7104 of such title is amended in subsection (d)—

(i) by redesignating paragraphs (1) through (3) as

paragraphs (2) through (4), respectively; and

(ii) by inserting before paragraph (2) (as so

redesignated), the following new paragraph:

“(1) with respect to a claim that the Board remands for

further action, a statement of the specific reasons such

claim was remanded, including any failure on the part of the

Secretary to comply with—

“(A) the Secretary's duty to assist under section 5103A of

this title; and

“(B) the Secretary's duty to notify under section 5103 of

this title;”.

(B) Notice of remanded decision for certain employees.—

Such section is further amended in—

(i) subsection (e)—

(I) by redesignating paragraphs (1) through (3) as

subparagraphs (A) through (C), respectively;

(II) by striking “After” and inserting “(1) After”; and

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

“(2) If, pursuant to a decision on an appeal, the Board

remands a claim for a benefit under a law administered by the

Secretary for further action, the Secretary shall, to the

maximum extent practicable, issue a copy of such decision to

each employee of the Veterans Benefits Administration who

committed the error resulting in the decision of the Board to

remand, when applicable.”; and

(ii) in subsection (g), as redesignated by subsection

(b)(4)(B)(i), by striking “under subsection (e)” and

inserting “under paragraph (1) of subsection (e)”.

(4) Annual reports for board of veterans' appeals.—

(A) In general.—Chapter 71 of title 38, United States

Code, is amended by inserting after section 7114 the

following new section:

“Sec. 7115. Annual report on Board of Veterans' Appeals

“The Chairman of the Board shall submit to the Committees

on Veterans' Affairs of the House of Representatives and the

Senate an annual report that includes, for each decision of

the Board to remand a claim for a benefit under a law

administered by the Secretary to the Secretary for further

adjudication during the period covered by the report, a

statement of the reasons for such decision of the Board,

disaggregated by decisions on—

“(1) claims with a rating decision dated on or after

February 19, 2019; and

“(2) claims with a rating decision dated before such

date.”.

(B) Deadlines.—The Secretary shall submit the first

reports required by subsections (a) and (b) of section 7115

of such title (as added by paragraph (1)) by not later than

one year after the date of the enactment of this Act.

beginning of such chapter is amended by inserting after the

item relating to section 7114 the following new item:

“7115. Annual report on Board of Veterans' Appeals”.

(5) Plan for improvements to quality in decisions of

board.—

(A) In general.—Not later than six months after the date

of the enactment of this Act, the Secretary of Veterans

Affairs, in consultation with the Chairman of the Board of

Veterans' Appeals and the head of the Office of

Administrative Review of the Veterans Benefits

Administration, shall develop a plan to—

(i) improve the quality of decisions of the Board to

remand, pursuant to section 7104 of title 38, United States

Code, claims for a benefit under a law administered by the

Secretary to the Secretary for further action; and

(ii) mitigate the number of such decisions that are

unnecessary under any applicable law or regulation.

(B) Report.—The Secretary shall submit to the Committees

on Veterans' Affairs of the House of Representatives and the

Senate a report on such plan by not later than six months

after the date of the enactment of this Act.

(d) Notice of Avoidable Deferrals of Claims for Benefits

Under Laws Administered by the Secretary of Veterans Affairs;

Study and Report on Certain Opinions of Department of

Veterans Affairs Office of General Counsel.—

(1) Notice of avoidable deferrals.—Not later than one year

after the date of the enactment of this Act, the Secretary of

Veterans Affairs shall develop policies, procedures, and

technological capabilities to ensure that each employee of

the Veterans Benefits Administration that commits an

avoidable deferral with respect to a claim for benefits under

the laws administered by the Secretary of Veterans Affairs in

the National Work Queue is notified of any avoidable

deferrals that such employee commits with respect to the same

claim.

(2) Study and report on certain ogc opinions.—

(A) Study.—Not later than one year after the date of the

enactment of this Act, the Secretary of Veterans Affairs, in

consultation with the Office of the General Counsel of the

Department of Veterans Affairs and the Chairman of the Board

of Veterans' Appeals, shall complete a study to identify—

(i) issues about which an opinion from the Office of the

General Counsel of the Department would foster consistency in

the decisions of the Secretary with respect to claims for

benefits under the laws administered by the Secretary; and

(ii) issues raised in appeals of such decisions to the

United States Court of Appeals for Veterans Claims before the

date of the enactment of this Act about which the Office of

the General Counsel has had inconsistent opinions in matters

involving substantially similar questions of law or fact.

(B) Report.—Not later than one year after the date of the

enactment of this Act, the Secretary of Veterans Affairs

shall submit to the Committees on Veterans' Affairs of the

Senate and House of Representatives a report that includes—

(i) the findings of the study required by subparagraph (A);

(ii) a statement of which issues identified pursuant to

such study about which the Office of the General Counsel of

the Department intends to publish an opinion; and

(iii) a timeline for the publication of any such opinion.

SEC. 106. ANNUAL REPORT ON CAUSES OF DEATH AMONG VETERANS.

(a) In General.—Subchapter II of chapter 5 of title 38,

United States Code, is amended by adding at the end the

following new section:

“Sec. 534. Annual report on causes of death among veterans

“(a) In General.—The Secretary shall submit to the

Committees on Veterans' Affairs of the House of

Representatives and the Senate an annual report that contains

data and information on causes of death among veterans.

“(b) Elements.—Such report shall include—

“(1) for each veteran that died during the period covered

by the report an identification of—

“(A) whether such veteran had a service-connected

disability rated as total;

“(B) the primary cause of death;

“(C) the secondary cause of death, if applicable; and

“(D) the manner of death;

“(2) for each primary cause of death identified pursuant

to paragraph (1), a statement of the total number of veterans

that died from such primary cause of death during the period

covered by the report; and

“(3) for each manner of death identified pursuant to

paragraph (1), a statement of the total number of veterans

that died in such manner during the period covered by the

report.

“(c) Sunset.—This section shall terminate on the date

that is five years after the date of the enactment of the

Take Care of America's Veterans Act.”.

(b) Clerical Amendment.—The table of sections at the

beginning of chapter 5 of such title is amended by inserting

after the item relating to section 533 the following new

item:

“534. Annual report on causes of death among veterans”.

SEC. 107. PLAN FOR USE OF AUTOMATION TOOLS TO PROCESS CLAIMS

UNDER LAWS ADMINISTERED BY THE SECRETARY OF

VETERANS AFFAIRS.

(a) In General.—Not later than one year after the date of

the enactment of this Act, the Secretary of Veterans Affairs

shall submit to the Committees on Veterans' Affairs of the

Senate and House of Representatives the plan of the Secretary

to make available, to the maximum extent practicable, an

automation tool described in subsection (b) to elements of

the Department of Veterans Affairs for the purpose of

processing claims under laws administered by the Secretary.

(b) Automation Tool Described.—An automation tool

described in this subsection is a technology developed for

the Compensation Service of the Veterans Benefits

Administration that—

(1) automates the retrieval of the service record or health

records of a veteran;

(2) compiles evidence relevant to the determination of a

claim for benefits under laws administered by the Secretary;

(3) provides automated decision support relevant to such a

determination;

(4) automates information sharing between Federal agencies;

and

(5) assists in generating correspondence regarding such a

claim.

subsection (a), the Secretary shall conduct an analysis of

each of the following:

(1) The feasibility and benefits of the use of an

automation tool described in subsection (b) by elements of

the Department for the purpose of processing claims under

laws administered by the Secretary.

(2) Any modification to an existing automation tool that

could render such tool usable for such purpose by such an

element.

(3) Any requirement of any such element pertaining to such

purpose that cannot be addressed by using an automation tool.

(4) The extent to which the technology offices of such

elements may need to collaborate with the technology office

responsible for developing an automation tool in the course

of the development and use of the tool by the element for

such purpose.

(5) A timeline for modifying and implementing any

automation tool for use by such elements for such purpose.

(d) Priority.—In providing or expanding an automation tool

described in subsection (b) to elements of the Department

pursuant to the plan required under subsection (a), the

Secretary shall give priority to the following elements:

(1) The Compensation Service.

(2) The Pension and Fiduciary Service of the Veterans

Benefits Administration.

(3) The Education Service of the Veterans Benefits

Administration.

(4) Program offices of the Veterans Benefits

Administration, as determined by the Secretary.

(5) The Debt Management Center.

(6) The Board of Veterans' Appeals.

(e) Other Requirements Relating to Technology at Department

of Veterans Affairs.—

(1) Automatic notices regarding benefits for certain

children of veterans.—

(A) In general.—Not later than one year after the date of

the enactment of this Act, the Secretary of Veterans Affairs

shall implement policies, processes, and technological

capabilities, including in the National Work Queue (or

successor system), to ensure that, in the case of any covered

situation, a claims processor is made aware of, and assigned

to address, such covered situation.

(B) Definitions.—In this subsection:

(i) The term “covered situation” means—

(I) any increase in the amount of dependency compensation

paid to a beneficiary for a child under the laws administered

by the Secretary; and

(II) any educational assistance paid to the child of a

veteran under the laws administered by the Secretary.

(ii) The term “child” has the meaning given such term in

section 101(4)(A)(iii) of title 38, United States Code.

(2) Correct labeling of documents.—Not later than one year

after the date of the enactment of this Act, the Secretary

shall submit to the Committees on Veterans' Affairs of the

Senate and House of Representatives a plan to ensure that

documents in the Veterans Benefits Management System (or any

successor system) are correctly labeled when such documents

are uploaded, including when such documents are labeled using

automation tools.

SEC. 108. REFORMS RELATING TO DEPARTMENT OF VETERANS AFFAIRS

DISABILITY RATINGS.

(a) Ratings for Sleep Apnea.—

(1) In general.—The Secretary of Veterans Affairs shall

revise the schedule for rating disabilities adopted and

applied under section 1155 of title 38, United States Code,

as follows:

(A) A grade of disability of 0 percent shall be assigned

for sleep apnea syndrome when the syndrome is asymptomatic,

with or without treatment.

(B) A grade of disability of 10 percent shall be assigned

for sleep apnea syndrome when treatment yields incomplete

relief.

for sleep apnea syndrome only if—

(i) treatment is either ineffective or the veteran is

unable to use the prescribed treatment due to comorbid

conditions; and

(ii) there is no end-organ damage.

(D) A grade of disability of 100 percent shall be assigned

for sleep apnea syndrome only if there is also end-organ

damage.

(2) Qualifying comorbid conditions.—For purposes of

paragraph (1)(C)(i), a comorbid condition is a condition

that, in the opinion of a qualified medical provider,

directly impedes or prevents the use of, or implementation

of, a recognized form of treatment intervention normally

shown to be effective.

(b) Ratings for Tinnitus.—The Secretary of Veterans

Affairs shall revise the schedule for rating disabilities

adopted and applied under section 1155 of title 38, United

States Code, as follows:

(1) Except as provided in paragraph (2), tinnitus may not

be assigned a separate compensable disability rating.

(2) A grade of disability of 10 percent shall be assigned

for tinnitus only when tinnitus is diagnosed as associated

with service-connected (as defined in section 101(16) of

title 38, United States Code) hearing loss that is otherwise

noncompensable under the laws administered by the Secretary.

(1) In general.—The revisions to the schedule for rating

disabilities adopted and applied under section 1155 of title

38, United States Code, made pursuant to this section shall

apply with respect to claims filed on or after October 1,

(2) Protection of existing ratings.—The revisions to the

schedule for rating disabilities made pursuant to this

section may not serve as the basis for reducing,

discontinuing, or otherwise adversely affecting compensation

that was in effect on the day before the date of the

enactment of this Act.

SEC. 109. IMPROVEMENTS TO TEMPORARY LICENSURE REQUIREMENTS

FOR CONTRACT HEALTH CARE PROFESSIONALS WHO

PERFORM MEDICAL DISABILITY EXAMINATIONS FOR THE

DEPARTMENT OF VETERANS AFFAIRS.

(a) Expansion.—Section 504 of the Veterans' Benefits

Improvements Act of 1996 (Public Law 104-275; 38 U.S.C. 5101

note), as amended by paragraph (1) of subsection (a) of

section 2002 of the Johnny Isakson and David P. Roe, M.D.

Veterans Health Care and Benefits Improvement Act of 2020

(Public Law 116-315; 38 U.S.C. 5101 note), is further

amended, subject to the sunset in paragraph (4) of such

subsection, by striking paragraph (2) of subsection (c) and

inserting the following:

“(2) Health care professional described.—A health care

professional described in this paragraph is a person who is

eligible for appointment to a position in the Veterans Health

Administration covered by section 7402(b) of title 38, United

States Code, who—

“(A) has a current and unrestricted license to practice

the health care profession for which they are licensed;

“(B) is not barred from practicing such health care

profession in any State, the District of Columbia, or a

Commonwealth, territory, or possession of the United States;

and

“(C) is performing authorized duties for the Department

pursuant to a contract entered into under subsection (a).

“(3) Source of funds.—Expenses of carrying out this

section, including payments for examination travel and

incidental expenses under the terms and conditions set forth

by section 111 of this title, shall be reimbursed to the

accounts available for the general operating expenses of the

Veterans Benefits Administration and information technology

systems from amounts available to the Secretary for payment

of compensation and pensions.

“(4) Mechanism for transmittal of evidence introduced by

applicants during examinations.—The Secretary shall

establish a mechanism whereby a health care professional who

conducts medical examinations or opinions under section

5103A(d) of this title may transmit to a veteran's claims

file, evidence introduced by the applicant during a medical

examination or in conjunction with a medical opinion that

examiner used to inform such medical examination or

opinion.”.

(b) Delayed Sunset of Amendment.—Paragraph (4) of

subsection (a) of section 2002 of the Johnny Isakson and

David P. Roe, M.D. Veterans Health Care and Benefits

Improvement Act of 2020 (Public Law 116-315; 38 U.S.C. 5101

note) is amended by striking “On the date that is five years

after the date of the enactment of this Act” and inserting

“On September 30, 2033”.

is amended by striking “physicians assistants, nurse

practitioners, audiologists, and psychologists” and

inserting “health care professionals”.

(d) Report.—Not later than the day that is 15 months after

the date of the enactment of

this Act, the Secretary of Veterans Affairs shall submit to

the Committees on Veterans' Affairs of the Senate and House

of Representatives a report regarding the use of the

authority under section 504 of the Veterans' Benefits

Improvements Act of 1996 (Public Law 104-275; 38 U.S.C. 5101

note), as temporarily amended by section 2002(a)(1) of the

Johnny Isakson and David P. Roe, M.D. Veterans Health Care

and Benefits Improvement Act of 2020 (Public Law 116-315; 38

U.S.C. 5101 note) and this section. Such report shall

include, with respect to the one-year period after the date

of the enactment of this Act, the following elements:

(1) The number of examinations conducted pursuant to a

contract under such authority.

(2) The cost, timeliness, and legal adequacy of such

examinations, disaggregated by—

(A) health care professional; and

(B) contract.

(3) The number of such examinations conducted in each

State, the District of Columbia, or a Commonwealth,

territory, or possession of the United States.

(4) The numbers of each kind of health care professionals

who conducted such examinations.

(5) The number of examinations that were erroneously

conducted by a health care professional—

(A) without such a contract; or

(B) unauthorized to enter into such a contract.

(6) The plan of the Secretary to correct errors in the use

of such authority.

SEC. 110. DISABILITY EXAMINATIONS: STUDY ON ACCESS IN RURAL

AREAS; REVIEW OF TRAINING; REVIEW OF INADEQUATE

OR UNNECESSARY EXAMINATIONS.

(a) Study on Improvements to Department of Veterans Affairs

Covered Medical Disability Examinations in Rural Areas.—

(1) Study required.—Not later than one year after the date

of the enactment of this Act, the Secretary of Veterans

Affairs shall complete a study on access by veterans who

reside in rural and highly rural areas to covered medical

disability examinations.

(2) Elements.—

(A) In general.—The study conducted under paragraph (1)

shall include the following:

(i) A comparison of the average number of days to complete

covered medical disability examinations, disaggregated by

type of examination, for veterans who reside in rural and

highly rural areas compared to an average time for veterans

who reside in other areas to complete a covered medical

disability examination, by either contractors or employees of

the Department.

(ii) A root cause analysis of differences identified

pursuant to clause (i).

(iii) The plan of the Secretary for the following year to

improve access described in paragraph (1), which shall

include a plan for the pursuit of a commercial or industry-

standard solution or technology that could enable housebound

veterans or veterans who live in rural areas to receive

examinations without traveling long distances.

(B) Number of days to complete defined.—For purposes of

subparagraph (A)(i), the term “number of days to complete”

means the number of days in the period—

(i) beginning on the date on which a contractor or employee

of the Department received a request from the Secretary to

conduct a covered medical disability examination; and

(ii) ending on the date on which the examination was

completed.

(3) Report on study.—Not later than one year after the

date of the enactment of this Act, the Secretary shall submit

to the Committee on Veterans' Affairs of the Senate and the

Committee on Veterans' Affairs of the House of

Representatives a report on the findings of the Secretary

with respect to the study completed under paragraph (1).

(4) Definitions.—In this subsection:

(A) The term “covered medical disability examination”

means a medical nexus examination or medical opinion for the

purposes of adjudicating a claim for a benefit under chapter

11 or 15 of title 38, United States Code, regardless of

whether conducted by an employee or a contractor of the

Department.

(B) The terms “rural” and “highly rural” have the

meanings given those terms under the rural-urban commuting

areas coding system of the Department of Agriculture.

(b) Review of Training for Veterans Service Representatives

and Rating Veterans Service Representatives.—

(1) Review required.—The Secretary of Veterans Affairs

shall conduct a comprehensive review of the training provided

to Veterans Service Representatives (VSRs) and Rating

Veterans Service Representatives (RVSRs) regarding covered

medical disability examinations for the purpose of claims

adjudication.

(2) Scope of review.—The review shall include, at minimum,

an evaluation of training and policies relating to—

(A) assessing the adequacy of covered medical disability

examinations for claims adjudication;

(B) determining the necessity of medical disability

examinations where claims can be adjudicated based on

existing evidence without ordering additional examinations;

Department policies, including—

(i) the duty to assist claimants;

(ii) evidentiary standards regarding causation;

(iii) required elements and standards for covered medical

disability examinations, including the need for reasoned

medical opinions; and

(iv) the absence of statutory or regulatory presumptions of

service connection in covered medical disability

examinations; and

(D) input from impacted Department employees, including

duly appointed labor representatives.

(3) Second-level review for new employees.—The Secretary

shall evaluate the effectiveness of current policies

requiring a second level of review of claims decisions made

by new Veterans Service Representatives and Rating Veterans

Service Representatives before such employees are authorized

to order covered medical disability examinations, including

any applicable accuracy thresholds.

(4) Report to congress.—Not later than 180 days after the

date of the enactment of this Act, the Secretary shall submit

to the Committee on Veterans' Affairs of the Senate and the

Committee on Veterans' Affairs of the House of

Representatives a report detailing the findings of the

Secretary with respect to the review conducted under

paragraph (1), the data used by the Secretary to support such

findings, and such recommendations as the Secretary may have

for improvements to training or policies.

(5) Comptroller general of the united states review of

findings.—Not later than 180 days after the date on which

the Secretary submits the report under paragraph (4), the

Comptroller General of the United States shall conduct a

review of the findings and recommendations contained in the

report.

(6) Modification of reports by the board of veterans'

appeals and united states court of appeals for veterans

claims.—

(A) Board of veterans' appeals.—Section 7101(d)(2) of

title 38, United States Code, is amended—

(i) in subparagraph (F), by striking “; and” and

inserting a semicolon;

(ii) in subparagraph (G), by striking the period at the end

and inserting “; and”; and

(iii) by adding at the end the following new subparagraph:

“(H) a summary of recurring issues that result in the

Board remanding appeals back to the agency of original

jurisdiction.”.

(B) United states court of appeals for veterans claims.—

Section 7288(b) of title 38, United States Code, is amended

by adding at the end the following new paragraph:

“(16) A summary of recurring issues that result in

remands.”.

(7) Definition of covered medical disability examination.—

In this subsection, the term “covered medical disability

examination” means a medical examination or medical opinion

that the Secretary determines necessary for the purposes of

adjudicating a claim for a benefit under chapter 11 or 15 of

title 38, United States Code, regardless of whether conducted

by an employee or a contractor of the Department.

Inadequate or Unnecessary Examinations.—

(1) Review.—Not later than 1 year after the date of the

enactment of this Act and not less frequently than once every

three months thereafter, the Secretary of Veterans Affairs

shall review a random and representative sample of all

covered medical disability examinations completed during the

previous three-month period.

(2) Further sample requirements.—Under each review

required by paragraph (1), the Secretary shall ensure the

review includes—

(A) a statistically significant sample of covered medical

disability examinations completed by employees of the

Department of Veterans Affairs; and

(B) a statistically significant sample of covered medical

disability examinations completed by each contractor that

provides such examinations for the Department.

(3) Analysis.—Under each review required by paragraph (1),

the Secretary shall—

(A) analyze the samples specified in paragraph (2); and

(B) pursuant to such analysis, identify—

(i) the percentage of examinations that were adequate for

purposes of adjudicating the particular claim for a benefit

under chapter 11 or 15 of title 38, United States Code, for

which the examination was ordered by the Department; and

(ii) the percentage of examinations considered

overdeveloped for purposes of adjudicating claims for a

benefit under chapter 11 or 15 of title 38, United States

Code, for which the examination was ordered by the

Department.

(4) Priority processing.—

(A) In general.—Except as provided for in subparagraph

(B), if during a review under paragraph (1) the Secretary

finds any covered medical disability examination to be not

adequate for adjudicating a claim, the Secretary shall ensure

the claimant examined by that examination—

(i) receives another examination, if necessary, on a

priority basis; and

(ii) receives priority processing for the entirety of the

impacted claim.

(B) Exception.—The Secretary is not required to furnish an

additional examination under subparagraph (A) if the

Secretary determines such an examination to be unnecessary

for purposes of adjudicating the claim.

(5) Comptroller general of the united states study.—The

Comptroller General of the United States shall conduct a

review of

the methodology and effectiveness of the review required in

paragraph (1).

(6) Covered medical disability examination defined.—In

this subsection, the term “covered medical disability

examination” means a medical examination or opinion for the

purposes of adjudicating a claim for a benefit under chapter

11 or 15 of title 38, United States Code, regardless of

whether conducted by an employee or a contractor of the

Department.

(d) Review and Plan Regarding Department of Veterans

Affairs Scheduling of Medical Examinations.—

(1) Review required.—Not later than one year after the

date of the enactment of this Act, the Secretary of Veterans

Affairs shall complete a review of scheduling request tools,

contracts, and systems used by employees and contractors of

the Department of Veterans Affairs to order and conduct

medical disability examinations.

(2) Plan required.—Not later than one year after the date

of the enactment of this Act, the Secretary shall submit to

the Committee on Veterans' Affairs of the Senate and the

Committee on Veterans' Affairs of the House of

Representatives a plan to ensure the following:

(A) Systems and processes used by the Department enable

seamless and clear communication of requirements between the

claims processors who request medical disability examinations

and the persons who conduct such examinations, including

through a contract.

(B) Medical disability examiners, including through a

contract, have access to the medical records and claims

information they need to conduct exams that are adequate for

purposes of rating claims for benefits under laws

administered by the Secretary.

examination is requested of the Department have agency in

determining when and where the examination is conducted.

(D) Claimants or appellants for whom a medical disability

examination is requested of the Department have a seamless

experience when scheduling their examinations without regard

to who conducts the examinations.

(E) The Department conducts customer satisfaction and

experience surveys of claimants or appellants who attend

medical disability examinations provided under laws

administered by the Secretary.

SEC. 111. IMPROVEMENTS TO PROCESSING AND OUTREACH REGARDING

CLAIMS INVOLVING MILITARY SEXUAL TRAUMA.

(a) Evaluation of Claims Involving Military Sexual

Trauma.—

(1) In general.—Subchapter VI of chapter 11 of such title

is amended by inserting after section 1166 the following new

section:

“Sec. 1166A. Evaluation of claims involving military sexual

trauma

“(a) Notice and Opportunity to Supply Evidence.—The

Secretary may not deny a claim of a veteran for compensation

under this chapter for military sexual trauma without first—

“(1) advising the veteran of the evidence that would

constitute credible corroborating evidence of the military

sexual trauma; and

“(2) allowing the veteran an opportunity to furnish such

corroborating evidence.

“(b) Point of Contact.—The Secretary shall ensure that

each document provided to a veteran relating to a claim for

compensation under this chapter for a military sexual trauma

includes contact information for an appropriate point of

contact with the Department.

“(c) Specialized Teams.—The Secretary shall ensure that

all claims for compensation under this chapter for a military

sexual trauma are reviewed and processed by a specialized

team established under section 1166 of this title.

“(1) The Secretary shall ensure that not less than

annually, the policies and procedures employed by the

specialized team established under section 1166 of this title

are reviewed by medical or mental health professionals as the

Secretary considers appropriate to determine whether the

current standard of evidentiary review for acceptable

documentation adequately evaluates the likelihood a military

sexual trauma occurred.

“(2) The Secretary shall also conduct periodic quality

reviews of claims processed by the specialized teams

established under section 1166 to identify inconsistencies,

training deficiencies, or procedural shortcomings and

implement corrective actions as appropriate.”.

(2) Outreach.—

(A) In general.—Not later than 180 days after the date of

the enactment of this Act, the Secretary of Veterans Affairs

shall implement, with input from the veteran community, an

informative outreach program for veterans regarding the

standard of proof for evaluation of claims relating to

military sexual trauma, including requirements for a medical

examination and opinion.

(B) Targeted outreach.—In implementing the program under

subparagraph (A), the Secretary shall, to the extent

practicable, target outreach to veterans who submitted a

claim relating to military sexual trauma that was denied.

(3) Clerical amendment.—The table of sections at the

beginning of chapter 11 of such title is amended by inserting

after the item relating to section 1166 the following new

item:

“1166A. Evaluation of claims involving military sexual trauma.”.

(b) Communications From the Department of Veterans Affairs

to Individuals Who Have Experienced Military Sexual Trauma.—

(1) Review working group.—

(A) In general.—The Secretary of Veterans Affairs shall

establish a working group to review correspondence relating

to military sexual trauma.

(B) Membership.—The working group established under

subparagraph (A) shall be composed of members who shall be

appointed by the Secretary from among employees of the

Department of Veterans Affairs who are experts in military

sexual trauma and mental health, of whom—

(i) one or more shall be appointed from among mental health

providers of the Veterans Health Administration;

(ii) one or more shall be appointed from among experts on

sexual assault and sexual harassment of the Veterans Benefits

Administration; and

(iii) one or more shall be appointed from among experts on

sexual assault and sexual harassment of the Board of

Veterans' Appeals.

subparagraph (A) shall—

(i) review standard correspondence, which may include

templates for notices under sections 5103, 5104, 5104B, and

7104 of title 38, United States Code, from the Department to

individuals who have experienced military sexual trauma for

sensitivity; and

(ii) ensure that the correspondence—

(I) treats such individuals with dignity and respect; and

(II) does not re-traumatize such individuals.

(D) Individual who has experienced military sexual trauma

defined.—In this subsection, the term “individual who has

experienced military sexual trauma” means—

(i) an individual who has filed a claim for compensation

under chapter 11 of title 38, United States Code, relating to

military sexual trauma;

(ii) a veteran who has been awarded compensation under such

chapter relating to military sexual trauma; or

(iii) a member of the Armed Forces (including a member of

the National Guard or Reserves), a former member of the Armed

Forces, or a veteran who is receiving care from the

Department relating to military sexual trauma.

(2) Contents of certain written communications to

individuals who have experienced military sexual trauma.—

(A) Notice to claimants of required information and

evidence.—Section 5103 of title 38, United States Code, is

amended by adding at the end the following new subsection:

“(c) Written Communications to Individuals Who Have

Experienced Military Sexual Trauma.—

“(1) The Secretary shall ensure that any written

communication under this section from the Department to an

individual who has experienced military sexual trauma

includes each of the following:

“(A) Contact information for each of the following:

“(i) The military sexual trauma coordinator of the

Veterans Benefits Administration.

“(ii) The military sexual trauma coordinator of the

Veterans Health Administration.

“(iii) The Veterans Crisis Line.

“(iv) The facility of the Veterans Health Administration

closest to where the individual resides.

“(v) The Readjustment Counseling Service location closest

to where the individual resides.

“(B) Information on the eligibility of the individual for

services provided through the Readjustment Counseling Service

location described in subparagraph (A)(v).

“(2) In this subsection:

“(A) The term `individual who has experienced military

sexual trauma' means—

“(i) an individual who has filed a claim for compensation

under chapter 11 of this title relating to military sexual

trauma;

“(ii) a veteran who has been awarded compensation under

such chapter relating to military sexual trauma; or

“(iii) a member of the Armed Forces (including a member of

the National Guard or Reserves), a former member of the Armed

Forces, or a veteran who is receiving care from the

Department relating to military sexual trauma.

“(B) The term `military sexual trauma' has the meaning

given that term in section 1166(d)(2) of this title.

“(C) The term `Veterans Crisis Line' means the toll-free

hotline for veterans established under section 1720F(h) of

this title.”.

(B) Decisions and notices of decisions.—Section 5104 of

title 38, United States Code, is amended by adding at the end

the following new subsection:

“(e)(1) The Secretary shall ensure that any written

communication under this section from the Department to an

individual who has experienced military sexual trauma

includes each of the following:

“(A) Contact information for each of the following:

“(i) The military sexual trauma coordinator of the

Veterans Health Administration.

“(ii) The Veterans Crisis Line.

“(iii) The facility of the Veterans Health Administration

closest to where the individual resides.

“(iv) The Readjustment Counseling Service location closest

to where the individual resides.

“(B) Information on the eligibility of the individual for

services provided through the Readjustment Counseling Service

location described in subparagraph (A)(iv).

“(2) The Secretary shall ensure that any written

communication under this section from the Department to an

individual who has experienced military sexual trauma that

includes notification of an award of compensation under

chapter 11 of this title relating to military sexual trauma

includes—

“(A) the contact information described in paragraph (1);

and

“(B) the contact information for the military sexual

trauma coordinator of the Veterans Benefits Administration.

“(3) In this subsection:

“(A) The term `individual who has experienced military

sexual trauma' means—

“(i) an individual who has filed a claim for compensation

under chapter 11 of this title relating to military sexual

trauma;

“(ii) a veteran who has been awarded compensation under

such chapter relating to military sexual trauma; or

“(iii) a member of the Armed Forces (including a member of

the National Guard or Reserves), a former member of the Armed

Forces, or a veteran who is receiving care from the

Department relating to military sexual trauma.

“(B) The term `military sexual trauma' has the meaning

given that term in section 1166(d)(2) of this title.

“(C) The term `Veterans Crisis Line' means the toll-free

hotline for veterans established under section 1720F(h) of

this title.”.

jurisdiction.—Section 5104B of title 38, United States Code,

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

“(f) Written Communications to Individuals Who Have

Experienced Military Sexual Trauma.—

“(1) The Secretary shall ensure that any written

communication under this section from the Department to an

individual who has experienced military sexual trauma

includes each of the following:

“(A) Contact information for each of the following:

“(i) The military sexual trauma coordinator of the

Veterans Health Administration.

“(ii) The Veterans Crisis Line.

“(iii) The facility of the Veterans Health Administration

closest to where the individual resides.

“(iv) The Readjustment Counseling Service location closest

to where the individual resides.

“(B) Information on the eligibility of the individual for

services provided through the Readjustment Counseling Service

location described in subparagraph (A)(iv).

“(2) The Secretary shall ensure that any written

communication under this section from the Department to an

individual who has experienced military sexual trauma that

includes notification of an award of compensation under

chapter 11 of this title relating to military sexual trauma

includes—

“(A) the contact information described in paragraph (1);

and

“(B) the contact information for the military sexual

trauma coordinator of the Veterans Benefits Administration.

“(3) In this subsection:

“(A) The term `individual who has experienced military

sexual trauma' means—

“(i) an individual who has filed a claim for compensation

under chapter 11 of this title relating to military sexual

trauma;

“(ii) a veteran who has been awarded compensation under

such chapter relating to military sexual trauma; or

“(iii) a member of the Armed Forces (including a member of

the National Guard or Reserves), a former member of the Armed

Forces, or a veteran who is receiving care from the

Department relating to military sexual trauma.

“(B) The term `military sexual trauma' has the meaning

given that term in section 1166(d)(2) of this title.

“(C) The term `Veterans Crisis Line' means the toll-free

hotline for veterans established under section 1720F(h) of

this title.”.

(D) Board of veterans' appeals.—Section 7104 of title 38,

United States Code, is amended by adding at the end the

following new subsection:

“(g)(1) The Secretary shall ensure that any written

communication under this section from the Department to an

individual who has experienced military sexual trauma

includes each of the following:

“(A) Contact information for each of the following:

“(i) The military sexual trauma coordinator of the

Veterans Health Administration.

“(ii) The Veterans Crisis Line.

“(iii) The facility of the Veterans Health Administration

closest to where the individual resides.

“(iv) The Readjustment Counseling Service location closest

to where the individual resides.

“(B) Information on the eligibility of the individual for

services provided through the Readjustment Counseling Service

location described in subparagraph (A)(iv).

“(2) The Secretary shall ensure that any written

communication under this section from the Department to an

individual who has experienced military sexual trauma that

includes notification of an award of compensation under

chapter 11 of this title relating to military sexual trauma

includes—

“(A) the contact information described in paragraph (1);

and

“(B) the contact information for the military sexual

trauma coordinator of the Veterans Benefits Administration.

“(3) In this subsection:

“(A) The term `individual who has experienced military

sexual trauma' means—

“(i) an individual who has filed a claim for compensation

under chapter 11 of this title relating to military sexual

trauma;

“(ii) a veteran who has been awarded compensation under

such chapter relating to military sexual trauma; or

“(iii) a member of the Armed Forces (including a member of

the National Guard or Reserves), a former member of the Armed

Forces, or a veteran who is receiving care from the

Department relating to military sexual trauma.

“(B) The term `military sexual trauma' has the meaning

given that term in section 1166(d)(2) of this title.

“(C) The term `Veterans Crisis Line' means the toll-free

hotline for veterans established under section 1720F(h) of

this title.”.

Disability Compensation Relating to Military Sexual Trauma.—

(1) Study required.—The Secretary of Veterans Affairs

shall conduct a study on—

(A) the quality of training provided to personnel of the

Department of Veterans Affairs who review claims for

disability compensation under chapter 11 of title 38, United

States Code, for disabilities relating to military sexual

trauma; and

(B) the quality of the procedures of the Department for

reviewing the accuracy of the processing of such claims.

(2) Elements.—The study required by subsection (a) shall

include the following:

(A) With respect to the quality of training described in

paragraph (1) of such subsection:

(i) Whether the Department ensures personnel complete such

training on time.

(ii) Whether the training has resulted in improvements to

the processing of claims described in such subsection and

issue-based accuracy.

(iii) Such recommendations as the Secretary may have for

improving the training.

(B) With respect to the quality of procedures described in

paragraph (2) of such subsection:

(i) Whether the procedures of the Department for reviewing

the accuracy of the processing of claims described in such

subsection comport with generally accepted statistical

methodologies to ensure reasonable accuracy of such reviews.

(ii) Whether such procedures adequately include mechanisms

to correct errors found in such reviews.

(iii) A summary of quality assurance reviews and reports

conducted as part of such procedures.

(iv) Such recommendations as the Secretary may have for

improving such procedures.

(3) Report required.—Not later than one year after the

date of the enactment of this Act, the Secretary shall submit

to the Committee on Veterans' Affairs of the Senate and the

Committee on Veterans' Affairs of the House of

Representatives a report detailing the findings of the

Secretary with respect to the study conducted under paragraph

(1).

(d) Annual Special Focus Review of Claims for Disability

Compensation for Disabilities Relating to Military Sexual

Trauma.—

(1) Annual special focus review.—

(A) In general.—Each year, the Under Secretary for

Benefits of the Department of Veterans Affairs shall conduct

a special focus review on the accuracy of the processing of

claims for disability compensation under chapter 11 of title

38, United States Code, for disabilities relating to military

sexual trauma.

(B) Elements.—Each review conducted under subparagraph (A)

shall include a review of the following:

(i) A statistically significant, nationally representative

sample of all claims for benefits under the laws administered

by the Secretary of Veterans Affairs relating to military

sexual trauma filed during the fiscal year preceding the

fiscal year in which the report is submitted.

(ii) The accuracy of each decision made with respect to

each claim described in clause (i).

(iii) The types of benefit entitlement errors found,

disaggregated by category.

(iv) Trends from year to year.

(v) Training completion rates for personnel of the

Department who process claims described in subparagraph (A).

(2) Reprocessing of claims.—If the Under Secretary finds,

pursuant to a special focus review conducted under paragraph

(1)(A), that an error was made with respect to the

entitlement of a veteran to a benefit under the laws

administered by the Secretary, the Secretary shall return the

relevant claim of the veteran to the appropriate office of

the Department for reprocessing to ensure that the veteran

receives an accurate decision with respect to the claim.

(3) Report.—Section 5501(b) of the Johnny Isakson and

David P. Roe, M.D. Veterans Health Care and Benefits

Improvement Act

of 2020 (Public Law 116-315; 134 Stat. 5048) is amended—

(A) in paragraph (1), by striking “through 2027” and

inserting “until the day described in section 109(d)(4) of

the Take Care of America's Veterans Act”; and

(B) in paragraph (2), by adding at the end the following

new subparagraph:

“(I) The findings of the most recent special focus review

conducted under subsection (d)(1)(A) of section 109 of the

Take Care of America's Veterans Act, including—

“(i) the elements under subsection (d)(1)(B) of such

section;

“(ii) the number of claims returned for reprocessing under

subsection (d)(2) of such section; and

“(iii) the number of claims described in clause (ii) for

which the decision relating to service-connection or

entitlement to compensation changed as a result of

reprocessing the claim.”.

(4) Sunset.—On the date that is 5 years after the

enactment of this Act, paragraph (1)(A) shall cease to be in

effect.

(e) Working Group on Medical Examinations for Claims for

Disability Compensation for Disabilities Relating to Military

Sexual Trauma.—

(1) In general.—Not later than 90 days after the date of

the enactment of this Act, the Secretary of Veterans Affairs

shall establish a working group on medical examinations for

claims for disability compensation under chapter 11 of title

38, United States Code, for disabilities relating to military

sexual trauma (in this section referred to as the “working

group”).

(2) Membership.—The working group shall be composed of the

following:

(A) Staff of the operations center for military sexual

trauma of the Department of Veterans Affairs who have

experience reviewing the quality of medical examinations in

support of claims for disability compensation under chapter

11 of title 38, United States Code.

(B) Staff of the Medical Disability Examination Office of

the Department.

claims described in paragraph (1).

(D) Medical examiners who have experience with such claims.

(E) Staff of the Veterans Experience Office of the

Department.

(F) Such other individuals as the Secretary considers

appropriate.

(3) Duties.—Not later than 180 days after the date of the

enactment of this Act, the working group shall—

(A) review the quality of medical examinations described in

paragraph (1);

(B) review the feasibility of minimizing re-examinations

for conditions relating to military sexual trauma; and

Department and the Secretary recommendations on how to—

(i) eliminate re-traumatization of individuals who file

claims described in paragraph (1); and

(ii) reduce the overdevelopment of such claims.

(4) Report.—Not later than one year after the date of the

enactment of this Act, the Secretary shall submit to Congress

a report that includes the following:

(A) The views of the working group on efforts by the

Department to eliminate re-traumatization of individuals who

file claims described in subsection (a).

(B) Legislative proposals to improve the experience of such

individuals in pursuing such claims.

(D) The plan of the Under Secretary for Benefits of the

Department and the Secretary to implement such

recommendations.

(5) Review and implementation.—Not later than one year

after the date of the enactment of this Act, the Under

Secretary for Benefits of the Department and the Secretary

shall—

(A) review the recommendations submitted under paragraph

(3)(C); and

(B) implement the recommendations that, as determined by

the Under Secretary and the Secretary, would improve the

claims process for individuals who file claims described in

paragraph (1).

(f) Military Sexual Trauma Claims Performance Dashboard.—

(1) Establishment.—The Secretary of Veterans Affairs shall

establish an interactive performance dashboard displaying

information about claims relating to military sexual trauma

submitted to the Secretary for benefits under laws

administered by the Secretary.

(2) Elements.—The dashboard established pursuant to

paragraph (1) shall cover the following:

(A) Claims relating to military sexual trauma submitted to

the Secretary for benefits under laws administered by the

Secretary that have been submitted, completed, or appealed,

including appeals pending at the agency of jurisdiction and

at the Board of Veterans' Appeals.

(B) For comparison purposes with subparagraph (A), claims

not relating to military sexual trauma submitted to the

Secretary for benefits under laws administered by the

Secretary that have been submitted, completed, or appealed.

relating to military sexual trauma submitted to the Secretary

for benefits under laws administered by the Secretary,

including the following:

(i) Average number of days a claim is pending review.

(ii) Average number of days for completed adjudication.

(iii) Total number of pending claims, disaggregated by

whether the claims have been partially adjudicated or not

adjudicated at all.

(iv) Total number of claims completely adjudicated.

(v) Of the number specified in clause (iv), the percentage

that were approved, denied, or appealed.

(D) The total number of claims relating to military sexual

trauma submitted to the Secretary for benefits under laws

administered by the Secretary.

(E) The methods used for submittal of claims relating to

military sexual trauma to the Secretary for benefits under

laws administered by the Secretary.

(F) The most frequent reasons the Secretary denies a claim

relating to military sexual trauma submitted to the Secretary

for a benefit under a law administered by the Secretary.

(G) The most frequent conditions or disabilities for which

a claim relating to military sexual trauma is denied.

(H) The most frequent conditions or disabilities for which

a claim relating to military sexual trauma is submitted to

the Secretary for disability compensation under chapter 11 of

title 38, United States Code, including the grant rate for

such contentions.

(3) Additional resource information.—The Secretary shall

make available via the performance dashboard established

pursuant to subsection (a) the following information:

(A) Veterans Crisis Line contact information.

(B) Information regarding the availability of services from

military sexual trauma coordinators of the Veterans Health

Administration.

military sexual trauma coordinators of the Veterans Benefits

Administration.

(D) Information on availability of specialized care,

services, and benefits from the Department for individuals

who have experienced military sexual trauma.

(E) Such additional information as the Secretary considers

appropriate.

(4) Availability.—The Secretary shall ensure that the

dashboard established pursuant to paragraph (1) is available

to the public from the website of the Department of Veterans

Affairs and is updated not less frequently than once every 30

days.

(5) Reporting requirements.—(A) Not later than 2 years

after the date of the enactment of this Act, the Secretary

shall submit to the Committee on Veterans' Affairs of the

Senate and the Committee on Veterans' Affairs of the House of

Representatives a report detailing—

(i) the annual cost to implement the dashboard required by

paragraph (2);

(ii) areas for improvement of the dashboard; and

(iii) such additional information as the Secretary

considers appropriate.

(B) Not later than 180 days after the date of the enactment

of this Act, the Secretary shall commence providing, on a

quarterly basis, to the Committee on Veterans' Affairs of the

Senate and the Committee on Veterans' Affairs of the House of

Representatives a quarterly briefing on the Department's

processing of military sexual trauma-related claims.

(6) Definition.—In this section, the term “military

sexual trauma” has the meaning given such term in section

1166(d)(2) of title 38, United States Code.

SEC. 112. INDEPENDENT ASSESSMENT OF NOTICES THAT THE

SECRETARY OF VETERANS AFFAIRS SENDS TO

CLAIMANTS.

(a) Agreement.—Not later than 30 days after the date of

the enactment of this Act, the Secretary of Veterans Affairs

shall seek to enter into an agreement with an FFRDC for an

assessment of notices that the Secretary sends to claimants.

(b) Assessment.—An FFRDC that enters into an agreement

under subsection (a) shall submit to the Secretary a written

assessment of such notices. The assessment shall include the

following:

(1) The determination of the FFRDC, made in consultation

with covered entities, whether each such notice may be

feasibly altered to reduce paper consumption by, and costs

to, the Federal Government.

(2) The recommendations of the FFRDC regarding how the

Secretary may make such notices clearer to claimants, better

organized, and more concise.

the Secretary receives the assessment under subsection (b),

the Secretary shall—

(1) submit to the Committees on Veterans' Affairs of the

Senate and House of Representatives a copy of such

assessment; and

(2) implement the recommendations in the assessment that

are in compliance with the laws administered by the

Secretary.

(d) Deadline for Implementation.—The Secretary shall

complete the implementation of such recommendations pursuant

to subsection (c)(2) by not later than one year after the

date on which the Secretary commences such implementation.

(e) Definitions.—In this section:

(1) The term “FFRDC” means a federally funded research

and development center.

(2) The term “covered entities” includes—

(A) the Secretary of Veterans Affairs;

(B) an expert in laws administered by the Secretary of

Veterans Affairs;

section 5902 of title 38, United States Code;

(D) an entity that advocates for veterans; and

(E) an entity that advocates for the survivors of veterans.

(3) The terms “claimant” and “notice” have the meanings

given such terms in section 5100 of title 38, United States

Code.

SEC. 113. INDEPENDENT ASSESSMENT OF FORMS THAT THE SECRETARY

OF VETERANS AFFAIRS SENDS TO CLAIMANTS.

(a) Agreement.—Not later than 30 days after the date of

the enactment of this Act, the Secretary of Veterans Affairs

shall seek to enter into an agreement with an FFRDC for an

assessment of forms that the Secretary sends to claimants.

(b) Assessment.—An FFRDC that enters into an agreement

under subsection (a) shall submit to the Secretary a written

assessment, made in consultation with covered entities, of

such forms. The assessment shall include the recommendations

of the FFRDC regarding how the Secretary may make such forms

clearer to claimants and better organized.

the Secretary receives the assessment under subsection (b),

the Secretary shall—

(1) submit to the Committees on Veterans' Affairs of the

Senate and House of Representatives a copy of such

assessment; and

(2) implement the recommendations in the assessment that

are in compliance with the laws administered by the

Secretary.

(d) Deadline for Implementation.—The Secretary shall

complete the implementation of such recommendations pursuant

to subsection (c)(2) by not later than two years after the

date on which the Secretary commences such implementation.

(e) Definitions.—In this section:

(1) The term “FFRDC” means a federally funded research

and development center.

(2) The term “covered entities” includes—

(A) the Secretary of Veterans Affairs;

(B) an expert in laws administered by the Secretary of

Veterans Affairs;

section 5902 of title 38, United States Code;

(D) an entity that advocates for veterans; and

(E) an entity that advocates for survivors of veterans.

(3) The term “claimant” has the meaning given such term

in section 5100 of title 38, United States Code.

TITLE II—EDUCATION AND ECONOMIC OPPORTUNITY

SEC. 201. VETS OPPORTUNITY ACT.

(a) Repayment of Members of the Armed Forces for

Contributions Towards Post-9/11 Educational Assistance:

Timing; Mechanism for Individuals Not Eligible for a Monthly

Housing Stipend.—

(1) In general.—Subsection (f) of section 3327 of title

38, United States Code, is amended—

(A) in paragraph (3), by striking “together” and all that

follows through “before” and inserting “not later than 60

days after”; and

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

“(4) Additional assistance for an individual not eligible

for a monthly housing stipend.—In the case of an individual

making an election under subsection (a) who is described by

subparagraph (A), (C), or (E) of paragraph (1) of that

subsection, and who is not eligible for a monthly stipend

payable under section 3313(c) of this title, the educational

assistance payable to the individual under this chapter shall

be paid—

“(A) in a lump sum calculated by multiplying—

“(i) the total amount of contributions described in

paragraph (1)(A) with regards to such individual; and

“(ii) the sum of the number of months described in

subclauses (I) and (II) of paragraph (1)(B)(i) with regards

to such individual; and

“(B) to the individual not later than 60 days after the

exhaustion of the individual's entitlement to educational

assistance under this chapter.”.

(2) Technical corrections and conforming amendment.—Such

subsection is further amended—

(A) by striking “paragraphs (2) through (7)” and

inserting “paragraphs (2) through (6)”; and

(B) in paragraph (1), in the heading, by inserting “for an

individual eligible for a monthly housing stipend” after

“Additional assistance”.

(3) Effective date.—The amendments made by this section

shall take effect on August 1, 2027.

(b) Treatment of Certain Independent Study Programs Under

Educational Assistance Programs of Department of Veterans

Affairs.—

(1) In general.—Section 3680A(a)(4)(A)(ii)(III) of such

title is amended—

(A) by inserting “that requires regular and substantive

interaction between students and instructors” after “course

of study”;

(B) in item (aa), by striking “; or” and inserting a

semicolon;

or”; and

(D) by adding at the end the following new item:

“(cc) an institution of higher education, as such term is

defined in section 102 of the Higher Education Act of 1965

(20 U.S.C. 1002), that is approved to participate or is

participating in the student financial assistance programs

authorized by title IV of that Act; and”.

(2) Applicability.—The amendment made by paragraph (1)

shall apply with respect to a quarter, semester, or term, as

applicable, that begins on or after August 1, 2027.

(3) Oversight.—During the first six years beginning on the

date of enactment of this Act, the Secretary, in coordination

with State approving agencies, shall, every two years,

conduct risk-based surveys or reviews of institutions

approved pursuant to section 3680A(a)(4)(A)(ii)(III)(cc) of

title 38, United States Code, as added by paragraph (1).

(4) GAO report.—Not later than 3 years after the date of

enactment of this Act, the Comptroller General of the United

States shall submit to the Committees on Veterans' Affairs of

the Senate and the House of Representatives a report on the

oversight and implementation of the amendments made by

paragraph (1), including—

(A) the effectiveness of oversight activities conducted by

the Department of Veterans Affairs and State approving

agencies;

(B) institutional compliance with applicable requirements

under chapter 36 of title 38, United States Code;

programs approved pursuant to section

3680A(a)(4)(A)(ii)(III)(cc) of such title, as added by

paragraph (1); and

(D) any recommendations to improve oversight, program

integrity, or educational outcomes for veterans.

(5) Applicability.—To the extent practicable for any

program requiring practical, laboratory, clinical, shop, or

hands on competencies, the online portion of instruction may

not substitute for the supervised in person training

necessary to demonstrate such competencies.

Service.—

(1) Options.—Section 3691A of such title is amended by

striking paragraph (1) of subsection (a) and inserting the

following:

“(1) A covered member may, after receiving orders to enter

a period of covered service—

“(A) withdraw from covered education;

“(B) take a leave of absence from covered education; or

“(C) subject to subsection (d), enter into an agreement

with the institution concerned to complete a course of

covered education to the satisfaction of such institution

concerned.”.

(2) Conforming amendment.—Such subsection is further

amended, in paragraph (2)(A), by striking “or takes a leave

of absence” and inserting “, takes a leave of absence, or

enters into an agreement”.

(3) Agreement.—Such section is further amended—

(A) by redesignating subsection (d) as subsection (e); and

(B) by inserting, after subsection (c), the following new

subsection (d):

“(d) Agreement With Institution Concerned.—A covered

member may enter into an agreement under subsection (a) only

if the covered member has completed at least half of a course

of covered education.”.

(4) Section heading.—Such section is further amended by

striking the heading and inserting “Absence from certain

education due to certain service”.

(5) Table of sections.—The table of sections at the

beginning of chapter 36 of such title is amended by striking

the item relating to section 3691A and inserting the

following new item:

“3691A. Absence from certain education due to certain service.”.

(d) Department of Veterans Affairs Compliance Surveys.—

Section 3693 of such title is amended—

(1) in subsection (c)—

(A) by striking “not more than 10 business days of

notice”;

(B) by striking “this section.” and inserting “this

section—”; and

“(1) in the case of an educational institution or training

establishment with a time stamp database collection feature,

not fewer than 10, and not more than 15, business days of

notice; and

“(2) in the case of any other educational institution or

training establishment, not more than 10 business days of

notice.”; and

(2) by striking subsection (d) and inserting the following

new subsection (d):

“(d) Definitions.—In this section:

“(1) The terms `educational institution' and `training

establishment' have the meanings given such terms in section

3452 of this title.

“(2) The term `school certifying official' means an

employee of an educational institution with primary

responsibility for certifying veteran enrollment at the

educational institution.”.

(e) Notification of School Certifying Officials of Handbook

Updates.—

(1) In general.—Not later than 14 business days after

updating the school certifying official handbook of the

Department of Veterans Affairs, the Secretary of Veterans

Affairs shall provide notice to all school certifying

officials of such update.

(2) School certifying official defined.—The term “school

certifying official” means

an employee of an educational institution with primary

responsibility for certifying veteran enrollment at the

educational institution.

SEC. 202. IMPROVEMENTS TO PROCESS FOR MAKING PAYMENTS TO

AUTOMOBILE SELLERS FOR AUTOMOBILES PURCHASED

FOR CERTAIN DISABLED VETERANS.

(a) Timeliness of Payments.—Section 3902 of title 38,

United States Code, is amended, in subsection (a)—

(1) by inserting “(1)” before “The Secretary”; and

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

“(2) The Secretary shall—

“(A) make payments under this section in compliance with

regulations prescribed under section 3903(a) of title 31,

except that no interest penalties shall be required to be

paid under this section; and

“(B) in the case of any payment under this section that is

not processed during the period of 30 days following receipt

by the Secretary of the final invoice for such payment, the

Secretary shall publish in the Federal Register the number of

days required to process the payment.”.

(b) Centralization of Process for Making Payments.—Such

section is amended by adding at the end the following new

subsection:

“(f)(1) The Secretary shall process payments under this

section through one office of the Department that the

Secretary determines has the capacity and expertise to make

such payments in compliance with regulations described in

subsection (a)(2).

“(2) The Secretary shall accurately track and resolve

payments due to sellers under this section that are more than

90 days overdue.”.

submit to the Committees on Veterans' Affairs of the Senate

and the House of Representatives, and publish on a publicly

accessible website of the Department of Veterans Affairs,

four semiannual reports after the date of the enactment of

this Act, regarding the administration of section 3902 of

title 38, United States Code, as amended by this section.

Each such report shall include, with respect to the period of

six months preceding the date of the report, the following

elements:

(1) The average and median number of days between receipt

of an invoice for payment under such section by the Claims

Intake Center of the Department and the day when the

Secretary makes such payment, disaggregated by whether the

claim was under review or being processed by—

(A) the Veterans Health Administration;

(B) the Veterans Benefits Administration; or

(2) Improvements to information technology of the

Department that the Secretary determines would reduce the

time required for such review or processing.

(d) GAO Report; Briefing.—

(1) Report.—Not later than 180 days after the date on

which the Secretary completes centralization under subsection

(f) of section 3902 of title 38, United States Code, as added

by this section, the Comptroller General of the United States

shall review such centralization and publish a report

containing the results of such review. Such report shall

include the determinations of the Comptroller General

regarding the following:

(A) The capacity of the office determined by the Secretary

under such subsection, to carry out processing described in

such subsection, including—

(i) a comprehensive assessment of employees of the

Department who carry out chapter 39 of such title;

(ii) a comprehensive skills assessment indicating what

resources the Secretary requires to otherwise improve such

centralization, including additional funds, employees, or

contractors; and

(iii) a review of systems of information technology,

including systems in use or to be acquired, to carry out such

centralization.

(B) Recommendations to improve such processing.

recommendations.

(2) Briefing.—Not later than 30 days after publishing the

report under paragraph (1), the Comptroller General shall

provide to the Committees on Veterans' Affairs of the House

of Representatives and the Senate a briefing on such report.

Such briefing shall include any response from the Secretary

to the Comptroller General regarding the recommendations in

the report.

SEC. 203. MONTHLY HOUSING STIPEND UNDER THE POST-9/11

EDUCATIONAL ASSISTANCE PROGRAM FOR INDIVIDUALS

WHO PURSUE SUMMER PROGRAMS OF EDUCATION SOLELY

THROUGH DISTANCE LEARNING.

(a) In General.—Section 3313(c)(1)(B) of title 38, United

States Code, is amended—

(1) in clause (i), by striking “and (iii)” and inserting

“, (iii), and (iv)”;

(2) by redesignating clause (iv) as clause (v); and

(3) by inserting after clause (iii) the following new

clause (iv):

“(iv) In the case of an individual pursuing, solely

through distance learning, a program of education that is

shorter than 12 weeks during the summer, for each month the

individual pursues the program of education, a monthly

housing stipend equal to the product of—

“(I) the national average of the monthly amount of the

basic allowance for housing payable under section 403 of

title 37 for a member with dependents in pay grade E-5,

multiplied by

“(II) the lesser of—

“(aa) 1.0 and

“(bb) the number of course hours borne by the individual

in pursuit of the program of education, divided by the

minimum number of course hours required for full-time pursuit

of the program of education, rounded to the nearest multiple

of 10.”.

(b) Effective Date.—The amendments made by subsection (a)

shall apply to a program of education beginning on or after

August 1, 2027.

SEC. 204. CLARIFICATION REGARDING INCLUSION OF MEDICALLY

NECESSARY AUTOMOBILE ADAPTATIONS IN DEPARTMENT

OF VETERANS AFFAIRS DEFINITION OF “MEDICAL

SERVICES”.

Section 1701(6)(I) of title 38, United States Code, is

amended to read as follows:

“(I) The provision of any medically necessary automobile

adaptations for driver or passenger use, including—

“(i) ramp and kneeling systems;

“(ii) raised doors or lowered floors;

“(iii) raised roofs;

“(iv) air conditioning;

“(v) occupied and unoccupied mobility lifts;

“(vi) ingress or egress accessibility modifications;

“(vii) wheelchair tiedowns; and

“(viii) adapted seating.”.

SEC. 205. DIGITAL COMMUNICATIONS: SOLID START PROGRAM;

EDUCATIONAL ASSISTANCE.

(a) Improvement to Certain Outreach Under Solid Start

Program of Department of Veterans Affairs.—Section 6320(b)

of title 38, United States Code, is amended—

(1) in paragraph (1)(B)—

(A) by striking “calling” and inserting “communicating

with”; and

(B) by inserting “through the use of tailored lines of

communication, including mailings, text messaging, virtual

chatting, and other electronic forms of messaging” after

“Armed Forces”; and

(2) in paragraph (2), by striking “tailored mailings” and

inserting “tailored lines of communication, including

mailings, text messaging, virtual chatting, and other

electronic forms of messaging,”.

(b) Department of Veterans Affairs Use of Tailored Lines of

Communication for Correspondence Relating to Educational

Assistance Benefits.—Section 3680 of title 38, United States

Code, is amended by adding at the end the following new

subsection:

“(i) Mechanism for Tailored Lines of Communication.—(1)

The Secretary shall provide a mechanism by which an eligible

veteran or eligible person may use tailored lines of

communication to send and receive correspondence with the

Department related to entitlement to and use of educational

assistance benefits under the laws administered by the

Secretary. The Secretary shall ensure that an eligible

veteran or eligible person is provided with an opportunity to

opt into sending and receiving such correspondence using such

lines of communication rather than by mail.

“(2) The Secretary shall provide to eligible veterans and

eligible persons who are enrolled in a course or program of

education or training notice of the opportunity to opt in to

sending and receiving correspondence using tailored lines of

communication pursuant to paragraph (1).

“(3) In this subsection, the term `tailored lines of

communication' includes mailings, text messaging, virtual

chatting, and other electronic forms of messaging.”.

SEC. 206. IMPROVEMENTS TO TRANSITION ASSISTANCE PROGRAM AND

SKILLBRIDGE.

(a) Transition Assistance Program: Amendments; Pilot

Program; Reports.—

(1) Special operations forces.—Subsection (a) of section

1142 of title 10, United States Code, is amended, in

paragraph (1), by inserting “(including each member of the

special operations forces)” after “armed forces”.

(2) Requirement of preseparation counseling: number of

days.—Such subsection is further amended, in paragraph (1)—

(A) by inserting “(A)” before “Within”; and

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

“(B) The Secretary concerned shall ensure that a member

described in subparagraph (A) receives preseparation

counseling in the following amounts:

“(i) In the case of a member who has accepted an offer of

full-time employment, or has enrolled in a program of

education or vocational training, that shall commence after

the member separates, retires, or is discharged, not fewer

than three days.

“(ii) In the case of a member other than a member

described in clause (i), not fewer than five days.”.

(3) Repeat attendance.—Such subsection is further amended

by adding at the end the following new paragraph:

“(6) A member who received preseparation counseling under

this section may, before separation, retirement, or

discharge, request to receive, on a space-available basis,

such preseparation counseling a second time.”.

(4) Pathways: standardization; establishment of pathway for

members of the reserve components.—Such section is further

amended, in paragraph (1) of subsection (c), in the matter

preceding subparagraph (A)(1)—

(A) by striking “Each Secretary concerned” and inserting

“The Secretaries of Defense and Homeland Security”; and

(B) by striking “pathways for members of the military

department concerned” and inserting “pathways, standardized

across the armed forces”.

(5) Pathways: record of pathway assignment.—Such

subsection is further amended by adding at the end the

following new paragraph:

“(4) The Secretary concerned shall ensure that the pathway

in which a member is placed, and the reasons for such

placement, are noted in the service record of such member.”.

(6) Coordination between departments of defense, veterans

affairs, and labor.—Such section is further amended, in

subsection (d)—

(A) by striking the heading and inserting “Transmission of

Certain Information to Other Departments”;

(B) by inserting “(1)” before “In the case”; and

“(2) Before a member described in subsection (a)

separates, retires, or is discharged, the Secretary concerned

shall transmit to the Secretary of Veterans Affairs the

Department of Defense Form DD-2648 regarding such member.

“(3)(A) Before a member described in subsection

(a)(1)(B)(ii) separates, retires, or is discharged, the

Secretary concerned shall provide such member with the

contact information of an employee of the Department of

Veterans Affairs and an employee of the Department of Labor;

and

“(B) Each employee described in subparagraph (A) shall

contact the member described in such subparagraph not later

than 60 days after such member separates, retires, or is

discharged.

“(C) The Secretary of Veterans Affairs and the Secretary

of Labor shall each submit to the Committees on Armed

Services and on Veterans' Affairs of the Senate and House of

Representatives an annual report that identifies the number

of times, and reasons why, an employee of the department

under the jurisdiction of such Secretary failed to carry out

subparagraph (B) in the year preceding the date of the

report.”.

(7) Report.—Not later than two years after the date of the

enactment of this Act and annually thereafter for four years,

the Secretary of Defense shall submit to the Committees on

Armed Services, and the Committees on Veterans' Affairs, of

the Senate and House of Representatives, a report on data

recorded with such tracking system during the year preceding

the date of such report. Such a report shall include a list

of the seven military installations located inside the

continental United States, and three military installations

located outside the continental United States, where members

are least likely to receive preseparation counseling in

accordance with such time periods. Such a report shall also

include the following.

(A) The number of members who, in the course of such

preseparation counseling, were referred to another Federal

agency or department.

(B) The Federal agencies or departments to which members

were so referred.

not, so referred, and reasons why such referrals did not

occur.

(D) The number of members who receive such preseparation

counseling and apply for unemployment compensation under

subchapter II of chapter 85 of title 5, United States Code.

(E) The total amount of such unemployment compensation paid

to members separating from the Armed Forces.

(8) Contracting: standardization.—Such section is further

amended by adding at the end the following new subsection:

“(f) Contracting.—A Secretary concerned may enter into an

agreement with an entity under which such entity shall

provide preseparation counseling under this section. If more

than one Secretary seeks to enter into such an agreement,

such Secretaries concerned shall, to the extent practicable,

seek to enter into such agreements with the same entity.”.

(b) Skillbridge: GAO Study.—

(1) Study required.—The Comptroller General of the United

States shall conduct a study of the Skillbridge programs

under section 1143(e) of title 10, United States Code.

(2) Report.—Not later than two years after the date of the

enactment of this Act, the Comptroller General shall submit

to the Committees on Armed Services, and the Committees on

Veterans' Affairs, of the Senate and House of

Representatives, a report regarding such study. Such report

shall include observations and recommendations of the

Comptroller General regarding, with respect to members and

employers who participate in Skillbridge—

(A) differences in criteria for participation between the

Armed Forces;

(B) other differences in Skillbridge programs between the

Armed Forces;

Forces, including—

(i) the selection of employers; and

(ii) the development of contracts; and

(D) the feasibility of making Skillbridge programs uniform

across the Armed Forces.

SEC. 207. TRANSITION ASSISTANCE PROGRAM: PRESENTATION IN

PRESEPARATION COUNSELING TO PROMOTE BENEFITS

AVAILABLE TO VETERANS.

(a) In General.—Section 1142(b) of title 10, United States

Code, is amended by adding at the end the following new

paragraph:

“(20) A presentation that promotes the benefits available

to veterans under the laws administered by the Secretary of

Veterans Affairs. Such presentation—

“(A) shall be standardized;

“(B) shall, before implementation, be reviewed and

approved by the Secretary of Veterans Affairs and Secretary

of Defense in collaboration with veterans service

organizations that provide claims assistance under the

benefits delivery at discharge program of the Department of

Veterans Affairs;

“(C) shall be submitted by the Secretary of Veterans

Affairs to the Committees on Veterans' Affairs and Armed

Services of the Senate and the House of Representatives for

review at least 90 days before implementation;

“(D) where available, shall be presented with the

participation of—

“(i) an employee or representative of the Department of

Veterans Affairs assisted by a representative of a veterans

service organization recognized under section 5902 of title

38; or

“(ii) an employee or representative of the Department of

Veterans Affairs assisted by an individual recognized under

section 5903 of such title and authorized by the Secretary

concerned to so participate;

“(E) shall include information on how a veterans service

organization may assist the member in filing a claim

described in paragraph (19);

“(F) may not encourage the member to join a particular

veterans service organization; and

“(G) may not be longer than one hour.”.

(b) Annual Report.—Not less frequently than once each year

after the date of the enactment of this Act, the Secretary of

Veterans Affairs shall submit, to the Committees on Armed

Services of the Senate and House of Representatives, and to

the Committees on Veterans' Affairs of the Senate and House

of Representatives, a report that—

(1) identifies each veterans service organization that

participated in a presentation under paragraph (20) of

section 1142(b) of title 10, United States Code, as added by

subsection (a);

(2) contains the number of members of the Armed Forces who

attended such presentations; and

(3) includes any recommendations of the Secretary regarding

changes to such presentation or to such paragraph.

SEC. 208. ELIMINATION OF REQUIREMENT THAT ON-CAMPUS

EDUCATIONAL AND VOCATIONAL COUNSELING IS

PROVIDED BY CERTAIN DEPARTMENT OF VETERANS

AFFAIRS EMPLOYEES.

(a) In General.—Section 3697B(a) of title 38, United

States Code, is amended—

(1) by striking the second sentence;

(2) by inserting “(1)” before “The Secretary”; and

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

“(2) Any individual providing services under paragraph (1)

on behalf of the Department who is not an employee of the

Department shall be subject to the same oversight, training,

and accountability standards applicable to Department

employees providing such services.”.

(b) Expansion of VetSuccess on Campus Program to at Least

One Location in Each State.—

(1) In general.—The Secretary of Veterans Affairs shall

ensure that the VetSuccess on Campus program of the

Department of Veterans Affairs is located in every State.

(2) Counselors.—In carrying out paragraph (1), the

Secretary shall ensure that at least one counselor of the

VetSuccess on Campus program is located in each State,

notwithstanding the number of individuals in a State or at an

educational institution who may qualify to participate in the

program.

(3) Preference.—In carrying out this section, the

Secretary shall give preference to educational institutions

that have the largest populations of students who are

pursuing programs of education at such institutions with

educational assistance provided under laws administered by

the Secretary.

(4) State defined.—In this section, the term “State” has

the meaning given such term in section 101 of title 38,

United States Code.

SEC. 209. EXPANSION OF ENTITLEMENT FOR PAYMENT FOR LICENSING

OR CERTIFICATION TESTS FOR VETERANS ENTITLED TO

EDUCATIONAL ASSISTANCE.

Section 3315 of title 38, United States Code, is amended—

(1) in subsection (a), by striking “educational assistance

under this chapter” and inserting “covered assistance”;

(2) in subsection (b)(3), by striking “under this

chapter” and inserting “with respect to covered

assistance”;

(3) in subsection (c), in the matter preceding paragraph

(1), by striking “under this chapter” and inserting “with

respect to covered assistance”; and

(4) by adding at the end the following new subsection:

“(d) Warnings.—Before providing any payment to or on

behalf of an individual described in subsection (a), the

Secretary shall provide notice to the individual a warning

that use of entitlement under this section for a licensing or

certification test may not lead to a license or

certification.

“(e) Covered Assistance Defined.—In this section, the

term `covered assistance' means educational assistance

available under—

“(1) this chapter, chapter 30 of this title, chapter 35 of

this title, or chapter 1606 of title 10; or

“(2) any other provision of law providing educational

assistance to a veteran, or to another individual in

connection with the service of a veteran in the Armed

Forces.”.

SEC. 210. INCREASE OF AMOUNT OF EDUCATIONAL ASSISTANCE PAID

BY THE SECRETARY OF VETERANS AFFAIRS FOR FIRST

YEAR OF A FULL-TIME PROGRAM OF APPRENTICESHIP

OR OTHER ON-JOB TRAINING.

Section 3313(g)(3)(B) of title 38, United States Code, is

amended—

(1) in the matter preceding clause (i), by inserting

“using educational assistance under this chapter”; and

(2) in clause (i)(II), by striking “80 percent” and

inserting “100 percent”.

SEC. 211. IMPROVING EMERGING TECHNOLOGY OPPORTUNITIES FOR

VETERANS.

(a) Inclusion of Emerging Technologies in High Technology

Program.—

(1) In general.—Section 3699C of title 38, United States

Code, is amended—

(A) in the section heading by striking “High technology”

and inserting “High technology and emerging technology”;

(B) by striking “high technology” and inserting “high

technology or emerging technology” each place such term

appears; and

new subparagraph:

“(E) Such criteria shall also identify which technologies

of critical importance, such as artificial intelligence and

semiconductor manufacturing, shall be treated as emerging

technologies for purposes of this section.”.

(2) Clerical amendment.—The table of sections at the

beginning of chapter 36 of such title is amended by striking

the item relating to section 3699C and inserting the

following new item:

“3699C. High technology and emerging technology program.”.

(3) Conforming amendments.—Section 3680A of title 38,

United States Code, is amended in subsections (a)(4)(B) and

(d)(8) by striking “high technology” each place such term

appears and inserting “high technology or emerging

technology”.

(b) Employment Rate Calculation for VET-TEC High Technology

and Emerging Technology Program.—Section 3699C of title 38,

United States Code, is amended—

(1) in subsection (f)—

(A) in the matter preceding paragraph (1) by inserting

after “House of Representatives” the following: “, and

make available to the public,”; and

(B) in paragraph (3) by adding at the end the following:

“Such rate shall be calculated as a fraction, the

denominator of which is the number of covered individuals who

completed such a program during such year and the numerator

of which is the number of individuals counted in the

denominator who are employed on the date that is 180 days

after the date on which the individual completed the program,

and expressed as a percentage. Notwithstanding the previous

sentence, the numerator shall not count in a case in which

the individual is employed by the same organization that was

the provider of the individual's program of education or a

case in which the individual is employed, by a parent or

affiliate of such organization, as an instructor for a

substantially similar program of education. To the maximum

extent practicable, the Secretary shall also report the rates

of full-time employment, part-time employment, and self-

employment.”; and

(2) in subsection (g) by adding at the end the following

new paragraph:

“(3) The Secretary on an ongoing basis shall solicit,

collect, and analyze feedback about the program from covered

individuals who participate in the program and from the GI

Bill School Feedback Tool. The Secretary shall use such

feedback to evaluate and improve the implementation of the

program.”.

TITLE III—HEALTH CARE

SEC. 301. EXTENSION AND MODIFICATION OF TRANSPORTATION GRANT

PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS.

Section 307 of the Caregivers and Veterans Omnibus Health

Services Act of 2010 (Public Law 111-163; 38 U.S.C. 1710

note) is amended—

(1) in subsection (a)—

(A) in paragraph (2), by adding at the end the following

new subparagraphs:

“(C) Indian tribes.

“(D) Tribal organizations.

“(E) Native Hawaiian organizations.

“(F) County veterans service organizations.”;

(B) in paragraph (3), in the matter preceding subparagraph

(A), by striking “State veterans service agency or veterans

service organization awarded” and inserting “recipient

of”; and

“(4) Maximum amount.—

“(A) In general.—Except as provided in subparagraphs (B)

and (C), the amount of a grant under this section may not

exceed $50,000.

“(B) Off-road communities.—In the case of a county that

has more than five communities that are off the road system,

the amount of a grant awarded with respect to that county

under this section may be increased by an amount not to

exceed 50 percent of the amount specified in subparagraph

(A).

“(C) Purchasing a vehicle.—

“(i) Amount.—The amount of a grant awarded under this

section to a recipient may be increased by not more than

$80,000 if the recipient is purchasing a vehicle to comply

with requirements under the Americans with Disabilities Act

of 1990 (42 U.S.C. 12101 et seq.) in carrying out this

section.

“(ii) Limitations.—The Secretary may prescribe

limitations on the number of vehicles purchased by each

recipient under this section.”;

(2) by striking subsection (d);

(3) by redesignating subsections (b) and (c) as subsections

(d) and (e), respectively;

(4) by inserting after subsection (a) the following new

subsections:

“(b) Additional Services.—

“(1) Nearby rural areas.—In addition to providing

innovative transportation options to veterans in highly rural

areas, a recipient of a grant under this section may use

amounts provided under the grant to provide innovative

transportation options to veterans in nearby rural areas.

“(2) Priority.—A recipient of a grant under this section

shall prioritize the provision of innovative transportation

options to veterans in highly rural areas, and shall

demonstrate to the Secretary such priority, and may only

provide services under paragraph (1) to veterans in nearby

rural areas if—

“(A) it does not impede the services provided to veterans

in highly rural areas; and

“(B) the grantee has excess capacity and resources

available to provide such services to veterans in nearby

rural areas.

“(c) Eligibility of Previous Areas.—Areas eligible for

assistance under the grant program under this section on the

day before the date of the enactment of the Take Care of

America's Veterans Act shall remain eligible for such

assistance on and after such date of enactment.”; and

(5) in subsection (e), as redesignated by paragraph (3)—

(A) by redesignating paragraph (2) as paragraph (5); and

(B) by striking paragraph (1) and inserting the following:

“(1) Indian tribe; tribal organization.—The terms `Indian

tribe' and `Tribal organization' have the meanings given

those terms in section 4 of the Indian Self-Determination and

Education Assistance Act (25 U.S.C. 5304).

“(2) Native hawaiian organization.—The term `Native

Hawaiian organization' has the meaning given that term in

section 6207 of the Elementary and Secondary Education Act of

1965 (20 U.S.C. 7517).

“(3) Nearby.—The term `nearby', with respect to a rural

area, includes rural areas adjacent to a highly rural area

and rural areas geographically between the highly rural area

and the nearest Department of Veterans Affairs medical

center.

“(4) Rural; highly rural.—The terms `rural' and `highly

rural' have the meanings given those terms under the Rural-

Urban Commuting Areas (RUCA) coding system of the Department

of Agriculture.”.

SEC. 302. VETERAN CAREGIVER REEDUCATION, REEMPLOYMENT, AND

RETIREMENT ACT.

(a) Extension of Period of Medical Care Coverage for

Caregivers Designated as Primary Providers of Personal Care

Services for Veterans.—Section 1781(a)(4) of title 38,

United States Code, is amended by inserting before the comma

at the end the following: “, including during the 180-day

period following discharge from the program under section

1720G(a) of this title unless the designation of the

individual was revoked due to fraud, abuse, mistreatment, or

other misconduct”.

(b) Employment and Other Benefits for Caregivers Designated

as Primary Providers of Personal Care Services for

Veterans.—

(1) Employment assistance.—Section 1720G of title 38,

United States Code, is amended—

(A) by redesignating subsection (d) as subsection (e); and

(B) by inserting after subsection (c) the following new

subsection (d):

“(d) Employment Assistance.—(1) The Secretary shall,

subject to paragraph (2), provide to an individual designated

as a primary provider of personal care services under

subsection (a)(7)(A) employment assistance as follows:

“(A) Reimbursement of fees associated with certifications

or relicensure necessary for such employment.

“(B) For purposes of gaining credit for continuing

professional education requirements, access to training

modules of the Department at no cost.

“(C) In consultation with the Secretary of Defense and the

Secretary of Labor, access to existing employment assistance

resources and programs as considered appropriate.

“(2) An individual described in paragraph (1) shall have

access to assistance described in such paragraph—

“(A) while participating in the program established under

subsection (a)(1); and

“(B) during the 180-day period following the date on which

the individual is no longer participating in such program

unless the designation of such individual under subsection

(a)(7)(A) was revoked for fraud, abuse, mistreatment, or

other misconduct.

“(3) The maximum lifetime amount that may be reimbursed

for an individual under paragraph (1)(A) is $1,000.”.

(2) Expansion of available services.—Subsection

(a)(3)(A)(ii) of such section is amended—

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

semicolon;

(B) in subclause (VI)—

(i) in the matter preceding item (aa), by inserting “or

agreements” after “contracts”;

(ii) in item (aa), by inserting “, including retirement

planning services,” after “services”; and

(iii) in item (bb), by striking the period at the end and

inserting “; and”; and

“(VII) such instruction, preparation, training, and

support as the Secretary considers appropriate to assist in

transitioning away from caregiving during the 180-day period

following the date on which the family caregiver is no longer

participating in the program required by paragraph (1),

unless such designation was revoked for fraud, abuse, or

mistreatment, or other misconduct.”.

(3) Assistance returning to workforce.—Subclause (VI) of

such subsection is further amended—

(A) in item (aa), by striking “; and” and inserting a

semicolon; and

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

“(cc) assistance returning to the workforce upon discharge

or dismissal from the program required by paragraph (1)

unless such designation was revoked for fraud, abuse,

mistreatment, or other misconduct; and”.

(4) Bereavement counseling and support.—Subsection

(a)(3)(A)(i)(III) of such section is amended by inserting

before the semicolon the following: “, including bereavement

counseling and support following the death of the eligible

veteran”.

(5) Study on provision of returnship program.—

(A) In general.—Not later than one year after the date of

the enactment of this Act, the Secretary of Veterans Affairs,

in partnership with the Secretary of Labor, shall complete a

study on the feasibility and advisability of conducting a

returnship program to assist individuals who are designated

as a primary provider of personal care services under section

1720G(a)(7)(A) of title 38, United States Code, or who were

discharged from such program, in returning to the workforce.

(B) Report.—Not later than 180 days after completion of

the study under subparagraph (A), the Secretary shall submit

to the Committee on Veterans' Affairs of the Senate and the

Committee on Veterans' Affairs of the House of

Representatives a report on the study.

(6) Study on incorporating former caregivers into workforce

of department of veterans affairs.—

(A) In general.—Not later than one year after the date of

the enactment of this Act, the Secretary of Veterans Affairs

shall complete a study on barriers and incentives to hiring

individuals who were designated as a primary provider of

personal care services under section 1720G(a)(7)(A) of title

38, United States Code, at facilities of the Department of

Veterans Affairs to address staffing needs.

(B) Report.—Not later than 180 days after completion of

the study under subparagraph (A), the Secretary shall submit

to the Committee on Veterans' Affairs of the Senate and the

Committee on Veterans' Affairs of the House of

Representatives a report on the study, which shall include—

(i) a plan for increasing employment opportunities at

facilities of the Department for individuals who were

designated as a primary provider of personal care services

under section 1720G(a)(7)(A) of title 38, United States Code;

and

(ii) such recommendations for legislative or administrative

action as the Secretary considers appropriate.

Veterans Affairs in Supporting Family Caregivers

Transitioning Away From Caregiving.—Not later than two years

after the date of the enactment of this Act, the Comptroller

General of the United States shall submit to Congress a

report assessing the efforts of the Secretary of Veterans

Affairs to support individuals serving as family caregivers

under section 1720G(a) of title 38, United States Code, in

transitioning away from caregiving, either by assisting those

individuals with retirement planning or returning to work.

(d) Report on Feasibility and Advisability of Establishing

a Retirement Plan or Retirement Savings for Family Caregivers

of Certain Veterans.—Not later than one year after the date

of the enactment of this Act, the Secretary of Veterans

Affairs, in consultation with the Secretary of the Treasury

and the heads of such other relevant entities as the

Secretary of Veterans Affairs determines necessary, shall

submit to Congress a report on the feasibility and

advisability of, for individuals serving as family caregivers

under section 1720G(a) of title 38, United States Code—

(1) establishing an individual retirement plan (as defined

in section 7701(a)(37) of the Internal Revenue Code of 1986

(26 U.S.C. 7701(a)(37))) or similar retirement plan; or

(2) permitting such individuals to join an already

established pathway to retirement savings.

SEC. 303. VETERANS TBI BREAKTHROUGH EXPLORATION OF ADAPTIVE

CARE OPPORTUNITIES NATIONWIDE ACT.

(a) Department of Veterans Affairs Grant Program for

Supplemental Neurorehabilitation Approaches to Chronic Mild

TBI Treatment.—

(1) Grant program.—

(A) In general.—The Secretary of Veterans Affairs shall

carry out a three-year program (to be known as the “TBI

Innovation Grant Program”) under which the Secretary shall

award grants to eligible entities described in paragraph (2)

for the development, implementation, and evaluation of

approaches and methodologies for prospective randomized

control trials for neurorehabilitation treatments for the

treatment of chronic mild traumatic brain injury (in this Act

referred to as “mTBI”) in veterans.

(B) Relationship to other department activities.—The grant

program required under subparagraph (A) shall be carried out

in a manner that—

(i) supplements, and does not supplant, other clinical care

and research of the Department of Veterans Affairs relating

to mTBI; and

(ii) facilitates, as practicable, coordination with

Veterans Health Administration facilities for referral,

continuity of care, and dissemination of findings.

(2) Eligible entities described.—An eligible entity

described in this paragraph is any of the following:

(A) A nonprofit organization with demonstrated capability

to conduct clinical trials and to deliver or research

effective neurorehabilitation treatments for mTBI, including

through patient care delivery.

(B) An academic institution that conducts significant

research on mTBI and has demonstrated capability to conduct

clinical trials relating to neurorehabilitation treatments.

neurorehabilitative therapies and demonstrated capability to

conduct clinical trials and to evaluate mTBI treatments

through patient care delivery.

(D) A partnership or consortium of two or more entities

described in subparagraphs (A) through (C).

(3) Use of funds.—An eligible entity in receipt of a grant

under this subsection shall use such grant to support

activities that include—

(A) designing and testing novel or integrative treatments

for mTBI that prioritize patient-centered care, including

non-pharmacological therapies;

(B) conducting clinical studies and assessments to measure

the effectiveness of funded approaches to—

(i) improve mental health outcomes among veterans;

(ii) reduce suicidality, and common risk factors for

completing suicide, including depression and substance use

disorders among veterans; and

(iii) mitigate long-term effects of mTBI and, to the extent

outcomes are collected under the applicable clinical

protocol, measure durability of outcomes at approximately six

months following completion of treatment;

veterans and their families to improve awareness and

accessibility of innovative mTBI treatments, including

information on available Department resources and pathways to

access such resources; and

(D) establishing partnerships with community organizations,

academic institutions, and health care facilities, including,

as practicable, coordination with Veterans Health

Administration facilities to facilitate referral of eligible

veterans, continuity of care, and dissemination of aggregate

findings.

(4) Limitation on grant amount.—The Secretary may not

award an eligible entity a grant under this section in an

amount that exceeds $5,000,000 for any fiscal year.

(5) Program administration.—

(A) Applications.—An eligible entity desiring a grant

under this subsection shall submit to the Secretary an

application in such form, at such time, and containing such

information and assurances as the Secretary determines

appropriate, including a detailed description of—

(i) activities proposed to be conducted using the grant;

(ii) expected outcomes of such activities;

(iii) plans for evaluating the effectiveness of such

activities;

(iv) how the eligible entity will coordinate, as

practicable, with Veterans Health Administration facilities

for referral and continuity of care for veterans who

participate in activities carried out using grant funds, and

for dissemination of aggregate findings;

(v) the budget of the entity for the use of the grant,

including a narrative justification and an identification of

the estimated amount of grant funds to be used for

administrative or overhead costs; and

(vi) assurances of compliance with applicable Federal laws

and regulations relating to human subjects protections and

patient safety.

(B) Priority.—In awarding grants under this subsection,

the Secretary shall give priority to eligible entities that

have demonstrated the capacity to coordinate with the

Department to facilitate referral and continuity of care for

veterans who participate in activities carried out using

grant funds.

under this section, an eligible entity shall, not less

frequently than annually during the grant period and not

later than 180 days after the end of the grant period, submit

to the Secretary a report that includes, with respect to the

period covered by the report—

(i) a description of how the eligible entity used such

grant;

(ii) a summary of the progress of activities funded with

amounts from such grant;

(iii) measured outcomes relating to such activities;

(iv) a detailed accounting of expenditures of grant funds,

including administrative or overhead costs;

(v) to the extent collected under the applicable clinical

protocol or in the ordinary course of care, a description of

any adverse events and serious adverse events, including

self-harm or suicide-related events; and

(vi) a description of actions taken pursuant to the

coordination plan described in subparagraph (A)(iv).

(D) Oversight; annual evaluations.—The Secretary shall—

(i) ensure rigorous oversight of the grant program under

this section, including by monitoring financial compliance

and timely receipt of the reports required under subparagraph

(B); and

(ii) on an annual basis until the termination date

specified in paragraph (9)(A), evaluate the efficacy of

activities carried out using grant funds based on the reports

submitted under subparagraph (B) and other appropriate

information.

(E) Rule of construction.—Nothing in this section shall be

construed to authorize the Secretary to require prior

approval of, or changes to, any clinical protocol, study

design, outcome measures, or follow-up schedule of an

eligible entity that receives a grant under this section,

except as necessary to ensure compliance with applicable

Federal laws and regulations relating to human subjects

protections and patient safety.

(F) Enforcement authority.—The Secretary may suspend,

modify, or terminate a grant awarded under this section, if

the Secretary determines that the recipient of such grant has

failed to comply with reporting requirements under

subparagraph (B) or other applicable terms and conditions of

the grant.

(6) Available amounts; authorization of appropriations.—

(A) Available amounts.—The Secretary may carry out the

program under this section using amounts available to the

Secretary for general mental health care programs, if the use

of such amounts supplements, and does not supplant, amounts

otherwise available for Department mental health and

traumatic brain injury programs.

(B) Authorization of appropriations.—There is authorized

to be appropriated to the Secretary $10,000,000 for each of

fiscal years 2026 through 2028 to carry out this section.

(7) Duration; annual review.—

(A) Duration.—The authority of the Secretary to carry out

the grant program under this section shall terminate on the

date that is three years after the date of the enactment of

this Act, except that the Secretary may continue to use

amounts made available to carry out this section after such

date solely for the purpose of administering activities and

obligations incurred before such termination date.

(B) Annual review.—During such three-year period, the

Secretary shall, on an annual basis, review the effectiveness

of the grant program to determine the potential of such grant

program for continuation or expansion.

(b) Department of Veterans Affairs Grant Program for

Independent Third-party Research Studies and Treatment With

Respect to Supplemental Neurorehabilitation Treatments for

MTBI.—

(1) Establishment.—The Secretary of Veterans Affairs shall

establish and carry out a research grant program to award

grants to eligible entities described in paragraph (2) to be

used to carry out studies and applied programs on approaches

and methodologies for the treatment of mTBI in veterans.

(2) Eligible entities described.—An eligible entity

described in this paragraph is any of the following:

(A) A nonprofit organization that has demonstrated the

capability to conduct clinical trials and to evaluate

traumatic brain injury treatments through patient care

delivery.

(B) An academic institution that conducts significant

research on traumatic brain injury and has demonstrated the

capability to conduct clinical trials relating to

neurorehabilitation treatments.

described in subparagraphs (A) and (B).

(3) Applications.—An eligible entity desiring a grant

under this section shall submit to the Secretary an

application in such form, at such time, and containing such

information and assurances as the Secretary determines

appropriate, including a summary of—

(A) the research and treatment activities proposed to be

carried out using grant funds;

(B) the methodology to be used for such activities;

(D) how the eligible entity will coordinate, as

practicable, with Veterans Health Administration facilities

for referral and continuity of care for veterans who

participate in activities carried out using grant funds, and

for dissemination of aggregate findings;

(E) the budget of the entity for the use of the grant,

including a narrative justification and an identification of

the estimated amount of grant funds to be used for

administrative or overhead costs; and

(F) assurances of compliance with applicable Federal laws

and regulations relating to human subjects protections and

patient safety.

(4) Administration.—

(A) Grant categories.—In carrying out the grant program

under this subsection, each fiscal year the Secretary shall—

(i) subject to the requirement under subparagraph (B),

award four grants for exploratory or pilot research and

treatment projects, each of which shall be in an amount of

not more than $625,000; and

(ii) award five grants for collaborative or

multidisciplinary research and treatment initiatives, each of

which shall be in an amount of not more than $1,500,000.

(B) Priority.—Of the grants awarded under subparagraph

(A)(i), the Secretary shall award not fewer than three to

nonprofit organizations.

modify, or terminate a grant awarded under this subsection,

if the Secretary determines that the recipient of such grant

has failed to comply with the applicable terms and conditions

of the grant.

(5) Agreement with independent organization.—

(A) In general.—The Secretary shall seek to enter into an

agreement with an independent organization that is not a

component of the Department and that has demonstrated

expertise in randomized controlled trials,

neurorehabilitation outcomes evaluation, and research

integrity, under which the organization agrees to—

(i) administer the research grant program under this

subsection;

(ii) carry out studies and implement efforts that include—

(I) analyzing data from mTBI treatment methodologies

developed pursuant to the research grant program to assess

the effect, among veterans, of such methodologies on enhanced

brain health outcomes, mental health, and long-term recovery,

including, to the extent outcomes are collected under the

applicable clinical protocol, durability of outcomes at

approximately six months following completion of treatment;

(II) identifying data-driven best practices and providing

recommendations for further research or clinical application,

including recommendations for dissemination to Veterans

Health Administration clinicians and facilities (as

appropriate); and

(III) randomized, controlled clinical trials to—

(aa) validate and deliver treatments;

(bb) establish a standard of care; and

(cc) improve access to such treatments for veterans;

(iii) submit to the Secretary not less frequently than

annually a report describing activities carried out under

this section, including outcome data and methodology; and

(iv) make available to the Secretary all data and findings

from the grants made under this section, consistent with

applicable Federal law, regulation, and Department policies

relating to patient protections, data security, and privacy.

(B) Rule of construction.—Nothing in this section shall be

construed to authorize the Secretary, or an independent

organization that enters into an agreement with the Secretary

under subparagraph (A), to require prior approval of, or

changes to, any clinical protocol, study design, outcome

measures, or follow-up schedule established by an eligible

entity that receives a grant under this section, except as

necessary to ensure compliance with applicable Federal laws

and regulations relating to human subjects protections and

patient safety.

include a requirement that the independent organization

submits to Congress and the Secretary a comprehensive report

that includes—

(i) the findings of the studies required under such

agreement;

(ii) recommendations with respect to the expansion of

successful TBI treatment methodologies and standard of care

recommendations, if any, developed pursuant to the research

grant program; and

(iii) to the extent available from the reports and study

materials of grant recipients, a summary of—

(I) the durability of outcomes at approximately six months

following completion of treatment, if collected under the

applicable clinical protocol;

(II) adverse events and serious adverse events, including

self-harm or suicide-related events, if collected under the

applicable clinical protocol or in the ordinary course of

care; and

(III) aggregate expenditures of grant funds, including

administrative or overhead costs.

(D) Surveys.—The Secretary may conduct surveys of any

independent organization that enters into an agreement with

the Secretary under subparagraph (A) in order to assess the

effectiveness of such organization in administering the

research grant program under this subsection.

(6) Available amounts; authorization of appropriations.—

(A) Available amounts.—The Secretary may use amounts

available to the Secretary for the operating budget of the

National Center for Posttraumatic Stress Disorder to carry

out the research grant program under this subsection, if the

use of such amounts supplements, and does not supplant,

amounts otherwise available for Department programs and

services.

(B) Authorization of appropriations.—There is authorized

to be appropriated to the Secretary $10,000,000 for each of

fiscal years 2026 through 2028 to carry out this subsection.

(7) Termination date.—The authority of the Secretary to

carry out the research grant program under this section shall

terminate on the date that is three years after the date of

the enactment of this Act.

the date on which the Secretary commences the research grant

program under subsection (a), and on an annual basis

thereafter until the termination date specified in paragraph

(8) of such subsection, the Secretary shall submit to

Congress a report on the grant programs under subsections (a)

and (b). Each such report shall include—

(1) the findings of the studies under subsection (a)(6)(B);

(2) a description of any agreement entered into by the

Secretary under subsection (b)(5)(A);

(3) recommendations of the Secretary with respect to policy

and programmatic improvements to services of the Department

to treat mTBI among veterans;

(4) any findings derived from surveys conducted under

subsection (b)(5)(D), including any recommendations of the

Secretary for improvements to the structure, oversight,

administration, or performance of the independent

organization that enters into an agreement with the Secretary

under subsection (b)(5)(A); and

(5) such other matters as the Secretary determines

appropriate.

(d) Definitions.—In this section:

(1) The terms “chronic mild traumatic brain injury” and

“mTBI” mean a mild traumatic brain injury with symptoms

that persist for not fewer than six months after the inciting

injury, as determined using validated clinical criteria.

(2) The term “nonprofit organization”—

(A) means an organization described in section 501(c)(3) of

the Internal Revenue Code of 1986 and exempt from taxation

under section 501(a) of such Code; and

(B) includes such an organization that is a hospital,

nonprofit health system, academic medical center, or clinic

that delivers neurorehabilitation care or conducts clinical

research relating to mTBI.

(3) The term “veteran” has the meaning given such term in

section 101 of title 38, United States Code.

SEC. 304. ASSIGNMENT OF TRAVELING PHYSICIANS TO SERVE

TERRITORIES, POSSESSIONS, AND FREELY ASSOCIATED

STATES.

(a) In General.—Subchapter I of chapter 74 of title 38,

United States Code, is amended by adding at the end the

following new section:

“Sec. 7415. Traveling physicians

“(a) In General.—(1) The Secretary may assign a physician

appointed under section 7401 or section 7431 of this title to

serve as a traveling physician for a period of not more than

one year at a time. A physician assigned to serve as a

traveling physician under this section may be assigned to

provide health care to veterans residing in American Samoa,

Guam, the Commonwealth of the Northern Mariana Islands, the

Commonwealth of Puerto Rico, the Virgin Islands of the United

States, or the Freely Associated States (as such term is

defined in section 1724(f) of this title), or any other

territory or possession of the United States at Department

facilities or other approved facilities located in such

territory, possession, or Freely Associated State.

“(2) The Secretary may assign multiple physicians to serve

as traveling physicians under this section and may assign

each such physician to serve in a specific territory or

possession.

“(b) Coordination of Care.—In providing care under this

section, traveling physicians shall coordinate with non-

Department medical providers to the extent practicable and

necessary to ensure high quality and coordinated care for

veterans receiving hospital care and medical services.

“(c) Pay.—In addition to pay under section 7431 of this

title, the Secretary shall provide a relocation or retention

bonus to traveling physicians under this section. Such

relocation or retention bonus shall be substantially similar

to a relocation or retention bonus offered under section

7410(a) of this title, as the Secretary considers

appropriate.”.

(b) Clerical Amendment.—The table of sections at the

beginning of such chapter is amended by inserting after the

item relating to section 7414 the following new item:

“7415. Traveling physicians.”.

States Code, is further amended as follows:

(1) In section 7410(a)(1), by—

(A) by striking “retention allowances” and inserting

“retention bonuses”; and

(B) by striking the second comma after “section 7401(1) of

this title”; and

(2) In section 7431(e)(5)(B), by striking “retention

allowances” and inserting “retention bonuses”.

SEC. 305. INCLUSION OF ADAPTIVE PROSTHESES AND TERMINAL

DEVICES FOR SPORTS AND OTHER RECREATIONAL

ACTIVITIES IN MEDICAL SERVICES FURNISHED TO

ELIGIBLE VETERANS BY THE SECRETARY OF VETERANS

AFFAIRS.

Section 1701 of title 38, United States Code, is amended,

in paragraph (6)(F)(i), by inserting “(including adaptive

prostheses and terminal devices for sports and other

recreational activities that are determined to be clinically

appropriate by the Secretary)” after “artificial limbs”.

SEC. 306. MODIFICATIONS TO AND REAUTHORIZATION OF STAFF

SERGEANT PARKER GORDON FOX SUICIDE PREVENTION

GRANT PROGRAM OF DEPARTMENT OF VETERANS

AFFAIRS.

(a) Coordination by Secretary.—Subsection (b) of section

201 of the Commander John Scott Hannon Veterans Mental Health

Care Improvement Act of 2019 (Public Law 116-171; 38 U.S.C.

1720F note) is amended by striking the second sentence.

(b) Use of Grant Funds.—Subsection (c) of such section is

amended—

(1) in the subsection heading, by inserting “; Use of

Grant Funds” after “Grants”; and

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

“(3) Renewal of grant amounts.—

“(A) In general.—In determining whether to renew a grant

awarded under this section to an eligible entity, the

Secretary shall consider, among such other factors as the

Secretary may consider appropriate—

“(i) the compliance by the eligible entity in

administering pre- and post-intervention assessments required

under subsection (e)(6); and

“(ii) any demonstrated improvements in participant

outcomes.

“(B) Additional amounts.—Based on a consideration of the

factors described in subparagraph (A), the Secretary may

award amounts, not to exceed $250,000 per grantee per fiscal

year, to a grantee in addition to the maximum amount under

paragraph (2)(A) based on a performance-based metric

established by the Secretary.”.

section is amended—

(1) in the subsection heading, by striking “and

Preference” and inserting “, Preference, and Priority”;

(2) in paragraph (1)(A)—

(A) in clause (iv), by striking the semi-colon at the end

and inserting “; and”;

(B) by striking clause (v); and

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

“(3) Priority for new recipients.—To the maximum extent

practicable, the Secretary shall prioritize grants for

eligible entities that have satisfied the requirements

provided under subsection (f) and are located in States in

which a grant has not been awarded under this section.”.

(d) Requirements for Receipt of Grants.—Subsection (e) of

such section is amended—

(1) in paragraph (3)—

(A) by redesignating subparagraphs (B) and (C) as

subparagraphs (C) and (D), respectively; and

(B) by inserting after subparagraph (A) the following new

subparagraph (B):

“(B) coordinate with the Secretary to develop a plan for

communication between the entity and local mental health

providers of the Department regarding whether veterans

receiving assistance under this section from the entity are

attending appointments to ensure continuity of care;”; and

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

“(6) Assessments.—An eligible entity receiving a grant

under this section shall conduct a pre- and post-intervention

assessment with respect to each eligible individual who

receives suicide prevention services pursuant to such grant

across all relevant metrics, as determined by the Secretary.

“(7) Metrics and outcomes.—An eligible entity receiving a

grant under this section shall collect and submit to the

Secretary such metrics and outcome data as the Secretary may

require, including—

“(A) throughput measures, including the number of veterans

screened, referred, connected to care, and retained in

services under the grant program;

“(B) reductions in severity scale measurements, including

reductions in suicidality identified through applicable

inventories or assessments; and

“(C) such other quantifiable metrics as the Secretary

determines appropriate.”.

(e) Training and Technical Assistance.—Subsection (g) of

such section is amended—

(1) in paragraph (1)—

(A) in the matter preceding subparagraph (A), by inserting

“, or interested in receiving such grants,” after “this

section”; and

(B) in subparagraph (A), by inserting “, including

training on how to properly use the Columbia Protocol (also

known as the Columbia-Suicide Severity Rating Scale (C-SSRS))

and other screening tools selected by the Secretary” after

“management”; and

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

“(3) Training for department employees.—The Secretary

shall provide training to employees of the Department as the

Secretary considers appropriate on the grant program under

this section.”.

(f) Briefing for Local VAMCS.—Subsection (h) of such

section is amended by adding at the end the following new

paragraph:

“(5) Briefing for local vamcs.—Not less frequently than

once per year, unless the Secretary determines that such

frequency is not advisable, the Secretary shall provide, to

the appropriate personnel of each medical center of the

Department identified on the grantee's application under this

section, a briefing about the grant program under this

section in order to improve coordination between such

recipient and personnel.”.

(g) Duration.—Subsection (j) of such section is amended by

striking “September 30, 2026” and inserting “September 30,

2029”.

(h) Reports.—Subsection (k)(2) is amended—

(1) in the paragraph heading, by striking “Final report”

and inserting “Annual reports”; and

(2) in subparagraph (B)—

(A) by redesignating clauses (iii) and (iv) as (v) and

(vi), respectively; and

(B) by adding the following new clauses (iii) and (iv):

“(iii) A description of the Secretary's compliance with

the requirement to train employees of the Department under

subsection (g)(3).

“(iv) An optional description and inclusion of subjective

or narrative stories of community or individual impact to

allow grant recipients to share meaningful

accomplishments.”.

(i) Referral for Care.—Subsection (m) of such section is

amended by adding at the end the following new paragraph:

“(4) Required response or action.—(A) If the Secretary

receives a referral under paragraph (1) for additional care,

the Secretary shall review such referral and contact the

veteran not later than 72-hours following the referral.

“(B) If the Secretary receives a referral under paragraph

(2) for emergent suicide care, the Secretary shall review

such referral and contact the veteran not later than 24 hours

following the referral by such entity under subsection

(m)(1).”.

(j) Reauthorization.—Subsection (p) of such section is

amended—

(1) by striking “section a total” and inserting

“section—

“(1) a total”;

(2) by striking the period at the end and inserting “;

and”; and

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

“(2) a total of $200,000,000 for fiscal years 2027 through

2029.”.

(k) Technical Correction to Definitions.—Subsection (q)(5)

of such section is amended, in the first sentence—

(1) by striking “Medical services” and inserting “The

term `emergency treatment' means medical services”; and

(2) by striking “was rendered” and inserting

“rendered”.

(l) Identification of Demand for Other Services and

Support.—Subsection (e) of such section, as amended, is

further amended—

(1) by redesignating paragraphs (5) and (6) as (6) and (7),

respectively; and

(2) by adding after paragraph (4) the following new

paragraph:

“(5) Demand for other services and support.—An entity

receiving a grant under this section shall submit to the

Secretary information concerning—

“(A) the number of individuals seeking services from the

entity who are not eligible individuals and the most common

reason such individuals are not eligible individuals;

“(B) a description of the types of services that eligible

individuals or individuals described in subparagraph (A)

require based on any screening conducted by the entity; and

“(C) any actions taken by the entity to provide the

services described in subparagraph (B) or to refer the

individual or eligible individual to another entity for the

receipt of such services.”.

(m) Suicide Prevention Services.—

(1) Required use of certain screening protocol.—Subsection

(q)(11)(A)(ii) of such section is amended by adding at the

end the following new sentence: “In the case of a recipient

of a grant awarded under this section on or after the date of

the enactment of the Take Care of America's Veterans Act,

such screening shall be Columbia Protocol (also known as the

Columbia-Suicide Severity Rating Scale (C-SSRS)) or the

Patient Health Questionnaire-9 (PHQ9), or a successor

screening tool selected by the Secretary.”;

(2) Transportation.—Subsection (q)(11)(A) of such section

is amended—

(A) by redesignating clause (xi) as clause (xii); and

(B) by inserting after clause (x) the following new clause:

“(xi) Transportation and rideshare services for eligible

individuals to use for appointments.”.

(n) Eligible Individuals.—Subsection (q)(4)(C) of such

section is amended by striking “clauses (i) through (iv)”

and inserting “clauses (i) through (vi)”.

(o) Effective Date.—The amendments made by this section

shall take effect on—

(1) the effective date of award following the date the

Secretary publishes a notice of funding opportunity for the

program required by section 201(a) of the Commander John

Scott Hannon Veterans Mental Health Care Improvement Act of

2019 (Public Law 116-171; (38 U.S.C. 1720F)), if the

Secretary determines such amendments do not require

rulemaking; or

(2) the effective date of award following the date the

Secretary publishes a notice of funding opportunity following

the effective date of subsequent rulemaking, if the Secretary

determines such amendments do require rulemaking.

SEC. 307. REPORTS ON THE USE OF HYPERBARIC OXYGEN THERAPY.

(a) GAO Report on the Use of Hyperbaric Oxygen Therapy to

Treat Traumatic Brain Injury and Post-traumatic Stress

Disorder.—Not later than one year after the date of the

enactment of this Act, the Comptroller General of the United

States shall submit to the Committees on Veterans' Affairs of

the Senate and House of Representatives an update to the

report titled “Research on Hyperbaric Oxygen Therapy to

Treat Traumatic Brain Injury and Post-Traumatic Stress

Disorder” (GAO-16-154). Such report shall include the

assessment of the Comptroller General of clinical trials

conducted, since the publication of such report—

(1) regarding the use of hyperbaric oxygen therapy to treat

traumatic brain injury and post-traumatic stress disorder;

and

(2) by—

(A) the Secretary of Veterans Affairs;

(B) the Secretary of Defense; and

(b) Follow-up Study.—

(1) In general.—Not later than 180 days after the date of

the enactment of this Act, the Secretary shall conduct a

systematic review of published research literature on the

off-label use of hyperbaric oxygen therapy to treat post-

traumatic stress disorder and traumatic brain injury among

veterans and nonveterans.

(2) Elements.—The review conducted under paragraph (1)

shall include the following:

(A) An analysis of available research literature published

after the review completed pursuant to section 702 of the

Commander John Scott Hannon Veterans Mental Health Care

Improvement Act (Public Law 116-171);

(B) An assessment of the current parameters for research on

the use by the Department of Veterans Affairs of hyperbaric

oxygen therapy, including—

(i) tests and questionnaires used to determine the efficacy

of such therapy; and

(ii) metrics for determining the success of such therapy.

to study post-traumatic stress disorder and traumatic brain

injury in other research conducted by the Department of

Veterans Affairs, other Federal agencies, and entities

outside the Federal Government.

(D) A market assessment of available hyperbaric oxygen

therapy facilities or units within facilities to assess the

most effective locations and practices, including—

(i) an analysis of whether multi-person chambers could

reduce per-veteran costs;

(ii) an analysis of areas with lower prices compared to a

national average; and

(iii) an identification of not fewer than two VISNs in

which the provision or furnishing of hyperbaric oxygen

therapy would benefit the most number of veterans at the

lowest cost to the Department.

SEC. 308. DEPARTMENT OF VETERANS AFFAIRS PILOT PROGRAM TO

PROVIDE GRANTS TO MENTAL HEALTH CARE PROVIDERS

FOR THE PROVISION OF MENTAL HEALTH CARE FOR

VETERANS.

(a) Establishment.—The Secretary of Veterans Affairs shall

carry out a three-year pilot program under which the

Secretary shall make grants to eligible mental health care

providers for the provision of mental health care, including

evidence-based mental health care delivered in person or via

telehealth.

(b) Eligibility.—To be eligible to receive a grant under

the pilot program, a mental health care provider shall—

(1) be a non-profit organization;

(2) have operated at least one outpatient mental health

facility in the United States for a continuous period of at

least three years;

(3) be licensed or certified under applicable state law to

provide outpatient mental health services;

(4) be accredited by—

(A) the Joint Commission on Accreditation of Healthcare

Organizations;

(B) the Commission on Accreditation of Rehabilitation

Facilities; or

Secretary determines appropriate; and

(5) submit to the Secretary an application that includes

such information and assurances as the Secretary may require,

including—

(A) an identification of the outpatient facility or

facilities where the mental health care services will be

provided;

(B) a plan for providing clinicians at each facility in

receipt of grant funds with units of continuing education

with respect to veterans issues; and

budget for each such facility that was provided through

Federal grants during the fiscal year preceding the year

during which the application is submitted.

(1) In general.—The recipient of a grant under the pilot

program shall use the grant—

(A) to deliver evidence-based mental health care for

veterans in person or via telehealth;

(B) to operate or expand an existing outpatient mental

health facility or establish a new outpatient mental health

facility for the purpose of providing such care;

in the patient enrollment system under section 1705 of title

38, United States Code, to enroll in such system and to

receive medical services furnished by the Department of

Veterans Affairs;

(D) to support activities necessary to deliver or sustain

care, including—

(i) outreach;

(ii) care coordination;

(iii) veteran engagement;

(iv) clinician training;

(v) implementation support; and

(vi) program evaluation; and

(E) to support continuous quality improvement and outcomes

measurement activities, including the collection and

reporting of clinical outcomes and operational metrics; and

(F) to support activities of the program that are not

billable, reimbursable, or otherwise authorized by law,

including—

(i) outreach;

(ii) care coordination;

(iii) engagement;

(iv) implementation support; and

(v) program evaluation; and

(G) to provide services to individuals for which

reimbursement is not otherwise available, including such

individuals who are—

(i) uninsured;

(ii) ineligible for health care furnished by the Department

of Veterans Affairs; or

(iii) in receipt of health care that is not reimbursable as

of the date of the enactment of this Act.

(2) Limitations on use of grant funds.—The recipient of a

grant under the pilot program may not—

(A) charge an eligible veteran a fee associated with the

receipt of mental health care funded by such grant;

(B) refuse to provide mental health care to an eligible

veteran on the basis that the veteran is not eligible for

reimbursement for such care under another payer source; or

(i) duplicate payments made under any contract or agreement

to which the Department is a party as of the date of the

enactment of this Act; or

(ii) pay for the same clinical services or service units

that are otherwise billable to a Federal payer, including the

Veterans Community Care Program under section 1703 of title

38, United States Code, or any other public or private health

plan.

(3) Rules of construction.—Nothing in this subsection may

be construed to—

(A) prohibit a grant recipient from seeking reimbursement

from non-Department payers for mental health services

provided by the grant recipient, except that grant funds

shall not be used to supplant or duplicate a reimbursement

otherwise available under Federal law; or

(B) authorize double billing or duplicate payments for the

same clinical service or unit of service.

(4) Spouse and dependent care.—A recipient may use grant

funds to provide care to spouses and dependent children of a

veteran when such services are integral to achieving a

successful clinical outcome. Permissible services include—

(A) family therapy;

(B) couples therapy;

(D) family psychoeducation; and

(E) other counseling services the Secretary determines are

clinically necessary.

(d) Selection of Facilities.—In awarding grants under the

pilot program, the Secretary—

(1) shall ensure that grants are distributed geographically

evenly among rural and urban areas;

(2) may consider the proportion of veterans historically

served by the grant recipient; and

(3) may prioritize outpatient mental health facilities

located in areas that the Secretary determines—

(A) are medically underserved;

(B) have large veteran populations;

(D) have large numbers of veterans at high risk of suicide.

(e) Amount of Grant.—

(1) In general.—

(A) In general.—Except as provided in subparagraph (B), no

grant under the pilot program for a facility for any fiscal

year may exceed $1,500,000.

(B) Limitation.—In the case of an outpatient mental health

facility for which at least 50 percent of the operating

budget of the facility for the preceding fiscal year was

provided through Federal grants, no grant under the pilot

program for the facility for any fiscal year may exceed the

lesser of—

(i) 50 percent of the operating budget of the facility; or

(ii) $1,500,000.

(2) Multiple grants.—The recipient of a grant under the

pilot program—

(A) may apply for, and receive, grants for more than one

facility of the recipient for any fiscal year; and

(B) may apply for, and receive, a grant for a facility that

has already received a grant under the pilot program.

(f) Regulations; Accountability.—The Secretary shall

prescribe regulations to carry out this section, which shall

include a requirement that each recipient of a grant under

the pilot program shall—

(1) demonstrate the capacity to provide accountability;

(2) demonstrate clinical outcomes;

(3) justify the effective use of any private investment

funds or Federal grant funds through data collection and

reporting metrics; and

(4) collect standardized outcome measures including symptom

improvement and program completion.

(g) Continuity of Care.—A recipient of a grant under the

pilot program shall adhere to the continuity of care model

established by the Secretary to the Veterans Community Care

Program.

(h) Report.—Not later than 180 days after the completion

of the pilot program under this section, the Secretary shall

submit to Congress a report on the pilot program that

includes the following:

(1) The number of veterans who received mental health care

under the program.

(2) An identification of the types of mental health care

provided and the time period for which such care was

provided.

(3) An identification and summary of program outcomes.

(4) The number of veterans who received mental health care

under the program and subsequently enrolled in the patient

enrollment system under section 1705 of title 38, United

States Code.

(5) An identification of any obstacles faced by grant

recipients in providing mental health care under the program.

(6) A summary of clinical outcomes based on pre- and post-

client functioning—

(A) the number of veterans who improved clinically based on

relevant clinical evaluation metrics that the Secretary

determines appropriate;

(B) the degree of clinical improvement based on such

relevant clinical evaluation metrics;

program; and

(D) any other outcome metrics as the Secretary determines

appropriate.

(7) Findings with respect to the sustainability of the

program.

(i) Authorization of Appropriations.—There is authorized

to be appropriated to the Secretary to carry out the pilot

program under this section $20,000,000 for each of fiscal

years 2027 through 2029.

SEC. 309. FURNISHING OF CERTAIN HEALTH SERVICES TO VETERANS

IN THE FREELY ASSOCIATED STATES.

(a) Agreements Required.—Consistent with section 1724(f)

of title 38, United States Code, and section 209(a)(4)(A) of

the Compact of Free Association Amendments Act of 2024 (48

U.S.C. 1988(a)(4)(A)), the Secretary of Veterans Affairs

shall work expeditiously with the governments of the Freely

Associated States to enter into the agreements described in

such sections.

(b) Inclusion of Telehealth and Mail Order Pharmacy

Services Required.—Consistent with such sections and with

the agreements required by subsection (a), the Secretary

shall furnish to veterans in the Freely Associated States

services that include, at a minimum—

(1) medical services authorized to be provided under

chapter 17 of title 38, United States Code, which can be

administered through telehealth; and

(2) pharmaceutical products authorized to be provided under

such chapter, delivered by mail.

and (b), the Secretary shall—

(1) initiate outreach to each such government not later

than 30 days after the date of the enactment of this Act;

(2) enter into each agreement required by paragraph (1) not

later than one year after the date of the enactment of this

Act; and

(3) begin furnishing the services required by paragraphs

(1) and (2) of subsection (b) not later than one year after

the date of the enactment of this Act.

(d) Beneficiary Travel.—Section 111(h)(1) of title 38,

United States Code, is amended by striking “the Secretary

may make payments” and inserting “beginning not later than

one year after the date of the enactment of the Take Care of

America's Veterans Act, the Secretary shall make payments”.

(e) Reports.—Not less frequently than quarterly, the

Secretary shall submit to the appropriate committees of

Congress a report on the implementation of this section and

the cost of such implementation. Until the Secretary has

entered into the agreements required by subsection (a) and

begun furnishing the services required by paragraphs (1) and

(2) of subsection (b), the report shall also describe the

technical and logistical factors that have prevented or

impeded the Secretary from doing so.

(f) Definitions.—In this subsection:

(1) Appropriate committees of congress.—The term

“appropriate committees of Congress” means—

(A) the Committee on Veterans' Affairs and the Committee on

Appropriations of the Senate; and

(B) the Committee on Veterans' Affairs and the Committee on

Appropriations of the House of Representatives.

(2) Freely associated states.—The term “Freely Associated

States” has the meaning given such term in section 1724(f)

of title 38, United States Code.

SEC. 310. MODIFICATION OF PRECISION MEDICINE FOR VETERANS

INITIATIVE; REPORTING ON SUICIDE BY VETERANS

AND MEMBERS OF THE ARMED FORCES.

(a) Modification of Precision Medicine for Veterans

Initiative.—Section 305 of the Commander John Scott Hannon

Veterans Mental Health Care Improvement Act of 2019 (Public

Law 116-171; 38 U.S.C. 1712A note) is amended—

(1) in subsection (a), by striking “and such other mental

health conditions” and inserting “repetitive low-level

blast exposure, dementia, and such other brain and mental

health conditions”;

(2) in subsection (d)(4), by adding at the end the

following new subparagraph:

“(E) Data-sharing partnership.—

“(i) In general.—The Secretary shall work with the

Secretary of Defense to establish a data-sharing partnership

between the Department of Veterans Affairs and the Department

of Defense.

“(ii) Storage.—The partnership established under clause

(i) shall be stored in the open platform made available under

this paragraph.

“(iii) Data.—The data supplied by the Secretary of

Defense under the partnership established under clause (i)

shall include relevant data throughout the Department of

Defense relating to low-level repetitive blast exposure and

traumatic brain injury collected by the Armed Forces and

other appropriate entities, as determined jointly by the

Secretary of Defense and the Secretary of Veterans

Affairs.”; and

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

“(f) Repetitive Low-level Blast Exposure Research.—In

carrying out the initiative under subsection (a), the

Secretary shall prioritize research—

“(1) to identify and validate biomarkers associated with

repetitive low-level blast exposure and traumatic brain

injury;

“(2) to evaluate clinical and non-clinical interventions

that improve cognitive function, quality of life, and mental

health outcomes among veterans with symptoms associated with

repetitive low-level blast exposure;

“(3) to improve the diagnosis, treatment, and care

coordination for veterans with a history of low-level

repetitive blast exposure or traumatic brain injury,

including veterans who performed duties or tasks associated

with increased risk of low-level repetitive blast exposure;

and

“(4) to develop evidence-based strategies to reduce

suicide risk among veterans with a history of low-level

repetitive blast exposure or traumatic brain injury.

“(g) Assistance and Report by National Academies of

Sciences, Engineering, and Medicine.—Not later than 180 days

after the date of the enactment of the Take Care of America's

Veterans Act, the Secretary of Veterans Affairs shall seek to

enter into a contract with the National Academies of

Sciences, Engineering, and Medicine under which the National

Academies shall—

“(1) work in tandem with the initiative under subsection

(a) on validation of brain and mental health biomarkers among

veterans; and

“(2) not less frequently than once every two years, submit

to the Committee on Veterans' Affairs of the Senate and the

Committee on Veterans' Affairs of the House of

Representatives a report on the work completed under

paragraph (1).

“(h) Assessment.—

“(1) In general.—The Secretary of Veterans Affairs shall

conduct an assessment of all translational research studies

in progress and planned under the initiative under subsection

(a), including research under subsection (f).

“(2) Report.—Not later than 60 days after completion of

the assessment conducted under paragraph (1), the Secretary

shall submit to the Committee on Veterans' Affairs of the

Senate and the Committee on Veterans' Affairs of the House of

Representatives a report on the assessment.

“(i) Reports.—

“(1) In general.—Not less frequently than once every two

years, the Secretary of Veterans Affairs shall submit to the

Committee on Veterans' Affairs of the Senate and the

Committee on Veterans' Affairs of the House of

Representatives a report on the initiative under subsection

(a).

“(2) Recommendations.—Each report required by paragraph

(1) may include recommendations for immediate administrative

and legislative action to improve the initiative under

subsection (a).

“(j) Authorization of Appropriations.—There is authorized

to be appropriated to the Secretary of Veterans Affairs

$5,000,000 to carry out the initiative under subsection (a)

for each of fiscal years 2027 through 2032.”.

(b) Inclusion of Information in Reports on Suicide

Prevention Among Veterans and Members of the Armed Forces.—

(1) Inclusion of information in national veteran suicide

prevention annual report.—Section 149(a)(4)(B) of the

Senator Elizabeth Dole 21st Century Veterans Healthcare and

Benefits Improvement Act (Public Law 118-210; 38 U.S.C. 1709B

note) is amended by adding at the end the following:

“(iv) Military occupation data of veterans who attempt or

commit suicide.”.

(2) Inclusion of information in department of defense

annual report.—The Secretary of Defense shall include in the

annual report of the Defense Suicide Prevention Office, or

successor office, information on—

(A) occupational data of members of the Armed Forces who

attempt suicide; and

(B) outcomes of suicide prevention interventions among

members of the Armed Forces.

SEC. 311. ESTABLISHMENT OF THE BLAST OVERPRESSURE TASK FORCE

OF THE DEPARTMENT OF VETERANS AFFAIRS.

(a) Establishment.—Not later than 180 days after the date

of the enactment of this Act, the Secretary of Veterans

Affairs shall appoint, through the Department of Veterans

Affairs-Department of Defense Joint Executive Committee under

section 320 of title 38, United States Code, the Blast

Overpressure Task Force of the Department of Veterans Affairs

(in this section referred to as the “Task Force”).

(b) Membership.—Each member of the Task Force appointed

under subsection (a) shall be a member of the Health

Executive Committee under subsection (b)(2) of such section

who, at the time of appointment, is involved in research

regarding the mitigation and treatment of blast overpressure

or blast exposure.

following:

(1) To improve how the Secretary of Veterans Affairs, in

consultation with the Secretary of Defense, provides health

care and other benefits to veterans or members of the Armed

Forces diagnosed with traumatic brain injury, post-traumatic

stress disorder, or other symptoms, from blast overpressure

or blast exposure.

(2) To align research agendas and acquisition strategies of

the Department regarding such health care.

(3) To establish physiological and cognitive performance

baselines for such veterans and members.

(4) To prioritize translational research regarding such

veterans and members, including research regarding—

(A) sleep therapy;

(B) blast-related gut health;

(D) vestibular dysfunction and balance impairment;

(E) autonomic nervous system dysregulation;

(F) cumulative mild traumatic brain injury;

(G) neuroinflammation and glial activation; and

(H) any other issue determined appropriate by the

Secretary.

(5) To monitor sensory decline (including with regard to

vision, hearing, and vestibular function) and stress-related

impairments among such veterans and members.

(6) To support continuity of such care by integrating

mobile and longitudinal diagnostic tools.

(d) Reports.—The Task Force shall issue annual reports to

the Committees on Veterans' Affairs and on Armed Services of

the Senate and House of Representatives. Each such report

shall include the following elements:

(1) Details of research initiatives, coordination outcomes,

and clinical advancements of the Task Force.

(2) Recommendations of the Task Force regarding—

(A) how claims processors of the Department of Veterans

Affairs should evaluate evidence that links such conditions

to active military, naval, air, or space service; and

(B) best practices regarding the evaluation of neurological

injuries in examinations for benefits under chapters 11 or 15

of title 38, United States Code.

(e) Sunset.—The Task Force shall terminate on September

30, 2029.

SEC. 312. EXTENSION OF SHARING OF DEPARTMENT OF VETERANS

AFFAIRS AND DEPARTMENT OF DEFENSE HEALTH CARE

RESOURCES; RESOURCE SHARING OVERSIGHT AND

IMPLEMENTATION PLAN.

(a) Oversight.—

(1) Justification.—Section 8111 of title 38, United States

Code, is amended, in subsection (a)—

(A) by striking “The Secretary” and inserting “(1) To

the extent practicable, the Secretary”; and

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

“(2) If the Secretary of Veterans Affairs elects not to

enter into such an agreement or contract, notwithstanding

paragraph (1), the Secretary and the Department of Veterans

Affairs-Department of Defense Joint Executive Committee shall

submit to the Committees on Veterans' Affairs of the House of

Representatives and the Senate a written justification for

such election.”.

(2) Information.—Such section is further amended by

inserting, after subsection (b), the following new subsection

(c):

“(c) Information.—(1) If the Committee on Veterans'

Affairs of the House of Representatives or the Senate

requests information from the Secretary of Veterans Affairs

regarding section, the Secretary shall provide such

information in the form requested by such committee,

including underlying records, datasets, methodologies,

contracts, and communications, and may not be limited to

summaries or briefing materials in lieu of original source

documents unless authorized by the requesting committee.

“(2) In response to such a request, no official or

employee of the Department of Veterans Affairs shall—

“(A) withhold, screen, or alter responsive information;

“(B) delay or condition production on initial clearance or

political review;

“(C) require a nondisclosure agreement unless required by

law;

“(D) substitute summaries for requested records; or

“(E) otherwise impede or interfere with direct

transmission of information to the Committee on Veterans'

Affairs of the House of Representatives or the Senate.

“(3) If, in responding to such a request, the Secretary

determines that any such information is classified, the

Secretary shall make arrangements to present such information

to the Chair and Ranking Member of such committee using

appropriate security measures.”.

(3) Extension.—Such section is further amended, in

subsection (d)(3), by striking

“September 30, 2026” and inserting “September 30, 2027”.

(1) Joint resource sharing implementation plan.—Not later

than 90 days after the date of the enactment of this Act, the

Secretary of Veterans Affairs, in coordination with the

Secretary of Defense, shall submit to the Committees on

Veterans' Affairs of the House of Representatives and the

Senate a Joint Resource Sharing Implementation Plan. Such

plan shall include—

(A) a comprehensive inventory of all agreements under

section 8111 of title 38, United States Code;

(B) a standardized reimbursement methodology;

and Department of Defense facilities; and

(D) identification of priority regions for expansion.

(2) Report.—Not later than 2 years after the date of the

enactment of this Act, the Comptroller General shall submit a

report to Congress on the implementation of section 8111 of

title 38, United States Code. Such report shall include—

(A) a description of use and effectiveness of agreements

under such section;

(B) a description of the role and output of the Joint

Executive Committee under such section;

care and sharing of resources by the Department of Veterans

Affairs and the Department of Defense under such section; and

(D) a description of any statutory, operational, or

cultural barriers to the implementation of such section.

SEC. 313. TIMELY REPORTING OF THE DEATH OF A VETERAN.

(a) Findings.—Congress finds the following:

(1) States and counties have reported significant delays in

the signing of death certificates for veterans who pass away

from natural causes.

(2) Such delays, caused by the refusal of, or postponement

by, physicians of the Department of Veterans Affairs have, in

some cases, lasted as long as eight weeks.

(3) Such delays prevent the timely burial of deceased

veterans and access to survivor benefits.

(b) Timely Certification of the Death of a Veteran.—

(1) In general.—

(A) VA physician, nurse practitioner, or physician

assistant.—Subject to subparagraph (B), a physician, nurse

practitioner, or physician assistant employed by the

Secretary of Veterans Affairs who is the primary care

provider of a veteran who dies of natural causes shall

certify the death of such veteran not later than two business

days after such physician, nurse practitioner, or physician

assistant learns of such death.

(B) Coroner or medical examiner.—If a physician, nurse

practitioner, or physician assistant described in

subparagraph (A) cannot comply with such paragraph with

respect to a death described in such paragraph, a coroner or

medical examiner in the jurisdiction where such death

occurred may certify such death.

(2) Report.—

(A) In general.—Not later than one year after the date of

the enactment of this Act, and annually thereafter for the

following five years, the Secretary shall submit to the

Committee on Veterans' Affairs of the Senate and the

Committee on Veterans' Affairs of the House of

Representatives a report regarding compliance with paragraph

(1).

(B) Elements.—Each report required under subparagraph (A)

shall include, with respect to the year preceding the date of

the report, the following elements:

(i) The percentage of cases in which a physician, nurse

practitioner, or physician assistant employed by the

Secretary complied with paragraph (1)(A).

(ii) The number of cases in which such a physician, nurse

practitioner, or physician assistant could not so comply.

(iii) An identification of the most common reasons why such

a physician, nurse practitioner, or physician assistant could

not so comply.

(3) Rule of construction.—Nothing in this section shall be

construed to authorize a physician assistant or nurse

practitioner to certify a death in any State in which such

authority is not permitted under State or local law.

SEC. 314. EXPANSION OF ACCESS BY VETERANS TO CRITICAL ACCESS

HOSPITALS AND AFFILIATED CLINICS UNDER THE

VETERANS COMMUNITY CARE PROGRAM.

(a) Pilot Program to Improve Care Coordination for Veterans

From Critical Access Hospitals and Affiliated Clinics.—

(1) In general.—Not later than one year after the date of

the enactment of this Act, the Secretary of Veterans Affairs

shall commence a five-year pilot program to improve care

coordination for eligible veterans who receive care from a

critical access hospital or a provider-based rural health

clinic affiliated with such hospital (in this section

referred to as the “pilot program”).

(2) Contracts, agreements, or other arrangements.—

(A) In general.—In carrying out the pilot program, the

Secretary shall enter into contracts, agreements, or other

arrangements with facilities participating in the pilot

program to reimburse critical access hospitals and affiliated

clinics for outpatient health care and medical services

provided to eligible veterans.

(B) Elements.—The Secretary, in coordination with

participating critical access hospitals, shall ensure that

any contract, agreement, or other arrangement entered into

under subparagraph (A) establishes criteria, as the Secretary

considers appropriate, to ensure—

(i) the provision of timely, safe, and high-quality health

care services to participants in the pilot program, including

through timely sharing of pertinent medical record and other

information between medical facilities participating in the

pilot program and medical facilities of the Department of

Veterans Affairs;

(ii) the provision of health care services through the

pilot program is in accordance with the medical benefits

package of the Department;

(iii) no additional charges are imposed on veterans

participating in the pilot program or the health care insurer

of such veterans for any medical service for which payment is

made by the Secretary;

(iv) appropriate reimbursement rates, including through the

consideration of cost-based reimbursements; and

(v) such other considerations as the Secretary considers

appropriate.

(3) Locations.—The Secretary shall ensure participation in

the pilot program is open to all qualified facilities located

in States that are designated by the Centers for Medicare &

Medicaid Services as frontier States.

(4) Authorization for care.—The Secretary shall provide

eligible veterans opting to participate in the pilot program

a one-year authorization from the Department to receive

outpatient services at facilities participating in the pilot

program.

(5) Outreach.—

(A) Eligible veterans.—Not less frequently than annually

during each year in which the pilot program is carried out,

the Secretary shall conduct direct outreach to eligible

veterans in areas in which the pilot program is carried out

to notify such veterans of their ability to participate in

the pilot program.

(B) Hospitals.—The Secretary shall conduct direct outreach

to critical access hospitals in areas in which the pilot

program is carried out to notify those hospitals of their

ability to participate in the pilot program.

(6) Staff.—The Secretary shall ensure that each medical

facility of the Department within the catchment area of a

location in which the pilot program is carried out has

sufficient dedicated staff to handle—

(A) administrative and technical challenges that arise from

the pilot program;

(B) care coordination and follow up with the veteran and

the facility participating in the pilot program after an

episode of care; and

(7) Limitation.—The Secretary may not extend the pilot

program beyond the five-year period specified under

subsection (a) or expand the pilot program to additional

States or convert the pilot program into a permanent

authority unless expressly authorized by a subsequent Act of

Congress.

(8) Report.—

(A) In general.—Not later than one year after the date of

the enactment of this Act, and annually thereafter for the

duration of the pilot program, the Secretary shall submit to

the Committee on Veterans' Affairs of the Senate and the

Committee on Veterans Affairs of the House of Representatives

a report on the pilot program.

(B) Elements.—

(i) In general.—Each report required under subparagraph

(A) shall contain the recommendation of the Secretary for the

expansion or continuation of the pilot program.

(ii) Initial report.—The initial report required under

clause (i) shall contain—

(I) a description of the outreach conducted to critical

access hospitals concerning the pilot program;

(II) a list of facilities that have opted to participate in

the pilot program;

(III) information, by facility, regarding total obligations

and expenditures, utilization, average time from

authorization to care, timeliness regarding medical records

return and claim payment, emergency department utilization,

veteran satisfaction, and any effect on care furnished by

Department facilities; and

(IV) a list of the barriers, if any, cited by facilities

that opted not to participate in the pilot program.

(iii) Subsequent reports.—Each report required under

clause (i) after the initial report shall contain—

(I) an updated list of facilities participating in the

pilot program;

(II) the number of veterans participating in the pilot

program, disaggregated by facility;

(III) an overview of the types of care received through the

pilot program;

(IV) feedback from the facilities participating in the

pilot program, with identifying information removed,

regarding the status of the pilot program, challenges in

participating in the pilot program, and the interest of the

facility in continued participation in such a program; and

(V) any additional information that the Secretary

determines relevant or necessary.

(9) Definitions.—In this subsection:

(A) Critical access hospital.—The term “critical access

hospital” has the meaning

given that term in section 1861(mm) of the Social Security

Act (42 U.S.C. 1395x(mm)).

(B) Eligible veteran.—The term “eligible veteran” means

a veteran—

(i) enrolled in the patient enrollment system of the

Department of Veterans Affairs established and operated under

section 1705(a) of title 38, United States Code;

(ii) who has received care at a facility of the Department

or in-network provider under the Veterans Community Care

Program under section 1703 of such title during the previous

two-year period;

(iii) who lives within 35 miles of a critical access

hospital; and

(iv) who would be eligible for care or services under the

Veterans Community Care Program.

(b) Action Plan to Address Barriers to Care for Veterans

Living in Rural Areas.—

(1) In general.—Not later than one year after the date of

the enactment of this Act, the Secretary of Veterans Affairs

shall develop and submit to the Committee on Veterans'

Affairs of the Senate and the Committee on Veterans' Affairs

of the House of Representatives a comprehensive action plan

to identify, address, and eliminate barriers to accessing

care for veterans residing in rural, highly rural, and

frontier areas.

(2) Elements.—In developing the action plan required under

paragraph (1), the Secretary shall—

(A) consult with health care providers that provide care in

the community under the laws administered by the Secretary,

State Offices of Rural Health, Tribal health authorities, and

other relevant stakeholders in rural, highly rural, and

frontier areas as the Secretary determines appropriate;

(B) assess barriers to care in the community for veterans

residing in rural and highly rural areas, including

challenges with respect to—

(i) network adequacy;

(ii) provider participation;

(iii) geographic distance;

(iv) transportation;

(v) information technology;

(vi) physical infrastructure;

(vii) outreach and understanding of eligibility for such

care;

(viii) timeliness of referrals, authorization, and medical

documentation exchange; and

(ix) any other matter the Secretary determines appropriate;

address the barriers and challenges assessed under

subparagraph (B), to include the consideration of—

(i) expanding participation in the Veterans Community Care

Program under section 1703 of title 38, United States Code,

among providers in rural, highly rural, and frontier areas;

(ii) physically locating health care facilities of the

Department of Veterans Affairs within the same building or on

the campuses of other health care facilities located in

rural, highly rural, or frontier areas;

(iii) enhancing transportation assistance;

(iv) increasing reimbursement rates, including through

cost-based reimbursements; and

(v) improving coordination with State, Tribal, and local

partners; and

(D) assess legislative and regulatory barriers, if any, to

addressing the barriers assessed under subparagraph (B).

(3) Implementation.—Not later than 90 days after

submitting the action plan under paragraph (1), the Secretary

shall begin implementation of the plan and shall ensure full

implementation not later than two years after the date of the

enactment of this Act.

(1) Outreach to veterans.—Not later than one year after

the date of the enactment of this Act, and annually

thereafter, the Secretary of Veterans Affairs, through the

Office of Rural Health (or successor office) and the Office

of Integrated Veteran Care (or successor office), shall

conduct outreach to veterans residing in rural, highly rural,

and frontier areas regarding—

(A) opportunities to seek care through facilities and

programs of the Department of Veterans Affairs, including via

telehealth, existing programs provided through grantees or

contractors of the Department, Vet Centers (as defined in

section 1712A of title 38, United States Code), and volunteer

programs and services for transportation;

(B) opportunities to seek care though the Veterans

Community Care Program under section 1703 of title 38, United

States Code;

with contracts, partnerships, or agreements with the

Department of Veterans Affairs; and

(D) any other matters the Secretary considers appropriate.

(2) Outreach to providers.—Not later than one year after

the date of the enactment of this Act, and annually

thereafter, the Secretary of Veterans Affairs, through the

Office of Rural Health (or successor office) and the Office

of Integrated Veteran Care (or successor office), shall—

(A) conduct outreach to health care facilities and critical

access hospitals in rural areas regarding—

(i) the Veterans Community Care program under section 1703

of title 38, United States Code, and the pilot program under

subsection (a) of this section; and

(ii) any other matters the Secretary considers appropriate;

and

(B) seek to enter into contracts, partnerships, agreements,

or other arrangements with health care facilities and

critical access hospitals in rural areas.

(3) Critical access hospital defined.—In this section, the

term “critical access hospital” has the meaning given that

term in section 1861(mm) of the Social Security Act (42

U.S.C. 1395x(mm)).

SEC. 315. PILOT PLATFORM FOR SERVICES FOR VETERANS;

COLLECTION FROM VETERANS OF INFORMATION RELATED

TO SOCIAL DETERMINANTS OF HEALTH.

(a) Pilot Program on Establishment or Enhancement of

Community Integration Platform for Veterans.—

(1) In general.—Commencing not later than 18 months after

the date of the enactment of this Act, the Secretary of

Veterans Affairs, acting through the Center for Innovation

for Care and Payment of the Department of Veterans Affairs,

shall carry out a pilot program under which the Secretary

shall establish a new, or enhance an existing, interoperable

community integration platform to coordinate local support

services for veterans through other governmental and

nongovernmental organizations (in this section referred to as

the “pilot program”).

(2) Elements of pilot program.—In carrying out the pilot

program, the Secretary shall ensure that the community

integration platform established or enhanced under the pilot

program—

(A) permits veterans to identify and connect with covered

entities that furnish covered services;

(B) permits covered entities to identify and connect with

veterans in need of covered services;

interoperable technology networks;

(D) prioritizes connectivity with appropriate existing

technology networks developed by public or private

organizations that comply with, as applicable, standards

adopted by the Secretary of Health and Human Services under

section 3004 of the Public Health Service Act (42 U.S.C.

300jj-14), for the provision of covered services;

(E) ensures that—

(i) reasonable measures are taken to promote connectivity

and interoperable exchange among covered entities and between

covered entities and veterans; and

(ii) appropriate privacy and security protections are in

place, in accordance with applicable Federal and State

privacy law;

(F) is accessible by employees of the Department, covered

entities, and veterans;

(G) connects covered entities and veterans for purposes of

communication, service coordination, and consumer assistance,

referral and capacity management, outcome tracking and

reporting, and related services; and

(H) is accessible via a web-based platform for all veterans

and via a non-web-based alternative platform or process for

veterans who are unable to easily and reliably access the

web-based platform.

(3) Locations.—

(A) Initial locations.—The Secretary shall carry out the

pilot program at not fewer than five medical facilities of

the Department of Veterans Affairs selected by the Secretary

for purposes of the pilot program.

(B) Expansion.—The Secretary may expand beyond initial

sites for the pilot program selected under paragraph (1) not

before two years after the date of enactment, not before

thirty days after briefing the Committees on Veterans'

Affairs of the Senate and the House of the expansion plan,

and after demonstrated success.

subparagraph (A), the Secretary shall ensure the selection of

a variety of different types of facilities, including—

(i) frontier facilities;

(ii) under-resourced facilities;

(iii) facilities at which there are existing efforts to

coordinate with community resources; and

(iv) facilities located in communities with an established

community-based veteran service coordination network capable

of integration with the pilot program.

(4) Procurement of technology.—In carrying out the pilot

program, the Secretary shall ensure full and open competition

in the procurement of any services or technology and shall

not enter into an exclusive national contract for the

operation of the community integration platform under the

pilot program. In procuring technology under this section,

the Secretary may prioritize, to the maximum extent

practicable, technologies, platforms, or capabilities that

are already deployed, validated, interoperable, or otherwise

in operational use within medical centers or other components

of the Department, unless the Secretary determines and

documents that an alternative solution would better achieve

the purposes of this section.

(5) Application process.—

(A) In general.—The Secretary may require covered entities

that seek to participate in the pilot program to submit to

the Secretary an application therefore in such form, in such

manner, and containing such commitments and information as

the Secretary considers necessary to carry out this section.

(B) Review.—

(i) In general.—The Secretary shall review the

applications of covered entities submitted under subparagraph

(A) to ensure that the participation of such entities would

be safe and appropriate for veterans participating in the

pilot program.

(ii) Due diligence.—In reviewing applications under clause

(i), the Secretary shall conduct due diligence consistent

with how

the Secretary conducts due diligence for public-private

partnerships under other laws administered by the Secretary.

(6) Screening and tracking of participants.—

(A) In general.—The Secretary shall require veterans

participating in the community integration platform under the

pilot program to provide information regarding social

determinants of health using the ICD-10 diagnostic codes Z55

through Z63 and Z75 (as in effect on the date of the

enactment of this Act) in a standardized risk assessment or

screening tool and such other information as the Secretary

considers necessary to administer the pilot program.

(B) Informed consent.—Information collected under the

pilot program with respect to a veteran shall be obtained

with the informed consent of the veteran and used solely for

purposes of care coordination, service delivery, or program

evaluation under the pilot program.

(i) In general.—The Secretary shall track—

(I) the number of referrals of veterans to covered entities

through the community integration platform under the pilot

program;

(II) the response time of covered entities to which such

veterans are referred; and

(III) the outcome of the initial meeting by a veteran and a

covered entity to which the veteran is referred, including a

description of the services that are provided to the veteran

by such entity.

(ii) Tracking by entities.—The Secretary may require

covered entities participating in the pilot program to track

the information required under clause (i) in a medium

determined appropriate by the Secretary.

(7) Coordination and integration of programs.—

(A) Coordination with existing networks.—In carrying out

the pilot program, the Secretary shall coordinate with

existing community networks.

(B) Coordination and integration with state medicaid

programs.—The Secretary may consult and coordinate with the

Secretary of Health and Human Services and with States

regarding existing Federal and State programs, but nothing in

this section shall be construed to authorize the Secretary of

Veterans Affairs to administer, direct, or modify a State

Medicaid program or waiver.

(8) Performance benchmarks.—The Secretary shall establish

performance benchmarks for the pilot program, including

measures of referral completion, timeliness of service

connection, and veteran-reported satisfaction.

(9) Report and briefings.—

(A) Report.—Not later than three years after the

commencement of the pilot program, the Secretary shall submit

to the appropriate committees of Congress a report analyzing

the needs of veterans for covered services reflected by the

use of such services under the community integration platform

under the pilot program, including an assessment of—

(i) the need for such services that is being met through

such platform; and

(ii) the need for such services that is not being met

through such platform.

(B) Briefing on entities not selected.—Not later than 180

days after the commencement of the pilot program, and not

less frequently than once every 180 days thereafter until the

conclusion of the pilot program, the Secretary shall brief

the appropriate committees of Congress on the covered

entities that submitted an application to participate in the

pilot program but were not selected for participation and the

reason those entities were not selected.

(10) Comptroller general evaluation, report, and

recommendations.—

(A) Evaluation.—The Comptroller General of the United

States shall conduct an evaluation that measures the overall

impact of the community integration platform established or

enhanced under the pilot program with respect to—

(i) changes in individual and population health outcomes

among veterans;

(ii) changes in access to health care or social services

among veterans; and

(iii) such other factors as the Comptroller General

considers appropriate.

(B) Report and recommendations.—

(i) In general.—Not later than four years after the

commencement of the pilot program, the Comptroller General

shall—

(I) submit to Congress a report on the evaluation conducted

under subparagraph (A);

(II) make such report publicly available; and

(III) based on such evaluation, make recommendations to the

Secretary on how to improve and sustain the community

integration platform established or enhanced under the pilot

program.

(ii) Elements of report.—The report under clause (i)(I)

shall include data on—

(I) what covered services under the pilot program are being

utilized the most;

(II) what requests for services under the pilot program

cannot be met; and

(III) the impact of the provision of services under the

pilot program on health outcomes of veterans.

(11) Limitations.—(A) The Secretary may not use the pilot

program established under subsection (a) to supplant services

otherwise required to be furnished by the Department under

title 38, United States Code.

(B) No covered entity participating in the pilot program

established under subsection (a) may receive access to

personally identifiable information, protected health

information, or social determinants information of a veteran

without the veteran's informed written consent, and such

information may be used only for the specific referral or

service authorized by the veteran.

(12) Definitions.—In this subsection:

(A) Appropriate committees of congress.—The term

“appropriate committees of Congress” means the Committee on

Veterans' Affairs of the Senate and the Committee on

Veterans' Affairs of the House of Representatives.

(B) Community integration platform.—The term “community

integration platform” means an interoperable platform or

network of interoperable systems used to enable the

coordination, alignment, and connection of covered entities

and veterans at the local level for purposes of

communication, service coordination, and referral management

of covered services.

of the following entities or providers that have entered into

an agreement with the Secretary to participate in the pilot

program:

(i) A community-based organization that—

(I) accepts referrals from health care organizations; and

(II) provides covered services.

(ii) A public or private health care provider organization.

(iii) A public or private funded payor of health care

services, including home- or community-based services.

(iv) A State, local, territorial, or Tribal health or

social services agency.

(v) A State public housing authority or housing finance

agency.

(vi) A public health information exchange or public health

information network, as defined by the Secretary.

(vii) A faith-based service provider.

(viii) Any other similar entity, as determined by the

Secretary.

(D) Covered services.—The term “covered services” means

any of the following:

(i) Nutritional assistance.

(ii) Housing.

(iii) Health care, including preventive health

intervention, chronic disease management, and behavioral

health care.

(iv) Transportation.

(v) Job training and employment.

(vi) Child development or care.

(vii) Caregiving and respite care.

(viii) Disability assistance.

(ix) Suicide prevention.

(x) Sexual assault services.

(xi) Legal aid.

(xii) Transition assistance for veterans newly separated or

discharged from active military, naval, air, or space service

(as defined in section 101(24) of title 38, United States

Code).

(xiii) Assistance with utilities necessary for safe

habitation.

(xiv) Other services directly related to health care

access, suicide prevention, homelessness prevention, food

insecurity, transportation to health care, or assistance

separating from military service and reentering civilian

life, as expressly authorized under laws administered by the

Secretary.

(E) Secretary.—The term “Secretary” means the Secretary

of Veterans Affairs.

(F) State.—The term “State” has the meaning given that

term in section 101 of title 38, United States Code.

(b) Collection of Information From Veterans Related to

Social Determinants of Health.—

(1) In general.—The Secretary of Veterans Affairs shall

collect from veterans enrolled in the system of annual

patient enrollment of the Department of Veterans Affairs

established and operated under section 1705(a) of title 38,

United States Code, as part of routine screenings of such

veterans under the laws administered by the Secretary,

information related to social determinants that may factor

into the health of such veterans.

(2) Social determinants of health.—

(A) In general.—The information collected under paragraph

(1) shall include standardized definitions for identifying

social determinants of health needs identified in the ICD-10

diagnostic codes Z55 through Z63 and Z75 (as in effect on the

date of enactment of this Act).

(B) Incorporation of measures.—Definitions included under

subparagraph (A) with respect to identifying social

determinants of health needs shall incorporate measures for

quantifying the relative severity of any such social

determinant of health need identified in an individual.

SEC. 316. IMPROVEMENTS TO DEPARTMENT OF VETERANS AFFAIRS

PROSTHETIC AND REHABILITATIVE ITEMS AND

SERVICE.

(a) Prosthetic and Rehabilitative Items and Services

Formulary.—

(1) In general.—Chapter 17 of title 38, United States

Code, is amended by inserting after section 1709C the

following new section:

“Sec. 1709D. Prosthetic and Rehabilitative Items and

Services Formulary

“(a) In General.—The Secretary shall establish a list of

prosthetic and rehabilitative items and services, which may

be referred to as the `Prosthetic and Rehabilitative Items

and Services Formulary' or the `Formulary', for purposes of

furnishing medical services under section 1701(6)(F) of this

title pursuant to section 1710 of this title.

“(b) Requirements.—

“(1) Input.—In developing the Formulary, the Secretary

shall solicit input from veterans and the public.

“(2) Availability of items.—The Secretary shall ensure

that all items and services included in the Formulary are

available at or through all facilities of the Department.

“(3) Items to be included.—In developing the Formulary,

the Secretary shall rely on the best available evidence to

identify which items and services should be included on the

Formulary.

“(c) Publication and Communication.—

“(1) Publication and update.—The Secretary shall publish

the Formulary on a website of the Department and shall update

the Formulary periodically.

“(2) Communication.—The Secretary shall communicate to

veterans the contents of the Formulary and information about

how to appeal decisions regarding the provision of items and

services on the Formulary.

“(d) Contracts.—The Secretary shall enter into such

contracts as the Secretary considers necessary to support the

availability of items and services included in the Formulary.

“(e) Training.—The Secretary shall ensure the

availability of training on the Formulary for clinicians and

other staff of the Department.

“(f) Exceptions.—

“(1) In general.—The Secretary shall establish a process

for clinicians of the Department to request, prescribe, and

furnish prosthetic and rehabilitative items and services that

are not included on the Formulary when medically necessary.

“(2) Monitoring of non-formulary items and services.—The

Secretary shall monitor requests and prescriptions for and

the furnishing of prosthetic and rehabilitative items and

services under paragraph (1)—

“(A) to ensure that such items and services are being

consistently and appropriately prescribed at all facilities

of the Department; and

“(B) to determine whether such items or services should be

added to the Formulary.

“(3) Prior authorization for non-formulary procurement.—

The Secretary shall establish a prior authorization process

for the procurement of prosthetic and rehabilitative items

that are not included on the Formulary or available through a

national contract.

“(4) Open market procurement.—The Secretary shall ensure

that procurement of items that are not included on the

Formulary or available through a national contract is

permitted only if a clinician determines the item is

medically necessary.

“(g) Consideration.—In developing the Formulary, the

Secretary shall consider how the approach of the Pharmacy

Benefits Management Services of the Department for formulary

management and medication safety can be adapted to support

the efficient and effective administration of the Formulary.

“(h) Enterprise Procurement and Ordering System.—

“(1) In general.—The Secretary shall implement an

enterprise electronic ordering system for prosthetic and

rehabilitative items and services furnished under this

section.

“(2) Systems elements.—The system required under

paragraph (1) shall—

“(A) enable the automated ordering of items included on

the Formulary;

“(B) provide visibility of contract pricing and

availability across all facilities of the Department;

“(C) allow enterprise loading of nationally contracted

products;

“(D) provide procurement analytics to monitor compliance

with national contracts and reduce open market purchasing;

and

“(E) contain all data elements required for the Federal

Electronic Healthcare Record in a searchable format.

“(3) Implementation.—The Secretary shall ensure that the

system required under paragraph (1) is implemented across all

medical centers of the Department by not later than three

years after the date of the enactment of this section.

“(i) Program Management.—

“(1) In general.—The Secretary shall ensure that the

Prosthetic and Sensory Aids Service of the Department

maintains adequate staffing to administer the Formulary and

associated procurement programs.

“(2) Staffing included.—Staffing required under paragraph

(1) shall include—

“(A) dedicated program managers for major prosthetic

product categories; and

“(B) full-time clinical staff responsible for clinical

evaluations and practice recommendations.

“(j) Report to Congress.—Not later than two years after

the date of the enactment of this section, and annually

thereafter, the Secretary shall submit to the Committee on

Veterans' Affairs of the Senate and the Committee on

Veterans' Affairs of the House of Representatives a report

describing—

“(1) rates of compliance by the Department with national

prosthetic contracts;

“(2) open market purchasing trends of the Department;

“(3) utilization of the Formulary across facilities of the

Department; and

“(4) steps taken by the Department to improve enterprise

procurement efficiency.”.

(2) Clerical amendment.—The table of sections at the

beginning of such chapter is amended by inserting after the

item relating to section 1709C the following new item:

“1709D. Prosthetic and rehabilitative items and services formulary”.

(b) Report.—

(1) In general.—Not later than one year after the date of

the enactment of this Act, the Secretary of Veterans Affairs

shall submit to the Committee on Veterans' Affairs of the

Senate and the Committee on Veterans' Affairs of the House of

Representatives a report containing a comprehensive,

independent, operational, and technology assessment for the

implementation of the Prosthetic and Rehabilitative Items and

Services Formulary established under section 1709D of title

38, United States Code, as added by subsection (a).

(2) Elements.—The report required by paragraph (1) shall

identify potential impacts of the Prosthetic and

Rehabilitative Items and Services Formulary on—

(A) access by veterans to prosthetic and rehabilitative

items and services;

(B) clinician workload;

(D) innovation adoption.

SEC. 317. IMPROVEMENT OF SUBMISSION OF MEDICAL DOCUMENTATION

TO THE SECRETARY OF VETERANS AFFAIRS BY

COMMUNITY CARE PROVIDERS.

(a) In General.—The Secretary of Veterans Affairs shall

ensure that each contract, agreement, or other arrangement

through which the Secretary furnishes hospital care, medical

services, or extended care services to eligible veterans

through non-Department of Veterans Affairs entities or

providers includes clear requirements, including requirements

regarding timeliness, regarding the submission of medical

documentation to the Secretary after a veteran receives such

care or services from the non-Department entity or provider.

(b) Internal Measures.—The Secretary shall establish such

goals and related performance measures for medical centers of

the Department as the Secretary determines appropriate in

obtaining medical documentation from non-Department entities

or providers under subsection (a).

related performance measures for the completion by non-

Department entities or providers of core training related to

the submission to the Secretary of medical documentation

under subsection (a) and may monitor the completion of such

training.

(d) Outreach.—The Secretary shall ensure that

communications by the Secretary with non-Department entities

or providers contain clear and accurate information regarding

requirements for submitting medical documentation under

subsection (a) and completing the core training described in

subsection (c).

(e) Submission of Goals, Measures, and Materials.—Not

later than one year after the date of the enactment of this

Act, and not less frequently than annually thereafter for the

following five years, the Secretary shall submit to the

Committee on Veterans' Affairs of the Senate and the

Committee on Veterans' Affairs of the House of

Representatives copies of any goals, performance measures,

training materials, or outreach materials pertaining to the

submission of medical documentation under this section.

SEC. 318. IMPLEMENTATION OF AND REPORT ON EFFORTS OF

DEPARTMENT OF VETERANS AFFAIRS TO IMPROVE

HEALTH CARE APPOINTMENT SCHEDULING.

(a) In General.—Not later than one year after the date of

the enactment of this Act, the Secretary of Veterans Affairs

shall submit to the appropriate committees of Congress a plan

to improve the process for scheduling appointments for health

care from the Department of Veterans Affairs, including

improvements for both patients and employees of the

Department responsible for scheduling such appointments.

(b) Elements of Plan.—

(1) In general.—The plan required by subsection (a) shall

include—

(A) such actions, resources, technology, and process

improvements as the Secretary determines necessary to ensure

the Department achieves, in a timely manner, improved

delivery of health care, access to health care, customer

experience and service relating to the receipt of health

care, and efficiency with respect to the delivery of health

care; and

(B) a proposed schedule and timeline to carry out such

plan.

(2) Objectives.—

(A) In general.—The Secretary shall ensure that the plan

required by subsection (a) addresses the following

objectives:

(i) To develop or continue the development of a scheduling

system that enables both personnel and patients of the

Department to view available appointments for care furnished

by the Department, including primary care, mental health

care, and all forms of specialty care.

(ii) To develop or continue the development of a self-

service scheduling platform, available for use by all

patients of the Department, which shall—

(I) enable such patients to view available appointments

and, subject to the process described in clause (iii), fully

schedule appointments for all care furnished by the

Department;

(II) if a referral is required for an appointment, provide

a method for the patient to request a referral and

subsequently book an appointment if the referral is approved;

and

(III) provide such patients with the ability to cancel or

reschedule appointments.

(iii) To create a process through which all patients of the

Department can telephonically speak with a scheduler who can

assist the patient to determine appointment availability and

can fully schedule appointments on behalf of the patient for

all care furnished by the Department.

(iv) To carry out such other functions, oversight, metric

development and tracking,

change management, cross-Department coordination, and other

related matters, including improvements to employee-facing

information technology, training, and processes, as the

Secretary determines appropriate as it relates to scheduling

tools, functions, and operations with respect to health care

appointments furnished by the Department.

(B) Explanation of inability to implement certain

objectives, features, or services.—If the Secretary

determines that an objective under subparagraph (A), or any

feature or service in connection with that objective, cannot

be implemented or otherwise incorporated into a final product

pursuant to the plan required by subsection (a), the

Secretary shall include with the plan submitted under such

subsection a report containing—

(i) an explanation as to why that objective, feature, or

service cannot be implemented or incorporated, as the case

may be; and

(ii) a plan for implementing the plan required by

subsection (a) without that objective, feature, or service.

submitting to the appropriate committees of Congress the plan

required by subsection (a), the Secretary shall fully

implement the plan.

(d) Coordination With Electronic Health Record

Modernization Program.—In developing the plan required by

subsection (a), the Secretary shall ensure that the elements

and objectives of such plan set forth under subsection (b)

are developed in consideration of the deployment schedule and

capabilities of the Electronic Health Record Modernization

Program of the Department to ensure a smooth transition to

using the tools and features under such plan as relevant and

appropriate.

(e) Implementation Reports.—Not later than each of one

year and two years after the date on which the Secretary

submits the plan required by subsection (a), the Secretary

shall submit to the appropriate committees of Congress a

report on the progress of the Secretary in implementing such

plan, including—

(1) the costs incurred to implement the plan as of the date

of the report;

(2) the expected costs to complete implementation of the

plan (including costs for management and technology);

(3) the schedule for deployment of any capabilities

developed pursuant to the plan; and

(4) the goals and metrics achieved, challenges, and lessons

learned in implementing the plan.

(f) Rule of Construction.—Nothing in this section shall be

construed to require the Secretary to include in the plan

required by subsection (a) any technology or process that

would preclude or impede the ability of a veteran to contact

or schedule an appointment directly with a facility or

provider through a non-online scheduling process, should the

veteran choose to do so.

(g) Definitions.—In this section:

(1) Appropriate committees of congress.—The term

“appropriate committees of Congress” means the Committee on

Veterans' Affairs of the Senate and the Committee on

Veterans' Affairs of the House of Representatives.

(2) Fully schedule.—The term “fully schedule”, with

respect to an appointment for health care, means that the

appointment booking is completed, rather than simply

requested.

SEC. 319. PILOT PROGRAM ON COORDINATION OF CARE BETWEEN

DEPARTMENT OF VETERANS AFFAIRS AND MEDICARE

PROGRAM.

(a) In General.—The Secretary, in consultation with the

Secretary of Health and Human Services, shall carry out a

pilot program (in this section referred to as the “pilot

program”) to coordinate, navigate, and manage care and

benefits for covered veterans.

(b) Purposes of Pilot Program.—The purposes of the pilot

program are as follows:

(1) To improve access to health care services for covered

veterans from the Department of Veterans Affairs and under

the Medicare program under title XVIII of the Social Security

Act (42 U.S.C. 1395 et seq.).

(2) To improve satisfaction with care received by covered

veterans.

(3) To improve quality of care received by covered

veterans.

(4) To lower costs to the Federal Government for care

received by covered veterans.

(5) To reduce gaps in care and duplication of services and

expenses for covered veterans.

(6) To improve care coordination for covered veterans,

including coordination of patient information and medical

records between providers and between the Department and the

Centers for Medicare & Medicaid Services.

program in not fewer than three but not more than five

Veterans Integrated Service Networks with a significant

number of covered veterans and geographic diversity,

including—

(1) locations that are in rural or highly rural areas, as

determined through the use of the Rural-Urban Continuum Codes

of the Department of Agriculture; and

(2) locations that are in medically underserved communities

(as defined in section 799B of the Public Health Service Act

(42 U.S.C. 295p)).

(d) Case Manager.—In carrying out the pilot program, the

Secretary shall assign each covered veteran participating in

the pilot program a case manager responsible for—

(1) coordinating with the veteran, the primary care team of

the veteran, and any relevant care coordinators already

assisting the veteran to develop an individualized needs

assessment for the veteran and, based on such assessment, a

care coordination plan with defined treatment goals; and

(2) navigating the systems of care under the laws

administered by the Secretary and under the Medicare program

under title XVIII of the Social Security Act (42 U.S.C. 1395

et seq.).

(e) Use of Existing Models.—In designing the pilot

program, the Secretary may use existing models used by

commercial health care programs to improve access, health

outcomes, quality, and customer experience and lower per

capita costs.

(f) Contracting With Private Sector Entities.—

(1) In general.—The Secretary, to the extent practicable,

shall consider entering into contracts or agreements with

private sector entities carrying out commercial health care

programs for assistance in designing, implementing, and

managing care and benefits under the pilot program, to

include providing care coordination.

(2) Notification.—If the Secretary determines that

entering into contracts or agreements with private sector

entities under paragraph (1) is not necessary or practicable,

the Secretary shall submit to the Committee on Veterans'

Affairs of the Senate and the Committee on Veterans' Affairs

of the House of Representatives—

(A) a notification of that determination;

(B) a description of the steps, if any, the Secretary has

taken to attempt to enter into a contract or an agreement

with a private sector entity;

that such contract or agreement is not necessary or

practicable; and

(D) a plan for how the Secretary will carry out the pilot

program without entering into a contract or an agreement with

a private sector entity, including through the use of

employees of the Department of Veterans Affairs or other

government agencies, nonprofit organizations, or other

entities.

(g) Metrics.—

(1) In general.—The Secretary shall track metrics under

the pilot program, including the following:

(A) The number of veterans participating in the pilot

program, disaggregated by Veterans Integrated Service

Network.

(B) Reliance on health care services administered by the

Secretary.

Medicare program under title XVIII of the Social Security Act

(42 U.S.C. 1395 et seq.).

(D) Quality of care, including patient outcomes.

(E) Cost of care.

(F) Access to care, including under the designated access

standards developed by the Secretary under section 1703B of

title 38, United States Code.

(G) Patient satisfaction.

(H) Provider satisfaction.

(I) Care coordination, including timely information sharing

and medical documentation return.

(2) Elements.—In tracking metrics under paragraph (1), the

Secretary shall track information relating to—

(A) whether care received by a covered veteran is related

to a service-connected disability (as defined in section 101

of title 38, United States Code);

(B) the priority group under section 1705(a) of title 38,

United States Code, through which each covered veteran was

enrolled in the system of annual patient enrollment of the

Department of Veterans Affairs under such section;

veterans; and

(D) the demographics of covered veterans participating in

the pilot program, including age.

(h) Supplement Not Supplant.—The services provided under

the pilot program shall supplement, not supplant, the

services provided under the education program under section

121 of the VA MISSION Act of 2018 (Public Law 115-182; 38

U.S.C. 1701 note).

(i) Duration.—The Secretary shall carry out the pilot

program for a three-year period beginning on the commencement

of the pilot program.

(j) Reports.—

(1) Development, implementation, results, and design of

pilot program.—

(A) In general.—Not less frequently than biannually during

the two-year period beginning on the date of the enactment of

this Act, the Secretary shall submit to the Committee on

Veterans' Affairs of the Senate and the Committee on

Veterans' Affairs of the House of Representatives a report on

the development, implementation, results, and design of the

pilot program, including information on the metrics tracked

under subsection (g).

(B) Final design.—One of the reports required under

subparagraph (A) shall contain a description of the final

design of the pilot program.

(2) Results of pilot program.—

(A) In general.—Not later than one year after the

submission of the final report under paragraph (1), and not

less frequently than annually thereafter during the duration

of the pilot program, the Secretary shall submit to the

Committee on Veterans' Affairs of

the Senate and the Committee on Veterans' Affairs of the

House of Representatives a report on the results of the pilot

program.

(B) Final report.—In the final report submitted under

subparagraph (A), the Secretary shall include the

recommendation of the Secretary for whether the pilot program

should be extended or made permanent.

(k) Definitions.—In this section:

(1) Covered veteran.—The term “covered veteran” means a

veteran who is enrolled in both the Medicare program under

title XVIII of the Social Security Act (42 U.S.C. 1395 et

seq.) and the system of annual patient enrollment of the

Department of Veterans Affairs under section 1705(a) of title

38, United States Code.

(2) Secretary.—The term “Secretary” means the Secretary

of Veterans Affairs.

SEC. 320. FISHER HOUSE AVAILABILITY.

Section 1708 of title 38, United States Code, is amended—

(1) in subsection (a), by striking “in connection with”

and all that follows through the period at the end and

inserting “in accordance with this section.”;

(2) in subsection (b)—

(A) in paragraph (2)—

(i) by inserting “described in paragraph (1)” after

“family of a veteran”; and

(ii) by inserting “such” after “accompany”; and

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

“(3) On a space-available basis, a covered beneficiary who

must travel a significant distance to receive care or

services at a Department or non-Department facility.

“(4) On a space-available basis, a member of the family of

a covered beneficiary described in paragraph (3) and others

who accompany such a covered beneficiary who is receiving

care or services and provide the equivalent of familial

support for such beneficiary when the covered beneficiary or

the family member is traveling to receive care or services at

a Department or non-Department facility.

“(5) On a space-available basis, a veteran and a member of

the family of a veteran and others who must travel a

significant distance for a member of the veteran's family to

receive care or services at a Department or non-Department

facility.

“(6) On a space available basis, a covered beneficiary and

a member of the family of a covered beneficiary and others

who must travel a significant distance for a member of the

covered beneficiary's family to receive care or services at a

Department or non-Department facility.”;

(3) by striking subsection (c) and redesignating

subsections (d) and (e) as subsections (c) and (d),

respectively;

(4) in subsection (d), as so redesignated—

(A) in paragraph (2), by striking “subsection (d)” and

inserting “subsection (c)”;

(B) in paragraph (3), by striking “under subsection

(b)(2)” and inserting “or a covered beneficiary under

subsection (b)”;

semicolon;

(D) by redesignating paragraph (5) as paragraph (6); and

(E) by inserting after paragraph (4) the following new

paragraph (5):

“(5) establishing criteria for providing access to

temporary lodging facilities on a space-available basis under

paragraphs (3) through (6) of subsection (b); and”; and

(5) by adding at the end the following new subsection:

“(e) In this section:

“(1) The term `covered beneficiary' means a member of the

uniformed services.

“(2) The term `Fisher House' means a housing facility

that—

“(A) is located at, or in proximity to, a Department

medical facility;

“(B) is available for residential use on a temporary basis

by patients of that facility and others described in

subsection (b); and

“(C) is constructed by, and donated to the Secretary by,

the Zachary and Elizabeth M. Fisher Armed Services Foundation

or the Fisher House Foundation.”.

SEC. 321. STUDY ON QUALITY OF MENTAL HEALTH AND ADDICTION

THERAPY CARE PROVIDED BY HEALTH CARE PROVIDERS

OF DEPARTMENT OF VETERANS AFFAIRS COMPARED TO

NON-DEPARTMENT PROVIDERS.

(a) In General.—Not later than 90 days after the date of

the enactment of this Act, the Secretary of Veterans Affairs

shall seek to enter into an agreement with an independent and

objective academic organization or research institute with

demonstrated expertise in evaluating health outcomes inside

and outside the Department of Veterans Affairs under which

that organization shall—

(1) conduct a comparative study, subject to applicable

Federal privacy laws, that evaluates the quality of mental

health and addiction therapy care furnished under laws

administered by the Secretary, by providers of the Department

and by non-Department providers, across a range of treatment

modalities, including telehealth, in-patient, intensive out-

patient, out-patient, and residential treatment; and

(2) submit to the Committee on Veterans' Affairs of the

Senate and the Committee on Veterans' Affairs of the House of

Representatives, and publish on a publicly available website,

a report containing the final results of such study.

(b) Timing.—The Secretary shall ensure that the

organization with which the Secretary enters into an

agreement pursuant to subsection (a) completes the study and

submits the required report not later than 18 months after

the date on which the agreement is executed.

(a)(2) shall include an assessment of the following:

(1) The degree of symptom improvement among veterans

receiving care from such Department and non-Department

providers across telehealth, in-patient, intensive

outpatient, outpatient, and residential modalities. For each

setting, symptom changes shall be measured between intake and

discharge (for inpatient, intensive-outpatient, and

residential programs) and between initiation of care and five

months thereafter (for outpatient programs). Symptom scores

shall be obtained for—

(A) Post-traumatic stress disorder, using the Clinician-

Administered PTSD Scale and the PTSD Checklist;

(B) depression, using the Patient Health Questionnaire-9;

Monitor; and

(D) suicidality, using the Columbia-Suicide Severity Rating

Scale.

(2) Treatment-fidelity scores, derived from electronic

health record documentation, assessing the extent to which

such Department and non-Department providers adhere to

evidenced-based practices in delivering mental health and

addiction therapy care, as measured against criteria

established by the VA/DOD Clinical Practice Guidelines and

other nationally recognized, evidence-based standards,

including those of the American Society of Addiction Medicine

and the American Psychiatric Association.

(3) Identification of any gaps or delays in coordination

between such Department and non-Department providers in

responding to veterans seeking mental health or addiction

therapy services, including the timeliness and completeness

of health record exchange and communication of care plans.

(4) Measures of patient satisfaction with care received

from such Department and non-Department providers.

(5) The number and percentage of such Department and non-

Department providers who have completed Department or other

accredited condition-specific training relevant to the

veterans they treat, including training on military culture

and trauma-informed care.

(6) The extent to which veterans with co-occurring mental-

health and substance-use conditions receive coordinated,

integrated care addressing the full range of their clinical

needs, regardless of provider affiliation.

(7) Whether such Department and non-Department providers

monitor and document health-outcome measures throughout the

course of treatment and at regular intervals during the three

years following the initiation of treatment.

(8) The number of veterans receiving treatment from such

Department and non-Department providers across all levels of

care, including inpatient, residential, intensive outpatient,

and standard outpatient programs.

(9) The proportion of veterans described in paragraph (8)

whose treatment progress is documented in their electronic

health records as follows:

(A) For inpatient, residential, and intensive outpatient

programs, entry and exit symptom-assessment data and

discharge summaries shall be recorded not later than one year

following admission.

(B) For outpatient programs, initial symptom-assessment

data shall be entered not later than one month of intake, and

follow-up data shall be recorded not later than one year

thereafter.

(10) The average elapsed time for such Department and non-

Department providers, between receipt of referral for care or

veteran outreach and completion of the initial appointment or

admission.

(11) The percentage of such Department and non-Department

providers who undergo formal peer-review or clinical-quality

review at least once every six months.

SEC. 322. LACTATION SPACES IN MEDICAL CENTERS OF THE

DEPARTMENT OF VETERANS AFFAIRS.

(a) In General.—Subchapter II of chapter 17 of title 38,

United States Code, is amended by adding at the end the

following new section:

“Sec. 1720M. Lactation spaces in medical centers of the

Department

“(a) Lactation Space Required.—The Secretary shall ensure

that each medical center of the Department contains a

lactation space.

“(b) No Unauthorized Entry.—Nothing in this section shall

be construed to authorize an individual to enter a medical

center of the Department or portion thereof that the

individual is not otherwise authorized to enter.

“(c) Lactation Space Defined.—In this section, the term

`lactation space' means a hygienic place, other than a

bathroom, that—

“(1) is shielded from view;

“(2) is free from intrusion;

“(3) is accessible to disabled individuals (including such

individuals who use wheelchairs);

“(4) contains a chair and a working surface;

“(5) is easy to locate;

“(6) is clearly identified with signage; and

“(7) is available for use by women veterans and members of

the public to express breast milk.”.

(b) Clerical Amendment.—The table of sections at the

beginning of such chapter is

amended by inserting after the item related to section 1720L

the following new item:

“1720M. Lactation spaces in medical centers of the Department.”.

shall ensure that—

(1) not later than two years after the date of the

enactment of this Act, not fewer than 80 percent of medical

centers of the Department of Veterans Affairs are in

compliance with section 1720M of title 38, United States

Code, as added by subsection (a); and

(2) not later than three years after such date of

enactment, all medical centers of the Department are in

compliance with such section.

(d) Report.—

(1) In general.—Not later than one year after the date of

the enactment of this Act, and annually thereafter, the

Secretary of Veterans Affairs shall submit to the Committee

on Veterans' Affairs of the Senate and the Committee on

Veterans' Affairs of the House of Representatives a report on

the progress of the Secretary in meeting the requirements

under section 1720M of title 38, United States Code, as added

by subsection (a), including—

(A) a list of which medical centers of the Department of

Veterans Affairs currently have a lactation space;

(B) a list of which medical centers of the Department do

not have a lactation space; and

a description of actions the Department has taken to design

and plan a lactation space and a timeline for such lactation

space to be fully functional and open for use within the time

periods specified under subsection (c).

(2) Termination.—The Secretary is not required to submit a

report under paragraph (1) on or after the date on which the

Secretary confirms in a report submitted under such paragraph

that each medical center of the Department contains a

lactation space.

SEC. 323. RESEARCH RELATED TO MENOPAUSE, PERIMENOPAUSE, AND

MID-LIFE WOMEN'S HEALTH: REPORT; PLAN.

(a) Definitions.—In this section:

(1) Covered provider.—The term “covered provider” means

a health care provider employed by the Department of Veterans

Affairs.

(2) Menopause.—The term “menopause” means the stage of a

woman's life—

(A) when menstrual periods stop permanently and she can no

longer get pregnant; and

(B) that is not a disease state, but a normal part of aging

for women.

(3) Mid-life.—The term “mid-life” means a life stage

that—

(A) coincides with the menopausal transition in women,

which may be physical or emotional;

(B) encompasses the late reproductive age, which can begin

at approximately 35 years of age, to the late postmenopausal

stages of reproductive aging, which can extend to

approximately 65 years of age; and

(4) Perimenopause.—The term “perimenopause” means the

time during a woman's life when levels of the hormone

estrogen fall unevenly in a woman's body and is also called

the menopausal transition.

(5) Postmenopausal.—The term “postmenopausal” means the

stage of a woman's life after a woman has been without a

menstrual period for 12 months that lasts for the rest of a

woman's life and reflects a time when women are at increased

risk for osteoporosis and heart disease.

(b) Evaluation of Certain Research Related to Menopause,

Perimenopause, or Mid-life Women's Health.—

(1) In general.—The Secretary of Veterans Affairs shall

evaluate—

(A) the results of completed research related to menopause,

perimenopause, or mid-life women's health among women who are

members of the uniformed services or veterans;

(B) the status of such research that is ongoing;

(i) treatments for menopause-related symptoms, including

hormone and non-hormone treatments;

(ii) the safety and effectiveness of treatments for

menopause-related symptoms;

(iii) the impact of perimenopause and menopause on the

mental health of women who are members of the uniformed

services or veterans;

(D) the availability of and uptake of professional training

resources for covered providers relating to mid-life women's

health with respect to the care, treatment, and management of

perimenopause and menopausal symptoms, and related support

services; and

(E) the availability of and uptake of treatments for women

who are members of the uniformed services or veterans who are

experiencing perimenopause or menopause.

(2) Report; strategic plan.—Not later than 180 days after

the date of the enactment of this Act, the Secretary of

Veterans Affairs shall submit to Congress a report

containing—

(A) the findings of the evaluation conducted under

paragraph (1);

(B) recommendations for improving professional training

resources described in paragraph (1)(D) for covered

providers; and

(i) resolves the gaps in knowledge and research identified

in the report; and

(ii) identifies topics in need of further research relating

to potential treatments for menopause-related symptoms of

women who are members of the uniformed services or veterans.

(3) Nonduplication and supplementation of efforts.—In

carrying out activities under this section, the Secretary of

Veterans Affairs shall ensure that such activities minimize

duplication and supplement, not supplant, existing

information-sharing efforts of the Department of Health and

Human Services.

Menopause, Perimenopause, or Mid-life Women's Health.—It is

the sense of Congress that the Secretary of Defense and the

Secretary of Veterans Affairs should each conduct research

related to menopause, perimenopause, or mid-life health

regarding women who are members of the uniformed services or

veterans.

SEC. 324. PILOT PROGRAM ON PROVISION OF OPIOID RESCUE

MEDICATIONS TO VETERANS.

(a) In General.—Commencing not later than 120 days after

the date of the enactment of this Act, the Secretary of

Veterans Affairs shall carry out a one-year pilot program

under which the Secretary shall make covered medications

available to any veteran at no charge (in this section

referred to as the “pilot program”).

(b) Provision of Medication Prior to Confirmation of

Status.—The Secretary may provide covered medication to an

individual under the pilot program prior to confirming the

status of the individual as a veteran if the individual

provides contact information for the individual and a written

self-attestation of veteran status.

carrying out the pilot program in geographical areas where

data indicates a disproportionately high risk of overdose

among the veteran population.

(d) Limitation on Use of Information.—

(1) In general.—In carrying out this section, the

Secretary may only collect the personally identifiable

information needed for prescribing covered medication under

the pilot program, and any personally identifiable

information collected under this section may be used solely

for the purpose of delivering, evaluating, and enhancing the

quality of health care.

(2) Exclusion.—The Secretary may not use any personally

identifiable information collected under this section—

(A) for the purpose of preventing a veteran from

employment;

(B) as evidence of a history of drug use; or

or addicted to any controlled substance.

(e) Provision of Information.—The Secretary shall ensure

that any individual who receives covered medication under the

pilot program also receives—

(1) information about addiction services, suicide

prevention services, mental health services, and other

related services provided by the Department of Veterans

Affairs; and

(2) information on the use and application of covered

medications.

(f) Report.—

(1) In general.—Not later than 30 days before the

completion of the pilot program under this section, the

Secretary shall submit to Congress a report on the pilot

program.

(2) Elements.—The report required by paragraph (1) shall

include the following:

(A) The number of veterans who received a covered

medication under the pilot program, disaggregated by those

enrolled in the system of annual patient enrollment of the

Department of Veterans Affairs under section 1705(a) of title

38, United States Code, and those not enrolled in such

system.

(B) An assessment of the feasibility of expanding the pilot

program to provide covered medications to immediate family

members of veterans.

expanding, or making permanent the pilot program.

(D) Any other recommendations of the Secretary with respect

to modifying or continuing the pilot program.

(g) Definitions.—In this section:

(1) Covered medication.—The term “covered medication”

means any opioid overdose rescue medication, such as

naloxone.

(2) Veteran.—The term “veteran” has the meaning given

that term in section 101 of title 38, United States Code.

SEC. 325. ESTABLISHMENT OF VETERANS HEALTH ADMINISTRATION

POLICY ADVISORY COMMISSION.

(a) In General.—Chapter 1 of title 38, United States Code,

is amended by adding at the end the following new section:

“Sec. 120. Veterans Health Administration Policy Advisory

Commission

“(a) Establishment.—There is established the Veterans

Health Administration Policy Advisory Commission (in this

section referred to as the `Commission').

“(b) Membership.—

“(1) Composition.—The Commission shall be composed of 17

members appointed by the Comptroller General of the United

States, of which not fewer than 2 shall be veterans.

“(2) Qualifications.—

“(A) In general.—An individual is eligible for

appointment to the Commission under paragraph (1) if the

individual has significant expertise in operating or advising

large

medical systems, including expertise in quality of care,

staffing issues, health information technology, artificial

intelligence in health care, medical research, and managed

care plans and networks.

“(B) Experience of members.—In appointing members under

paragraph (1), the Comptroller General shall select

individuals from backgrounds that reflect the broad diversity

of health care received by veterans, including nonprofit

health systems, public and private health systems, care

furnished by the Veterans Health Administration, and care

furnished by the Department of Defense.

“(3) Ethical disclosure.—A member of the Commission shall

be considered an employee of Congress whose compensation is

disbursed by the Secretary of the Senate for purposes of

applying subchapter I of chapter 131 of title 5, United

States Code, except that a member of the Commission is

required to file public financial disclosure reports without

regard to their number of days of service or rate of pay.

“(c) Period of Appointment; Vacancies.—

“(1) Vacancies.—

“(A) In general.—A vacancy on the Commission shall be

filled in the manner in which the original appointment was

made and shall be subject to any conditions that applied with

respect to the original appointment.

“(B) Filling unexpired term.—An individual chosen to fill

a vacancy shall be appointed for the unexpired term of the

member replaced.

“(2) Expiration of terms.—The term of any member shall

not expire before the date on which the member's successor

takes office.

“(d) Meetings.—

“(1) Frequency.—The Commission shall meet at the call of

the Chairman, but not less frequently than once per year.

“(2) Quorum.—A majority of the members of the Commission

shall constitute a quorum, but a lesser number of members may

hold meetings.

“(e) Chairman and Vice Chairman.—The Comptroller General

shall designate one member of the Commission as Chairman and

one member of the Commission as Vice Chairman, at the time of

appointment of such member and for the term of appointment of

such member, except that in the case of vacancy of the

Chairmanship or Vice Chairmanship, the Comptroller General

may designate another member for the remainder of that

member's term.

“(f) Duties of the Commission.—

“(1) Review.—The Commission shall—

“(A) review operations at the Veterans Health

Administration; and

“(B) prepare reports for Congress based on such review,

including recommendations to Congress.

“(2) Topics to be reviewed.—In conducting a review under

paragraph (1)(A), the Commission shall include periodic

reviews of the following, taking into consideration other

independent assessments in selecting topics to limit

duplicative efforts:

“(A) Information technology infrastructure at medical

facilities of the Department, including with respect to

electronic health record systems.

“(B) Referrals to care at facilities of the Department and

under the Veterans Community Care Program under section 1703

of this title, and factors impacting those referrals.

“(C) Access and wait times at medical facilities of the

Department and under the Veterans Community Care Program,

including both primary and specialty care, and factors

impacting those wait times.

“(D) The quality of health care furnished by the

Department and through the Veterans Community Care Program.

“(E) Workforce issues, including workforce performance,

recruitment, and retention factors.

“(F) Patient satisfaction and customer service at medical

facilities of the Department and through the Veterans

Community Care Program.

“(G) The training of health care providers and the

standards of care at facilities of the Department and in the

Veterans Community Care Program.

“(H) The long-term budgetary outlook of the Veterans

Health Administration, as well as key components driving

budgetary changes over time.

“(I) The research program of the Department, including

both internal and external research.

“(J) The interaction of care under the Medicare program

under title XVIII of the Social Security Act (42 U.S.C. 1395

et seq.), the Medicaid program under title XIX of such Act

(42 U.S.C. 1396 et seq.), the TRICARE program under chapter

55 of title 10, and commercial health care plans with care

furnished by the Veterans Health Administration.

“(3) Use of existing data.—In carrying out the

requirements of this subsection, the Commission, to the

extent practicable, shall use existing data that has been

compiled by the Department, compiled for the Department, or

purchased by the Department, including—

“(A) data described in subsection (c)(1) of section 1704A

of this title; and

“(B) the results of the independent assessments conducted

under such section.

“(4) Issues regarding veteran health care delivery

generally.—In carrying out the requirements of this

subsection, the Commission shall review the effect of

policies under this title on the delivery of health care

services to veterans and assess the implications of changes

in health care delivery for veterans under the laws

administered by the Secretary.

“(5) Transmittal of certain reports.—If the Secretary or

the Inspector General of the Department of Veterans Affairs

submits to Congress (or a committee of Congress) a report

that is required by law and that relates to policies for

health care furnished under the laws administered by the

Secretary, the Secretary shall transmit a copy of that report

to the Commission.

“(6) Consultation and additional reviews and studies.—

“(A) Consultation.—In carrying out the requirements of

this subsection, the Commission shall consult periodically

with the chairmen and ranking members of the Committee on

Veterans' Affairs of the Senate and the Committee on

Veterans' Affairs of the House of Representatives regarding

the agenda of the Commission and progress towards achieving

that agenda.

“(B) Additional reviews and reports.—The Commission may

conduct additional reviews, and may submit additional reports

to the Committee on Veterans' Affairs of the Senate and the

Committee on Veterans' Affairs of the House of

Representatives, from time to time on such topics relating to

the activities of the Commission as may be requested by the

Chairman and members and as the Commission determines

appropriate.

“(C) Special studies.—The Commission may conduct special

studies requested by the chairman or ranking member of the

Committee on Veterans' Affairs of the Senate or the Committee

on Veterans' Affairs of the House of Representatives and as

the Commission determines appropriate.

“(7) Coordination.—In carrying out reviews, preparing

reports, and conducting studies under this section, the

Commission shall, to the extent practicable, coordinate with

the Inspector General of the Department to ensure the work of

the Commission does not interfere with investigations or

remediations underway by the Inspector General.

“(8) Budgetary considerations.—Before making any

recommendations to Congress, the Commission shall examine the

budget consequences of such recommendations, directly or

through consultation with appropriate expert entities.

“(9) Report.—

“(A) In general.—By not later than March 15 of each year,

the Commission shall submit to Congress a report containing

the results and recommendations from the review conducted

under paragraph (1).

“(B) Inclusion of recommendations.—A recommendation may

be included in a report under subparagraph (A) if a simple

majority of the members of the Commission vote to include the

recommendation in the report.

“(10) Limitation.—Nothing in this section shall be

construed to authorize the Commission to direct, control,

approve, suspend, delay, or administer any program, policy,

contract, personnel action, budgetary decision, clinical

decision, or operational activity of the Department. The

Commission shall serve solely in an advisory capacity to

Congress and to the Department on matters expressly

authorized under laws administered by the Secretary.

“(g) Powers of Commission.—

“(1) In general.—The Commission may—

“(A) employ and fix the compensation:

“(i) of an Executive Director (at a rate of pay not

greater than that provided for level III of the Executive

Schedule under section 5314 of title 5) who is confirmed by

two-thirds vote by members of the Commission; and

“(ii) other such personnel as may be necessary to carry

out the duties of the Commission, without regard to the

provisions of title 5 governing appointments in the

competitive service;

“(B) seek such assistance and support as may be required

in the performance of its duties from appropriate departments

and agencies of the United States or departments or agencies

of a State;

“(C) enter into a contract or conduct original research

only upon a written determination by the Chair and Vice Chair

that comparable information is unavailable, insufficient, or

outdated;

“(D) make advance, progress, and other payments that

relate to the work of the Commission;

“(E) provide transportation and subsistence for

individuals serving the Commission without compensation; and

“(F) prescribe such rules and regulations as the

Commission determines necessary with respect to the internal

organization and operation of the Commission.

“(2) Data collection.—In order to carry out its

functions, the Commission shall—

“(A) utilize existing information, both published and

unpublished, if possible, collected and assessed either by

its own staff or under other arrangements made in accordance

with this section;

“(B) to the maximum extent practicable, rely on existing

data, reports, audits, evaluations, and assessments prepared

by the Department, the Inspector General of the Department,

the Government Accountability Office, the Congressional

Research Service, the Congressional Budget Office, and other

relevant Federal entities before entering into any contract

or conducting original research; and

“(C) adopt procedures allowing any interested party to

submit information for use by the Commission in making

reports and recommendations.

“(3) Information from federal agencies.—

“(A) In general.—The Commission may secure directly from

any relevant department or agency of the United States health

care information the Chairman determines would be helpful to

enable the Commission to carry out this section.

“(B) Timing.—Upon request of the Chairman, the head of a

department or agency of the United States shall furnish

information requested under subparagraph (A) to the

Commission on an agreed upon schedule or not later than 180

days after the date of the request.

“(h) Compensation.—

“(1) Members.—

“(A) In general.—While conducting the business of the

Commission (including travel time), a member of the

Commission shall be entitled to compensation at the per diem

equivalent of the rate provided for level IV of the Executive

Schedule under section 5315 of title 5.

“(B) Travel expenses.—While conducting the business of

the Commission away from home and the regular place of

business of the member, a member may be allowed travel

expenses, as authorized by the Chairman.

“(2) Physician comparability allowance for personnel.—The

Commission may provide a physician comparability allowance to

physicians serving as personnel of the Commission in the same

manner as physicians of the Federal Government may be

provided such an allowance by an agency under section 5948 of

title 5, and for such purpose, subsection (i) of such section

shall apply to the Commission in the same manner as it

applies to the Tennessee Valley Authority.

“(3) Treatment of personnel.—For purposes of pay (other

than pay of members of the Commission) and employment

benefits, rights, and privileges, all personnel of the

Commission shall be treated as if they were employees of the

United States Senate.

“(i) Detail of Federal Employees.—An employee of the

Federal Government may be detailed to the Commission without

reimbursement and without interruption or loss of civil

service status or privileges.

“(j) Access of Congressional Support Agencies to

Information.—The Commission shall provide to the Comptroller

General, the Congressional Research Service, and the

Congressional Budget Office unrestricted access to all

deliberations, records, and nonproprietary data of the

Commission not later than 30 days after such access is

requested.

“(k) Authorization of Appropriations.—The Commission

shall submit requests for appropriations in the same manner

as the Comptroller General submits requests for

appropriations, but amounts appropriated for the Commission

shall be separate from amounts appropriated for the

Comptroller General.

“(l) Termination.—

“(1) The Commission shall terminate on September 30, 2032.

“(2) Not later than 1 year before the date of termination

under paragraph (1), the Commission shall submit to the

Committees on Veterans' Affairs of the House of

Representatives and the Senate a final assessment on whether

the Commission should be continued, modified, or allowed to

terminate.

“(3) A member of the Commission shall be appointed under

subsection (b)(1) for a term of 5 years, except that the

Comptroller General shall designate staggered terms for the

members first appointed.

“(4) No funds may be obligated by the Commission after the

date of termination under paragraph (1), except for

activities necessary to close out the operations of the

Commission.”.

(b) Clerical Amendment.—The table of sections at the

beginning of such chapter is amended by inserting after the

item relating to section 119 the following new item:

“120. Veterans Health Administration Policy Advisory Commission.”.

date on which amounts are first appropriated to the Veterans

Health Administration Policy Advisory Commission established

under section 120 of title 38, United States Code, as added

by subsection (a), the Comptroller General of the United

States shall make initial appointments of members to the

Commission under subsection (b)(1) of such section.

SEC. 326. ACCESS TO HEALTH CARE.

(a) Connection to Veterans Health Administration When a

Disability Claim Related to Military Sexual Trauma Is

Submitted to Veterans Benefits Administration.—Section 2 of

the MST Claims Coordination Act (Public Law 117-303; 38

U.S.C. 1166 note) is amended—

(1) in subsection (a)(1)—

(A) in subparagraph (C), by striking “; and” and

inserting a semicolon; and

(B) by striking subparagraph (D) and inserting the

following:

“(D) the contact information for the nearest military

sexual trauma coordinator for the veteran at the Veterans

Benefits Administration and a description of the assistance

such coordinator can provide;

“(E) the contact information for the nearest military

sexual trauma coordinator for the veteran at the Veterans

Health Administration and a description of the assistance

such coordinator can provide;

“(F) the types of services that individuals who have

experienced military sexual trauma are eligible to receive

from the Department of Veterans Affairs, such as mental

health counseling from providers trained in military sexual

trauma issues and peer support services, including the

nearest locations where such services are furnished,

including the nearest Readjustment Counseling Service

location, and the contact information for the providers of

such services; and

“(G) such other information on services, care, or

resources for military sexual trauma as the Secretary

determines appropriate.”; and

(2) in subsection (d)—

(A) in paragraph (3)—

(i) in subparagraph (B), by striking “; and” and

inserting a semicolon;

(ii) in subparagraph (C), by striking the period and

inserting “; and”; and

(iii) by adding at the end the following:

“(D) submitting a claim for disability compensation to the

Veterans Benefits Administration for a disability relating to

military sexual trauma.”; and

(B) by amending paragraph (5) to read as follows:

“(5) The term `military sexual trauma' with respect to

eligibility for health care, has the meaning given such term

in section 1166(d)(2) of title 38, United States Code.”.

(b) Care Relating to Military Sexual Trauma for Individuals

Who Withdraw From or Otherwise Do Not Complete Service at

Service Academies.—

(1) In general.—The Secretary of Veterans Affairs, in

coordination with the Secretary of Defense, the Secretary of

Homeland Security, and the Secretary of Transportation, shall

ensure that each individual who withdraws from, or otherwise

does not complete service at, a service academy is provided—

(A) information on the potential eligibility of such

individual for care and counseling relating to military

sexual trauma provided through the Department of Veterans

Affairs; and

(B) the option to receive copies of—

(i) the individual's service treatment records or military

personnel records that document military sexual trauma;

(ii) reporting forms of the Department of Defense, the

Department of Homeland Security, or the Department of

Transportation on sexual assault or sexual harassment for

which the individual was the victim; and

(iii) any investigative reports into military sexual trauma

that occurred during the individual's service in the Armed

Forces and for which the individual was the victim, which are

in the possession of the Department of Defense, the

Department of Homeland Security, or the Department of

Transportation.

(2) Definitions.—In this subsection:

(A) Military sexual trauma.—The term “military sexual

trauma” has the meaning given such term in section

1166(d)(2) of title 38, United States Code.

(B) Service academy.—The term “service academy” means

any of the following:

(i) The United States Military Academy.

(ii) The United States Naval Academy.

(iii) The United States Air Force Academy.

(iv) The United States Coast Guard Academy.

(v) The United States Merchant Marine Academy.

SEC. 327. RESEARCH ON HEALTH CONDITIONS OF DESCENDANTS OF

TOXIC-EXPOSED VETERANS.

(a) Research on Diagnosis and Treatment of Health

Conditions of Descendants of Individuals Exposed to Toxic

Substances While Serving in Armed Forces.—

(1) Contract or agreement.—The Secretary of Veterans

Affairs shall enter into a contract or interagency agreement

with the Agency for Toxic Substances and Disease Registry (in

this section referred to as the “Agency”) to perform the

services covered by this section.

(2) Services.—Under a contract or agreement between the

Secretary and the Agency under this section, the Agency

shall—

(A) conduct a literature review on the health effects on

descendants of toxic-exposed veterans and toxic-exposed

members of the Armed Forces from their toxic exposure and

identify any gaps in knowledge or research on such topic;

(B) not later than 180 days after completing the literature

review under subparagraph (A) establish and maintain a

publicly available report with information on—

(i) the findings of the Agency with respect to such

literature review; and

(ii) the ongoing research and activities directed by the

Agency, including a review of all relevant data to determine

the strength of evidence for a positive association between a

health condition researched and a toxic exposure based on the

categories set forth under section 1173(c)(2) of title 38,

United States Code; and

first review is published under subparagraph (B) and not less

frequently than once every year thereafter, publish a new

report containing the information made available under clause

(ii) of such subparagraph.

(3) Sunset.—On the date that is 7 years after the date of

enactment of this Act.

(4) Literature review.—

(A) In general.—In carrying out the literature review

under paragraph (2)(A), the Agency shall review available

literature to determine the association between military

toxic exposures and the incidence or prevalence of birth

defects among the descendants of toxic-exposed veterans and

toxic-exposed members of the Armed Forces.

(B) Report.—Not later than one year after the date of the

enactment of this Act, the Agency shall submit to the

Secretary, the

Committee on Veterans' Affairs of the Senate, and the

Committee on Veterans' Affairs of the House of

Representatives a report containing the findings of the

Agency with respect to the activities of the Agency under

paragraph (2)(A).

(i) In general.—Not later than 180 days after the date of

the enactment of this Act, the Agency shall submit to the

Secretary and to the Committee on Veterans' Affairs of the

Senate and the Committee on Veterans' Affairs of the House of

Representatives a plan describing the Agency's proposed

approach to carrying out the literature review under

paragraph (2)(A).

(ii) Contents.—The plan submitted pursuant to clause (i)

shall include—

(I) the scope and key research questions to be addressed;

and

(II) the methodology to be used in identifying, evaluating,

and synthesizing relevant scientific and medical literature.

(5) Consultation.—The Agency shall carry out the services

covered by this subsection in consultation with such Federal,

State, and research partners as the Agency and the Secretary

jointly consider appropriate.

(6) Prohibition on expansion of services.—Nothing in this

section shall be construed to authorize the expansion of

compensation or healthcare benefits furnished by the

Department to the descendants of members of the Armed Forces.

(b) Program for Monitoring Health of Descendants of

Veterans and Members of the Armed Forces Subjected to Toxic

Exposure in the Armed Forces.—

(1) In general.—The Secretary of Veterans Affairs shall

use the results of the literature review conducted under

subsection (a)(2)(A) to establish a health monitoring or

screening program for descendants of toxic-exposed veterans

and toxic-exposed members of the Armed Forces, to assist in

identifying potential patterns or signals, supporting public

health surveillance, and facilitating epidemiologic and

clinical research related to birth defects.

(2) Requirements.—In carrying out the program required by

paragraph (1), the Secretary shall—

(A) leverage Government data sets to improve the program;

(B) recruit additional descendants;

strategy to coordinate collection of information under the

program; and

(D) ensure data from the program is used to inform basic

research, translational research, and epidemiological studies

to help address data and knowledge gaps identified in the

literature review conducted under subsection (a)(2)(A).

(3) Mechanisms for administration.—The Secretary may

administer the program required by paragraph (1) either

directly or through such mechanisms as the Secretary

considers appropriate, such as through the award of a grant

or cooperative agreement.

(4) Collection of information.—In administering the health

monitoring program required by paragraph (1), the Secretary

may collect, process, maintain, and consolidate information

on birth defects among descendants of toxic-exposed veterans

and toxic-exposed members of the Armed Forces, including

biological samples, environmental factors, and personal and

social factors.

(5) Consultation.—The Secretary shall carry out the

services covered by this section in consultation with such

Federal, State, and research partners as the Department

considers appropriate.

(6) Sunset.—This section shall terminate on the date that

is 7 years after the date of enactment of this Act.

(7) Prohibition on expansion of services.—No information

collected by this program shall be used to inform the

expansion of compensation or healthcare benefits furnished by

the Department to the descendants of members of the Armed

Forces, unless otherwise authorized by another Act of

Congress on a date after the passage of this legislation.

(1) Active military, naval, air, or space service.—The

term “active military, naval, air, or space service” has

the meaning given such term in section 101 of title 38,

United States Code.

(2) Relevant stakeholders.—The term “relevant

stakeholders” means—

(A) public health experts with experience in developing and

maintaining registries;

(B) epidemiologists with experience in studying health

effects of toxic exposure on the descendants of toxic-exposed

veterans;

(D) veterans service organizations.

(3) Toxic-exposed member of the armed forces.—The term

“toxic-exposed member of the Armed Forces” means a member

of the Armed Forces who was subject to a toxic exposure in

line of duty in the active military, naval, air, or space

service.

(4) Toxic-exposed veteran.—The term “toxic-exposed

veteran” means a veteran who was subject to a toxic exposure

in line of duty in the active military, naval, air, or space

service.

(5) Toxic exposure.—The terms “toxic exposure” and

“toxic-exposed veteran” have the meanings given such terms

in section 101 of title 38, United States Code.

SEC. 328. VETERANS SPINAL TRAUMA ACCESS TO NEW DEVICES ACT.

Section 1706 of title 38, United States Code, is amended by

adding at the end the following new subsection:

“(d)(1) In managing the provision of hospital care and

medical services under section 1710(a) of this title, the

Secretary shall furnish (through direct provision of service,

referral, or a telehealth program operated by the Department)

a preventative health evaluation annually to any veteran with

a spinal cord injury or disorder who elects to undergo the

evaluation.

“(2) The evaluation described in paragraph (1) shall

include the following:

“(A) An assessment of any circumstance or condition the

veteran is experiencing that indicates a risk for any health

complication related to the spinal cord injury or disorder,

including a risk of comorbidities.

“(B) An assessment regarding chronic pain and, if

applicable, the management of chronic pain.

“(C) An assessment regarding dietary management and weight

management.

“(D) An assessment regarding prosthetic equipment,

including which prosthetic equipment the veteran needs, how

well any existing prosthetic equipment is functioning

considering the needs of the veteran, and any safety concerns

regarding the prosthetic equipment in use by or recommended

to the veteran.

“(E) An assessment with respect to the provision of

assistive technology, including spinal cord neuromodulation

technology (such as non-invasive transcutaneous spinal

stimulation), that could help maximize the veteran's

voluntary motor or autonomic function, independence, or

mobility, including suitability for home use and need for

training, programming, and remote follow-up.

“(3)(A) In maintaining, prescribing, or amending any

guidance, rules, or regulations issued by the Department

regarding the requirements set out in this subsection, the

Secretary shall consult with—

“(i) the spinal cord injury and disorder program managers

of the Department;

“(ii) clinicians employed by the Department as specialists

in spinal cord injuries and disorders;

“(iii) clinicians and technologists with demonstrated

expertise in spinal cord neuromodulation therapies, including

non-invasive transcutaneous approaches; and

“(iv) representatives of organizations recognized under

section 5902 of this title.

“(B) Before issuing any guidance, rules, or regulations

regarding the requirements set out in this subsection, the

Secretary shall consult with manufacturers of assistive

technologies and other entities relevant to the provision of

assistive technologies if the guidance, rules, or regulations

would directly affect such manufacturers or entities.

“(C) The Secretary shall ensure, to the extent possible,

that any veteran known by the Secretary to have a spinal cord

injury or disorder receives information annually about the

evaluation available under this subsection and the benefits

to the veteran of choosing to undergo the evaluation.

“(4) As the Secretary determines clinically appropriate,

the Secretary may provide training, programming, remote

monitoring, and follow-up for assistive technologies through

telehealth.

“(5) Not later than one year after the date of the

enactment of the Take Care of America's Veterans Act, and

every two years thereafter, the Secretary shall submit to the

Committees on Veterans' Affairs of the Senate and the House

of Representatives a report that includes the following:

“(A) For the period covered by the report—

“(i) the number of veterans who—

“(I) received medical care or hospital services from the

Department and used an assistive technology;

“(II) received medical care or hospital services from the

Department and were assessed for the provision of an

assistive technology; and

“(III) received medical care or hospital services from the

Department and were prescribed an assistive technology.

“(ii) for any assistive technology prescribed, an

identification of the category of such technology, including

spinal cord neuromodulation, and a summary of functional

outcomes associated with the prescription of such technology,

if available.

“(B) The year-to-year change (for the period covered by

the report, including the two years immediately prior to the

year the report is submitted) in the percent of veterans with

a spinal cord injury or disorder who received an evaluation

under this subsection.

“(6) In reviewing the performance metrics of a Veterans

Integrated Service Network for any year beginning after the

date that is one year after the date of the enactment of the

Take Care of America's Veterans Act, the Secretary shall

consider the provision of evaluations under paragraph (1).

“(7) In this subsection, the term `assistive technology'

means a powered medical device or electronic tool used to

treat or alleviate symptoms or conditions caused by a spinal

cord injury or disorder, including the following:

“(A) A personal mobility device, including a powered

exoskeleton device.

“(B) A speech generating device.

“(C) A spinal cord neuromodulation technology, including

non-invasive transcutaneous spinal stimulation using sensory

(afferent) pathways, intended to improve voluntary motor

function, autonomic function, independence, or quality of

life.

“(D) Where clinically appropriate, and consistent with the

prosthetic and sensory aids

policies of the Department, an implantable spinal cord

stimulation system that is approved by the Food and Drug

Administration.”.

SEC. 329. DEPARTMENT OF VETERANS AFFAIRS PILOT PROGRAM TO

AWARD GRANTS FOR THE PROVISION OF SERVICE DOGS

TO VETERANS.

(a) In General.—

(1) Pilot program required.—Not later than 24 months after

the date of the enactment of this Act, the Secretary of

Veterans Affairs shall establish a pilot program under which

the Secretary shall award grants, on a competitive basis

based on the application elements listed in subsection

(b)(2), to nonprofit entities to provide service dogs to

eligible veterans.

(2) Duration.—The Secretary shall carry out the pilot

program during the three-year period beginning on the date on

which the first grant is awarded under this section.

(b) Applications.—

(1) In general.—To be eligible to receive a grant under

this section, a nonprofit entity shall submit an application

to the Secretary at such time and in such manner as the

Secretary may require.

(2) Elements.—An application submitted by a nonprofit

entity under paragraph (1) shall include the following:

(A) A proposal for the provision of service dogs to

eligible veterans, including how the nonprofit entity will

communicate with the Secretary to ensure an increasing number

of service dogs are provided to veterans.

(B) A description of the following services or commitments

to be provided by the nonprofit entity:

(i) The training that will be provided to eligible

veterans.

(ii) The training of dogs that will serve as service dogs.

(iii) Any additional support or services that will be

provided for such dogs and eligible veterans.

(iv) The plan for publicizing the availability of such

service dogs through a marketing campaign that targets

eligible veterans.

(v) The commitment to have humane standards for animals.

(vi) The demonstrated experience of the nonprofit entity in

training service dogs in compliance with the requirements of

the Americans with Disabilities Act of 1990 (42 U.S.C. 12101

et seq.).

(1) In general.—The Secretary shall award a grant to each

nonprofit entity for which the Secretary has approved an

application submitted under subsection (b)(1).

(2) Agreement required.—Before the provision of any grant

amounts to a nonprofit entity selected to receive a grant

under this section, the Secretary shall enter into an

agreement, containing such terms, conditions, and limitations

as the Secretary determines appropriate, with such entity.

(3) Maximum grant amount.—A grant awarded to a nonprofit

entity under this section may not exceed $2,000,000 in a

fiscal year.

(4) Payments.—The Secretary shall establish intervals of

payment for the administration of each grant awarded under

this section.

(d) Use of Funds.—

(1) In general.—

(A) Requirement.—A recipient of a grant under this section

shall use the grant amounts to plan, develop, implement, and

manage one or more covered programs.

(B) Covered program defined.—In this paragraph, the term

“covered program” means a program under which—

(i) service dogs are provided to participants in the

program; and

(ii) only eligible veterans are allowed to participate in

the program.

(2) Administrative expenses.—The Secretary may establish a

maximum amount for each grant awarded under this section that

may be used by the recipient of the grant to cover

administrative expenses.

(3) Other conditions and limitations.—The Secretary may

establish other conditions or limitations on the use of grant

amounts under this section.

(e) Requirements for Grant Recipients.—

(1) Notifications and information.—A recipient of a grant

under this section shall—

(A) notify each veteran who receives a service dog through

such grant that the service dog is being paid for, in whole

or in part, by the Department of Veterans Affairs; and

(B) inform each such veteran of the benefits and services

available from the Secretary for the veteran and the service

dog.

(2) Prohibition on certain fees.—A recipient of a grant

under this section may not charge a fee to a veteran

receiving a service dog through such grant.

(f) Veterinary Insurance.—

(1) In general.—The Secretary shall provide to each

veteran who receives a service dog through a grant under this

section a commercially available veterinary insurance policy

for the service dog.

(2) Continuation.—If the Secretary provides a veterinary

insurance policy to a veteran under paragraph (1), the

Secretary shall continue to provide the policy to the veteran

without regard to the continuation or termination of the

pilot program.

(g) Training and Technical Assistance.—The Secretary may

provide training and technical assistance regarding grant

application and administration to recipients of grants under

this section.

(h) Oversight and Monitoring.—The Secretary—

(1) may require each recipient of a grant under this

section to provide, in such form as may be prescribed by the

Secretary, such reports or answers in writing to specific

questions, surveys, or questionnaires as the Secretary

determines necessary to carry out the pilot program;

(2) shall establish such oversight and monitoring

requirement as the Secretary determines appropriate to ensure

that grant amounts awarded under this section are used

appropriately; and

(3) may take such actions as the Secretary determines

necessary and according to the terms of the grant agreement

to address any issues identified through the enforcement of

such requirements.

(i) Definitions.—In this section:

(1) Eligible veteran.—The term “eligible veteran” means

a veteran (as defined in section 101 of title 38, United

States Code) who—

(A) as determined by a physician, has one or more

disabilities, conditions, or diagnoses described in paragraph

(2); and

(B) is enrolled in the system of annual patient enrollment

of the Department of Veterans Affairs established and

operated under section 1705(a) of title 38, United States

Code, or is otherwise entitled to receive such care and

services under subsection (c)(2) of such section.

(2) Disability, condition, diagnosis described.—A

disability, condition, or diagnosis described in this

subparagraph is any of the following:

(A) Blindness or visual impairment.

(B) Loss of use of a limb, paralysis, or other significant

mobility issue.

(D) Post-traumatic stress disorder.

(E) Traumatic brain injury.

(F) Any other disability, condition, or diagnosis for which

the Secretary determines, based on medical judgment, that it

is optimal for the veteran to manage the disability,

condition, or diagnosis and live independently through the

assistance of a service dog.

(3) Pilot program.—The term “pilot program” means the

pilot program required by subsection (a)(1).

(4) Service dog.—The term “service dog” means any dog

that is individually trained to do work or perform tasks that

are—

(A) for the benefit of a veteran with a disability,

condition, or diagnosis described in paragraph (2); and

(B) directly related to the disability, condition, or

diagnosis of the veteran.

(j) Authorization of Appropriations.—There is authorized

to be appropriated to carry out this section $10,000,000 for

each of the three consecutive fiscal years beginning the

fiscal year in which the pilot program is established under

subsection (a).

(k) Termination.—

(1) The authority to carry out a pilot program under this

section shall terminate on September 30, 2029.

(2) No funds may be obligated by the Secretary to carry out

a pilot program under this section after the date of

termination in paragraph (1), except for activities necessary

to close operations of such pilot program.

SEC. 330. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECT OF

DEPARTMENT OF VETERANS AFFAIRS FOR FISCAL YEAR

2027 IN MANCHESTER, NEW HAMPSHIRE.

(a) Authorization of Major Medical Facility Project of

Department of Veterans Affairs for Fiscal Year 2027 in

Manchester, New Hampshire.—

(1) In general.—The Secretary of Veterans Affairs shall

carry out a major medical facility project for the

replacement of a medical center, a new central utility plant,

a community living center, a residential rehabilitation

treatment facility, associated parking, and demolition of

existing buildings in Manchester, New Hampshire.

(2) Non-department federal entity waiver.—In order to

reduce cost and expedite timelines, the Secretary may waive

the requirements under section 8103(e) of title 38, United

States Code, and section 1096 of the National Defense

Authorization Act for Fiscal Year 2016 (Public Law 114-92; 38

U.S.C. 8103 note) for a non-Department Federal entity to be

engaged in project management and other activities for the

project under paragraph (1).

(3) Notification.—Not later than 60 days after making a

waiver, modification, or substitution relating to the project

under subsection (a), including a waiver under paragraph (2),

the Secretary shall submit to the appropriate committees of

Congress a notification describing the waiver, modification,

or substitution and the reason for such waiver, modification,

or substitution.

(4) Authorization of appropriations.—There is authorized

to be appropriated to the Secretary of Veterans Affairs for

the Construction, Major Projects account $1,180,000,000 for

the project under paragraph (1), to remain available until

expended.

(5) Appropriate committees of congress defined.—In this

section the term “appropriate committees of Congress”

means—

(A) the Committee on Veterans' Affairs and the Committee on

Appropriations of the Senate; and

(B) the Committee on Veterans' Affairs and the Committee on

Appropriations of the House of Representatives.

(b) Access to Information for Medical Facility Construction

Projects and Leases.—

(1) In general.—Subchapter I of chapter 81 of title 38,

United States Code, is amended by inserting after section

8106 the following:

“Sec. 8107. Access to information for medical facility

construction projects and leases

“(a) In General.—For any major construction project,

lease, or enhanced-use lease for a medical facility of the

Department, the Secretary shall ensure that the Committee on

Veterans' Affairs of the Senate and the Committee on

Veterans' Affairs of the House of Representatives are

provided timely access to all information, records,

documents, data, analyses, communications, contracts,

agreements, project schedules, cost estimates, memoranda,

briefings, reports, and other materials relating to the

project or lease.

“(b) Prohibition on Withholding Information.—The

Secretary may not withhold information under subsection (a)

from the Committee on Veterans' Affairs of the Senate and the

Committee on Veterans' Affairs of the House of

Representatives solely on the basis that the information is

predecisional, deliberative, advisory, procurement-sensitive,

or subject to an internal policy or directive of the

Department.”.

(2) Clerical amendment.—The table of sections at the

beginning of such chapter is amended by inserting after the

item relating to section 8106 the following new item:

“8107. Access to information for medical facility construction

projects and leases.”.

SEC. 331. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECT OF

DEPARTMENT OF VETERANS AFFAIRS FOR FISCAL YEAR

2027 IN SAN ANTONIO, TEXAS.

(a) In General.—The Secretary of Veterans Affairs shall

carry out a major medical facility project for the

acquisition of land for a new Department of Veterans Affairs

health care facility in San Antonio, Texas.

(b) Non-Department Federal Entity Waiver.—In order to

reduce cost and expedite timelines, the Secretary may waive

the requirements under section 8103(e) of title 38, United

States Code, and section 1096 of the National Defense

Authorization Act for Fiscal Year 2016 (Public Law 114-92; 38

U.S.C. 8103 note) for a non-Department Federal entity to be

engaged in project management and other activities for the

project under subsection (a).

waiver, modification, or substitution relating to the project

under subsection (a), including a waiver under subsection

(b), the Secretary shall submit to the appropriate committees

of Congress a notification describing the waiver,

modification, or substitution and the reason for such waiver,

modification, or substitution.

(d) Authorization of Appropriations.—There is authorized

to be appropriated to the Secretary of Veterans Affairs for

the Construction, Major Projects account $30,000,000 for the

project under subsection (a) to remain available until

expended.

SEC. 332. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECT OF

DEPARTMENT OF VETERANS AFFAIRS FOR FISCAL YEAR

2027 IN INDIANAPOLIS, INDIANA.

(a) In General.—The Secretary of Veterans Affairs shall

carry out a major medical facility project for the

replacement of a medical center, a new central utility plant,

a replacement multi-specialty outpatient clinic, and

associated parking in Indianapolis, Indiana.

(b) Non-Department Federal Entity Waiver.—In order to

reduce cost and expedite timelines, the Secretary may waive

the requirements under section 8103(e) of title 38, United

States Code, and section 1096 of the National Defense

Authorization Act for Fiscal Year 2016 (Public Law 114-92; 38

U.S.C. 8103 note) for a non-Department Federal entity to be

engaged in project management and other activities for the

project under subsection (a).

waiver, modification, or substitution relating to the project

under subsection (a), including a waiver under subsection

(b), the Secretary shall submit to the appropriate committees

of Congress a notification describing the waiver,

modification, or substitution and the reason for such waiver,

modification, or substitution.

(d) Authorization of Appropriations.—There is authorized

to be appropriated to the Secretary of Veterans Affairs for

the Construction, Major Projects account $1,641,570,000 for

the project under subsection (a), to remain available until

expended.

SEC. 333. BOWEL AND BLADDER CARE PROGRAM OF DEPARTMENT OF

VETERANS AFFAIRS.

(a) Findings; Sense of Congress.—

(1) Findings.—Congress finds the following:

(A) Bowel care and bladder care are supportive and

necessary medical services for veterans with spinal cord

injuries and disorders when they are unable to manage their

bowel and bladder functions independently.

(B) Inadequate care will lead to complications and problems

such as autonomic dysreflexia that can be potentially life-

threatening and result in illness and hospitalization.

veterans with spinal cord injuries and disorders in non-

institutional settings, improve quality of life, optimize

health, and prevent complications from neurogenic bowel and

bladder.

(D) Family caregivers and individually employed caregivers

provide life-sustaining care for the bowel and bladder care

needs of veterans that allow them to live in their

communities.

(2) Sense of congress.—It is the sense of Congress that—

(A) family caregivers and individually employed caregivers

should not be subjected to self-employment taxes and treated

as vendors or contractors for the veterans to whom they

provide care;

(B) veterans should not be forced to finish their bowel and

bladder care needs in a set period of time that does not

consider their individual needs; and

determinations regarding their bowel and bladder care needs

absent a decision by their medical care provider that such

care is no longer needed.

(b) In General.—The Secretary of Veterans Affairs shall

establish a program to address the bowel and bladder care

needs of covered veterans (in this section referred to as the

“program”).

(1) Clinical need.—The Secretary shall provide bowel and

bladder care under the program to covered veterans based on

clinical need, which may include covered veterans receiving

aid and attendance benefits from the Department of Veterans

Affairs.

(2) Caregiver or agency.—A covered veteran may receive

bowel and bladder care under the program through a qualified

family member, an individually employed caregiver, or a

contracted home health agency.

(3) Individualized assessment.—The Secretary shall conduct

an individualized assessment with respect to a covered

veteran to determine the number of hours of bowel and bladder

care needed by such veteran under the program.

(4) Denial of care.—Before denying bowel and bladder care

for any covered veteran under the program, the Secretary

shall first obtain review of and concurrence with respect to

such denial from a designated Spinal Cord Injuries and

Disorders Center of the Department.

(d) Coordination of Care and Benefits.—The Secretary shall

ensure the program is coordinated with other programs and

benefits of the Department for which the covered veteran is

eligible to ensure that covered veterans and caregivers

receive appropriate support without duplicating benefits or

services.

(e) Supportive Medical Training and Qualifications.—

(1) In general.—The Secretary shall provide to each family

member or individually employed caregiver providing care to a

covered veteran under the program necessary supportive

medical training to participate in and receive payment by the

Secretary for the provision of such care.

(2) Qualifications.—The Secretary shall establish such

requirements, conditions, and qualifications for providers of

care under the program as necessary to provide clinically

appropriate bowel and bladder care to covered veterans and to

ensure the financial and administrative integrity of the

program.

(f) Payment.—

(1) In general.—The Secretary shall provide a monthly

stipend to family members and individually employed

caregivers and payment to contracted home health agencies for

care provided to covered veterans under the program.

(2) Limitation.—

(A) Family members and individually employed caregivers.—

The stipend for a family member or individually employed

caregiver for care provided to a covered veteran under the

program—

(i) shall be determined by the Secretary;

(ii) shall be based on the amount and degree of assistance

provided; and

(iii) may not exceed the fifth step of the applicable grade

of the General Schedule hourly rate paid to nursing

assistants who provide such care at the medical facility of

the Department that is nearest to the residence of such

veteran.

(B) Home health agencies.—Payment to a home health agency

for care provided to a covered veteran under the program may

not exceed the payment rates of the Department under section

17.4035 of title 38, Code of Federal Regulations (relating to

payment rates and methodologies), or successor regulations.

(g) Submission of Documentation.—Family members and

individually employed caregivers providing care to covered

veterans under the program shall provide such documentation

and information in such format and under such terms as the

Secretary may require as a condition of receiving payment

under the program.

(h) Continued Participation in Program.—If a covered

veteran has been medically determined to require care under

the program for a continuous period of three years or more,

the veteran is deemed to require such care for life or until

such time as the medical provider for such veteran determines

the service is no longer needed.

(i) Not Vendors or Contractors.—Family members and

individually employed caregivers providing care to covered

veterans under the program shall not be considered vendors or

contractors for purposes of the program.

(j) Limitation.—Care may not be provided under the program

to a veteran who can perform the bowel and bladder functions

of the veteran without assistance.

(k) Covered Veteran Defined.—In this section, the term

“covered veteran” means a veteran who—

(1) is enrolled in the system of annual patient enrollment

of the Department of Veterans Affairs established and

operated under

section 1705(a) of title 38, United States Code;

(2) has a spinal cord injury or disorder; and

(3) is dependent upon others for bowel and bladder care

while residing in non-institutional settings.

TITLE IV—ORGANIZATION

SEC. 401. AUTHORIZATION OF APPROPRIATIONS TO THE OFFICE OF

INFORMATION AND TECHNOLOGY OF THE DEPARTMENT OF

VETERANS AFFAIRS FOR CERTAIN PURPOSES.

(a) Authorization of Appropriations.—There is authorized

to be appropriated, and there is appropriated, to the

Secretary of Veterans Affairs $500,000,000 for fiscal year

2026, to remain available until September 30, 2031, for

deposit into the accounts of the Office of Information and

Technology of the Department of Veterans Affairs for the

purposes described in subsection (b).

(b) Use of Funds.—Funds shall be allocated and expended

only as follows:

(1) $150,000,000 for Enterprise Logistics and Supply Chain

Visibility — To develop and deploy integrated, real-time

enterprise-wide logistics systems, inventory visibility,

pharmaceutical tracking, and medical supply chain resiliency

capabilities. These systems shall support both routine

veteran care operations and 4th Mission medical surge,

patient movement, and emergency distribution requirements in

consultation with the Secretary of Defense, the Administrator

of the Federal Emergency Management Agency, and the heads of

other Federal agencies.

(2) $200,000,000 for Cybersecurity and Operational

Resiliency — For zero trust architecture implementation,

threat detection, secure cloud hardening, endpoint

protection, continuity of operations (COOP) platforms, and

protection of mission-essential systems against cyber and

physical disruptions. Funds shall prioritize high-risk legacy

systems and medical device security.

(3) $150,000,000 for Resilient Communications and Digital

Records Modernization — For interoperable, survivable

communications infrastructure, and targeted digitization/

automation of high-volume paper-based workflows (claims,

correspondence, administrative records) to reduce fraud risk

and improve continuity during degraded or emergency

environments. Funds shall not be used for broad Electronic

Health Record Modernization expansion.

(1) The Secretary may obligate and expend amounts under

this section in classified, controlled, or protected

environments consistent with applicable law.

(2) Not later than 90 days after the date of enactment of

this Act, and annually thereafter until September 30, 2031,

the Secretary shall provide to the Committees on Veterans'

Affairs of the House of Representatives and the Senate a

briefing and report on—

(A) activities carried out using funds made available under

this section;

(B) progress on improving cybersecurity, resiliency,

continuity, logistics, communications, digitization, and

mission assurance capabilities; and

appropriate. Such reports may include a classified annex.

(3) Detailed implementation plan and quarterly briefings.—

(A) Not later than 90 days after the date of enactment of

this Act, the Secretary, acting through the Office of

Information and Technology, shall submit to the Committees on

Veterans' Affairs of the House of Representatives and the

Senate a comprehensive implementation plan. The plan shall

include—

(i) specific milestones, deliverables, and performance

metrics for each category of activities in subsection (b);

(ii) a zero trust architecture strategy with timelines and

technical requirements;

(iii) a detailed expenditure plan by fiscal quarter and by

activity category; and

(iv) any proposed interagency or private-sector

partnerships.

(B) Not later than 30 days after the end of each fiscal

quarter through September 30, 2031, the Secretary shall

provide the Committees a briefing and written report on—

(i) obligations and expenditures to date, by category;

(ii) progress against the implementation plan;

(iii) any deviations from the plan and corrective actions;

and

(iv) updated projections for remaining funds.

person and subsequent briefings may be virtual unless

otherwise requested by the Committees. Reports under such

subparagraph may include a classified annex.

(d) Limitation.—Funds made available under this section

may not be used for any purpose unrelated to information

technology modernization, cybersecurity, operational

resilience, logistics modernization, communications

modernization, digitization, or fraud prevention activities

of the Department.

(e) Supplement, Not Supplant.—Amounts made available under

this section shall supplement and not supplant other amounts

otherwise authorized to be appropriated for the Office of

Information and Technology of the Department of Veterans

Affairs.

(f) Rule of Construction.—Nothing in this section shall be

construed to require the public disclosure of classified

information, controlled unclassified information, operational

details, cybersecurity architecture, contingency planning

information, mission-essential system design, or information

otherwise protected from disclosure under Federal law or

Executive Order.

(g) Reauthorization and Sunset.—

(1) Reauthorization required.—The authority provided under

this section to obligate or expend amounts appropriated

pursuant to subsection (a) shall terminate on September 30,

2031, unless subsequently reauthorized by law.

(2) Limitation on new obligations after sunset.—Beginning

on October 1, 2031, the Secretary may not initiate, award,

enter into, renew, extend, or otherwise obligate funds for

any new program, project, activity, contract, task order, or

operational capability carried out pursuant to this section

unless expressly authorized by a subsequent Act of Congress.

(3) Continuation of existing activities.—Nothing in

paragraph (2) shall be construed to prohibit the Secretary

from—

(A) maintaining, sustaining, securing, operating,

completing, or supporting any program, project, activity,

contract, system, platform, infrastructure capability, or

operational activity lawfully initiated using amounts

obligated before September 30, 2031; or

(B) carrying out similar information technology

modernization, cybersecurity, continuity of operations,

logistics modernization, communications modernization,

operational resiliency, or mission assurance activities using

amounts otherwise authorized and appropriated under any other

provision of law.

(h) Use of Existing Contracting Authorities.—The Secretary

shall carry out the activities authorized under this section,

to the maximum extent practicable, through contracts, task

orders, delivery orders, interagency agreements, cooperative

agreements, or other agreements entered into under existing

authorities of title 38, United States Code, as applicable.

Amounts made available under this section shall not be used

to establish a new full-time equivalent position, hire

additional employees of the Department, or otherwise increase

the number of full-time equivalent employees of the

Department, except to the extent the Secretary determines

that such personnel are necessary for the oversight,

management, cybersecurity supervision, acquisition

administration, or operational integration of activities

carried out under this section.

SEC. 402. ESTABLISHMENT OF UNDER SECRETARY FOR MANAGEMENT AND

CHIEF FINANCIAL OFFICER.

(a) Chief Financial Officer; Office of Budget.—Section 309

of title 38, United States Code, is amended to read as

follows:

“Sec. 309. Under Secretary for Management and Chief

Financial Officer

“(a) Under Secretary for Management and Chief Financial

Officer.—

“(1) The Under Secretary for Management and Chief

Financial Officer shall be the principal management and

financial officer of the Department.

“(2) The Under Secretary shall report directly to the

Secretary.

“(3) The Under Secretary shall serve as the Chief

Financial Officer of the Department for purposes of chapter 9

of title 31.

“(4) The Under Secretary shall exercise authority,

direction, and control over the Office of Budget and such

other offices as may be assigned by law or by the Secretary.

“(b) Duties.—The duties of the Under Secretary include

the following:

“(1) To advise the Secretary on financial management of

the Department.

“(2) To formulate, justify, execute, oversee, and certify

the budget of the Department.

“(3) To control, account for, audit, and report on the

finances of the Department.

“(4) To coordinate and assist the Chief Acquisition

Officer with the life cycle of major acquisition programs of

the Department.

“(5) To exercise the authority and carry out the functions

specified in section 902 of title 31.

“(6) To ensure compliance with sections 1341, 1342, 1349,

1350, and 1511 through 1519 of title 31.

“(7) To provide to Congress, or a congressional committee

upon request, information regarding the budget, finances, and

fiscal condition of the Department.

“(8) To serve as the head of the Office of Budget of the

Department.

“(9) To establish and oversee Department-wide financial

management policies, accounting systems, internal controls,

enterprise risk management programs, strategic planning

processes, and capital planning activities.

“(10) To oversee infrastructure investment planning,

financial systems modernization, and business transformation

initiatives of the Department.

“(c) Deputy Assistant Secretary.—(1) There is in the

Department a Deputy Assistant Secretary for Infrastructure

and Construction.

“(2) Such Deputy Assistant Secretary shall be a career

appointee (as that term is defined in section 3132(a) of

title 5) within the Senior Executive Service of the

Department.

“(d) Office of Infrastructure and Construction.—There is

an Office of Infrastructure and Construction in the

Department.

“(e) Budget and Appropriations Affairs Office.—(1) There

is within the Office of Management a Budget and

Appropriations

Affairs Office (in this subsection referred to as the `BAA

Office'). The Under Secretary shall appoint a head of the BAA

Office who shall report exclusively to the Under Secretary.

“(2) The sole function of the BAA Office is to provide to

Congress (or a congressional committee), accurate, timely,

and certified information regarding the finances and budget

of the Department.

“(3) Congress or a congressional committee may submit a

request for information described in paragraph (2) directly

to the BAA Office.

“(4) Paragraphs (2) and (3) notwithstanding, the Assistant

Secretary for Congressional and Legislative Affairs may

facilitate and transmit responses to requests described in

paragraph (3) that are submitted to the BAA Office. Any

response containing information described in paragraph (2)

shall be prepared and certified by the BAA Office and may not

be altered, delayed, withheld, edited, or modified by any

other officer or employee of the Department prior to

transmission to Congress or a congressional committee.

“(5) Not more than six full-time equivalent employees,

including supervisors, may be assigned to the BAA Office.

“(f) Limitation on Authority to Appoint.—The Secretary

may not establish an employee position—

“(1) that performs a function substantially similar to the

function of the Budget and Appropriations Affairs Office

established under section 309(e); and

“(2) that is not within the Office of Management.

“(g) Transfer of Functions.—(1) All functions, powers,

duties, authorities, responsibilities, personnel, property,

records, contracts, delegations, directives, regulations,

administrative actions, and unobligated balances of

appropriations relating to the Chief Financial Officer of the

Department immediately before the effective date of this Act

are transferred to the Under Secretary for Management and

Chief Financial Officer.

“(2) Any delegation, determination, rule, regulation,

order, permit, contract, agreement, certification, or other

administrative action in effect immediately before the

effective date of this Act shall continue in effect according

to its terms until modified, superseded, terminated, or

revoked.

“(h) References.—Any reference in any law, regulation,

rule, directive, delegation, contract, agreement,

determination, record, or other official document of the

United States to the Chief Financial Officer of the

Department shall be deemed to refer to the Under Secretary

for Management and Chief Financial Officer.”.

(b) Technical and Conforming Amendments.—

(1) The table of sections for chapter 3 of title 38, United

States Code, is amended accordingly.

(2) The Secretary shall make such additional technical and

conforming amendments to regulations, directives,

delegations, organizational charters, manuals, and internal

guidance as may be necessary to carry out this Act.

title is amended by inserting after section 715 the following

new section (and the table of sections at the beginning of

such chapter is amended accordingly):

“Sec. 716 Employees with certain financial authority:

management; limitation on duties

“(a) In General.—An employee described in subsection

(b)—

“(1) shall report exclusively to the Chief Financial

Officer of the Department designated under section 309 of

this title; and

“(2) may not perform a programmatic or operational

function in the Department.

“(b) Employee Described.—An employee described in this

subsection is an employee of the Department—

“(1) whose position is that of chief financial officer of

an Administration of the Department or a Veterans Integrated

Service Network; or

“(2) whose duties are substantially similar to a position

described in paragraph (1).”.

SEC. 403. DEPARTMENT OF VETERANS AFFAIRS ACQUISITION REFORM

AND COST ASSESSMENT.

(a) Department of Veterans Affairs Acquisition

Organization.—

(1) Definitions.—Chapter 81 of title 38, United States

Code, is amended by inserting after subchapter VI the

following new subchapter:

“SUBCHAPTER VII—ACQUISITION ORGANIZATION, COST ASSESSMENT, AND

PROGRAM EVALUATION

“Sec. 8181. Definition of major acquisition program

“In this subchapter, the term `major acquisition program'

means a program of the Department to acquire services,

supplies, technology, systems, or a combination thereof, with

an estimated total program cost, estimated by the Secretary,

that exceeds—

“(1) $1,000,000,000 (adjusted pursuant to section 1908 of

title 41) for the total life cycle cost of the program; or

“(2) $200,000,000 (adjusted pursuant to section 1908 of

title 41) annually.”.

(2) Assistant secretary for acquisition.—Section 308 of

such title is amended—

(A) in subsection (a)(1), by striking “seven” and

inserting “eight”;

(B) in subsection (b)(10), by striking “Procurement

functions” and inserting “Acquisition functions”; and

(3) Acquisition organization.—Subchapter VII of chapter 81

of such title, as added by paragraph (1), is amended by

adding at the end the following new section:

“Sec. 8182. Acquisition organization

“(a) Assistant Secretary for Acquisition; Chief

Acquisition Officer.—(1) The Secretary shall designate one

of the Assistant Secretaries specified in subsection (a)(1)

of section 308 of this title as the Assistant Secretary of

Veterans Affairs for Acquisition, who shall focus solely on

the administration of functions specified in subsection

(b)(10) of such section.

“(2) Pursuant to section 1702(a) of title 41, the

Secretary shall designate the Assistant Secretary of Veterans

Affairs for Acquisition as the Chief Acquisition Officer of

the Department.

“(b) Office of Acquisition.—(1) There is in the

Department an Office of Acquisition.

“(2) The head of the Office of Acquisition shall be the

Assistant Secretary of Veterans Affairs for Acquisition

designated pursuant to subsection (a).

“(3) The Secretary shall take such actions as may be

necessary to ensure that major acquisition program offices of

the Department align under the Office of Acquisition and

report directly to the Assistant Secretary of Veterans

Affairs for Acquisition.

“(4) The budget of the Office of Acquisition, including

budgets for major acquisition programs, shall be established

in the budget justification materials submitted to Congress

in support of the budget of the Department (as submitted with

the budget of the President under section 1105(a) of title

31).

“(c) Deputy Assistant Secretary for Logistics.—(1)

Pursuant to section 308(d) of this title, the Secretary shall

appoint a Deputy Assistant Secretary of Veterans Affairs for

Logistics, who shall report to the Assistant Secretary for

Acquisition.

“(2) The Deputy Assistant Secretary of Veterans Affairs

for Logistics shall be responsible for administration of

logistics and supply chain operations of the Department.

“(d) Deputy Assistant Secretary for Procurement.—(1)

Pursuant to section 308(d) of this title, the Secretary shall

appoint a Deputy Assistant Secretary of Veterans Affairs for

Procurement, who shall report to the Assistant Secretary for

Acquisition.

“(2) The Deputy Assistant Secretary of Veterans Affairs

for Procurement shall be responsible for all procurement and

contracting organizations of the Department.

“(e) Deputy Assistant Secretary for Acquisition, Program

Management, and Performance.—(1) Pursuant to section 308(d)

of this title, the Secretary shall appoint a Deputy Assistant

Secretary of Veterans Affairs for Acquisition, Program

Management, and Performance, who shall report to the

Assistant Secretary for Acquisition.

“(2) The Deputy Assistant Secretary for Acquisition,

Program Management, and Performance shall be responsible for

the following:

“(A) Lifecycle management.

“(B) Requirements planning.

“(C) Programming and budgeting.

“(D) Policy.

“(E) Performance standards.

“(F) Governance.

“(G) Enhancing the capabilities of the acquisition

workforce.

“(f) Program Executive Officers.—(1) The Assistant

Secretary for Acquisition shall appoint no fewer than four

Program Executive Officers, each responsible for overseeing

major acquisition programs in one of the following areas:

“(A) Medical.

“(B) Information technology.

“(C) Professional services.

“(D) Other areas not included in subparagraphs (A) through

(C).

“(2) Each Program Executive Officer shall report directly

to the Assistant Secretary for Acquisition and shall

supervise the managers of major acquisition programs within

their respective area, as appointed under section 8183 of

this title.

“(3) Each Program Executive Officer shall be—

“(A) certified in project management at level three by—

“(i) the Department;

“(ii) the Federal Acquisition Institute pursuant to

section 1201 of title 41; or

“(iii) the Department of Defense pursuant to section 1701a

of title 10; or

“(B) hold an equivalent certification by a private sector

project management certification organization, as determined

appropriate by the Secretary.”.

(b) Department of Veterans Affairs Major Acquisition

Program Managers.—Subchapter VII of chapter 81 of title 38,

United States Code, as added by subsection (a), is amended by

adding at the end the following new section:

“Sec. 8183. Major acquisition program managers

“(a) Appointments.—Not later than 30 days after any date

on which the Secretary approves a major acquisition program

to commence, the applicable Program Executive Officer shall

appoint a manager to be responsible for administering such

program.

“(b) Qualifications.—Each manager appointed pursuant to

subsection (a) shall be—

“(1) certified in project management at level three by—

“(A) the Department;

“(B) the Federal Acquisition Institute pursuant to section

1201 of title 41; or

“(C) the Department of Defense pursuant to section 1701a

of title 10; or

“(2) hold an equivalent certification by a private sector

project management certification organization, as determined

appropriate by the Secretary.

“(c) Duties.—Each manager appointed pursuant to

subsection (a) for a major acquisition program shall—

“(1) report to the Assistant Secretary for Acquisition

through the Program Executive Officer responsible for the

major acquisition program; and

“(2) be responsible for, with respect to the major

acquisition program—

“(A) developing, in coordination with the Program

Executive Officer, a plan to administer the major acquisition

program, which shall be known as the `program baseline' for

the major acquisition program, that includes—

“(i) a description of each acquisition phase of the major

acquisition program;

“(ii) for each such acquisition phase, requirements for

advancing the major acquisition program to a subsequent

acquisition phase; and

“(iii) estimates of the cost, schedule, and performance of

the major acquisition program that account for the entire

life cycle of the major acquisition program;

“(B) ensuring the major acquisition program is in

compliance with such requirements and providing all program

documentation, including program baseline documentation,

cost, schedule, performance and risk assessments, and other

relevant materials, to designated officials and relevant

governance boards;

“(C) developing resource requests and justifications

necessary to satisfy such requirements; and

“(D) on a continuous basis, assessing and managing risks

to satisfying the requirements of such program baseline

relating to cost and schedule.

“(d) Program Decision Authority.—(1) The Assistant

Secretary for Acquisition is the program decision authority

regarding a major acquisition program.

“(2) Program management offices for major acquisition

programs shall—

“(A) report directly to the Assistant Secretary for

Acquisition; and

“(B) operate independently of the Veterans Benefits

Administration, the Veterans Health Administration, the

National Cemetery Administration, and staff offices of the

Department.

“(e) Notification Required.—Not later than 30 days after

any date on which a major acquisition program concludes an

acquisition phase, the manager of such program appointed

pursuant to subsection (a) shall notify the Assistant

Secretary for Acquisition.”.

Procurement Reorganization Matters.—

(1) Organizational consolidation.—Not later than one year

after the date of the enactment of this Act, the Secretary of

Veterans Affairs shall organizationally consolidate under the

Assistant Secretary of Veterans Affairs for Acquisition every

activity of the Department of Veterans Affairs, including the

Veterans Benefits Administration, the Veterans Health

Administration, and the National Cemetery Administration,

that relates to—

(A) acquisition;

(B) procurement and contracting; or

(2) Relocation.—Paragraph (1) shall not be construed to

require the physical relocation of employees of the

Department.

(3) Plan and briefing.—

(A) In general.—Not later than 90 days after commencing

organizational consolidation under paragraph (1), the

Secretary shall—

(i) submit to the Committee on Veterans' Affairs of the

Senate and the Committee on Veterans' Affairs of the House of

Representatives a written plan to carry out such

organizational consolidation; and

(ii) provide such committees a briefing on such plan.

(B) Contents.—The plan submitted pursuant to subparagraph

(A)(i) shall include the following:

(i) A timeline.

(ii) A plan for communication and training activities for

relevant Department personnel.

(iii) A plan for modification of relevant Department policy

and guidance.

(iv) Such other matters as the Secretary considers relevant

and appropriate.

(d) Independent Verification and Validation of Major

Acquisition Programs of Department of Veterans Affairs.—

(1) Contracting authority.—Not later than 120 days after

the date of the enactment of this Act, the Secretary of

Veterans Affairs shall seek to enter into one or more

contracts using competitive procedures with one or more

entities to carry out the functions described in paragraph

(3).

(2) Eligibility.—

(A) In general.—An entity is not eligible to be awarded a

contract under this section unless the Chief Acquisition

Officer of the Department of Veterans Affairs determines, at

the time of evaluation of offers submitted under paragraph

(1), that the entity is currently performing or has

performed, during the preceding three-year period, not fewer

than three prime contracts from either governmental or

commercial health care organizations for—

(i) the independent verification and validation services or

equivalent services, including systems engineering and

technical advisory (SETA) support of major acquisition

programs; or

(ii) the independent verification and validation or systems

engineering and technical advisory (SETA) support of the

development or acquisition of major acquisition programs or

defense systems, in accordance with guidance of the

Department of Defense relating to such acquisition programs

or such business systems.

(B) Past performance.—For any contract used to demonstrate

eligibility under subparagraph (A), an entity must have

performed the work at a satisfactory or better level as

indicated by the past performance information in the

Contractor Performance Assessment Reporting System, or

successor system.

Secretary shall revoke the eligibility of an entity under

this subsection if an entity does not demonstrate clear and

unmitigable evidence that the entity does not have a conflict

of interest with respect to the effective performance of

functions under paragraph (3).

(D) No mitigation plans acceptable.—The Secretary may not

accept from an entity a plan to mitigate a conflict of

interest in order to ameliorate any limitation or prohibition

under this subsection.

(3) Functions.—The functions specified in this subsection

are the following:

(A) The independent verification and validation of each

major acquisition program project—

(i) when such major acquisition program is initiated, with

respect to its design and the development of its requirements

and acquisition;

(ii) at the conclusion of such program; and

(iii) at any other intervals during such program selected

by the Chief Acquisition Officer of the Department.

(B) The independent verification and validation of other

programs or projects of the Department selected by the Chief

Acquisition Officer of the Department, at intervals selected

by the Chief Acquisition Officer.

(4) Funding.—The Chief Financial Officer of the Department

shall ensure that each organizational subdivision of the

Department that enters into a contract under paragraph (1)

proportionally contributes amounts to fund each such

contract.

(5) Definitions.—In this section:

(A) Covered contract.—The term “covered contract” means

any prime or subcontract with the Department, including—

(i) information technology support or software or system

design, development, sustainment, or maintenance services;

(ii) professional or management consulting services; or

(iii) advisory and assistance services.

(B) Independent verification validation.—The term

“independent verification and validation” means a

comprehensive inspection, a review, analysis, and testing, or

an assessment of systems, software, or hardware, as

applicable, performed by an entity awarded a contract under

paragraph (1)—

(i) to verify that the requirements of a program, project

or system, or a development phase of such a program or

project, are correctly defined; and

(ii) to validate cost, schedule, and performance baselines

of current programs and measure program effectiveness.

(e) Department of Veterans Affairs Cost Assessment and

Program Evaluation.—

(1) In general.—Subchapter VII of chapter 81 of title 38,

United States Code, as added by subsection (a) and amended by

subsection (b), is further amended by adding at the end the

following new section:

“Sec. 8184. Cost assessment and program evaluation

“(a) Director of Cost Assessment and Program Evaluation.—

There is in the Department a Director of Cost Assessment and

Program Evaluation, who shall report directly to the

Secretary.

“(b) Responsibilities.—The responsibilities of the

Director are as follows:

“(1) To develop policies and procedures for cost

estimation and analysis of major acquisition programs of the

Department.

“(2) To conduct independent cost estimates and analyses

for major acquisition programs to support acquisition

decisions, or any other acquisitions as directed by the

Secretary.

“(3) To provide an independent cost estimate to the

Assistant Secretary for Acquisition in advance of a decision

to proceed with full-scale acquisition for a major

acquisition program or any other program as directed by the

Director.

“(4) To evaluate the effectiveness of major acquisition

programs in meeting Department objectives.

“(5) Not less frequently than once each year, to submit to

the Secretary and the Committee on Veterans' Affairs of the

Senate and the Committee on Veterans' Affairs of the House of

Representatives an annual report on cost estimation and

program evaluation activities, including recommendations to

improve acquisition efficiency. Such report shall include a

list of all acquisitions where the independent cost estimate

for a major acquisition program exceeded the budget request

for the program by more than 5 percent.

“(c) Support and Resources.—The Chief Financial Officer

of the Department shall

provide to the Secretary such support and resources as may be

necessary for the Secretary to ensure the effective

establishment and functioning of the Director of Cost

Assessment and Program Evaluation.”.

(2) Report on monitoring of operating and support costs for

major acquisition programs.—

(A) Report to secretary of veterans affairs.—Not later

than one year after the date of the enactment of this Act,

and not less frequently than once each year thereafter until

December 31, 2028, the Director of Cost Assessment and

Program Evaluation of the Department of Veterans Affairs

shall submit to the Secretary of Veterans Affairs a report on

systems and methods for tracking and assessing operating and

support costs of major acquisition programs (as defined in

section 8181 of title 38, United States Code, as added by

subsection (a)), including recommendations for establishing

cost baselines.

(B) Transmittal to congress.—Not later than 30 days after

receiving a report pursuant to subparagraph (A), the

Secretary shall submit to the Committee on Veterans' Affairs

of the Senate and the Committee on Veterans' Affairs of the

House of Representatives the report received by the

Secretary.

(f) Improvements to Hiring of Entry-level Acquisition

Positions in Department of Veterans Affairs.—

(1) Priority use of internship programs for hiring into

entry-level positions in acquisitions.—The Secretary of

Veterans Affairs shall prioritize the use of acquisition

internship programs to hire employees to entry-level

positions relating to acquisition in the Department of

Veterans Affairs.

(2) Annual number of participants in acquisition internship

programs.—

(A) In general.—Not later than September 30 of the first

fiscal year beginning after the date of the enactment of this

Act, the Secretary shall take such actions as may be

necessary to ensure that the annual number of participants in

acquisition internship programs of the Department is—

(i) not fewer than twice the number of participants in such

programs during fiscal year 2025; and

(ii) not more than 4 times the number of participants in

such programs during such fiscal year.

(B) Termination.—The requirements of subparagraph (A)

shall terminate on the date on which the Secretary certifies

to the appropriate committees of Congress that the projected

number of graduates of acquisition internship programs is

sufficient to satisfy the human capital needs of the

Department with respect to acquisition, taking into account

the rate of attrition and projected retirements of personnel.

subsection, the term “appropriate committees of Congress”

means the Committee on Veterans' Affairs of the Senate and

the Committee on Veterans' Affairs of the House of

Representatives.

(g) Independent Analysis of Acquisition Process of

Department of Veterans Affairs.—

(1) Systems engineering analysis.—Not later than one year

after the date of the enactment of this Act, the Secretary of

Veterans Affairs shall enter into a memorandum of

understanding with the Executive Director of the Acquisition

Research Center of the Department of Defense to conduct a

systems engineering analysis of the acquisition process of

the Department of Veterans Affairs.

(2) Report.—Not later than one year after the date in

which the Secretary enters into the memorandum of

understanding required by paragraph (1), the Secretary shall

submit to 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 Executive

Director with respect to the analysis conducted under such

subsection.

(h) Requirements Development Process.—

(1) In general.—Subchapter VII of chapter 81 of title 38,

United States Code, as added by subsection (a) and amended by

subsections (b) and (e), is further amended by adding at the

end the following new section:

“Sec. 8185. Requirements development process

“(a) Establishment of Process.—(1) The Secretary shall

establish a standardized requirements development process for

major acquisition programs.

“(2) The process established pursuant to paragraph (1)

shall—

“(A) define and validate mission-driven requirements for

major acquisition programs exceeding $200,000,000 annually or

$1,000,000,000 in lifecycle costs, in coordination with the

Assistant Secretary for Acquisition;

“(B) incorporate data-driven needs assessments,

stakeholder input from relevant administrations, staff

offices, and other elements of the Department, and alignment

with statutory mandates, such as section 8121 of this title;

and

“(C) ensure iterative validation of requirements through

independent verification and validation, as described in

section 8183 of this title, to confirm cost, schedule, and

performance baselines.

“(b) Limitation on Personnel.—The Secretary shall

implement the process established pursuant to subsection (a)

using staff within the Office of Acquisition and other

relevant offices of the Department, as established under

section 8182 of this title, without creating new positions,

unless a subsequent cost-benefit analysis, validated by the

Director of Cost Assessment and Program Evaluation, justifies

additional resources.”.

(2) Report.—Not later than 180 days after the enactment of

this Act, the Secretary shall submit to the Committee on

Veterans' Affairs of the Senate and the Committee on

Veterans' Affairs of the House of Representatives a report

detailing the requirements process established pursuant to

section 8183 of such title, as added by paragraph (1) and a

plan for implementation of such process, including timelines

for integration with major acquisition program baselines.

(i) Conforming Amendments.—Subchapter VI of chapter 81 of

title 38, United States Code, is amended—

(1) in section 8171, by striking paragraphs (5) and (6);

and

(2) by striking section 8172.

(j) Clerical Amendments.—The table of sections at the

beginning of chapter 81 of title 38, United States Code, is

amended—

(1) by striking the item relating to section 8172; and

(2) by adding at the end the following:

“subchapter vii—acquisition review, cost assessment, and program

evaluation

“8181. Definition of major acquisition program.
“8182. Acquisition reorganization.
“8183. Major acquisition program managers.
“8184. Cost assessment and program evaluation.
“8185. Requirements development process.”.

SEC. 404. IMPROVEMENT OF TELEPHONE COMMUNICATION BY

DEPARTMENT OF VETERANS AFFAIRS.

(a) In General.—Chapter 63 of title 38, United States

Code, is amended by adding at the end the following new

section:

“Sec. 6321. Telephone communication

“(a) Calls Associated With Department.—Not later than one

year after the date of the enactment of the Take Care of

America's Veterans Act, the Secretary shall ensure, to the

extent practicable and feasible, that any call made to a

veteran, beneficiary, claimant, or other relevant individual

by an employee or contractor of the Department regarding

services or benefits furnished by the Department—

“(1) is made from a single, well-known telephone number;

and

“(2) uses caller identification branding that indicates to

the individual that the call is from or on behalf of the

Department.

“(b) Call Centers for Health Care Appointments and

Referrals.—

“(1) In general.—Not later than one year after the date

of the enactment of the Take Care of America's Veterans Act,

the Secretary shall ensure that the Veterans Health

Administration has at least one call center in each of the

time zones specified in paragraph (3) to address concerns

regarding appointments and referrals for health care under

the laws administered by the Secretary.

“(2) Existing efforts and call centers.—In carrying out

paragraph (1), the Secretary—

“(A) shall ensure coordination with existing efforts of

the Department to improve call center operations; and

“(B) may use existing call centers to meet the

requirements of such paragraph.

“(3) Time zones specified.—The time zones specified in

this paragraph are the following:

“(A) Eastern time.

“(B) Central time.

“(C) Mountain time.

“(D) Pacific time.

“(E) Alaska time.

“(F) Hawaii time.

“(4) Clarification.—The Secretary is not required to

ensure that the Veterans Health Administration has a call

center in any location generally within a time zone specified

in paragraph (3) that does not follow daylight saving

time.”.

(b) Clerical Amendment.—The table of sections at the

beginning of chapter 63 of such title is amended by adding at

the end the following new item:

“6321. Telephone communication.”.

annually for three years thereafter, the Secretary shall

submit to the Committees on Veterans' Affairs of the Senate

and House of Representatives a report on implementation,

including call-answer rates, abandoned-call rates, average

wait times, veteran complaints, spoofing or fraud-prevention

measures, and any exceptions granted.

SEC. 405. ADVANCING DEPARTMENT OF VETERANS AFFAIRS EMERGENCY

RESPONSE TO CRISIS.

(a) Report on Emergency Management Roles for Department of

Veterans Affairs.—

(1) In general.—Not later than 180 days after the date of

the enactment of this Act, the Secretary of Veterans Affairs

shall submit to the Committee on Veterans' Affairs of the

Senate and the Committee on Veterans' Affairs of the House of

Representatives a report outlining the roles and

responsibilities of all offices of the Department of Veterans

Affairs involved with emergency management.

(2) Consultation.—In preparing the report required by

paragraph (1), the Secretary of Veterans Affairs shall

consult with the Comptroller General of the United States,

the Inspector General of the Department of Veterans Affairs,

the Secretary of Homeland Security, the Secretary of Defense,

and such other Federal agencies as the Secretary of Veterans

Affairs considers relevant, to obtain insights from their

experience and

trends that they have found, and such recommendations as they

may have with respect to the management by the Department of

Veterans Affairs of emergency management functions.

(3) Contents.—The report submitted pursuant to paragraph

(1) shall include the following:

(A) A description of the organizational structure of each

office, both during normal operations and during emergency or

disaster operations.

(B) The roles and responsibilities of each office.

that are shared by both the Office of Emergency Management of

the Department and the Office of Operations, Security, and

Preparedness of the Department, including an analysis of how

each office plays a part in emergency management functions.

(D) Recommendations for improving the structure and

alignment of relevant offices to better prepare the

Department for emergencies, remove redundancies, and improve

accountability.

(E) An analysis of the feasibility and advisability of

consolidating relevant offices into one centralized emergency

management office to improve communication and streamline

emergency preparedness and response efforts of the

Department.

(b) Plan to Allow Fuel Sharing and Increased Coordination

Between the Federal Emergency Management Agency and the

Department of Veterans Affairs.—Not later than 90 days after

the date of the enactment of this Act, the Secretary of

Veterans Affairs shall, after consulting with the

Administrator of the Federal Emergency Management Agency,

submit to the Committee on Veterans' Affairs of the Senate,

the Committee on Veterans' Affairs of the House of

Representatives, the Committee on Homeland Security and

Government Affairs of the Senate, and the Committee on

Homeland Security of the House of Representatives a report

regarding—

(1) the current limitations preventing the Federal

Emergency Management Agency from providing fuel or other

resources to the Department of Veterans Affairs during

emergencies;

(2) whether the Department requires action by Congress to

allow such resource provision to occur;

(3) whether the Secretary has been unable to coordinate

with the Administrator during prior emergencies or Fourth

Mission activations due to a lack of authority for such

coordination;

(4) whether the Secretary requires action by Congress to

address any of the issues mentioned under paragraph (3); and

(5) whether the Secretary requires action by Congress to

address the issue of Department employees or responders being

unable to use Department-purchased fuel.

SEC. 406. MEMBERSHIP OF DEPARTMENT OF VETERANS AFFAIRS

GERIATRICS AND GERONTOLOGY ADVISORY COMMITTEE.

Section 7315 of title 38, United States Code, is amended,

in subsection (a)—

(1) in the second sentence, by striking “and at least one

representative of a national veterans service organization”

and inserting “, at least one individual who represents a

national veterans service organization, at least one

individual who has served veterans or families of veterans in

a State home, and at least one individual who holds a

professional license in nursing home administration”; and

(2) by designating the first, second, and third sentences

as paragraphs (1) through (3), respectively (and adjusting

the margins accordingly).

SEC. 407. SCHEDULING OF APPOINTMENTS UNDER THE VETERANS

COMMUNITY CARE PROGRAM.

(a) Electronic Process.—Subsection (d) of section 3101 of

the Johnny Isakson and David P. Roe, M.D. Veterans Health

Care and Benefits Improvement Act of 2020 (Public Law 116-

315; 38 U.S.C. 1701 note) is amended to read as follows:

“(d) Electronic Process.—(1) The Secretary shall

implement an electronic process through which a scheduler of

the Department, using an information technology system, may

schedule an appointment for health care furnished by the

Department or through the Veterans Community Care Program,

under section 1703 of this title, by a non-Department health

care provider.

“(2) The electronic process under this subsection shall

allow a scheduler, with regards to appointments described

in—

“(A) either clause of subparagraph (A) of subsection

(a)(1), to view, search, and sort such appointments by type

of care, location, and date; and

“(B) clause (ii) of such subparagraph—

“(i) to schedule such an appointment;

“(ii) to provide referral and authorization documents

directly to a non-Department provider; and

“(iii) to perform any other function the Secretary

determines necessary.

“(3) The Secretary shall ensure that the electronic

process allows a scheduler to schedule an appointment for

health care furnished by the Secretary through a health care

provider of the Department.

“(4) The Secretary shall implement the electronic process

through an existing agreement if practicable.

“(5) The Secretary shall submit to the Committees on

Veterans' Affairs of the Senate and House of Representatives

the following regarding the electronic process:

“(A) Not later than 90 days after the Secretary makes a

determination under subparagraph (B)(iii) of paragraph (2), a

briefing regarding the functions the Secretary has determined

necessary.

“(B) Not later than six months after the date of the

enactment of Take Care of America's Veterans Act, and

semiannually thereafter during the following three years, a

report regarding operation of the electronic process during

both the semiannual period preceding the date of the report

and the cumulative period since the date of the enactment of

such Act. Such a report shall include the following for each

such period:

“(i) The number of non-Department health care providers

that participated in such electronic process, disaggregated

by—

“(I) category of hospital care or medical services

provided; and

“(II) medical center of the Department;

“(ii) The number of appointments scheduled pursuant to the

electronic process, disaggregated by—

“(I) category of hospital care or medical services

provided;

“(II) medical center of the Department; and

“(III) month.

“(iii) A comparison of the average wait time for

appointments scheduled through the electronic process and

through non-electronic methods, disaggregated by medical

center of the Department.

“(iv) The rates at which veterans cancelled appointments

scheduled through the electronic process.

“(v) The rates at which veterans did not appear for

appointments scheduled through the electronic process.”.

(b) Implementation.—

(1) Date.—The Secretary of Veterans Affairs shall

implement the electronic process under subsection (d) of

section 1703H of such title, as added by this section, not

later than two years after the date of the enactment of this

Act.

(2) Guidelines.—Not later than 90 days after the date of

the enactment of this Act, the Secretary of Veterans Affairs

shall establish guidelines. Such guidelines shall include the

following:

(A) Procedures for schedulers and other employees of the

Department involved in the scheduling of appointments

described in such section.

(B) A directive that employees described in subparagraph

(A) use the electronic process to the extent practicable.

(A), when scheduling an appointment for a covered veteran (as

such term is used in section 1703 of such title) for health

care furnished by the Secretary, inform such covered veteran

of available appointments through providers of the Department

and through providers under the Veterans Community Care

Program when eligible.

(D) Procedures for engaging with non-Department health care

providers in specialized cases.

(E) Standards regarding timeliness and accuracy.

(F) Escalation protocols for scheduling failures or delays.

(3) Training.—Not later than 180 days after the date of

the enactment of this Act, the Secretary shall implement a

mandatory training program for employees described in

subparagraph (B) regarding the guidelines under subparagraph

(B).

(4) Evaluation.—Not later than 60 days after the date of

the enactment of this Act, the Secretary shall prescribe

performance benchmarks and outcome-based metrics for the

electronic process under such section, including—

(A) time between a referral and a scheduled appointment;

(B) patient satisfaction; and

through the electronic process.

(5) Outreach.—Not later than 90 days after the date of the

enactment of this Act, the Secretary shall plan and carry out

an outreach strategy to encourage non-Department of Veterans

Affairs health care providers that participate in the

Veterans Community Care Program to participate in the

electronic process under such subsection. Such outreach

shall—

(A) include contacting each such provider during such 90

days;

(B) include seeking to enter into an agreement with each

such provider under which the provider shall participate in

the electronic process;

and rural health associations to promote such participation;

(D) focus on providers in specialties or underserved areas,

as determined by the Secretary; and

(E) include the publication, on a publicly accessible

website of the Department, of information regarding—

(i) details of the electronic process;

(ii) how a provider may elect to participate in the

electronic process; and

(iii) a point of contact in the Department regarding the

electronic process.

(6) Oversight.—The Secretary shall submit to the

Committees on Veterans' Affairs of the Senate and House of

Representatives, with regards to the electronic process under

such subsection, the following:

(A) Not later than 30 days after the Secretary establishes

guidelines under paragraph (2) of this subsection, a copy of

such guidelines.

(B) Not later than 30 days after the Secretary formulates

the plan under paragraph (5) of this subsection, a briefing

on the outreach strategy under such paragraph.

of this Act, the benchmarks and metrics prescribed under

paragraph (4).

the enactment of this Act, the Secretary shall submit to the

Committees on Veterans' Affairs of the Senate and House of

Representatives a plan to integrate the scheduling of

appointments for health care furnished through health care

providers of the Department of Veterans Affairs into the

electronic process under subsection (d) of section 1703H of

such title, as added by this section. Such plan shall include

the following elements:

(1) A timeline to implement such plan.

(2) Estimated costs to carry out such plan.

(3) Changes to policies and procedures of the Department

the Secretary determines necessary to implement such plan.

(d) Codification.—

(1) In general.—Section 3101 of such Act, as amended by

subsection (a), is transferred to subchapter I of chapter 17

of title 38, United States Code, inserted after section

1703G, and redesignated as section 1703H.

(2) Conforming amendments.—Section 1703H of such title, as

transferred and redesignated by this subsection, is amended—

(A) by striking any heading that is not a section heading

or subsection heading and conforming the margins accordingly;

(B) by striking “of title 38, United States Code” both

places it appears and inserting “of this title”;

year after the date of the enactment of this Act, the

Secretary” and inserting “The Secretary”;

(D) in subsection (c)—

(i) in paragraph (1), in the matter preceding subparagraph

(A), by striking “Not later than 180 days after the date of

the enactment of this Act, the Secretary” and inserting

“The Secretary”; and

(ii) in paragraph (2), by striking subparagraphs (A) and

(B) and inserting “The Secretary shall require each medical

facility of the Department to use the method or tool

described in paragraph (1).”;

(E) in the section enumerator, by striking “sec.” and

inserting “Sec. ”; and

(F) in the section heading—

(i) by striking “process and requirements for scheduling

appointments for health care from department of veterans

affairs and non-department health care.” and inserting

“scheduling of appointments”; and

(ii) by conforming the typeface and typestyle, including

capitalization, to the typeface and typestyle used in the

section heading of section 1703G of such title.

(3) Table of sections.—The table of sections at the

beginning of such chapter is amended by inserting, after the

item relating to section 1703G, the following new item:

“1703H. Scheduling of appointments.”.

TITLE V—MEMORIAL AFFAIRS

SEC. 501. EXPANSION OF ELIGIBILITY FOR DEPARTMENT OF VETERANS

AFFAIRS MEMORIAL HEADSTONE OR MARKER FOR

CERTAIN INDIVIDUALS.

Section 2306(b)(2) of title 38, United States Code, is

amended in subparagraphs (B) and (C) by striking “who dies

on or after November 11, 1998,” each place it appears.

SEC. 502. DEPARTMENT OF VETERANS AFFAIRS PROVISION OF

ADDITIONAL BURIAL BENEFITS WHEN AN URN OR

COMMEMORATIVE PLAQUE IS FURNISHED.

(a) In General.—Paragraph (2) of section 2306(h) of title

38, United States Code, is amended to read as follows:

“(2) If the Secretary furnishes an urn or commemorative

plaque for an individual under paragraph (1), the Secretary

may not provide for such individual a headstone or marker

under this section, or any interment benefit under section

2402 of this title, unless—

“(A) in the case of a request for a headstone or marker

under this section—

“(i) such request is made at the same time as a request

for placement of a headstone or marker for another individual

who is eligible to have such a headstone or marker placed in

a national cemetery, a veterans' cemetery in receipt of a

grant made under section 2408 of this title, or a post

cemetery; and

“(ii) the Secretary furnishes one headstone or marker

inscribed for both individuals; or

“(B) in the case of a request for interment, the

individual is interred at the same time and in the same

gravesite as the interment of another individual eligible for

interment in a national cemetery under section 2402(a) of

this title.”.

(b) Applicability.—The amendment made by subsection (a)

shall apply with respect to an individual who dies on or

after January 5, 2021.

SEC. 503. FALLEN SERVICEMEMBERS RELIGIOUS HERITAGE

RESTORATION PROGRAM.

(a) Findings.—Congress finds the following:

(1) An estimated 900 American-Jewish servicemembers of the

Armed Forces, killed in World War I and World War II and

buried overseas in United States military cemeteries, were,

for various reasons, mistakenly buried under Latin Crosses.

In most instances, those mistakes were made inadvertently.

(2) In 2022, more than 2,000,000 people visited the United

States World War I and World War II cemeteries in foreign

countries.

(3) American-Jewish servicemembers played a vital role in

the Allied victories in World War I and World War II.

(4) American-Jewish servicemembers who fought and died for

the United States must have their heritage properly

recognized and honored.

(5) The United States Government has a solemn

responsibility to ensure that every American servicemember

killed in action and buried overseas is properly honored.

(6) The work of properly identifying American-Jewish

servicemembers buried overseas is vital and integral to the

responsibility of the American Battle Monuments Commission to

ensure that past mistakes in honoring those servicemembers

who died in the line of duty are corrected.

(b) Fallen Servicemembers Religious Heritage Restoration

Program.—

(1) Establishment.—The American Battle Monuments

Commission shall establish a program to identify covered

members and to contact survivors and descendants of such

covered members. Such program shall be known as the “Fallen

Servicemembers Religious Heritage Restoration Program”.

(2) Duration.—The Commission shall carry out the Fallen

Servicemembers Religious Heritage Restoration Program during

the first five fiscal years that begin after the date of the

enactment of this Act.

(3) Contracts.—

(A) Authority.—During each fiscal year described in

subsection (b), the Commission shall seek to enter into a

contract with a nonprofit organization under which such

nonprofit organization shall carry out the purpose described

in subsection (b)(1).

(B) Term; amount.—Each contract under this subsection

shall be for one year and in the amount of $500,000 to the

nonprofit organization.

subsection, the Commission shall give priority to a nonprofit

organization that has demonstrated capability and expertise

in carrying out the purpose described in subsection (b)(1).

(4) Definitions.—In this section:

(A) The term “covered member” means a deceased member of

the Armed Forces who was Jewish and buried—

(i) in a United States military cemetery located outside

the United States; and

(ii) under a marker that indicates such member was not

Jewish.

(B) The term “nonprofit organization” means an

organization described in section 501(c)(3) of the Internal

Revenue Code of 1986 and exempt from taxation under section

501(a) of such Code.

TITLE VI—VETERANS' ASSURING CRITICAL CARE EXPANSIONS TO SUPPORT

SERVICEMEMBERS

Subtitle A—Improvement of Veterans Community Care Program

SEC. 601. CODIFICATION OF REQUIREMENTS FOR ELIGIBILITY

STANDARDS FOR ACCESS TO COMMUNITY CARE FROM

DEPARTMENT OF VETERANS AFFAIRS.

(a) Eligibility Access Standards.—Section 1703B of title

38, United States Code, is amended—

(1) by striking subsections (a) through (e) and inserting

the following:

“(a) Access Standards for Community Care.—(1) For

purposes of section 1703(d)(1)(D) of this title, the

eligibility access standards for hospital care, medical

services, or non-institutional extended care services, are as

follows:

“(A) With respect to primary care, mental health care, or

non-institutional extended care services, the Secretary must

schedule an appointment for the covered veteran with a health

care provider of the Department who can provide the needed

service—

“(i) within 30 minutes average driving time from the

residence of the veteran unless a longer average driving time

has been agreed to by the veteran in consultation with a

health care provider of the veteran; and

“(ii) within 20 days of either the date of request for

such an appointment or a later date agreed to by the veteran

in consultation with a health care provider of the veteran.

“(B) With respect to specialty care, the Secretary must

schedule an appointment for the covered veteran with a health

care provider of the Department who can provide the needed

service—

“(i) within 60 minutes average driving time from the

residence of the veteran unless a longer average driving time

has been agreed to by the veteran in consultation with a

health care provider of the veteran; and

“(ii) within 28 days of either the date of request for

such an appointment or a later date agreed to by the veteran

in consultation with a health care provider of the veteran.

“(C) With respect to a covered treatment program, the

Secretary must—

“(i) provide to a covered veteran a screening not later

than 48 hours after the date on which the veteran, or a

relevant health care provider, makes a documented request for

the veteran to be admitted to a covered treatment program;

and

“(ii) if the veteran is determined eligible for priority

admission to a covered treatment program—

“(I) admit the veteran to a covered treatment program not

later than 48 hours after the date of such determination; or

“(II) give the veteran the option of seeking care at a

non-Department facility pursuant to section 1792(e) of this

title.

“(2) For the purposes of determining the ability of the

Secretary to schedule an appointment for a covered veteran

with a health care provider of the Department under paragraph

(1), the Secretary shall not take into consideration the

availability of telehealth appointments from the Department.

“(3) In the case of a covered veteran who has had an

appointment with a health care provider of the Department

canceled by the Department for a reason other than either the

request of the veteran or the failure of the veteran to

appear as scheduled, in calculating a wait time for a

subsequent appointment under the eligibility access standards

established under paragraph (1), the Secretary shall

calculate such wait time from the date of the request for the

original, canceled appointment.

“(4) If a veteran agrees to a longer average drive time or

a later date under paragraph (1), the Secretary shall

document the agreement to such longer average drive time or

later date in the electronic health record of the veteran and

provide the veteran a copy of such documentation. Such copy

may be provided electronically.

“(5) Paragraph (1)(C) shall not be construed to affect a

covered veteran in a covered treatment program pursuant to a

determination made on or before the date of the enactment of

the Take Care of America's Veterans Act.

“(6)(A) Subject to the provisions of this paragraph,

subparagraphs (A) and (B) of paragraph (1) shall terminate on

the date that is eight years after the date of the enactment

of the Take Care of America's Veterans Act.

“(B) Not later than seven years after the date of the

enactment of the Take Care of America's Veterans Act, the

Secretary shall submit to the Committee on Veterans' Affairs

of the Senate and the Committee on Veterans' Affairs of the

House of Representatives a report containing—

“(i) an assessment of the effects of the codification of

eligibility access standards for primary care, mental health

care, non-institutional extended care services, and specialty

care under this subsection on the management and oversight of

the Veterans Community Care Program under section 1703 of

this title; and

“(ii) the recommendation of the Secretary for continued

codification of such standards along with a justification for

such recommendation.

“(C) On and after the date that is eight years after the

date of the enactment of the Take Care of America's Veterans

Act, the Secretary may not establish access standards for

care and services described in subparagraph (A) or (B) of

paragraph (1) that are different from the standards set forth

in those subparagraphs unless, not later than 180 days before

establishing such different standards—

“(i) the Secretary submits to the Committee on Veterans'

Affairs of the Senate and the Committee on Veterans' Affairs

of the House of Representatives notification of the intent of

the Secretary to establish such different standards,

including a description of the changes the Secretary intends

to make and the justification for such changes; and

“(ii) a joint resolution of approval is enacted that

approves such different standards.

“(D) For purposes of this subsection, the term `joint

resolution of approval' means only a joint resolution the

matter after the resolving clause of which is as follows:

`That Congress approves the access standards established by

the Secretary submitted on __ relating to __.', with the

first blank space filled by the appropriate date and the

second blank space filled with a description of the access

standards.

“(E) A joint resolution of approval shall be considered

under the expedited procedures outlined in section 802 of

title 5 to the same extent as a joint resolution described in

subsection (a) of that section is considered.

“(b) Application.—The Secretary shall ensure that the

eligibility access standards established under subsection (a)

apply—

“(1) to all care and services within the medical benefits

package of the Department to which a covered veteran is

eligible under section 1703 of this title; and

“(2) to all covered veterans, regardless of whether a

veteran is a new or established patient.

“(c) Periodic Review of Access Standards.—(1) Not later

than three years after the date of the enactment of the Take

Care of America's Veterans Act, and not less frequently than

once every three years thereafter, the Secretary shall—

“(A) conduct a review of the eligibility access standards

under subsection (a) in consultation with—

“(i) such Federal entities as the Secretary considers

appropriate, including the Department of Defense, the

Department of Health and Human Services, and the Centers for

Medicare & Medicaid Services;

“(ii) entities and individuals in the private sector,

including—

“(I) veteran patients;

“(II) representatives of veterans, including individual

veterans and participants from veteran stakeholder

organizations selected through an open and transparent

process; and

“(III) health care providers participating in the Veterans

Community Care Program under section 1703 of this title; and

“(iii) other entities that are not part of the Federal

Government; and

“(B) submit to the appropriate committees of Congress a

report on—

“(i) the findings of the Secretary with respect to the

review conducted under paragraph (1); and

“(ii) such recommendations as the Secretary may have with

respect to the eligibility access standards under subsection

(a).

“(2) Chapter 10 of title 5 shall not apply to the

consultation required by paragraph (1)(A).”;

(2) by striking subsection (g);

(3) by redesignating subsections (f), (h), and (i) as

subsections (d), (e), and (f), respectively;

(4) in subsection (d), as redesignated by paragraph (3)—

(A) by striking “established” each place it appears; and

(B) in paragraph (1), by striking “(1) Subject to” and

inserting “Compliance by Community Care Providers With

Access Standards.—(1) Subject to”;

(5) in subsection (e), as so redesignated—

(A) in paragraph (1)—

(i) by striking “(1) Consistent with” and inserting

“Determination Regarding Eligibility.—(1) Consistent

with”; and

(ii) by striking “designated access standards established

under this section” and inserting “eligibility access

standards under subsection (a)”; and

(B) in paragraph (2)(B), by striking “designated access

standards established under this section” and inserting

“eligibility access standards under subsection (a)”; and

(6) in subsection (f), as redesignated by paragraph (2)—

(A) in the matter preceding paragraph (1), by striking “In

this section” and inserting “Definitions.—In this

section”; and

(B) in paragraph (2)—

(i) by striking “covered veterans” and inserting

“covered veteran”;

(ii) by striking “veterans described” and inserting “a

veteran described”;

(iii) by redesignating paragraphs (3) and (4) as paragraphs

(4) and (5), respectively; and

(iv) by inserting after paragraph (2) the following new

paragraph (3):

“(3) The term `covered treatment program' has the meaning

given such term in section 1791 of this title.”.

(b) Conforming Amendments.—Section 1703(d) of such title

is amended—

(1) in paragraph (1)(D), by striking “designated access

standards developed by the Secretary under section 1703B of

this title” and inserting “eligibility access standards

under section 1703B(a) of this title”;

(2) in paragraph (3), by striking “designated access

standards developed by the Secretary under section 1703B of

this title” and inserting “eligibility access standards

under section 1703B(a) of this title”; and

(3) in paragraph (4), by striking “designated access

standards developed by the Secretary under section 1703B of

this title” and inserting “eligibility access standards

under section 1703B(a) of this title”.

SEC. 602. REQUIREMENT THAT SECRETARY NOTIFY VETERANS OF

ELIGIBILITY FOR CARE OR DENIAL OF REQUEST FOR

CARE UNDER VETERANS COMMUNITY CARE PROGRAM.

(a) In General.—Section 1703(a) of title 38, United States

Code, is amended by adding at the end the following new

paragraph:

“(5)(A)(i) Except as provided in clause (iii), the

Secretary shall notify each covered veteran in writing of the

eligibility of such veteran for care or services under this

section as soon as possible but not later than five days

after the date on which the Secretary is aware that the

veteran is seeking care or services and is eligible for such

care or services under this section.

“(ii) The Secretary is required to notify a covered

veteran under clause (i) only at the start of an episode of

care for such veteran.

“(iii) The Secretary shall allow a covered veteran to opt

out of receiving notification under clause (i).

“(B) With respect to each covered veteran eligible for

care or services under subsection (d), and consistent with

subparagraph (A), the Secretary shall provide such veteran

periodic reminders, as applicable and as the Secretary

determines appropriate, of their ongoing eligibility under

such subsection.

“(C) Any notification or reminder under this paragraph may

be provided electronically.

“(6)(A) If a request by a veteran for the Secretary to

authorize care or services under this section is denied,

except as provided in subparagraph (C), the Secretary shall

notify the veteran in writing as soon as possible but not

later than five days after the denial is made—

“(i) of the reason for the denial; and

“(ii) with instructions on how to appeal such denial using

the clinical appeals process of the Veterans Health

Administration.

“(B) If a denial under subparagraph (A) is due to the

Secretary meeting the eligibility access standards under

section 1703B(a) of this title, notice under such

subparagraph shall include an explanation of how the

Secretary met such standards.

“(C) The Secretary shall allow a covered veteran to opt

out of receiving notification under subparagraph (A).

“(D) Any notification under this paragraph may be provided

electronically.”.

(b) Reports to Congress.— Not later than one year after

the date of the enactment of

this Act, and not less frequently than annually thereafter

for a period of five years, the Secretary of Veterans Affairs

shall submit to the Committee on Veterans' Affairs of the

Senate and the Committee on Veterans' Affairs of the House of

Representatives a report on the implementation of the

amendments made by subsection (a), including—

(1) an assessment of the timeliness of the notifications

required by those amendments;

(2) a description of barriers to increasing the timeliness

of those notifications; and

(3) the number of veterans who opt out of receiving those

notifications.

SEC. 603. CONSIDERATION UNDER VETERANS COMMUNITY CARE PROGRAM

OF CONTINUITY OF CARE AND NEED FOR CAREGIVER OR

ATTENDANT.

Section 1703(d) of title 38, United States Code, is

amended—

(1) in paragraph (2), by adding at the end the following

new subparagraphs:

“(F) The potential for improved continuity of care,

including if a veteran has an established relationship with a

non-Department provider and the likelihood of the covered

veteran to seek and complete recommended care, including if

the veteran would abstain from seeking such care if required

to seek such care at a facility of the Department.

“(G) Whether the covered veteran needs an attendant to

provide required aid or assistance to the veteran, including

for the veteran to travel to a facility of the Department.”;

and

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

“(5) The Secretary shall ensure that consideration of the

factors specified in paragraph (2) includes consideration of

all relevant factors, is driven by clinical need, and that no

single factor is required to be determinative when

considering the best medical interest of a covered

veteran.”.

SEC. 604. DISCUSSION OF TELEHEALTH OPTIONS UNDER VETERANS

COMMUNITY CARE PROGRAM.

Section 1703 of title 38, United States Code, is amended—

(1) by redesignating subsection (q) as subsection (r); and

(2) by inserting after subsection (p) the following new

subsection (q):

“(q) Discussion of Options for Telehealth.—(1) When

discussing options for care or services for a covered veteran

under this section, the Secretary shall ensure that the

veteran is informed of the ability of the veteran to seek

care or services via telehealth, either through a medical

facility of the Department or through a non-Department

provider, if—

“(A) telehealth is—

“(i) available to the veteran;

“(ii) appropriate for the type of care or services the

veteran is seeking, as determined by the Secretary; and

“(iii) is acceptable to the veteran; or

“(B) the care or services the veteran is seeking is only

or primarily available through telehealth.

“(2) Nothing in paragraph (1) shall be construed to

prohibit a health care provider specified in subsection (c)

from furnishing hospital care, medical services, or extended

care services under this section via telehealth.”.

SEC. 605. EXTENSION OF DEADLINE FOR SUBMITTAL OF CLAIMS BY

HEALTH CARE ENTITIES AND PROVIDERS UNDER PROMPT

PAYMENT STANDARD.

Section 1703D of title 38, United States Code, is amended—

(1) in subsection (a)(2), by striking “the reason for

denying the claim and what, if any, additional information is

required to process the claim” and inserting “the reason

for denying the claim and request additional missing

information, if any, that is required to process the claim”;

(2) by amending subsection (b) to read as follows:

“(b) Submittal of Claims by Health Care Entities and

Providers.—(1) A health care entity or provider that

furnishes hospital care, a medical service, or an extended

care service under this chapter pursuant to a contract,

agreement, or other arrangement shall submit to the Secretary

a claim for payment for furnishing the hospital care, medical

service, or extended care service not later than one year

after the date on which the entity or provider furnished the

hospital care, medical service, or extended care service.

“(2) No health care entity or provider may seek payment

from a patient if the health care entity or provider failed

to comply with the timely filing requirement set forth in

paragraph (1).”; and

(3) in subsection (c), by adding at the end the following

new paragraph:

“(3)(A) If the Secretary determines, based on reliable

evidence, that a health care entity or provider has submitted

or caused to be submitted a fraudulent claim for payment

under this chapter, the Secretary may suspend such entity or

provider from furnishing hospital care, medical services, or

extended care services under this chapter.

“(B) Before imposing a suspension under subparagraph (A)

with respect to an entity or provider, the Secretary shall—

“(i) provide written notice to the entity or provider

identifying the basis for the proposed suspension;

“(ii) afford the entity or provider an opportunity to

respond within a period of 30 days; and

“(iii) consider any evidence or explanation submitted by

the entity or provider.

“(C)(i) The Secretary shall take all necessary actions to

resolve a suspension under subparagraph (A) as soon as

possible and not later than one year after the date of such

suspension unless the Secretary determines and provides a

written determination that an extension beyond one year is

strictly necessary to protect the interests of veterans and

taxpayers and to preserve the integrity of the health care

delivery system of the Department.

“(ii) Any extension under clause (i) of a suspension

shall—

“(I) be for an additional period of not longer than one

year; and

“(II) shall be reported to the Committee on Veterans'

Affairs of the Senate and the Committee on Veterans' Affairs

of the House of Representatives.

“(D) The Secretary shall establish procedures for

reinstatement of an entity or provider suspended under

subparagraph (A) following the resolution of any fraud-

related investigation or proceeding.

“(E) The Secretary shall coordinate actions under this

paragraph with the Office of Inspector General of the

Department.

“(F) The Secretary shall prescribe regulations to carry

out this paragraph, including standards of evidence, notice,

and appeal procedures.

“(G)(i) Not less frequently than quarterly, the Secretary

shall submit to the Committee on Veterans' Affairs of the

Senate and the Committee on Veterans' Affairs of the House of

Representatives a written notification of the suspensions

entered into, if any, during the preceding quarter that

includes—

“(I) the identity of the suspended entity or provider;

“(II) the statutory or regulatory basis for the

suspension;

“(III) a summary of the factual findings or evidence

supporting the action; and

“(IV) the status of any related investigation of or

referral to the Office of Inspector General of the Department

or any other appropriate Federal agency.

“(ii) The Secretary shall provide to the Committee on

Veterans' Affairs of the Senate and the Committee on

Veterans' Affairs of the House of Representatives, upon

request, all records, memoranda, and communications relevant

to any suspension or reinstatement action taken under this

paragraph, in accordance with applicable laws related to

privacy, ongoing investigations, or sensitive law enforcement

information.

“(iii) Failure by the Secretary to provide notice under

clause (i) shall be treated as a failure to comply with a

statutory reporting requirement.”.

SEC. 606. AUDIT OF REPRESENTATIVE SAMPLE OF VETERANS

RECEIVING CARE AND SERVICES UNDER VETERANS

COMMUNITY CARE PROGRAM.

Not later than one year after the date of the enactment of

this Act, and not less frequently than annually thereafter

for the following five years, the Secretary of Veterans

Affairs shall—

(1) conduct an audit, for the one-year period preceding the

audit, of—

(A) the number of veterans eligible for care or services

under section 1703 of title 38, United States Code, and the

reasons for such eligibility, including multiple such reasons

for veterans eligible under more than one eligibility

criteria;

(B) with respect to veterans eligible for care or services

under section 1703 of title 38, United States Code, the

number of veterans who are informed of such eligibility;

under such section;

(D) the number of veterans who do not opt to seek care or

services under such section;

(E) the timeliness of referrals for care or services under

such section and the timeliness of receipt of such care or

services, including whether care or services received by the

veteran through a non-Department of Veterans Affairs provider

had a shorter wait time than the average wait time for such

care or services at a facility of the Department;

(F) the number of requests for an appeal of a denial of

care or services under such section using the clinical

appeals process of the Veterans Health Administration;

(G) the timeliness of each such appeal; and

(H) the outcome of each such appeal; and

(2) submit to the Committee on Veterans' Affairs of the

Senate and the Committee on Veterans' Affairs of the House of

Representatives a report on the audit conducted under

paragraph (1).

SEC. 607. INFORMATION ON WAIT TIME AND DRIVE TIME OPTIONS FOR

RECEIPT OF CARE BY VETERANS.

(a) In General.—To the greatest extent practicable, the

Secretary of Veterans Affairs shall ensure that veterans are

informed in writing, for each episode of care provided under

the laws administered by the Secretary, of current wait time

and average drive time options for such episode of care

disaggregated by care provided—

(1) in person at a facility of the Department of Veterans

Affairs;

(2) via telehealth through a provider of the Department;

(3) in person through the nearest suitable non-Department

facility with which the Department has a provider agreement

or other arrangement for non-Department care pursuant to

section 1703 of title 38, United States Code; and

(4) via telehealth through a non-Department provider with

which the Department has a provider agreement or other

arrangement for non-Department care pursuant to such section

with the shortest wait time.

(b) Form of Information.—Information provided under

subsection (a)—

(1) may be provided electronically; and

(2) shall be documented in the health record of the

veteran.

out of receiving information under subsection (a).

SEC. 608. ESTABLISHMENT OF PERIOD DURING WHICH A REFERRAL

UNDER VETERANS COMMUNITY CARE PROGRAM REMAINS

VALID.

Section 1703(a) of title 38, United States Code, as amended

by section 602(a), is further amended by adding at the end

the following new paragraph:

“(7) When authorizing care or services under this section,

the Secretary shall ensure that the period during which such

care or services may be performed by a health care provider

specified in subsection (c) begins on the date that the

covered veteran has the first appointment with such

provider.”.

SEC. 609. UPDATES TO CONTRACTING REQUIREMENTS UNDER VETERANS

COMMUNITY CARE PROGRAM.

Section 1703(h) of title 38, United States Code, is

amended—

(1) in paragraph (3)—

(A) by amending subparagraph (A) to read as follows:

“(A) The Secretary may terminate a contract with an entity

entered into under paragraph (1) at such time and upon such

notice to the entity as the Secretary may specify for

purposes of this section, if the Secretary notifies the

appropriate committees of Congress that, at a minimum—

“(i) the entity failed to comply substantially with the

provisions of the contract or with the provisions of this

section and the regulations prescribed under this section,

including with respect to access, quality, training, and

medical documentation;

“(ii) it is reasonable to terminate the contract based on

the health care needs of veterans; or

“(iii) it is reasonable to terminate the contract based on

coverage provided by contracts or sharing agreements entered

into under authorities other than this section.”;

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

subparagraphs:

“(B)(i) The Secretary shall terminate a contract with an

entity entered into under paragraph (1) at such a time and

upon such notice to the entity as the Secretary may specify

for the purposes of this section, if the entity—

“(I) is excluded from participation in a Federal health

care program (as defined in section 1128B(f) of the Social

Security Act (42 U.S.C. 1320a-7b(f))) under section 1128 or

1128A of the Social Security Act (42 U.S.C. 1320a-7 and

1320a-7a);

“(II) has been convicted of a felony or other serious

offense under Federal or State law and the continued

participation of the entity would be detrimental to the best

interests of veterans or the Department; or

“(III) is identified as an excluded source on the list

maintained in the System for Award Management, or any

successor system.

“(ii) The Secretary may issue a waiver for entities

subject to clause (i) for a one-year period, and such a

waiver shall be reported to Congress not later than 30 days

after such waiver is issued.

“(C) Any entities ineligible to enter into contracts with

the Department due to one or more reasons specified in this

paragraph may be listed on a publicly available website of

the Department or appropriate third party administrator.”;

(D) in subparagraph (D), as redesignated by subparagraph

(B) of this paragraph, by striking “in subparagraph (A)”

and inserting “in this paragraph”; and

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

“(7) Any contract or agreement between the Department and

a third party administrator or between a third party

administrator and a health care provider specified in

subsection (c) that is made with respect to care or services

provided under this section shall include—

“(A) notice of obligations to comply with Federal laws and

the consequences for failure to comply with those laws,

including specific information regarding claims for payment

and consequences for any false claims, statements, or

documents, or concealment of a material fact;

“(B) confirmation by the health care provider that they

are accredited to provide any specialized services subject to

the contract or agreement and that they will only use

qualified staff to provide those services; and

“(C) confirmation that the health care provider will

identify any individuals providing specialized services or

treatments included in the contract or agreement and provide

proof of the licensure of those individuals to the

Department.”.

SEC. 610. PUBLICATION OF COMMUNITY CARE NETWORK SUFFICIENCY

AND PAYMENT WAIVER REQUESTS AND APPROVALS.

Not later than one year after the date of the enactment of

this Act, and not less frequently than annually thereafter,

the Secretary of Veterans Affairs shall publish on a publicly

available and user-friendly website—

(1) the information contained in the most recent report

required by section 1703(p) of title 38, United States Code;

and

(2) an overview, disaggregated by region, of the waivers

requested, approved, and denied under section 1703B(f)(3) of

such title.

SEC. 611. REQUIREMENTS RELATING TO QUALITY OF COMMUNITY CARE

PROVIDERS.

(a) Monthly Checks Against List of Excluded Individuals or

Entities.—The Secretary of Veterans Affairs shall ensure

that third party administrators under the Veterans Community

Care Program perform automated monthly checks for all

community care providers against the list of excluded

individuals or entities set forth by the Office of Inspector

General of the Department of Health and Human Services using

national provider identifier records or other unique

identifiers.

(b) Revision of Provider Exclusion Standard Operating

Procedures.—Not later than 90 days after the date of the

enactment of this Act, the Secretary shall ensure that the

Office of Integrated Veteran Care or successor office revises

its provider exclusion standard operating procedures to

require automated matching of community care providers in the

provider profile management system of the Department of

Veterans Affairs to the system for award management

exclusions of the General Services Administration using both

taxpayer identification number and national provider

identifier as identifiers.

Resigning From Employment.—Not later than 90 days after the

date of the enactment of this Act, the Secretary shall ensure

that the Under Secretary for Health of the Department of

Veterans Affairs develops a process to identify health care

providers that are terminated, retire, or resign from

employment with the Department for quality of care concerns

or while under investigation for quality of care concerns so

those health care providers can be prevented from

participating in the Veterans Community Care Program.

(d) Update of Information on Providers.—Not later than one

year after the date of the enactment of this Act, the

Secretary, through the Office of Integrated Veteran Care or

successor office, shall develop a process to ensure that

third party administrators regularly, not less frequently

than quarterly—

(1) update their lists of community care providers to

reflect accurate provider contact information;

(2) annotate providers that are not currently accepting

patients under the Veterans Community Care Program; and

(3) remove providers from the provider profile management

system that—

(A) are on the list of excluded individuals or entities set

forth by the Office of Inspector General of the Department of

Health and Human Services;

(B) are in the system for award management exclusions of

the General Services Administration; or

Department of Veterans Affairs due to quality of care

concerns or left such employment voluntarily, through

resignation, or through retirement, while under investigation

for quality of care concerns.

(e) Definitions.—In this section:

(1) Community care provider.—The term “community care

provider” means a health care provider specified under

section 1703(c) of title 38, United States Code.

(2) Veterans community care program.—The term “Veterans

Community Care Program” means the Veterans Community Care

Program under section 1703 of title 38, United States Code.

SEC. 612. PROVIDER TRAINING.

(a) Development of Plan.—Not later than 180 days after the

date of the enactment of this Act, the Secretary of Veterans

Affairs shall develop a comprehensive plan to better align

training and incentive requirements applicable to community

care providers participating in the Veterans Community Care

Program and health care providers, residents, and trainees of

the Department of Veterans Affairs.

(b) Elements.—The plan required under subsection (a)

shall—

(1) identify existing training requirements or incentives

applicable to health care providers of the Department;

(2) identify existing training requirements or incentives

applicable to health care trainees or residents of the

Department;

(3) identify existing training requirements or incentives

applicable to community care providers;

(4) assess gaps between training requirements and

incentives for health care providers of the Department,

trainees or residents of the Department, and community care

providers;

(5) establish standardized baseline training requirements

to ensure consistency in the quality of care furnished

through the Department from health care providers of the

Department, trainees or residents of the Department, and

community care providers; and

(6) provide a strategy, assessment of barriers, and

timeline for implementing such baseline training

requirements, including—

(A) through online modules and continuing medical education

programs; and

(B) within such strategy—

(i) metrics to measure the effectiveness of baseline

training requirements in improving clinical quality,

satisfaction of veterans, and health outcomes for veterans;

(ii) a mechanism to account for non-Department training

that is equivalent or substantially similar to the Department

training in length, scope, and content, as determined by the

Secretary;

(iii) a mechanism to regularly communicate, including

through direct outreach

and publication online and in provider handbooks of third

party administrators under the Veterans Community Care

Program, requirements and expectations with respect to

training;

(iv) a mechanism to track, report, and address non-

compliance, to include corrective actions, which may include

suspending or barring providers who are routinely non-

compliant; and

(v) a mechanism to designate community care providers who

routinely meet or exceed baseline training requirements as

preferred providers or part of the high performing provider

program of the Department, as the Secretary considers

appropriate.

submission of the report required under subsection (d), the

Secretary shall begin implementing the plan required under

subsection (a).

(d) Report to Congress.—Not later than 180 days after the

date of the enactment of this Act, the Secretary shall submit

to the Committee on Veterans' Affairs of the Senate and the

Committee on Veterans' Affairs of the House of

Representatives a report containing—

(1) the plan required under subsection (a);

(2) a description of identified gaps between training or

incentives for providers of the Department, trainees or

residents of the Department, and community care providers;

(3) the estimated costs associated with implementation of

the plan; and

(4) a description of any legislative or regulatory changes

necessary to carry out the plan.

(e) Annual Updates.—Not later than one year after the

submission of the report required by subsection (d), and

annually thereafter for the following two years, the

Secretary shall submit to the Committee on Veterans' Affairs

of the Senate and the Committee on Veterans' Affairs of the

House of Representatives an update—

(1) describing progress in implementing the plan required

under subsection (a);

(2) assessing any measurable impacts of such implementation

on quality of care; and

(3) assessing any improvements in rates of compliance with

training requirements among health care providers, trainees,

and residents of the Department and community care providers.

(f) Definitions.—In this section:

(1) Community care provider.—The term “community care

provider” means a health care provider specified under

section 1703(c) of title 38, United States Code.

(2) Training.—The term “training” includes training

relating to—

(A) veteran-specific cultural competency;

(B) health conditions related to military service,

including toxic exposures, post-traumatic stress disorder,

traumatic brain injury, and military sexual trauma;

(D) pain management and opioid safety; and

(E) any other matter the Secretary determines appropriate.

(3) Veterans community care program.—The term “Veterans

Community Care Program” means the Veterans Community Care

Program under section 1703 of title 38, United States Code.

SEC. 613. OVERSIGHT AUTHORITY OVER COMMUNITY CARE.

(a) In General.—The Secretary of Veterans Affairs shall

include in each contract or agreement used to provide care or

services through the Veterans Community Care Program

provisions requiring the contractor and any subcontractor or

participating provider to provide government officials,

including the Office of the Inspector General of the

Department of Veterans Affairs, access, within a reasonable

time and manner, to records, materials, documents, data, and

personnel necessary to conduct audits, inspections,

evaluations, or investigations related to such care or

services.

(b) Third Party Administrators.—

(1) Requirement.—The Secretary shall require third party

administrators under the Veterans Community Care Program to

include provisions in agreements with participating providers

that are equivalent to the provisions required under

subsection (a).

(2) Notification.—Notification of the requirements under

this section and any other related information as the

Secretary determines appropriate shall be included in the

provider handbooks of third party administrators under the

Veterans Community Care Program.

establish standard contract language under this section in

consultation with the Inspector General of the Department of

Veterans Affairs.

(d) Veterans Community Care Program Defined.—In this

section, the term “Veterans Community Care Program” means

the Veterans Community Care Program under section 1703 of

title 38, United States Code.

Subtitle B—Mental Health Treatment Programs

SEC. 621. VETERAN PARTICIPATION IN CERTAIN MENTAL HEALTH

PROGRAMS.

(a) Establishment.—Chapter 17 of title 38, United States

Code, is amended by adding at the end the following new

subchapter:

“SUBCHAPTER IX—PARTICIPATION BY VETERANS IN CERTAIN MENTAL HEALTH

TREATMENT PROGRAMS

“Sec. 1791. Definitions

“In this subchapter:

“(1) Activities of daily living.—The term `activities of

daily living' means specific personal care activities that

are required for basic daily maintenance and sustenance, to

include eating, toileting, bathing, grooming, dressing and

undressing, and mobility.

“(2) Covered treatment program.—

“(A) In general.—The term `covered treatment program'—

“(i) means—

“(I) a mental health residential rehabilitation treatment

program of the Department; or

“(II) a program of the Department for residential care for

mental health and substance use disorders;

“(ii) includes—

“(I) the programs designated as of the date of the

enactment of the Take Care of America's Veterans Act as

domiciliary residential rehabilitation treatment programs;

and

“(II) any programs designated as domiciliary residential

rehabilitation treatment programs on or after such date of

enactment; and

“(iii) does not include—

“(I) Compensated Work Therapy Transition Residence

programs of the Department; or

“(II) Department or non-Department programs in which more

than 20 percent of the care provided is provided through

telehealth.

“(B) Accreditation.—A program described in subparagraph

(A) must maintain accreditation by the Commission on

Accreditation of Rehabilitation Facilities and the Joint

Commission.

“(3) Covered veteran.—The term `covered veteran' means a

veteran described in section 1703(b) of this title.

“(4) Evidence-based treatment.—The term `evidence-based

treatment' means treatment provided in accordance with the

Department of Veterans Affairs/Department of Defense Clinical

Practice Guidelines for Mental Health and Substance Use

Disorder, or any successor similar guidelines.

“(5) Social support systems.—The term `social support

systems', with respect to a covered veteran—

“(A) means—

“(i) a member of the family of the covered veteran,

including a parent, spouse, child, step-family member, or

extended family member; or

“(ii) an individual who lives with the veteran but is not

a member of the family of the veteran; and

“(B) does not include a facility-organized peer support

program.

“Sec. 1792. Standardized process to determine eligibility of

covered veterans for participation in certain mental health

treatment programs

“(a) Standardized Screening Process.—Not later than one

year after the date of the enactment of the Take Care of

America's Veterans Act, the Secretary shall establish a

standardized screening process to determine, based on

clinical need, whether a covered veteran satisfies criteria

for priority or routine admission to a covered treatment

program.

“(b) Eligibility Criteria for Priority Admission.—

“(1) In general.—Under the standardized screening process

required by subsection (a), a covered veteran shall be

eligible for priority admission to a covered treatment

program if the covered veteran meets criteria established by

the Secretary that shall include the following:

“(A) A clinical assessment of the symptoms of the veteran,

including symptoms that—

“(i) significantly affect activities of daily life; and

“(ii) increase the risk of adverse outcomes, such as

overdose, suicide, self-harm, or an unsafe living situation.

“(B) The lack of availability and applicability of other

treatment options.

“(C) Whether the veteran has a recent suicide or overdose

attempt.

“(D) Whether the veteran is determined to be a high risk

for suicide or overdose.

“(E) Whether the veteran has a demonstrated history of

non-responsiveness, relapse, or inability to find recovery

from two other completed courses of treatment, such as

outpatient or intensive outpatient treatment, through a

program that—

“(i) is licensed by a State;

“(ii) is accredited by the Commission on Accreditation of

Rehabilitation Facilities or the Joint Commission; and

“(iii) provides evidence-based treatment.

“(F) Such other criteria as the Secretary determines

appropriate, in consultation with Congress.

“(2) Consideration.—In making a determination that a

covered veteran meets criteria established by the Secretary

under paragraph (1) for priority admission to a covered

treatment program, the Secretary shall—

“(A) consider any referral of a health care provider of a

covered veteran; and

“(B) ensure that consideration of such criteria includes

consideration of all relevant factors, is driven by clinical

need, and that no single factor is required to be

determinative when considering the best medical interest of a

covered veteran.

“(3) Provision of higher-level care.—The Secretary shall

provide immediate and clinically necessary care under other

authorities available to the Secretary to any covered veteran

who is not clinically recommended for admission to a covered

treatment program based on the need for a higher level of

care, such as being at a high acute risk for suicide.

“(c) Screening for Traumatic Brain Injury.—Under the

standardized screening process required by subsection (a),

the Secretary shall ensure a covered veteran is screened at

an appropriate time for potential mild, moderate, or severe

traumatic brain injury.

“(d) Considerations.—In making placement decisions in a

covered treatment program for veterans who meet criteria for

priority or routine admission, the Secretary shall—

“(1) consider the input of the covered veteran with

respect to the—

“(A) program specialty, subtype, and treatment track

offered to the covered veteran; and

“(B) geographic placement of the covered veteran,

including proximity to the current residence, time zone, or

geographic region of the covered veteran;

“(2) maximize the proximity of the covered veteran to

social support systems; and

“(3) to the greatest extent practicable, place the veteran

in a covered treatment program located within the same time

zone and geographic region as the residence of the veteran at

the time of admission.

“(e) Conditions Under Which Care Shall Be Furnished

Through Non-Department Providers.—

“(1) Priority admission.—If the Secretary determines a

covered veteran is eligible for priority admission to a

covered treatment program pursuant to the standardized

screening process required by subsection (a) and the

Secretary is unable to admit such covered veteran to a

covered treatment program at a facility of the Department in

a manner that complies with the requirements under subsection

(d) and section 1703B(a)(1)(C) of this title, the Secretary

shall offer the covered veteran the option to receive care at

a non-Department facility that—

“(A) can admit the covered veteran within the period

required by section 1703B(a)(1)(C)(ii)(I) of this title;

“(B) is party to a contract or agreement with the

Department or enters into such a contract or agreement under

which the Department furnishes a program that is equivalent

to a covered treatment program to a veteran through such non-

Department facility;

“(C) is licensed by a State;

“(D) is accredited by the Commission on Accreditation of

Rehabilitation Facilities or the Joint Commission; and

“(E) provides evidence-based treatment.

“(2) Routine admission.—If the Secretary determines a

covered veteran is eligible for routine admission to a

covered treatment program pursuant to the standardized

screening process required by subsection (a) and the

Secretary is unable to admit such covered veteran to a

covered treatment program at a facility of the Department in

a manner that complies with the requirements under section

1703B(a)(1)(C) of this title with respect to routine

admission, the Secretary shall offer the covered veteran the

option to receive care at a non-Department facility that—

“(A) is party to a contract or agreement with the

Department or enters into such a contract or agreement under

which the Department furnishes a program that is equivalent

to a covered treatment program to a veteran through such non-

Department facility;

“(B) is licensed by a State;

“(C) is accredited by the Commission on Accreditation of

Rehabilitation Facilities or the Joint Commission; and

“(D) provides evidence-based treatment.

“(3) Rule of construction.—This subsection shall not be

construed to affect a covered veteran in a covered treatment

program pursuant to a determination made on or before the

date of the Take Care of America's Veterans Act.

“Sec. 1793. Improvements to Department of Veterans Affairs

mental health residential rehabilitation treatment program

“(a) Performance Metrics.—

“(1) In general.—The Secretary shall develop metrics to

track, and shall subsequently track, the performance of

medical facilities of the Department, Veterans Integrated

Service Networks, and non-Department facilities in meeting

the requirements for—

“(A) screening, under section 1792 of this title, for a

covered treatment program;

“(B) timely admission, under section 1792 of this title,

to a covered treatment program pursuant to such screening;

and

“(C) adherence to evidence-based treatment standards

developed by the Secretary in consultation with appropriate

governmental and non-governmental professional organizations

with a demonstrated history of providing or accrediting

programs that are substantially similar to covered treatment

programs, or made of professionals who provide for such

programs, including by—

“(i) using placement criteria established by the American

Society of Addiction Medicine; and

“(ii) maintaining standards to meet accreditation by the

Commission on Accreditation of Rehabilitation Facilities or

the Joint Commission.

“(2) Elements.—The metrics developed under paragraph (1)

shall include metrics for tracking the performance of medical

facilities of the Department, Veterans Integrated Service

Networks, and non-Department facilities with respect to

routine and priority admission under a covered treatment

program as well as adherence to evidence-based treatment

standards.

“(3) Consultation.—In developing metrics under paragraph

(1), the Secretary shall consult with mental health and

substance use disorder providers, including providers

employed by the Department and those employed by non-

Department entities, and ensure adherence to industry

standards.

“(4) Report.—Not later than one year after the date of

the enactment of the Take Care of America's Veterans Act, the

Secretary shall submit to the Committee on Veterans' Affairs

of the Senate and the Committee on Veterans' Affairs of the

House a report describing the consultation and performance

metrics required under this subsection.

“(b) Oversight.—

“(1) In general.—The Secretary shall develop a process

for systematically assessing at the facility, network, and

regional level, as the Secretary considers appropriate, the

quality of care delivered by facilities of the Department and

non-Department facilities treating covered veterans under

this section as well as a process for rectifying any

identified concerns.

“(2) Elements.—The processes required under paragraph (1)

shall include assessments of—

“(A) the extent to which providers at the facility deliver

evidence-based treatments to covered veterans;

“(B) clinical outcomes for covered veterans, including

those outcomes assessed pursuant to a subsequent clinical

screening under subsection (g)(3)(F);

“(C) the ratio of licensed independent practitioners per

resident;

“(D) the rate of completion of training under section 1795

of this title by licensed independent practitioners;

“(E) whether non-Department facilities and providers

generally meet the criteria outlined in section 1792(e) of

this title;

“(F) the timeliness, completeness, and rate of

transmission, if applicable, of medical records during and

following treatment of covered veterans; and

“(G) potentially wasteful, fraudulent, or inappropriate

referral or billing practices.

“(3) Consultation.—In developing the processes required

under paragraph (1), the Secretary shall consult with

relevant stakeholders, including mental health and substance

use disorder providers employed by the Department and those

employed by non-Department entities, and ensure adherence to

industry standards.

“(4) Report.—Not later than one year after the date of

the enactment of the Take Care of America's Veterans Act, the

Secretary shall submit to the Committee on Veterans' Affairs

of the Senate and the Committee on Veterans' Affairs of the

House of Representatives a report describing the consultation

and oversight processes required by this subsection.

“(c) Placement; Transportation.—

“(1) Locations.—If the Secretary determines that a

covered veteran is in need of residential care under a

covered treatment program, the Secretary shall provide to the

covered veteran a list of locations at which such covered

veteran can receive such residential care that meets—

“(A) the standards for screening under section 1792 of

this title; and

“(B) the care needs of the covered veteran, including

applicable treatment tracks.

“(2) Transportation coverage.—

“(A) In general.—Notwithstanding any other provision of

law regarding the transportation of individuals under this

title, or any other law administered by the Secretary, and

except as provided in subparagraph (B), the Secretary shall

provide transportation, pay for, or reimburse the costs of

transportation for any covered veteran who is admitted into a

covered treatment program and needs transportation

assistance—

“(i) from the residence of the covered veteran or a

facility of the Department or authorized non-Department

facility that does not provide such care to another

Department or non-Department facility that provides

residential care covered under a covered treatment program;

and

“(ii) back to the residence of the covered veteran or to a

facility of the Department or an authorized non-Department

facility after the conclusion of a covered treatment program,

if applicable.

“(B) Limitations.—

“(i) Costs incurred by veterans.—The Secretary shall

provide reimbursement under subparagraph (A) directly to a

covered veteran only for costs directly incurred by the

covered veteran and pre-approved by the Department.

“(ii) No coverage of transportation provided by covered

treatment program.—The Secretary shall not reimburse a

covered veteran for transportation provided to the covered

veteran by a covered treatment program, unless for a purpose

and amount approved by the Secretary.

“(d) Appeals.—

“(1) In general.—The Secretary shall develop a national

policy and associated procedures, in accordance with the

existing clinical appeals process of the Veterans Health

Administration, under which a covered veteran, a

representative of a covered veteran, or a provider who

requests a covered veteran be admitted to a covered treatment

program, including a provider of the Department or a non-

Department provider, may file a clinical appeal pursuant to

this subsection if the covered veteran is—

“(A) denied admission into a covered treatment program; or

“(B) accepted into a covered treatment program but is not

offered bed placement in a timely manner.

“(2) Timeliness standards for review.—

“(A) In general.—The national policy and procedures

developed under paragraph (1) for appeals described in such

paragraph shall include timeliness standards for the

Department to review and make a decision on such an appeal.

“(B) Decision.—The Secretary shall review and respond to

any appeal under paragraph (1) not later than 72 hours after

the Secretary receives such appeal.

“(3) Public guidance.—The Secretary shall develop, and

make available to the public, guidance on how a covered

veteran, a representative of the covered veteran, or a

provider of the covered veteran can file a clinical appeal

pursuant to this subsection—

“(A) if the covered veteran is denied admission into a

covered treatment program;

“(B) if the first date on which the covered veteran may

enter a covered treatment program does not comply with the

eligibility access standards under section 1703B(a) of this

title for care at a covered treatment program; or

“(C) with respect to such other factors as the Secretary

may specify.

“(4) Rule of construction.—Nothing in this subsection may

be construed as granting a covered veteran, a representative

of a covered veteran, or a provider who requests a covered

veteran be admitted to a covered treatment program, including

a provider of the Department or a non-Department provider,

the right to appeal a decision of the Secretary with respect

to admission to a covered treatment program to the Board of

Veterans' Appeals under chapter 71 of this title.

“(e) Tracking of Availability and Wait Times.—

“(1) In general.—The Secretary, to the extent

practicable, shall create a method for tracking availability

and wait times under a covered treatment program across all

facilities of the Department, Veterans Integrated Service

Networks, and non-Department providers throughout the United

States.

“(2) Availability of information.—The Secretary shall

make the information tracked under paragraph (1) available,

in real time to—

“(A) the mental health treatment coordinators at each

facility of the Department;

“(B) the leadership of each medical center of the

Department;

“(C) the leadership of each Veterans Integrated Service

Network; and

“(D) the Office of the Under Secretary for Health of the

Department.

“(3) Publication of information.—Not less frequently than

monthly, the Secretary shall publish the information tracked

under paragraph (1) on a publicly accessible website of the

Department.

“(f) Staffing Matters.—

“(1) Training.—

“(A) In general.—The Secretary shall update and implement

training for staff of the Department directly involved in a

covered treatment program regarding referrals, screening,

admission, placement decisions, and appeals for such program,

including all changes to processes and guidance under such

program required by this section and section 1792.

“(B) Covered veterans awaiting admission.—The training

under subparagraph (A) shall include procedures for the care

of covered veterans awaiting admission into a covered

treatment program and communication with such covered

veterans and the providers of such covered veterans.

“(C) Timing of training.—

“(i) In general.—The Secretary shall require the training

under subparagraph (A) to be completed by staff required to

complete such training—

“(I) not later than 60 days after beginning employment at

the Department in a position that includes work directly

involving a covered treatment program; and

“(II) not less frequently than annually.

“(ii) Tracking.—The Secretary shall track completion of

training required under clause (i) by staff required to

complete such training.

“(2) Oversight standards.—The Secretary shall review and

revise oversight standards for the leadership of the Veterans

Integrated Service Networks and the Veterans Health

Administration to ensure that facilities and staff of the

Department are adhering to the policy on access to care of

each covered treatment program.

“(3) Staff coverage.—The Secretary shall not require

staff of a covered treatment program to act as coverage for

any other team, service, or project unrelated to the covered

treatment program for a period of greater than three days per

month unless such coverage is for purposes of the fourth

mission of the Department or under an emergency declaration.

“(g) Care Coordination and Follow-up Care.—

“(1) Continuity of care.—The Secretary shall ensure each

covered veteran who is screened for admission to a covered

treatment program is offered, and provided if agreed upon,

care options during the period between screening of the

covered veteran and admission of the covered veteran to such

program to ensure the covered veteran does not experience any

lapse in care.

“(2) Care coordination for substance use disorder.—For a

covered veteran being treated for substance use disorder, the

Secretary shall—

“(A) ensure there is a care plan in place during the

period between any detoxification services or inpatient care

received by the covered veteran and admission of the covered

veteran to a covered treatment program; and

“(B) communicate that care plan to the covered veteran,

the primary care provider of the covered veteran, and the

facility where the covered veteran is or will be residing

under such program.

“(3) Care planning and clinical screening.—

“(A) In general.—A covered treatment program, in

consultation with the covered veteran and the treating

providers of the covered veteran in the covered treatment

program, shall ensure the completion of a care plan and a

clinical screening upon admittance to the covered treatment

program and prior to discharge from the covered treatment

program, which shall include an assessment of, with respect

to the covered veteran—

“(i) overall mental health;

“(ii) risk for suicide;

“(iii) risk for overdose;

“(iv) housing insecurity;

“(v) food insecurity;

“(vi) employment;

“(vii) complex medical needs and diagnoses; and

“(viii) any other factors the Secretary determines

necessary.

“(B) Matters to be included.—The care plan required under

subparagraph (A) for a covered veteran shall include details

on the course of treatment for the covered veteran following

completion of treatment under the covered treatment program,

including recommended length of stay and any necessary

follow-up care and the results of any screening conducted

under such subparagraph.

“(C) Length of stay.—

“(i) In general.—Covered treatment programs at non-

Department facilities shall submit the care plan under

subparagraph (A) for a covered veteran, including the

requested or recommended length of stay for the covered

veteran, to the Department not later than 72 hours after the

veteran is admitted to the covered treatment program.

“(ii) Approval required.—Any length of stay of a covered

veteran at a covered treatment program longer than 30 days or

extensions of length of stay greater than a total of 30 days

shall require approval by the Secretary. The Secretary shall

respond to any such requests for approval within 72 hours.

Any such requests that have not received a response within 72

hours shall be automatically approved on a daily basis until

the Secretary responds.

“(D) Sharing of care plan.—The care plan required under

subparagraph (A) shall be shared with the covered veteran,

the primary care provider of the covered veteran, and any

other providers with which the covered veteran consents to

sharing the plan.

“(E) Discharge from non-department facility.—Upon

discharge of a covered veteran under a covered treatment

program from a non-Department facility, and not later than 30

days after discharge, the facility shall share with the

Department all care records maintained by the facility with

respect to the covered veteran and shall work in consultation

with the Department on the care plan of the covered veteran

required under subparagraph (A).

“(F) Subsequent clinical screening.—Not later than 180

days after the end of treatment of a covered veteran in a

covered treatment program, the covered treatment program or a

Department or non-Department provider shall conduct a

subsequent clinical screening, which shall include an

assessment of the factors specified in clauses (i) through

(viii) of subparagraph (A) and recommendations for follow-up

care as the Secretary considers appropriate.

“(G) Complex medical needs.—Before, during, and after

treatment in a covered treatment program, the Secretary shall

provide greater engagement, coordination, and monitoring of

care for covered veterans with—

“(i) complex medical diagnoses, including diagnoses of

dementia, spinal cord injury or disorder, epilepsy,

Parkinson's, anemia, severe mental illness, multiple

sclerosis, incontinence of the bladder or bowel, mobility

limitations, or impaired vision; or

“(ii) complex medical needs, including chemotherapy or

other oncology care, dialysis, recurring blood transfusions,

or physical or occupational therapy.

“(h) Data Collection.—The Secretary shall consult with

the Office of Research and Development of the Department, or

any successor office, regarding any data the Department

should consider requesting or requiring from non-Department

facilities to assist with research studies and projects in

which the Department is participating relating to mental

health residential rehabilitation treatment programs.

“(i) Reports to Congress.—

“(1) Report on modifications to programs.—

“(A) In general.—Not later than two years after the date

of the enactment of the Take Care of America's Veterans Act,

the Secretary shall submit to the Committee on Veterans'

Affairs of the Senate and the Committee on Veterans' Affairs

of the House of Representatives a report on modifications

made to the guidance, operation, and oversight of covered

treatment programs to fulfill the requirements of this

section.

“(B) Elements.—The report required by subparagraph (A)

shall include—

“(i) an assessment of whether costs of covered treatment

programs, including for residential care provided through

facilities of the Department and non-Department facilities,

serve as a disincentive to placement in such a program;

“(ii) a description of actions taken by the Department to

address the findings and recommendations by the Secretary

contained in the report under section 503(c) of the STRONG

Veterans Act of 2022 (division V of Public Law 117-328; 136

Stat. 5515), including—

“(I) such actions with respect to—

“(aa) any new locations added for covered treatment

programs;

“(bb) any beds added at existing facilities of such

programs; and

“(cc) any additional treatment tracks or sex-specific

programs created or added at facilities of the Department;

and

“(II) a breakdown of the number and percentage of covered

veterans who are determined eligible for priority placement

into a covered treatment program and the number and

percentage of covered veterans who are determined eligible

for routine placement into a covered treatment program; and

“(iii) such recommendations as the Secretary may have for

legislative or administrative action to address any funding

constraints or disincentives for use of a covered treatment

program.

“(2) Annual report on operation of programs.—

“(A) In general.—Not later than one year after the

submission of the report under paragraph (1), and not less

frequently than annually thereafter for the following five

years, the Secretary shall submit to the Committee on

Veterans' Affairs of the Senate and the Committee on

Veterans' Affairs of the House of Representatives a report on

the operation of covered treatment programs.

“(B) Elements.—Subject to subparagraph (C), each report

required by subparagraph (A) shall include the following:

“(i) The number of covered veterans served by a covered

treatment program, disaggregated by—

“(I) Veterans Integrated Service Network in which the

covered veteran receives care;

“(II) facility, including facilities of the Department and

non-Department facilities, at which the covered veteran

receives care;

“(III) type of residential rehabilitation treatment care

received by the covered veteran under such program;

“(IV) sex of the covered veteran; and

“(V) race or ethnicity of the covered veteran.

“(ii) Wait times under a covered treatment program for the

most recent year data is available, disaggregated by—

“(I) treatment track or specificity of residential

rehabilitation treatment care sought by the covered veteran;

“(II) sex of the covered veteran;

“(III) State or territory in which the covered veteran is

located;

“(IV) Veterans Integrated Service Network in which the

covered veteran is located; and

“(V) facility of the Department at which the covered

veteran seeks care.

“(iii) A list of all locations of a covered treatment

program and number of bed spaces at each such location,

disaggregated by residential rehabilitation treatment care or

treatment track provided under such program at such location.

“(iv) A list of any new locations of covered treatment

programs added or removed and any bed spaces added or removed

during the one-year period preceding the date of the report.

“(v) Average cost of a stay under a covered treatment

program, including total stay average and daily average, at

facilities of the Department compared to non-Department

facilities.

“(vi) A review of staffing needs and gaps with respect to

covered treatment programs that is data-driven and aligned

with industry benchmarks and standards, including—

“(I) a list of facilities that had unstaffed beds or

closed beds due to lack of staffing at any point in the

previous year;

“(II) the number of additional staff needed to staff those

beds;

“(III) the number of beds at each facility;

“(IV) the average wait-times for the covered treatment

program, disaggregated by month, during the periods of bed

closures; and

“(V) a list of facilities that required staff of covered

treatment programs to perform duties unrelated to covered

treatment programs for a period of greater than three days.

“(vii) An overview of data collected pursuant to a

subsequent clinical screening under subsection (g)(3)(F).

“(viii) A list of health care systems without a covered

treatment program and an assessment of the feasibility and

advisability of opening a covered treatment program at such

health care system that is aligned and justified by patient

demand and market factors.

“(ix) A list of health care systems that offer a covered

treatment program aligned with patient demand and market

factors and that have an average wait time of more than 20

days and an assessment of the feasibility and advisability of

expanding such covered treatment program to lower such

average wait time.

“(x) Any recommendations for changes to the operation of

covered treatment programs, including any policy changes,

guidance changes, training changes, or other changes.

“(C) Anonymity.—To ensure that the data provided under

this paragraph, or some portion of that data, will not

undermine the anonymity of a veteran, the Secretary shall

provide such data pursuant to applicable Federal law and in a

manner that is wholly consistent with applicable Federal

privacy and confidentiality laws, including—

“(i) section 552a of title 5 (commonly known as the

`Privacy Act of 1974');

“(ii) the Health Insurance Portability and Accountability

Act of 1996 (Public Law 104-191);

“(iii) parts 160 and 164 of title 45, Code of Federal

Regulations, or successor regulations; and

“(iv) sections 5701, 5705, and 7332 of this title.

“(3) Notification to congress of beds not available due to

lack of staffing.—The Secretary shall notify Congress of any

covered treatment programs of the Department with more than

five beds or more than ten percent of beds unavailable,

closed, or reassigned due to lack of staffing, including—

“(A) information on the staff needed to reopen beds that

are closed;

“(B) plans to recruit and retain staff;

“(C) the total number of beds closed or expected to be

closed;

“(D) the estimated length of time until those closed beds

are made available; and

“(E) the current wait time for access to those beds.

“(j) Third-party Assessment.—

“(1) In general.—Not later than two years after the date

of the enactment of the Take Care of America's Veterans Act,

the Secretary shall seek to enter into a contract with an

appropriate entity to conduct a study of the care provided

under covered treatment programs through facilities of the

Department and non-Department facilities.

“(2) Elements.—The study required under paragraph (1)

shall include a review of—

“(A) whether facilities are meeting requirements of the

Department pursuant to law, regulation, or policy;

“(B) staffing models used by facilities and level of

adherence to those models;

“(C) success rates of covered treatment programs in

preventing readmittance to a covered treatment program or

death by suicide or overdose within a year of discharge from

the program;

“(D) adherence of non-Department facilities to timelines

for claim submission and record returns to the Department;

and

“(E) any other factors the Secretary or the appropriate

entity determines relevant or appropriate to include.

“(3) Completion of study.—The contract sought under

paragraph (1) shall include a requirement that the

appropriate entity, not later than four years after the date

of the enactment of the Take Care of America's Veterans Act,

complete the study required under such paragraph and submit

to the Secretary a report on the study.

“(4) Action plan and commentary.—Not later than five

years after the date of the enactment of the Take Care of

America's Veterans Act, the Secretary shall submit to the

Committee on Veterans' Affairs of the Senate and the

Committee on Veterans' Affairs of the House of

Representatives, and publish on a publicly accessible website

of the Department, a report containing—

“(A) the results of the study required under paragraph

(1);

“(B) action plans for improvement based on the results of

the study; and

“(C) general commentary and feedback on the results of the

study.

“(5) Appropriate entity defined.—In this subsection, the

term `appropriate entity' means—

“(A) a nongovernmental entity with experience in assessing

programs that deliver services provided under covered

treatment programs on a large scale; or

“(B) a federally funded research and development center.

“(k) Revision of Guidance.—The Secretary shall update the

guidance of the Department on the operation of covered

treatment programs to reflect each of the requirements under

this section.

“(l) Deadline.—Unless otherwise specified, the Secretary

shall carry out each requirement under this section by not

later than one year after the date of the enactment of the

Take Care of America's Veterans Act.

“(m) Comptroller General Review.—

“(1) In general.—Not later than two years after the date

of the enactment of the Take Care of America's Veterans Act,

the Comptroller General of the United States shall review

access to care under a covered treatment program for covered

veterans in need of residential mental health care and

substance use disorder care.

“(2) Elements.—The review required by paragraph (1) shall

include the following:

“(A) A review of wait times for covered veterans under a

covered treatment program, disaggregated by—

“(i) treatment track or specificity of residential

rehabilitation treatment care needed;

“(ii) sex of the covered veteran;

“(iii) home State of the covered veteran;

“(iv) home Veterans Integrated Service Network of the

covered veteran; and

“(v) wait times for—

“(I) facilities of the Department; and

“(II) non-Department facilities.

“(B) A review of policy and training of the Department on

screening, admission, and placement under a covered treatment

program.

“(C) A review of the rights of covered veterans and

providers to appeal admission decisions under a covered

treatment program and how the Department adjudicates appeals.

“(D) When determining the facility at which a covered

veteran admitted to a covered treatment program will be

placed in such program, a review of how the input of the

covered veteran is taken into consideration with respect to—

“(i) program specialty, subtype, or treatment track

offered to the covered veteran; and

“(ii) the geographic placement of the covered veteran,

including family- or occupation-related preferences or

circumstances.

“(E) A review of staffing and staffing needs and gaps of

covered treatment programs, including with respect to—

“(i) mental health providers and coordinators at the

facility level;

“(ii) staff of facilities of such programs;

“(iii) staff of Veterans Integrated Service Networks; and

“(iv) overall administration of such programs at the

national level.

“(F) A review of outcomes from Department and non-

Department covered treatment programs based at least in part

on the subsequent clinical screenings required under

subsection (g)(3)(F).

“(G) Recommendations for improvement of access by covered

veterans to care under a covered treatment program, including

with respect to—

“(i) any new sites or types of programs needed or in

development;

“(ii) changes in training or policy;

“(iii) changes in communications with covered veterans;

and

“(iv) oversight of covered treatment programs by the

Department.

“Sec. 1794. Fee schedule

“(a) In General.—Not later than 180 days after the date

of the enactment of the Take Care of America's Veterans Act,

the Secretary shall make publicly available on an appropriate

website of the Department a fee schedule for each covered

treatment program provided by a non-Department provider

through which the Secretary furnishes care and services under

section 1710 of this title.

“(b) Elements.—The fee schedule required under subsection

(a) for a covered treatment program shall—

“(1) reflect reasonable charges for the services provided;

“(2) be based on the amounts customarily paid for similar

services under the Medicaid program under title XIX of the

Social Security Act (42 U.S.C. 1396 et seq.) and by

commercial health insurance providers;

“(3) to the greatest extent practicable, be consistent

with payment rates under section 1703(i) of this title;

“(4) be comprehensive to include a variety of possible

types of care, services, and charges; and

“(5) be sufficient to ensure a robust network of qualified

community providers able to provide services under a covered

treatment program to covered veterans.

“(c) Coordination of Payment Rates.—After the date of the

initial publication of the fee schedule under subsection (a),

the rate paid by the Department for residential substance use

disorder treatment shall be the rate provided in the fee

schedule required under such subsection.

“(d) Recoupment of Amounts.—

“(1) In general.—The Secretary shall recoup from a non-

Department entity, including a third party administrator, any

amount paid to such entity that exceeds the amount specified

under the fee schedule under subsection (a) for the care or

services provided.

“(2) Limitation.—A non-Department entity shall not bill a

veteran for any charges recouped under paragraph (1).

“Sec. 1795. Training

“(a) In General.—Not later than one year after the date

of the enactment of the Take Care of America's Veterans Act,

the Secretary shall—

“(1) develop and implement a plan to ensure that health

care providers caring for veterans under covered treatment

programs receive and complete relevant training aligned with

industry standards and practices; and

“(2) submit that plan to the Committee on Veterans'

Affairs of the Senate and the Committee on Veterans' Affairs

of the House of Representatives.

“(b) Elements of Training.—Training required under

subsection (a) shall—

“(1) be easily accessible, no-cost, and offered in such a

manner as to qualify for or fulfill continuing education

requirements for health care professionals;

“(2) include course modules related to military culture,

post-traumatic stress disorder, the evaluation and management

of suicide, traumatic brain injury, and opioid safety, or

comparable course modules, as determined by the Secretary;

and

“(3) be offered through Department and non-Department

entities or organizations.

“(c) Elements of Plan.—The plan required under subsection

(a) shall—

“(1) allow for Department or non-Department providers to

receive credit for non-Department training that is equivalent

or substantially similar to training required under

subsection (a); and

“(2) include details regarding consequences for non-

compliance with training required under such plan, which may

include removal from a network of providers under the

Veterans Community Care Program under section 1703 of this

title for a specified period of time.

“(d) Consultation.—The Secretary shall consult with

relevant professional organizations with respect to the

content of relevant training required under subsection

(a).”.

(b) Clerical Amendment.—The table of sections at the

beginning of such chapter is amended by adding at the end the

following new items:

“subchapter ix—participation by veterans in certain mental health

treatment programs

“1791. Definitions. “1792. Standardized process to determine eligibility of covered

veterans for participation in certain mental health

treatment programs. “1793. Improvements to Department of Veterans Affairs mental health

residential rehabilitation treatment program.
“1794. Fee schedule.
“1795. Training.”.

SEC. 622. ACCESS TO MENTAL HEALTH RESIDENTIAL REHABILITATION

TREATMENT PROGRAMS FOR VETERANS WITH SPINAL

CORD INJURY OR DISORDER.

(a) Plan.—

(1) In general.—Not later than 90 days after the date of

the enactment of this Act, the Secretary of Veterans Affairs

shall submit to the Committee on Veterans' Affairs of the

Senate and the Committee on Veterans' Affairs of the House of

Representatives a plan to ensure access to mental health

residential treatment programs for veterans with a spinal

cord injury or disorder.

(2) Elements.—The plan required under paragraph (1) shall

include—

(A) a staffing plan, which shall include a plan for how the

Department will—

(i) incorporate staff from other facilities to support the

pilot program required under subsection (b); and

(ii) ensure adequate staffing to support the needs of

veterans with a spinal cord injury or disorder;

(B) an assessment of medical equipment needs; and

and health care under mental health residential treatment

programs, including through the use of spinal cord injury or

disorder centers, spinal cord injury or disorder spokes, and

community care providers.

(b) Pilot Program.—

(1) In general.—Commencing not later than 120 days after

the date of the enactment of this Act, the Secretary shall

carry out a pilot program to provide improved access to

mental health residential treatment programs of the

Department of Veterans Affairs for veterans with a spinal

cord injury or disorder at not fewer than three medical

facilities of the Department.

(2) Selection of locations.—In selecting sites for the

pilot program under paragraph (1), the Secretary shall

prioritize sites in the following areas:

(A) Areas with geographic diversity, including areas that

serve veterans residing in rural or highly rural areas.

(B) Areas with a significant number of veterans with spinal

cord injury or disorder.

enactment of this Act, the Secretary shall submit to the

Committee on Veterans' Affairs of the Senate and the

Committee on Veterans' Affairs of the House of

Representatives a report on—

(1) the implementation of the plan required under

subsection (a);

(2) the initial results from the pilot program under

subsection (b), including the number of unique veterans who

participated in the pilot program, the cost of the pilot

program, and an assessment of the effectiveness of the pilot

program in increasing access to, and improving outcomes for,

participants in the pilot program;

(3) plans, if any, to expand or extend the pilot program to

address demand for the highly specialized treatment provided

under the mental health residential treatment programs of the

Department for veterans with a spinal cord injury or

disorder; and

(4) such other matters as the Secretary considers

appropriate.

Subtitle C—Staffing Matters

SEC. 631. TREATMENT OF PSYCHOLOGISTS.

(a) Treatment as Title 38 Employees.—Section 7401 of title

38, United States Code, is amended—

(1) in paragraph (1), by inserting “psychologists,” after

“chiropractors,”; and

(2) in paragraph (3), by striking “psychologists,”.

(b) Inclusion in Contracts for Scarce Medical Specialist

Services.—Section 7409(a) of title 38, United States Code,

is amended by inserting “psychologists,” after

“chiropractors,”.

SEC. 632. MENTORSHIP PROGRAM FOR EXECUTIVE LEADERSHIP TEAMS

AT MEDICAL CENTERS OF THE DEPARTMENT OF

VETERANS AFFAIRS.

(a) In General.—The Secretary of Veterans Affairs may

establish a program to connect covered individuals (in this

section referred to as “mentees”) with peer mentors to

facilitate sharing of best practices and leadership

experiences and to foster opportunities to develop knowledge

and skills required to lead successfully at medical

facilities of the Department (in this section referred to as

the “mentorship program”).

(b) Covered Individual Defined.—In this section, the term

“covered individual” means—

(1) an individual in the position of Facility Director,

Chief of Staff, Associate Director of Patient Care Services,

Associate Director, Assistant Director, or Deputy Director at

a medical center of the Department; or

(2) any other employee of the Department who is determined

by the Secretary to be an executive leader at a medical

center of the Department.

are eligible for participation as mentees in the mentorship

program:

(1) An employee appointed to a position as a covered

individual who has been in that position for less than one

year.

(2) A covered individual employed at a medical center of

the Department (regardless of appointment commencement date)

that meets one or more of the following criteria:

(A) Reports poor performance, as defined by the Secretary,

on the Strategic Analytics for Improvement and Learning Value

Model of the Department, or successor similar model.

(B) Reports data under section 1703C(a)(3) of title 38,

United States Code, as published on the Access to Care

website of the Department, or successor similar website,

that—

(i) does not consistently meet the level reported in the

community surrounding such medical center, as determined by

the Secretary; or

(ii) does not meet a threshold level determined by the

Secretary.

Office of Inspector General of the Department of Veterans

Affairs that is still open more than one year after the

report was published.

(3) A covered individual employed at a medical center of

the Department (regardless of appointment commencement date)

who is recommended by the regional leadership overseeing such

medical center.

(d) Criteria for Peer Mentors.—Each peer mentor to be

paired with a mentee under subsection (a) shall meet each of

the following criteria:

(1) Previous or current employment in the same position

title as the mentee.

(2) Employment in that position for not less than two

years.

(3) Employment at a medical center of the Department that

reports—

(A) above average performance, as defined by the Secretary,

on the Strategic Analytics for Improvement and Learning Value

Model of the Department, or successor similar model; and

(B) data under section 1703C(a)(3) of title 38, United

States Code, as published on the Access to Care website of

the Department, or successor similar website, that exceeds

the level reported in the community surrounding such medical

center, as determined by the Secretary.

(e) Report.—Not later than one year after the date of the

enactment of this Act, and annually thereafter for an

additional three years, the Secretary shall submit to the

Committee on Veterans' Affairs of the Senate and the

Committee on Veterans' Affairs of the House of

Representatives a report on the mentorship program,

including—

(1) the number of mentees and peer mentors participating in

the mentorship program, disaggregated by medical center of

the Department;

(2) the number of mentor-mentee pairings initiated under

each of the eligibility criteria outlined in paragraphs (1),

(2), and (3) of subsection (c), including information on any

circumstances in which multiple criteria under such

paragraphs were met;

(3) a description of the actions taken by the Department to

encourage communication between mentees and peer mentors;

(4) aggregated feedback from participants in the mentorship

program; and

(5) the turnover rate for mentee participants in the

mentorship program.

(f) Termination.—The authority under this section shall

terminate on September 30, 2030.

SEC. 633. REQUIREMENT FOR EQUIVALENT ROLE POSTINGS FOR VACANT

POSITIONS AT DEPARTMENT OF VETERANS AFFAIRS.

(a) In General.—Whenever possible and practicable, if the

Secretary of Veterans Affairs is issuing a posting for vacant

positions at the Department of Veterans Affairs that may be

filled by more than one type of professional or clinician,

the Secretary shall issue postings for all possible

clinicians or professionals who could fill the position.

(b) Application to Certain Positions.—The Secretary shall

consider the requirement under subsection (a) in particular

with respect to hard-to-recruit, hard-to-retain, primary

care, and mental health care positions.

SEC. 634. IMPROVEMENTS TO DEPARTMENT OF VETERANS AFFAIRS

HIRING PROCESSES.

(a) In General.—Subchapter I of chapter 7 of title 38,

United States Code, is amended by inserting after section 701

the following new section:

“Sec. 702. Hiring processes

“(a) Standardized Approval Process for Filling Vacant

Positions.—

“(1) Process required.—

“(A) In general.—The Secretary shall establish a

standardized, nationwide approval process for filling vacant

employment positions within the Department.

“(B) Variability.—The process required by subparagraph

(A) may be different for each type of employment position in

the Department.

“(C) Approval windows.—The process required by

subparagraph (A) shall include a standardized approval window

for each approval step.

“(2) Delegation.—If the approval authority for a step in

the hiring process established under paragraph (1) is vacant,

on leave, or otherwise unable to respond to requests for

approval in an appropriate timeframe, such authority for

approval shall be delegated to the extent practicable to the

supervisor of such approval authority or such other designee

as may be specified in the chain of command.

“(3) Time to fill goal.—Each window of time allotted for

each approval step under paragraph (1)(C) when added together

shall not exceed the time-to-fill goal of the Department for

such employment position.

“(b) Process for Tentative Offers of Employment.—The

Secretary shall develop a standardized process for issuing

tentative offers of employment with the Department and such

process shall require that each such offer includes a

specified rate of basic pay when possible and practicable.

“(c) Third-party Contracts.—The Secretary may conduct

laboratory testing, background clearances, and other

candidate approval and vetting procedures through a contract

with a third party if the Secretary determines that the

contract would ensure equal or better quality or timeliness.

“(d) Electronic Signatures.—

“(1) Authority.—The Secretary shall allow electronic

signatures on any hiring, recruitment, retention, or other

employment documents once a standardized process for such

signatures is developed and implemented under paragraph (2).

“(2) Standardized process.—The Secretary shall develop a

standardized process for use of electronic signatures as

described in paragraph (1), which shall include exceptions

and limitations as the Secretary considers appropriate and

that allows for use of electronic signatures for employment

documents, including SF 1152 and related successor forms, SF

2823 and related successor forms, and SF 3102-FERS and

related successor forms.

“(e) Employee Community Building Program.—The Secretary

shall, to the extent practicable, establish an employee

community building program that connects employees in similar

positions, offices, and programs to connect with each other

nationwide.”.

(b) Clerical Amendment.—The table of sections at the

beginning of chapter 7 of such title is amended by inserting

after the item relating to section 701 the following new

item:

“702. Hiring processes.”.

SEC. 635. DEPARTMENT OF VETERANS AFFAIRS TELEWORK POLICY.

(a) Policy Required.—Not later than 180 days after the

date of the enactment of this Act, the Secretary of Veterans

Affairs shall, in accordance with the requirements of this

section and the requirements of section 6502 of title 5,

United States Code, establish a policy for the use of

telework within the Department of Veterans Affairs.

(b) Locations.—The policy established under subsection (a)

may be different for different locations, specialties, and

categories of employees, as determined appropriate by the

Secretary.

subsection (a), the Secretary shall assess the following for

each category of employees at the Department—

(1) staffing levels and trends over the last 5 years;

(2) exit survey data related to telework;

(3) the availability of dedicated work space at facilities

of the Department to enable onsite work at a duty station;

(4) a comparison of productivity levels when duties are

performed on site or through telework;

(5) telework flexibilities for comparable categories of

employees in the private sector and in other Federal

agencies; and

(6) particular duties that necessitate on site work.

(d) Notice and Reporting.—

(1) In general.—For any change made to the policy

established pursuant to subsection (a), the Secretary shall—

(A) notify all affected employees of the Department of the

changes; and

(B) submit to the Committee on Veterans' Affairs of the

Senate and the Committee on Veterans' Affairs of the House of

Representatives a report on the changes.

(2) Report contents.—For each report submitted to Congress

under paragraph (1)(B), the Secretary shall include the

analyses for each category conducted in subsection (c) and

the role of those analyses in the telework policy for each

category.

(3) Deadline.—A report submitted under paragraph (1)(B)

regarding a change to the policy established under subsection

(a) shall be made not fewer than 90 days before the change

goes into effect.

(e) Report on Budgetary Impact.—Not later than 1 year

after the date on which the policy established pursuant to

subsection (a) goes into effect, the Secretary shall submit

to the Committee on Veterans' Affairs and the Committee on

Appropriations of the Senate and the Committee on Veterans'

Affairs and the Committee on Appropriations of the House of

Representatives a report on the annual budgetary impact of

such policy.

(f) Effective Date and Changes.—

(1) Effective date of initial policy.—The initial policy

established pursuant to subsection (a) shall go into effect

not later than 180 days after the date on which the policy is

established.

(2) Effective date of subsequent changes.—Any change made

to the policy established pursuant to subsection (a) after

the effective date set forth in paragraph (1) shall take

effect not less than 90 days after the date on which the

change is made.

(3) Notice.—For any change made to the policy established

pursuant to subsection (a) after the effective date set forth

in paragraph (1), the Secretary shall—

(A) notify all affected employees of the Department of the

changes; and

(B) submit to the Committee on Veterans' Affairs of the

Senate and the Committee on Veterans' Affairs of the House of

Representatives a report on the changes.

SEC. 636. EXPANSION OF REIMBURSEMENT OF CONTINUING

PROFESSIONAL EDUCATION EXPENSES.

(a) In General.—Section 7411 of title 38, United States

Code, is amended to read as follows:

“Sec. 7411. Reimbursement of continuing professional

education expenses

“(a) Required Reimbursement.—The Secretary shall

reimburse any full-time physician, dentist, podiatrist,

chiropractor, optometrist, psychologist, registered nurse

(including any advanced practice registered nurse), or

physician assistant appointed under section 7401(1) of this

title not more than $1,000 per year for each such individual

for expenses incurred for continuing professional education

directly related to the duties and responsibilities of the

position of the employee or related to the duties and

responsibilities of the position or positions of the

employees overseen by the employee.

“(b) Authorized Reimbursement.—The Secretary may

reimburse any full-time licensed practical or vocational

nurse (including any nurse practitioner), medical

technologist, pharmacist, pharmacy technician, diagnostic

radiologic technologist, or social worker appointed under

section 7401(3) of this title, not more than $1,000 per year

for each such individual for expenses incurred for continuing

professional education directly related to the duties and

responsibilities of the position of the employee or related

to the duties and responsibilities of the position or

positions of the employees overseen by the employee.

“(c) Maximum Number of Individuals Reimbursed.—The total

number of individuals who may be reimbursed under this

section may not exceed 50,000 per year.

“(d) Priority Reimbursements.—In providing reimbursement

under subsection (a), the Secretary shall prioritize

reimbursement for individuals providing direct patient care

or individuals who are decision-makers for direct patient

care.

“(e) Report Required.—

“(1) In general.—Not less frequently than annually after

the end of the first fiscal year following the date of the

enactment of the Take Care of America's Veterans Act, the

Secretary shall submit to the Committee on Veterans' Affairs

of the Senate and the Committee on Veterans' Affairs of the

House of Representatives information on utilization of

reimbursement under this section, including—

“(A) locations at which reimbursement is claimed;

“(B) position title and specialty of the individual

claiming reimbursement;

“(C) average amount claimed per position and specialty;

and

“(D) percent utilization by each position and specialty

overall.

“(2) Authority to include in existing report.—The

information required under paragraph (1) may be submitted

independently or included in another annual report to

Congress.”.

(b) Clerical Amendment.—The table of sections at the

beginning of subchapter I of chapter 74 of title 38, United

States Code, is amended by striking the item relating to

section 7411 and inserting the following new item:

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

SEC. 637. DEPARTMENT OF VETERANS AFFAIRS PERSONNEL

TRANSPARENCY.

(a) In General.—Section 505 of the John S. McCain III,

Daniel K. Akaka, and Samuel R. Johnson VA Maintaining

Internal Systems and Strengthening Integrated Outside

Networks Act of 2018 (Public Law 115-182; 38 U.S.C. 301 note)

is amended—

(1) in subsection (a)—

(A) in paragraph (1)—

(i) in the matter before subparagraph (A), by striking

“information,” and all that follows through “facility:”

and inserting “information:”;

(ii) in subparagraph (B)—

(I) by inserting “(i)” before “The number”; and

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

“(ii) Information made available under this subparagraph

shall be updated not less frequently than once each quarter

to account for delays in data processing and shall reflect

the most recently available data.”;

(iii) in subparagraph (C), by striking “vacancies, by

occupation.” and inserting “positions currently undergoing

a recruitment action, disaggregated by occupation and by

stage of recruitment.”;

(iv) in subparagraph (E)(iii), by striking “potential

hires or”; and

(v) by adding at the end the following new subparagraph:

“(F) The number of positions vacated during the quarter

for which the Department has not initiated a recruitment

action or is not planning to initiate a recruitment

action.”;

(B) by redesignating paragraph (5) as paragraph (6);

paragraph (5):

“(5) Display of information.—The display of information

made publicly available on a website of the Department

pursuant to paragraph (1) shall be disaggregated—

“(A) by departmental component;

“(B) in the case of information relating to Veterans

Health Administration positions, by medical facility; and

“(C) in the case of information relating to Veterans

Benefits Administration positions, by regional office.”; and

(D) in paragraph (6), as redesignated by subparagraph (B),

by striking “shall” and all that follows and inserting the

following: “shall—

“(A) review the administration of the website required

under paragraph (1);

“(B) develop recommendations relating to the improvement

of such administration; and

“(C) submit to the Committee on Veterans' Affairs of the

Senate and the Committee on Veterans' Affairs of the House of

Representatives a report containing—

“(i) the findings of the Inspector General with respect to

the most recent review conducted under subparagraph (A); and

“(ii) the recommendations most recently developed under

subparagraph (B).”; and

(2) by amending subsection (b) to read as follows:

“(b) Annual Report.—Each year, the Secretary shall submit

to Congress an annual report that includes the following:

“(1) A description of the steps the Department is taking

to achieve full staffing capacity.

“(2) A description of the actions the Department is taking

to improve the onboard timeline for facilities of the

Department, including—

“(A) in the case of facilities of the Veterans Health

Administration, for facilities for which the duration of the

onboarding process exceeds the metrics laid out in the Time

to Hire Model of the Veterans Health Administration, or

successor model; and

“(B) in the case of the Veterans Benefits Administration,

for regional offices that exceed the time-to-hire target of

the Office of Personnel Management.

“(3) The amount of additional funds necessary to enable

the Department to reach full staffing capacity.

“(4) Such recommendations for legislative or

administrative action as the Secretary may have in order to

achieve full staffing capacity at the Department.”.

(b) Effective Date.—The amendments made by subsection (a)

shall take effect on the date of the enactment of this Act

and shall apply with respect to the second update under

section 505(a)(3) of such Act beginning after the date of the

enactment of this Act and each update thereafter.

SEC. 638. MODIFICATION OF AUTHORITY OF LICENSURE OF HEALTH

CARE PROFESSIONALS PROVIDING TREATMENT VIA

TELEMEDICINE.

Section 1730C of title 38, United States Code, is amended—

(1) by amending subsection (a) to read as follows:

“(a) In General.—Notwithstanding any provision of law

regarding the licensure of health care professionals or the

prescribing of controlled substances, a covered health care

professional may practice the health care profession of the

health care professional and prescribe controlled substances

at any location in any State or any of the Freely Associated

States (as defined in section 1724(f) of this title),

regardless of where the covered health care professional or

the patient is located, if the covered health care

professional is using telemedicine to provide treatment or

prescribe controlled substances to an individual under this

chapter.”;

(2) in subsection (b), by adding at the end the following

new paragraph:

“(4) A health care professional who is a contractor of the

Department acting in the scope of a contract with the

Department to furnish care in a facility or clinic of the

Department and who has an active, current, full, and

unrestricted license, registration, or certification in a

State to practice the health care profession of the health

care professional, excluding the following:

“(A) A health care professional located outside a facility

or clinic of the Department providing care through the

Veterans Community Care Program under section 1703 of this

title or a similar authority under the laws administered by

the Secretary.

“(B) A health care professional conducting disability

compensation evaluations pursuant to a contract with the

Department.”;

(3) in subsection (d)—

(A) by redesignating paragraph (2) as paragraph (3); and

(B) by inserting after paragraph (1) the following new

paragraph (2):

“(2) State laws that may be inconsistent under paragraph

(1) include—

“(A) the laws of—

“(i) the State of licensure, certification, or

registration of the covered health care professional;

“(ii) the State of practice of the covered health care

professional;

“(iii) the State in which the patient is located; or

“(iv) the State of residence of the patient; and

“(B) such laws specified under subparagraph (A) as

incorporated by the Controlled Substances Act (21 U.S.C. 801

et seq.).”; and

(4) in subsection (e), striking “Nothing” and inserting

“Except as provided in subsections (a) and (d), nothing”.

SEC. 639. PROVISION OF DATA ON EDUCATIONAL ASSISTANCE

PROGRAMS OF VETERANS HEALTH ADMINISTRATION.

(a) In General.—Beginning not later than 180 days after

the date of the enactment of this Act, the Secretary of

Veterans Affairs shall provide to the Committee on Veterans'

Affairs of the Senate and the Committee on Veterans' Affairs

of the House of Representatives data on graduate medical

education programs, health profession scholarship programs,

and any other educational assistance programs within the

Veterans Health Administration.

(b) Elements.—The data required to be provided under

subsection (a) shall include, for each program, the

following:

(1) The number of active participants, broken down by

position or expected future position or licensure.

(2) The amount of funds spent each fiscal year.

(3) The number of participants who have completed their

education and are currently completing their service

requirements at the Department of Veterans Affairs.

(4) The number of participants who were previously active

in the program but left the program before completing their

education or service requirement during the year preceding

the date on which the data is provided.

(5) An overview of outreach by the Department to

prospective participants in the program.

(6) Such other information as the Secretary considers

appropriate.

provided under subsection (a)—

(1) shall be updated not less frequently than annually; and

(2) may be submitted to the Committee on Veterans' Affairs

of the Senate and the Committee on Veterans' Affairs of the

House of Representatives as part of another report required

by law.

(d) Initial Data.—With the first iteration of data

provided under subsection (a), the Secretary shall provide to

the Committee on Veterans' Affairs of the Senate and the

Committee on Veterans' Affairs of the House of

Representatives a report on the implementation of the pilot

program under section 246 of the Military Construction,

Veterans Affairs, and Related Agencies Appropriations Act,

2018 (division J of Public Law 115-141; 38 U.S.C. 7601 note),

including the current status of the pilot program and a

timeline of the status of the pilot program since its initial

implementation.

Subtitle D—Optimization of Workforce

SEC. 641. DEPARTMENT OF VETERANS AFFAIRS STRATEGIC HUMAN

CAPITAL PLAN.

(a) In General.—Subchapter I of chapter 7 of title 38,

United States Code, is amended by adding at the end the

following new section:

“Sec. 729. Strategic human capital plan

“(a) Plan Development.—(1) Not later than September 30,

2027, the Secretary shall develop and submit to the

appropriate committees of Congress a five-year strategic

human capital plan to support the mission and

responsibilities of the Department, disaggregated by the

Veterans Health Administration, the Veterans Benefits

Administration, the National Cemetery Administration, and

such other administrative components of the Department as the

Secretary considers necessary to carry out the mission of the

Department.

“(2) Not later than September 30, 2028, and each September

30 thereafter, the Secretary shall update the plan developed

pursuant to paragraph (1) and extend the plan so that it

covers the next period of five fiscal years commencing

immediately after the date of the update.

“(b) Requirements.—(1) In developing the plan required by

subsection (a), the Secretary shall take into account and

document current and future projected demand for benefits and

services administered by the Department, disaggregated for

each component by facility location, facility type, region,

administration, program office, the type of benefit or

service, and such other categories as the Secretary

determines appropriate.

“(2) The Secretary shall develop and update the plan under

subsection (a) in consultation with veterans service

organizations and such other stakeholders as the Secretary

considers appropriate.

“(c) Contents.—The strategic human capital plan required

by subsection (a) shall incorporate leading practices,

including the following:

“(1) A workforce gap analysis, including an assessment

of—

“(A) the staffing levels of each employee position needed

to deliver high quality, accessible, and timely health care,

benefits, and other services the Secretary considers

appropriate, disaggregated by employee position, facility

location, facility type, region, administration, program

office, the type of benefit or service, and such other

categories as the Secretary determines appropriate;

“(B) how the staffing levels described in subparagraph (A)

align with industry best practices in each employee position

for the anticipated demand for health care, benefits, and

other services described in subsection (b); and

“(C) core competencies, as defined by the Secretary, and

the staffing levels needed in each of these core

competencies, disaggregated by employee position, facility

location, facility type, region, administration, program

office, the type of benefit or service and such other

categories as the Secretary considers appropriate.

“(2) An implementation plan that includes the following:

“(A) Specific recruitment and retention goals to fulfill

the staffing needs identified in the strategic human capital

plan and the strategy of the Department to achieve such

goals.

“(B) Specific strategies—

“(i) to improve workforce productivity using

technological, organizational, behavioral, and such other

approaches as the Secretary determines appropriate and

productivity measures that are specific to employee positions

and the benefits or services they provide; and

“(ii) that are informed by applicable industry best

practices.

“(C) Specific strategies for recruiting and retaining

veterans, spouses of veterans and members of the Armed

Forces, family members of veterans and members of the Armed

Forces, caregivers of veterans, and survivors of members of

the Armed Forces as employees of the Department.

“(D) Specific goals to reduce the time to hire and onboard

employees of the Department and a strategy to achieve such

goals, including draft legislative language for any

legislative action necessary to achieve such goals, without

degradation of—

“(i) necessary background checks; and

“(ii) measures to protect Department customer and employee

safety.

“(d) Annual Updates.—Not later than September 30, 2028,

and on September 30 of each of year thereafter, the Secretary

shall submit to the appropriate committees of Congress an

update on the implementation of the strategic human capital

plan developed pursuant to subsection (a), including an

assessment by the Secretary of—

“(1) the progress of the Department in implementing the

strategic human capital plan;

“(2) the progress of the Department in improving outcomes

for veterans and their spouses, dependents, and caregivers

through the delivery of high quality, accessible, and timely

health care, benefits, and other services the Secretary

considers appropriate using results based performance

measures;

“(3) changes to projected demand for benefits and services

based on new legislative action or other factors,

disaggregated for each component by facility location,

facility type, region, administration, program office and the

type of benefit or service;

“(4) changes to the staffing levels included in the

strategic human capital plan, including justifications for

such changes, disaggregated by employee position, facility

location, facility type, region, administration, program

office, the type of benefit or service and such other

categories as the Secretary determines appropriate;

“(5) any differentiation between the staffing levels

included in the strategic human capital plan and those

included in the budget justification materials most recently

submitted to Congress in support of the budget of the

Department (as submitted with the budget of the President

under section 1105(a) of title 31); and

“(6) any differentiation from the Quadrennial Veterans

Health Administration review required by section 7330C of

this title.

“(e) Comptroller General of the United States Biennial

Reviews.—Not later than 180 days after the date on which the

human capital plan is submitted to the appropriate committees

of Congress pursuant to subsection (a), and not less

frequently than once every 2 years thereafter, the

Comptroller General of the United States shall—

“(1) review the strategic human capital plan developed

pursuant to subsection (a) and updated pursuant to subsection

(d), as the case may be, particularly with respect to the

adequacy of the plan to fulfill the mission and

responsibilities of the Department; and

“(2) submit to Congress the findings of the Comptroller

General with respect to the review conducted pursuant to

paragraph (1).

“(f) Definitions.—In this section:

“(1) The term `appropriate committees of Congress' means—

“(A) the Committee on Veterans' Affairs and the Committee

on Appropriations of the Senate; and

“(B) the Committee on Veterans' Affairs and the Committee

on Appropriations of the House of Representatives.

“(2) The term `veterans service organization' means any

organization recognized by the Secretary under section 5902

of this title.”.

(b) Clerical Amendment.—The table of sections at the

beginning of chapter 7 of such title is amended by inserting

after the item relating to section 728 the following new

item:

“729. Strategic human capital plan.”.

SEC. 642. DEPARTMENT OF VETERANS AFFAIRS REDUCTION IN FORCE

NOTICE REQUIREMENT.

(a) In General.—Subchapter I of chapter 7 of title 38,

United States Code, as amended

by section 641, is further amended by inserting after section

729 the following new section:

“Sec. 729A. Reductions in force

“(a) Notice Required.—In any case in which the Secretary

plans to carry out a reduction in force, the Secretary shall,

not later than the date that is 60 days before the date on

which the Secretary commences carrying out such reduction in

force, submit to the appropriate committees of Congress and

the employees of the Department who will be affected by the

reduction in force notice of the intention of the Secretary

to carry out such reduction in force.

“(b) Limitation.—Notwithstanding any other provision of

law, the Secretary may not carry out any reduction in force

with respect to any employee who has not received the notice

required under subsection (a) in the manner and within the

time required by such subsection.

“(c) Contents.—Notice regarding plans to carry out a

reduction in force submitted pursuant to subsection (a) shall

include the following:

“(1) The total number of employees of the Department who

will be affected by the reduction.

“(2) The offices of the Department that will be affected

by the reduction, including, for each such office, the

following:

“(A) The location of the office.

“(B) The program of the Department carried out by the

office.

“(C) The total number of employees of the office before

and after the reduction in force.

“(D) The services provided by the office.

“(3) A justification for the reduction in force, including

how—

“(A) the new staffing levels resulting from the reduction

in force align with the current and future projected demand

for benefits and services administered by the Department,

disaggregated for each component by facility location,

facility type, region, administration, program office, the

type of benefit or service, and such other categories as the

Secretary determines appropriate; and

“(B) the reduction in force aligns with the strategic

human capital plan required by section 729 of this title.

“(4) Budgetary effects of the reduction in force.

“(5) An assessment of the anticipated impact of the

reduction in force on the delivery of benefits and services

furnished by the Department and the actions the Secretary

plans to take to mitigate any adverse impacts.

“(d) Equal Content.—A notice regarding a reduction in

force sent to an employee pursuant to subsection (a) shall be

the same as the notice submitted under such subsection to

Congress for the same reduction in force.

“(e) Administrative Remedy.—A reduction in force carried

out with respect to an employee in violation of subsection

(b) shall have no force or effect with respect to such

employee until the Secretary complies with subsection (a).

“(f) Definitions.—In this section:

“(1) The term `appropriate committees of Congress' means—

“(A) the Committee on Veterans' Affairs and the Committee

on Appropriations of the Senate; and

“(B) the Committee on Veterans' Affairs and the Committee

on Appropriations of the House of Representatives.

“(2) The term `reduction in force' means any action that

would have required notice under part 351 of title 5, Code of

Federal Regulations, as in effect on January 1, 2026.”.

(b) Clerical Amendment.—The table of sections at the

beginning of chapter 7 of such title is amended by inserting

after the item relating to section 729 the following new

item:

“729A. Reductions in force.”.

SEC. 643. DETAILED PLANS AND JUSTIFICATIONS FOR

REORGANIZATION OF OFFICES.

Section 510 of title 38, United States Code, is amended—

(1) in subsection (f)(2)—

(A) in subparagraph (D), by inserting “in improving

outcomes for veterans and their spouses, dependents, and

caregivers through the delivery of high quality, accessible,

and timely health care, benefits, and other services the

Secretary considers appropriate” before the period at the

end; and

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

“(G) A description of how the Secretary will analyze

success of the reorganization using results based performance

metrics that are derived from the justification for the

reorganization.

“(H) A risk mitigation plan identifying significant

operational, workforce, financial, information technology,

patient care, and service-delivery risks reasonably

anticipated by the Secretary and the actions planned to

mitigate such risks.”;

(2) by redesignating subsections (e) and (f) as subsections

(f) and (g), respectively; and

(3) by inserting after subsection (d) the following new

subsection (e):

“(e) Not later than 180 days after the date on which the

Secretary completes an administrative reorganization for

which the Secretary submitted under subsection (b) a report

containing a detailed plan and justification for the

administrative reorganization, and not less frequently than

once every 180 days thereafter until the date that is two

years after the date of the completion of such administrative

reorganization, the Secretary shall submit to the Committee

on Veterans' Affairs of the Senate and the Committee on

Veterans' Affairs of the House of Representatives a report

assessing the administrative reorganization using the

performance metrics described in the detailed plan and

justification pursuant to subsection (g)(2)(G).”.

SEC. 644. RULE OF CONSTRUCTION.

Nothing in this subtitle or an amendment made by this

subtitle shall be construed to have any effect on any

provision of law in effect before the date of the enactment

of this Act.

Subtitle E—Veterans Infrastructure and Transformation

SEC. 651. SHORT TITLE.

This subtitle may be cited as the “Veterans Infrastructure

and Transformation Act of 2026” or the “VITAL Act of

2026”.

SEC. 652. MODIFICATION OF AUTHORITY FOR SHARING OF HEALTH-

CARE RESOURCES OF DEPARTMENT OF VETERANS

AFFAIRS TO INCLUDE FLEXIBLE SPACE UTILIZATION

AND STREAMLINED SERVICE AGREEMENTS.

Section 8153 of title 38, United States Code, is amended—

(1) in subsection (a)(3)—

(A) in subparagraph (A), by inserting “physical” before

“space”;

(B) in subparagraph (B)(i), by inserting “physical”

before “space”;

(D) by redesignating subparagraphs (C) and (D) as

subparagraphs (D) and (E), respectively;

(E) by inserting after subparagraph (B) the following new

subparagraph (C):

“(C) If the health-care resource required is physical

space or common services with respect to existing buildings

and is to be acquired from an institution affiliated with the

Department in accordance with section 7302 of this title or

another entity, the Secretary may enter into contracts or

agreements for the acquisition of the space or service—

“(i) without regard to any law or regulation (including

any Executive order, circular, or other administrative

policy) that would otherwise require the use of competitive

procedures for acquiring the resource; and

“(ii) if all obligations are funded through available

appropriations or borne by the institution or entity, without

regard to any limitations applicable to leases of the

Department, if, in the case of a multi-year space-sharing

agreement, the agreement—

“(I) requires that payments for each fiscal year be made

only from appropriated funds and available that year; and

“(II) includes a provision that the Government's

obligations for future years is contingent upon availability

of appropriations.”;

(F) in subparagraph (D), as redesignated by subparagraph

(D) of this paragraph, by striking “subparagraph (A) or

(B)” and inserting “subparagraph (A), (B), or (C)”;

(2) by adding at the end the following:

“(h) In this section:

“(1) The term `commercial service' means a service that is

offered and sold competitively in the commercial marketplace,

is performed under standard commercial terms and conditions,

and is procured using firm-fixed price contracts.

“(2) The term `common service' means a commercial service

necessary to maintain or operate existing physical space,

including maintenance, heating, ventilation, air

conditioning, electricity, energy, water, wastewater,

landscaping, security, laundry, or any other service as

determined by the Secretary.

“(3) The term `physical space' means a portion of a

building or parking facilities.”.

SEC. 653. USE OF COMMERCIAL CONSTRUCTION AND FACILITIES CODE

AND STANDARDS.

(a) In General.—The Secretary of Veterans Affairs may use

commercial codes and standards instead of or in addition to

Federal codes and standards in the construction or alteration

of facilities of the Department of Veterans Affairs, where

such commercial codes and standards do not conflict with

statutory and regulatory requirements.

(b) Pilot Projects.—The Secretary shall carry out not

fewer than three pilot projects during each of fiscal years

2027, 2028, 2029, 2030, and 2031 utilizing commercial codes

and standards instead of Federal codes and standards to lease

or construct facilities of the Department for major

construction, minor construction, or major lease projects.

on Veterans' Affairs of the Senate and the Committee on

Veterans' Affairs of the House of Representatives not later

than 90 days after the end of each of fiscal years 2027,

2028, 2029, 2030, and 2031, a report detailing the use by the

Secretary of the authority provided by subsection (a) and

conduct of each pilot project required by subsection (b) that

was initiated, ongoing, or completed during the fiscal year.

(d) Definitions.—In this section:

(1) Commercial codes and standards.—The term “commercial

codes and standards” means building codes or standards of

the following:

(A) The National Fire Protection Association.

(B) The International Code Council.

(D) The American Society of Civil Engineers.

(E) Any other building code or standard, other than those

described in paragraph (2), determined by the Secretary.

(2) Federal codes and standards.—The term “Federal codes

and standards” means the following:

(A) Building codes or standards specific to one or more

Federal agencies.

(B) Building codes or standards specific to the Department,

including the Technical Information Library.

SEC. 654. FEASIBILITY STUDY FOR FULL-SERVICE HOSPITAL OF

DEPARTMENT OF VETERANS AFFAIRS IN CERTAIN

STATES.

(a) In General.—The Secretary of Veterans Affairs shall

conduct a study on the feasibility of establishing a full-

service hospital of the Department of Veterans Affairs in

Alaska and Hawaii.

(b) Publication.—Not later than one year after the date of

the enactment of this title, the Secretary shall publish on a

publicly available website of the Department the findings of

the Secretary with respect to the study conducted under

subsection (a).

SEC. 655. REPORT ON STRATEGIC PLAN FOR INFRASTRUCTURE AND

CAPITAL ASSETS OF DEPARTMENT OF VETERANS

AFFAIRS.

(a) Report.—Not later than one year after the date of the

enactment of this Act, the Secretary of Veterans Affairs

shall submit to the Committee on Veterans' Affairs of the

Senate and the Committee on Veterans' Affairs of the House of

Representatives a report on the strategic plan for

infrastructure and capital assets of the Department of

Veterans Affairs, which summarizes a facility lifecycle

strategy targeting modernization of owned and leased

facilities and infrastructure required to mitigate increasing

systemic failures, veteran and staff safety, benefits

delivery interruptions, and funding associated to address

emergency repairs.

(b) Elements.—The report required by subsection (a) shall

cover known and projected requirements over a period of not

less than 10 years for the following:

(1) Land acquisition.

(2) Operations and maintenance of facilities of the

existing capital asset portfolio of the Department.

(3) Operations and maintenance of the planned future

capital asset portfolio of the Department.

(4) New construction, disaggregated by type of new

construction, including the following types of construction:

(A) Major construction.

(B) Minor construction.

(5) Leasing.

(6) Alternative acquisition methods, such as partnerships

and donations.

(7) Activation of space.

(8) Disposal, reuse, and remediation.

(9) Facility lifecycle strategy process supporting the

planning, programming delivery, management, and maintenance

of the current and future capital asset portfolio of the

Department.

(10) A discussion of the negative effect of the lack of

stable and predictable capital asset funding on the ability

of the Department to plan, staff, and execute effective

capital asset management.

(11) Overview of the strategy being utilized in the

approach of the Secretary to capital investment, across all

the capital and leasing programs, including the approach of

repair versus recapitalization, use of leasing, and other

relevant strategies as deemed appropriate by the Secretary.

(12) Such other matters as the Secretary considers

appropriate, including with respect to legislative or

administrative action, if such actions are subject to the

availability of appropriated funds.

report submitted under this section shall be construed to

create or imply any financial or operational obligation

beyond the availability of appropriated funds.

SEC. 656. PILOT PROGRAM ON ACCEPTANCE BY THE DEPARTMENT OF

VETERANS AFFAIRS OF DONATED FACILITIES AND

RELATED IMPROVEMENTS: EXTENSION; MODIFICATION.

(a) Extension.—Section 2 of the Communities Helping Invest

through Property and Improvements Needed for Veterans Act of

2016 (Public Law 114-294; 38 U.S.C. 8103 note) is amended, in

subsection (i), by striking “December 16, 2026” and

inserting “the day that is five years after the date of the

enactment of the Take Care of America's Veterans Act”.

(b) Modification of Acceptance of Property.—Paragraph (1)

of subsection (b) of such section is amended to read as

follows:

“(1) the donation aligns with—

“(A) a need identified in a Strategic Capital Investment

Planning process priority list, a five-year development plan,

a facility master plan, or an annual capital needs inventory

of the Department; or

“(B) any component or phase of a need described in

paragraph (1); and”.

SEC. 657. AUTHORITY TO ACCEPT DONATIONS OF CONSTRUCTION

SERVICES, MINOR CONSTRUCTION OR NONRECURRING

MAINTENANCE PROJECTS, AND TARGETED

CONTRIBUTIONS.

(a) Authority.—Notwithstanding any other provision of law,

the Secretary of Veterans Affairs may accept donations

comprising the total cost or a portion of the cost of—

(1) minor construction projects;

(2) nonrecurring maintenance projects; or

(3) construction services relating—

(A) to minor construction projects;

(B) to nonrecurring maintenance projects;

(D) to a new facility or portion thereof of the Department.

(b) Alignment to Needs.—The Secretary may accept a

donation under this section only if—

(1) the donation aligns with—

(A) a need identified in a Strategic Capital Investment

Planning process priority list, a five-year development plan,

a facility master plan, or an annual capital needs inventory

of the Department; or

(B) any component or phase of a need described in

subparagraph (A);

(2) the donation is from an entity described in section

2(a)(2) of the Communities Helping Invest through Property

and Improvements Needed for Veterans Act of 2016 (Public Law

114-294; 38 U.S.C. 8103 note);

(3) the Secretary determines such donation would—

(A) accelerate project completion;

(B) reduce the expense to the Department;

(D) otherwise benefit veterans;

(4) the donor enters into a formal agreement with the

Secretary that includes—

(A) provisions for the Department's oversight during

performance;

(B) compliance with applicable construction codes and

standards, and applicable laws and regulations;

protections;

(D) the amount of the donation and the amount of the

Department's funding contribution, if any;

(E) that the donation shall not increase the cost to the

Federal Government of completing such project described in

subsection (a) (excluding activation and sustainment of such

facility); and

(F) such other terms as the Secretary determines necessary.

section that do not involve transfer of real property title—

(1) the donor shall enter into an agreement with the

Department that determines who is responsible to ensure

environmental or historic preservation due diligence is

completed;

(2) the donor shall obtain all federally required

construction and facility related permits; and

(3) agreements may be simplified relative to those under

section 2 of the Communities Helping Invest through Property

and Improvements Needed for Veterans Act of 2016 (Public Law

114-294; 38 U.S.C. 8103 note) to reflect the nature of

services or targeted contributions.

(d) Reporting.—The Secretary shall include information on

donations accepted under this section in the reports required

under section 2(g) of the Communities Helping Invest through

Property and Improvements Needed for Veterans Act of 2016

(Public Law 114-294; 38 U.S.C. 8103 note), with separate

tracking for donations under this section.

SEC. 658. REPORT ON USE OF ADDITIONAL AUTHORITIES RELATING TO

RECRUITMENT AND RETENTION OF PERSONNEL.

(a) Report Required.—Not later than 90 days after the date

of the enactment of this Act, the Secretary of Veterans

Affairs shall submit to the appropriate committees of

Congress a report detailing how the Secretary will use the

authorities of section 706 of title 38, United States Code,

to increase the size and performance of the acquisition

workforce of the Department of Veterans Affairs.

(b) Definitions.—In this section:

(1) Acquisition workforce of the department.—The term

“acquisition workforce of the Department of Veterans

Affairs” means personnel of the Department of Veterans

Affairs occupying positions within occupational series, as

defined by the Director of the Office of Personnel

Management, responsible for acquisition functions, as

determined by the Secretary.

(2) Appropriate committees of congress.—The term

“appropriate committees of Congress” means the Committee on

Veterans' Affairs of the Senate and the Committee on

Veterans' Affairs of the House of Representatives.

SEC. 659. REPORTS ON KEY CAPITAL ASSET INVESTMENTS,

ACTIVITIES, AND PERFORMANCE OF DEPARTMENT OF

VETERANS AFFAIRS.

(a) In General.—Section 8120 of title 38, United States

Code, is amended to read as follows:

“Sec. 8120. Reports on key capital asset investments,

activities, and performance

“(a) Capital Asset Investment, Activities, and

Performance.—

“(1) In general.—Not later than 30 days after the end of

each fiscal year, and every 60 days thereafter until the end

of the subsequent fiscal year, the Secretary shall submit to

the appropriate committees of Congress a report on key

capital asset investments, activities, and performance of the

Department.

“(2) Elements.—

“(A) First report in each fiscal year.—The first report

under paragraph (1) in each fiscal year shall include the

following:

“(i) A brief summary of work that was completed on each

capital asset project that was completed in the previous

fiscal year.

“(ii) A brief summary of the accomplishments, impediments,

and challenges experienced by the Department with respect to

capital asset projects in the previous fiscal year and a

description of efforts made to address any such impediments

and challenges.

“(iii) With respect to each capital asset project

completed in such year, the following:

“(I) The type of project (major construction, minor

construction, nonrecurring maintenance, leases, or other

category, including disposals).

“(II) The estimated total cost and the actual total cost

of the project.

“(III) A description of the project.

“(IV) The location and facility with respect to which the

project was carried out.

“(V) The fiscal quarter the project was expected to begin,

the fiscal quarter the project began, the month and year the

project was completed, and the fiscal quarter the facility in

connection to such project was in use by veterans, employees

of the Department, or other relevant users, as the case may

be.

“(iv) In the case of any capital asset project completed

during the previous fiscal year with respect to which the

final cost of the project (or any increment of the project)

was more than 10 percent greater than the estimated cost of

the project (or increment) or the completion of such project

(or increment) was more than 180 days later than the planned

schedule for such project (or increment)—

“(I) the reason for any such overage or delay; and

“(II) actions being taken to prevent any such overage or

delay in future projects.

“(v) A list of any capital asset projects cancelled during

the previous fiscal year, including any projects in the

design phase and including the reason for the cancellation.

“(vi) A summary of total actual obligations for capital

asset projects for the previous fiscal year, broken out by

major construction, minor construction, nonrecurring

maintenance, and leases from the medical facilities

appropriation account of the Department.

“(vii) A projected list of capital asset projects, broken

out by type of project under subclause (I), that are expected

to be initiated during the current fiscal year and those that

are expected to be completed during the current fiscal year,

which shall include the following:

“(I) The type of project (major construction, minor

construction, nonrecurring maintenance, leases, or other

category, including disposals).

“(II) The estimated total cost of the project.

“(III) A description of the project.

“(IV) The location and facility with respect to which the

project was carried out or is expected to be carried out.

“(V) The fiscal quarter the project is expected to begin,

the fiscal quarter the project is expected to be completed,

and the fiscal quarter the facility in connection to such

project is expected to be in use by veterans, employees of

the Department, or other relevant users, as the case may be.

“(viii) Projected total obligations for capital asset

projects for the current fiscal year, broken out by major

construction, minor construction, nonrecurring maintenance,

and leases, from the medical facilities appropriation account

of the Department.

“(ix) Such observations of best practices, impediments,

and accomplishments related to the capital asset management

and performance of the Department, including any legislative

or administrative action, as the Secretary considers

appropriate with respect to such practices, impediments, and

accomplishments.

“(x) Meaningful metrics that show the progress of the

Department toward meeting relevant goals of the Department

relating to capital asset management.

“(xi) Such other matters as the Secretary considers

appropriate.

“(B) Subsequent reports.—Each report in a fiscal year

after the first report shall include, at a minimum, relevant

updates on any capital asset projects that are ongoing during

that fiscal year, including any updates to information

provided with respect to such projects under subparagraph

(A).

“(3) Matters relating to reporting costs.—In each report

under paragraph (1), when reporting on costs for capital

asset projects, the Secretary may include information

regarding Federal requirements, including those specific to

the Department, that may not exist in the non-Federal

construction sector that may increase costs for capital asset

projects.

“(b) Super Construction Projects.—

“(1) In general.—Not later than 30 days after the end of

each fiscal year, and every 60 days thereafter until the end

of that fiscal year, the Secretary shall submit to the

appropriate committees of Congress a report on the super

construction projects carried out by the appropriate non-

Department Federal entity described in section 8103(e)(1) of

this title during such year.

“(2) Elements.—Each report required under paragraph (1)

shall include, for each project described in such paragraph—

“(A) the budgetary and scheduling status of the project,

as of the last day of the most recent fiscal quarter ending

before the date on which the report is required to be

submitted; and

“(B) the actual cost and schedule variances of the

project, as of such day, compared to the planned cost and

schedules for the project.

“(c) Definitions.—In this section:

“(1) Appropriate committees of congress.—The term

`appropriate committees of Congress' means—

“(A) the Committee on Appropriations and the Committee on

Veterans' Affairs of the Senate; and

“(B) the Committee on Appropriations and the Committee on

Veterans' Affairs of the House of Representatives.

“(2) Capital asset project.—The term `capital asset

project' means a capital asset investment or activity of the

Department.

“(3) Super construction project.—The term `super

construction project' has the meaning given such term in

section 8103(e)(3) of this title.”.

(b) Clerical Amendment.—The table of sections at the

beginning of chapter 81 of title 38, United States Code, is

amended by striking the item relating to section 8120 and

inserting the following new item:

“8120. Reports on key capital asset investments, activities, and

performance.”.

SEC. 660. DEVELOPMENT OF STREAMLINED PROCUREMENT MODEL;

REPORT.

Not later than 180 days after the date of enactment of this

Act, the Secretary of Veterans Affairs, in consultation with

the Comptroller General of the United States, the Director of

the Office of Management and Budget, and private sector

stakeholders, shall develop a revised process for the

procurement of major medical facility leases under chapter 81

of title 38, United States Code, and submit to the Committees

on Veterans' Affairs of the House of Representatives and the

Senate a report that includes a description of such revised

process.

SEC. 661. SUBMISSION AND NOTIFICATION OF COST ESTIMATES FOR

MEDICAL FACILITY LEASES.

(a) Submission of Cost Estimates for Major Medical Facility

Leases With Presidential Budget Request.—Subchapter I of

chapter 81 of title 38, United States Code, is amended by

inserting after section 8104 the following new section:

“Sec. 8104A. Submission of cost estimates for major medical

facility leases with president's budget request

“(a) In General.—For each major medical facility lease or

prospectus-level lease for which the Secretary seeks

authorization, appropriations, or prospectus approval, the

Secretary shall include in the budget justification materials

submitted to Congress in connection with the budget of the

Department for the applicable fiscal year (as submitted with

the budget of the President under section 1105(a) of title

31) a market-based cost estimate and full life-cycle cost

estimate for such lease.

“(b) Market-based Cost Estimate.—Each market-based cost

estimate required under subsection (a) shall include an

evaluation of—

“(1) local land values;

“(2) applicable construction costs; and

“(3) other cost factors the Secretary determines relevant

to build-to-suit facilities.

“(c) Standardized Methodology.—

“(1) In general.—The Secretary shall adopt and apply a

standardized methodology for estimating under subsection (a)

the full life-cycle cost of major medical facility leases and

prospectus-level leases.

“(2) Required elements.—The methodology required under

paragraph (1) shall include, at a minimum—

“(A) base rent projections over the full lease term;

“(B) tenant improvement and buildout costs based on

current medical facility standards;

“(C) estimated operating expenses, including utilities,

maintenance, and security;

“(D) annual escalation factors tied to construction cost

indices, labor rates, and market trends;

“(E) cost assumptions for option periods or potential

renewal terms; and

“(F) geographic adjustments using current regional market

data to reflect location-specific construction and leasing

conditions.

“(d) Annual Adjustment.—

“(1) In general.—To reflect inflation and market

escalation, the Secretary shall annually adjust each cost

estimate for a lease submitted to Congress for authorization,

appropriations, or prospectus approval during the period

beginning on the date on which the Secretary first includes

such cost estimate in the budget justification materials

described in subsection (a) and ending on the projected award

date for the lease.

“(2) Indices.—In adjusting a cost estimate under

paragraph (1), the Secretary shall use such medical

construction or real estate indices as the Secretary

determines appropriate.

“(e) Rules of Construction.—

“(1) Budgetary treatment.—Nothing in this section shall

be construed to alter, supersede, waive, or otherwise affect

the application of the scorekeeping guidelines, including the

budgetary treatment of leases under Office of Management and

Budget Circular A-11 or any successor guidance.

“(2) Preservation of existing budget authority

requirements.—Nothing in this section shall be construed to

authorize the Secretary to enter into a lease, incur an

obligation, or make an expenditure except to the extent and

in the amount provided in advance in appropriations Acts.

“(f) Definitions.—In this section, the term `major

medical facility lease' has the meaning given that term in

section 8104(a)(3)(B) of this title.”.

(b) Congressional Notification and Plan Required for Cost

Estimates Exceeding Approved Prospectus Amounts.—Subchapter

I of such chapter is further amended

by inserting after section 8104A the following new section:

“Sec. 8104B. Congressional notification and plan required

for cost estimates exceeding approved prospectus amounts

“(a) Price Estimates Required During Solicitation Phase.—

As part of the request for lease proposals (or equivalent

formal solicitation) for a major medical facility lease, the

Secretary shall require offerors to provide detailed price

proposals, including the cost of land (if applicable), to

enable evaluation against the authorized prospectus amount.

“(b) Notification Required.—If the lowest responsive

offer for a major medical facility lease exceeds the

unserviced shell rent authorized in the approved prospectus

by more than 10 percent, the Secretary shall notify the

Committee on Veterans' Affairs of the Senate and the

Committee on Veterans' Affairs of the House of

Representatives not later than 45 days after the date on

which the Secretary determines that such offer exceeds such

authorized amount.

“(c) Plan Required.—

“(1) In general.—Not later than 60 days after

notification under subsection (b) with respect to a major

medical facility lease, the Secretary shall submit to the

Committee on Veterans' Affairs of the Senate and the

Committee on Veterans' Affairs of the House of

Representatives a plan to address the cost discrepancy for

such lease, which may include scope adjustment, value

engineering, requesting additional authority, or other

appropriate measures.

“(2) Limitation on award.—The Secretary shall not award a

major medical facility lease until the Committee on Veterans'

Affairs of the Senate and the Committee on Veterans' Affairs

of the House of Representatives have received the plan

required under paragraph (1) with respect to such lease.

“(d) Limitation on Further Action.—If the Secretary is

required to submit a notification under subsection (b), the

Secretary may not issue a request for lease proposals for the

applicable major medical facility lease until the date on

which the Secretary submits the plan required under

subsection (c).

“(e) Rule of Construction.—Nothing in this section shall

be construed to authorize the Secretary to exceed any amount

authorized in an approved prospectus or any amount provided

in advance in an appropriations Act.”.

beginning of such chapter is amended by inserting after the

item relating to section 8104 the following new items:

“8104A. Submission of cost estimates for major medical facility leases

with President's budget request

“8104B. Congressional notification and plan required for cost

estimates exceeding approved prospectus amounts”.

SEC. 662. REPORT ON CAPITAL ASSET AND INFORMATION TECHNOLOGY

NEEDS OF THE RESEARCH AND DEVELOPMENT PROGRAM

OF DEPARTMENT OF VETERANS AFFAIRS.

(a) Report Required.—Not later than two years after the

date of the enactment of this Act, the Secretary of Veterans

Affairs shall submit to Congress a report on the capital

asset and information technology needs of the research and

development program of the Department of Veterans Affairs.

(b) Contents.—

(1) In general.—The report required by subsection (a)

shall include the following:

(A) A comprehensive summary of new facilities, renovations

of existing facilities, leasing of facilities, and any other

such facilities or physical infrastructure the Department

requires to effectively perform its research and development

functions, including projected functions.

(B) Detailed information on the information technology

resources, projects, equipment, and related information

technology needs, disaggregated by type of information

technology funding categories, such as development or

operations and maintenance, the Department requires in order

to make the research and development program and activities

of the Department functional and high-performing in the

short-, medium-, and long-term, and those needed to enable

employees of the Department to perform their research and

development activities in an effective and efficient manner.

maintain and further improve and advance the research and

development functions of the Department through improved

capital asset and information technology support.

(2) Requirements.—

(A) Facilities.—

(i) Summaries by project.—In providing information under

paragraph (1)(A), the Secretary shall provide estimated

summaries for each project with cost data as well as a

realistic multi-year plan to design and deliver the capital

asset projects, assuming required funding is provided.

(ii) Identification of projects.—The Secretary shall

identify each project under paragraph (1)(A) by its project

type, such as major construction, minor construction,

nonrecurring maintenance, major lease, minor lease, or such

other category as the Secretary determines may be

appropriate.

(B) Information technology.—In providing information under

paragraph (1)(B), the Secretary shall provide estimated

summaries for each project or investment with individual and

total cost data as well as a realistic multi-year plan to

develop relevant requirements and acquire and deploy the

relevant information technology services, projects,

equipment, and related matters.

subsection (a) is on the capital asset, information

technology, and other related critical support functions,

excluding human capital related needs, needed for the

Department to perform research and development in an

effective and efficient manner.

subsection (a), the Secretary may consider the following:

(1) The findings of the 2012 final report of the Research

Infrastructure Program of the Department.

(2) Current and updated data providing the most accurate

and holistic presentation of the physical infrastructure,

information technology, and other relevant support function

needs of the research and development program of the

Department.

(3) Such other matters as the Secretary considers

appropriate.

SEC. 663. IMPROVING PREVENTION, DETECTION, AND REPORTING OF

WASTE, FRAUD, AND ABUSE IN DEPARTMENT OF

VETERANS AFFAIRS CAPITAL ASSET PROJECTS AND

ACTIVITIES.

(a) Report Required.—Not later than one year after the

date of the enactment of this Act, the Secretary of Veterans

Affairs shall submit to the appropriate committees of

Congress a report on actions the Department of Veterans

Affairs is taking or plans to take to enhance the ability of

the Department to prevent, detect, and report waste, fraud,

and abuse occurring in capital asset projects of the

Department, whether by employees, contractors, or other

relevant persons or entities involved with the Department.

(b) Elements.—The report required by subsection (a) shall

include the following:

(1) An assessment of whether new training or enhancements

to existing training should be undertaken to improve the

prevention, detection, and reporting of waste, fraud, and

abuse.

(2) Recommendations for such legislative and administrative

action as the Secretary determines appropriate to improve the

prevention, detection, and reporting of waste, fraud, and

abuse.

(3) Such other matters as the Secretary considers

appropriate.

Secretary—

(1) shall consult with the Inspector General of the

Department of Veterans Affairs and the Comptroller General of

the United States on matters relating to best practices and

strategies to improve detection and prevention by the

Department of waste, fraud, and abuse in capital asset

projects and management; and

(2) may consult with such other persons and entities on

such matters as the Secretary considers appropriate.

SEC. 664. REPORT ON LONG-TERM CARE PHYSICAL INFRASTRUCTURE

NEEDS OF DEPARTMENT OF VETERANS AFFAIRS.

(a) In General.—Not later than one year after the date of

the enactment of this Act, the Secretary of Veterans Affairs

shall submit to the appropriate committees of Congress a

report, disaggregated by medical center or other relevant

health care facility of the Department of Veterans Affairs,

identifying the physical infrastructure needs of the

Department to support current and future anticipated long-

term care needs and models of care for veterans, including—

(1) infrastructure needed to support the delivery of long-

term care for women veterans, veterans with spinal cord

injuries and diseases, veterans with traumatic brain injury,

veterans with unique behavioral health needs, veterans with

memory loss, and other population groups with unique needs or

projected future needs;

(2) information regarding the plans of the Department to

provide such care as the Department builds internal capacity

but space is not yet available to meet the demand for such

care; and

(3) with respect to any projects needed to provide the

infrastructure specified under paragraph (1)—

(A) the estimated individual project cost and total cost to

accomplish those projects; and

(B) the estimated individual project timeline to accomplish

each such project upon receipt of appropriate funding.

(b) Inclusion of Information Regarding Prioritization of

Certain Projects.—The Secretary shall include in the report

required under subsection (a) information regarding how the

infrastructure prioritization processes of the Department,

such as the Strategic Capital Investment Planning process, or

successor process, could be modified to include higher

prioritization of projects that support the provision of a

health care service that is not widely available, or is not

available in compliance with appropriate quality or access

standards, from non-Department providers.

required under subsection (a), the Secretary shall consult

with relevant regional and national program offices of the

Veterans Health Administration with responsibility for

managing the various health care services covered by the

report, including long-term care and care relating to spinal

cord injuries and diseases, to ensure that the report

contains a holistic, comprehensive, and integrated plan to

address the capital asset and other space needs for the

population of veterans who require those services.

(d) Indication of Types of Projects.—In the report

required under subsection (a), the Secretary shall indicate

the projects that can be most efficiently and effectively

accomplished through smaller individual infrastructure

projects or through a larger medical facility replacement or

new site of care, as determined by the Secretary.

Subtitle F—Other Health Care Matters

SEC. 671. PRESCRIPTION, DELIVERY, DISTRIBUTION, AND

DISPENSATION OF CONTROLLED SUBSTANCE

MEDICATIONS BY COVERED HEALTH CARE

PROFESSIONALS OF DEPARTMENT OF VETERANS AFFAIRS

VIA TELEMEDICINE.

(a) In General.—Subchapter III of chapter 17 of title 38,

United States Code, is amended by adding at the end the

following new section:

“Sec. 1730D. Prescription, delivery, distribution, and

dispensation of controlled substance medications via

telemedicine

“(a) In General.—Notwithstanding sections 102(54) and

309(e) of the Controlled Substances Act (21 U.S.C. 802(54)

and 829(e)), a covered health care professional may

prescribe, deliver, distribute, and dispense a controlled

substance if the covered health care professional is using

telemedicine through the use of an interactive

telecommunications system, including an audio-only

telecommunications system when necessary, to prescribe,

deliver, distribute, or dispense to a patient eligible to

receive hospital care or medical services under this chapter

a controlled substance that is a prescription drug as

determined under the Federal Food, Drug, and Cosmetic Act (21

U.S.C. 301 et seq.), regardless of whether such covered

health care professional has conducted an in-person medical

examination of such patient, if—

“(1) such covered health care professional—

“(A) is acting in the usual course of professional

practice;

“(B) is registered pursuant to section 303(g) of the

Controlled Substances Act (21 U.S.C. 823(g)) in any State or

is utilizing the registration of a facility of the Department

registered pursuant to section 303(f) of such Act (21 U.S.C.

823(f));

“(C) has access to medical documentation from an in-person

medical evaluation of such patient in the past two years by—

“(i) a covered health care professional;

“(ii) a health care professional who furnished care and

services under the Veterans Community Care Program under

section 1703 of this title; or

“(iii) a health care professional of the Department of

Defense; and

“(D) at the time of the telemedicine visit of the

patient—

“(i) has reviewed the prescription data of the individual

from the electronic health record database of the Department

and data from the prescription drug monitoring program for

the State in which the patient is located at the time of the

telemedicine encounter (if such a program exists) for at

least the one-year period preceding the date of the visit or,

if less than one year of data is available, for the entire

period available; and

“(ii) provides documentation of—

“(I) such review;

“(II) all successful attempts to access such databases and

program; and

“(III) all unsuccessful attempts to access such databases

and program that resulted in the prescription of a limited

supply under subsection (b); and

“(2) such substance is delivered, distributed, or

dispensed for a legitimate medical purpose.

“(b) Authority for Limited Supply.—

“(1) In general.—If the databases and program described

in subsection (a)(1)(D) are unavailable or inaccessible at

the time of a telemedicine encounter conducted by a covered

health care professional, the covered health care

professional may not prescribe, deliver, distribute, or

dispense more than a seven-day supply of a controlled

substance until the covered health care professional is able

to review such databases and program.

“(2) Databases unavailable or inaccessible.—If a database

or program required to be reviewed under subsection (a)(1)(D)

is unavailable or inaccessible for an extended period, as

determined by the Secretary, a covered health care

professional may provide additional seven-day supplies of a

controlled substance until such database or program is

accessible.

“(c) Maximum Supply.—The authority under this section may

be used to supply a controlled substance for not more than a

six-month period.

“(d) Use of Authority.—The Secretary shall ensure that

the authority under this section is used to prevent

interruptions to patient care and not as a replacement for

routine in-person patient care.

“(e) Regulations.—

“(1) In general.—The Secretary shall establish in

regulations guidelines and a process for the prescription,

delivery, distribution, and dispensation of a controlled

substance pursuant to subsection (a).

“(2) Elements.—The Secretary shall ensure the guidelines

and process described in paragraph (1)—

“(A) do not restrict access of a patient to in-person

care; and

“(B) provide for the collection and analysis of data to

determine if an individual has evidence of a prior in-person

medical evaluation by a health care professional described in

subsection (a)(1)(C) who would reasonably be expected to have

prescribing authority based on their credential or

organizational role.

“(3) Initiating treatment.—

“(A) In general.—The guidelines established by paragraph

(1) shall prohibit a covered health care professional from

initiating treatment with an opioid medication listed in

schedule II or III under section 202 of the Controlled

Substances Act (21 U.S.C. 812) unless the covered health care

professional is providing treatment—

“(i) for opioid use disorder;

“(ii) for a patient receiving palliative care or enrolled

in hospice care; or

“(iii) for a patient who is physically located in a

medical facility where the patient is receiving in-person

care.

“(B) Exception.—The prohibition under subparagraph (A)

shall not apply to renewal or maintenance of a previously

prescribed medication described in such subparagraph.

“(f) Reporting.—

“(1) In general.—Not later than one year after the date

of the enactment of the Take Care of America's Veterans Act,

and not less frequently than annually thereafter until the

termination date under subsection (g), the Secretary shall

submit to the Committee on Veterans' Affairs of the Senate

and the Committee on Veterans' Affairs of the House of

Representatives a report that addresses the use of the

authority under this section during the fiscal year preceding

the date of submission of the report in each Veterans

Integrated Service Network.

“(2) Elements.—Each report under paragraph (1) shall

indicate, at a minimum—

“(A) how many patients received prescriptions for

controlled substance medications through telemedicine under

this section;

“(B) which controlled substances are being prescribed

under this section and how many prescriptions were written

for each such substance;

“(C) the number of individuals who received a controlled

substance medication that was prescribed, delivered,

distributed, or dispensed under this section without evidence

of an in-person medical evaluation within the previous two

years by a health care professional described in subsection

(a)(1)(C); and

“(D) the barriers that exist to reviewing prescription

drug monitoring programs of States and how often those

barriers occur.

“(g) Duration.—The authority under this section shall

terminate on September 30, 2031.

“(h) Definitions.— In this section:

“(1) The terms `controlled substance', `deliver',

`dispense', and `distribute' have the meanings given those

terms in section 102 of the Controlled Substances Act (21

U.S.C. 802).

“(2) The term `covered health care professional' means—

“(A) a health care professional who—

“(i) is—

“(I) an employee of the Department appointed under section

7306, 7401, 7405, 7406, or 7408 of this title or under title

5; or

“(II) operating from a facility of the Department,

including a clinic of the Department;

“(ii) is authorized by the Secretary to provide health

care under this chapter;

“(iii) is required to adhere to all standards for quality

relating to the provision of health care in accordance with

applicable policies of the Department;

“(iv) has an active, current, full, and unrestricted

license, registration, or certification or meets

qualification standards set forth by the Secretary within a

specified time frame; and

“(v) with respect to a health care profession listed under

section 7402(b) of this title, has the qualifications for

such profession as set forth by the Secretary; and

“(B) a health professions trainee who—

“(i) is appointed under section 7405 of this title; and

“(ii) is under the clinical supervision of a health care

professional described in subparagraph (A).”.

(b) Clerical Amendment.—The table of sections at the

beginning of such chapter is amended by inserting after the

item relating to section 1730C the following new item:

“1730D. Prescription, delivery, distribution, and dispensation of

controlled substance medications via telemedicine.”.

SEC. 672. COPAYMENTS FOR LIMITED SUPPLIES OF MEDICATIONS.

Paragraph (4) of section 1722A(a) of title 38, United

States Code, is amended to read as follows:

“(4) Paragraph (1) does not apply—

“(A) to opioid antagonists furnished under this chapter to

a veteran who is at high risk for overdose of a specific

medication or substance in order to reverse the effect of

such an overdose; and

“(B) to any limited supply prescription for medication, up

to a 30-day supply of such medication, under section 1730D(b)

of this title if the covered health care professional would

have prescribed, delivered, distributed, or dispensed a

supply for more than seven days if not for the restrictions

under such section.”.

SEC. 673. PLAN ON ESTABLISHMENT OF INTERACTIVE, ONLINE SELF-

SERVICE MODULE FOR CARE.

(a) In General.—The Secretary of Veterans Affairs shall

develop and implement a plan to establish, to the greatest

extent practicable, an interactive, online self-service

module—

(1) to allow veterans enrolled in the system of annual

patient enrollment of the Department of Veterans Affairs

established and operated under section 1705(a) of title 38,

United States Code—

(A) to request appointments, track referrals for health

care under the laws administered by the Secretary, whether at

a facility of the Department of Veterans Affairs or through a

non-Department provider, and receive appointment reminders;

(B) to appeal and track decisions relating to—

(i) denials of requests for authorization for care or

services under section 1703 of title 38, United States Code;

(ii) denials of requests for care or services at facilities

of the Department, including under section 1710 of such

title;

the type of care sought by the veteran at facilities of the

Department and with non-Department facilities and providers

through which the Secretary furnishes care and services under

section 1703 of such title;

(D) to compare average driving times between their

residence and the nearest facility of the Department that

provides the care they are seeking and between their

residence and the closest non-Department provider that

provides the care they are seeking and through which the

Secretary furnishes care and services under section 1703 of

such title; and

(E) to view a provider directory, information regarding

pending medical claims, and explanations of benefits; and

(2) to implement such other matters as determined

appropriate by the Secretary.

(b) Submittal of Plan.—

(1) Initial plan.—Not later than 180 days after the date

of the enactment of this Act, the Secretary shall submit to

the Committee on Veterans' Affairs of the Senate and the

Committee on Veterans' Affairs of the House of

Representatives the plan developed under subsection (a).

(2) Biannual update.—Not less frequently than once every

180 days during the two-year period beginning on the

submittal of the plan under paragraph (1), the Secretary

shall brief the Committee on Veterans' Affairs of the Senate

and the Committee on Veterans' Affairs of the House of

Representatives on any updates on the implementation of such

plan.

SEC. 674. MODIFICATION OF REQUIREMENTS FOR CENTER FOR

INNOVATION FOR CARE AND PAYMENT OF THE

DEPARTMENT OF VETERANS AFFAIRS AND TRANSFER OF

AUTHORITY.

(a) In General.—Chapter 3 of title 38, United States Code,

is amended by adding at the end the following new section:

“Sec. 326. Center for Innovation

“(a) Establishment.—There is established in the

Department, within the Office of the Secretary, a Center for

Innovation (in this section referred to as the `Center').

“(b) Purpose.—The purpose of the Center is to test

innovative payment and service delivery models to reduce

program expenditures of the Department under chapter 17 of

this title while preserving or enhancing the quality of care

furnished to veterans and other eligible individuals.

“(c) Identification and Testing of Models.—

“(1) In general.—The Center shall—

“(A) identify and test health care payment and service

delivery models under this title, including care from non-

Department providers under subchapter I of chapter 17 of this

title, that have the potential to—

“(i) reduce program expenditures; and

“(ii) preserve or enhance the quality of care furnished to

veterans;

“(B) give preference to models that improve the

coordination, quality, and efficiency of health care services

furnished under this title; and

“(C) evaluate the effect of applying such models on

program expenditures and quality outcomes under this title.

“(2) Included models.—The models identified and tested

under paragraph (1) may include the following:

“(A) Bundled payment arrangements.

“(B) Preventive care initiatives.

“(C) Chronic care coordination models.

“(d) Selection of Models.—

“(1) In general.—The Secretary, acting through the

Center, shall select models to be tested under subsection (c)

from among those that—

“(A) address a defined population for which there are

demonstrated deficits in care leading to poor clinical

outcomes or potentially avoidable expenditures; and

“(B) are expected to reduce program costs while preserving

or enhancing the quality of care furnished to veterans.

“(2) Criteria.—In selecting models under paragraph (1),

the Secretary shall apply criteria consistent with the model

selection framework used in evidence-based criteria that the

Secretary determines appropriate.

“(e) Testing and Evaluation.—

“(1) In general.—The Secretary shall design and test each

model under this section in a manner that allows for the

evaluation of—

“(A) changes in program expenditures;

“(B) changes in quality and outcomes of care for veterans;

and

“(C) other factors the Secretary determines relevant to

care coordination, access, and equity.

“(2) Evaluation.—The Secretary shall evaluate each model

under this section using scientifically valid methodologies,

including control or comparison groups if practicable.

“(f) Reporting.—

“(1) Annual report.—Not less frequently than annually,

the Secretary shall submit to the Committee on Veterans'

Affairs of the Senate and the Committee on Veterans' Affairs

of the House of Representatives a report on models being

tested under this section and their preliminary results,

including—

“(A) a brief narrative description of the model explaining

its intent and the proposed manner in which it is supposed to

reduce expenditures and increase quality of or access to care

for veterans;

“(B) the number of veterans and providers participating in

the model, broken down by demographics such as age, race or

ethnicity, geographic location, and other characteristics as

chosen by the Secretary;

“(C) gross and net savings or increases to the medical

services account of the Department, including in comparison

to baseline budgetary assumptions in the absence of the

model;

“(D) an assessment of the utilization of the model,

including the proportion of providers choosing to participate

in the model and the proportion of veterans choosing to

participate in the model, as the case may be;

“(E) an assessment of quality of care and patient outcomes

as measured by discrete objective metrics, including changes

to morbidity and mortality, changes to admission rates,

changes to readmission rates, changes to population health

metrics such as average blood pressure, A1C levels, body mass

index, or other relevant health metrics, or other relevant

clinical outcome metrics;

“(F) a description of provider, stakeholder, and veteran

experiences; and

“(G) such other matters as the Secretary may consider

relevant.

“(2) Final report on models.—Not later than 180 days

after completing each model under this section, the Secretary

shall submit to the Committee on Veterans' Affairs of the

Senate and the Committee on Veterans' Affairs of the House of

Representatives a final report on such model, including—

“(A) findings from the evaluation of such model;

“(B) updated findings under paragraph (1) with respect to

such model;

“(C) an assessment of the fiscal impact of such model; and

“(D) recommendations for expansion or termination of the

use of such model.

“(g) Expansion of Successful Models.—

“(1) In general.—Except as provided in paragraph (2), the

Secretary may, through rulemaking, expand the duration and

scope of a model tested under this section to the extent

that—

“(A) the Secretary determines such expansion is expected

to—

“(i) reduce program expenditures without reducing quality

of care; or

“(ii) improve quality of care without increasing program

expenditures; and

“(B) the Chief Financial Officer of the Department

certifies that such expansion will maintain budget

neutrality.

“(2) Limitation.—The Secretary shall not expand a model

unless the results of the evaluation of the model under

subsection (e) demonstrate that the requirements of paragraph

(1) are satisfied.

“(h) Cost Neutrality and Funding.—

“(1) In general.—Implementation or expansion of any model

under this section shall be conducted in a manner that is

cost-neutral to the Department over the duration of the use

of the model, including administrative costs.

“(2) Use of available amounts.—The Secretary shall ensure

that expenditures under this section are made from amounts

otherwise available to the Department for medical services,

community care, or medical support and compliance.

“(i) Rule of Construction.—Nothing in this section shall

be construed to authorize the Secretary to reduce the scope

or amount of benefits under this title, or to impose

additional eligibility requirements, except as may be

necessary to carry out an approved model under this

section.”.

(b) Conforming and Clerical Amendments.—

(1) Conforming repeal.—Section 1703E of title 38, United

States Code, is repealed.

(2) Conforming amendments.—

(A) Pilot program to improve administration of care under

veterans community care program.—Section 105(a) of the

Senator Elizabeth Dole 21st Century Veterans Healthcare and

Benefits Improvement Act (Public Law 118-210; 38 U.S.C. 1703

note) is amended, in the matter preceding paragraph (1), by

striking “Pursuant to section 1703E of title 38, United

States Code, the Secretary of Veterans Affairs, acting

through the Center for Innovation for Care and Payment” and

inserting “Pursuant to section 326 of title 38, United

States Code, the Secretary of Veterans Affairs, acting

through the Center for Innovation”.

(B) Pilot program on consolidating approval process of

department of veterans affairs for covered dental care.—

Section 106(a) of the Senator Elizabeth Dole 21st Century

Veterans Healthcare and Benefits Improvement Act (Public Law

118-210; 38 U.S.C. 1703 note) is amended, in the matter

preceding paragraph (1), by striking “the Center for

Innovation for Care and Payment established under section

1703E of title 38, United States Code” and inserting “the

Center for Innovation established under section 326 of title

38, United States Code”.

veterans health administration; pilot program.—Section 107

of the Senator Elizabeth Dole 21st Century Veterans

Healthcare and Benefits Improvement Act (Public Law 118-210;

38 U.S.C. 1701 note) is amended—

(i) in subsection (a)(2)(A)(viii), by striking “the Center

for Innovation for Care and Payment of the Department under

section 1703E of title 38, United States Code” and inserting

“the Center for Innovation under section 326 of title 38,

United States Code”; and

(ii) in subsection (c)(1), by striking “the Center for

Innovation for Care and Payment established under section

1703E of title 38, United States Code” and inserting “the

Center for Innovation under section 326 of title 38, United

States Code”.

(3) Clerical amendments.—

(A) Chapter 17.—The table of sections at the beginning of

chapter 17 of title 38, United States Code, is amended by

striking the item relating to section 1703E.

(B) Chapter 3.—The table of sections at the beginning of

chapter 3 of such title is amended by adding at the end the

following new item:

“326. Center for Innovation.”.

after the date of the enactment of this Act, the Comptroller

General of the United States shall submit to Congress a

report—

(1) on the efforts of the Center for Innovation of the

Department of Veterans Affairs in fulfilling the objectives

and requirements under section 326 of title 38, United States

Code, as added by subsection (a); and

(2) containing such recommendations as the Comptroller

General considers appropriate.

(d) Review of Veterans Community Care Program.—

(1) In general.—Not later than one year after the date of

the enactment of this Act, the Secretary of Veterans Affairs,

acting through the Office of Management of the Department of

Veterans Affairs, shall conduct a review of all aspects of

the Veterans Community Care Program.

(2) Elements.—The review required by paragraph (1) shall—

(A) identify proven management and payment best practices

of the Federal Government used under the Medicare program

under title XVIII of the Social Security Act (42 U.S.C. 1395

et seq.), the Medicaid program under title XIX of such Act

(42 U.S.C. 1396 et seq.), and the TRICARE program (as defined

in section 1072 of title 10, United States Code);

(B) determine what best practices, if any, identified under

subparagraph (A) should be adopted and implemented by the

Secretary, including those practices that would require

legislative action before adoption and implementation;

through the Veterans Community Care Program for veterans

eligible for such care;

(D) identify solutions to ease administrative, legislative,

and regulatory burdens and improve efficiency in the Veterans

Community Care Program;

(E) identify improvements to the Veterans Community Care

Program that can enhance the experience of veterans and

participating entities and providers furnishing hospital

care, medical services, and extended care services under the

Veterans Community Care Program;

(F) review how the Secretary—

(i) identifies eligibility for and reviews, processes, and

approves referrals for care under the Veterans Community Care

Program;

(ii) authorizes the furnishing of services under the

Veterans Community Care Program; and

(iii) receives, reviews, processes, and approves requests

for payment from participating entities and providers

furnishing services under the Veterans Community Care

Program.

(G) assess such other factors as determined appropriate by

the Secretary in consultation with Congress.

(3) Briefing and report.—

(A) Briefing.—Periodically throughout the duration of the

review required under paragraph (1), but not less frequently

than quarterly, the Secretary shall brief the Committee on

Veterans' Affairs of the Senate and the Committee on

Veterans' Affairs of the House of Representatives on the

status and preliminary findings of such review.

(B) Report.—Not later than 30 days after the conclusion of

the review required under paragraph (1), the Secretary shall

submit to the Committee on Veterans' Affairs of the Senate

and the Committee on Veterans' Affairs of the House of

Representatives a written report containing—

(i) a complete and unredacted list of all findings and

recommendations from the review; and

(ii) any legislative, administrative, regulatory, policy,

or other changes sought by the Secretary as a result of such

findings.

(4) Veterans community care program defined.—In this

subsection, the term “Veterans Community Care Program”

means the Veterans Community Care Program under section 1703

of title 38, United States Code.

(e) Pilot Programs.—

(1) In general.—Not later than one year after the date of

the enactment of this Act, the Secretary of Veterans Affairs

shall commence carrying out the pilot programs described in

paragraph (2) through the Center for Innovation established

by section 326 of title 38, United States Code, as added by

subsection (a), and the Office of Management of the

Department of Veterans Affairs.

(2) Pilot programs described.—The Secretary shall carry

out the following pilot programs:

(A) A pilot program to test innovative payment models for

the furnishing of preventive health services, as such term is

defined in section 1701 of title 38, United States Code.

(B) A pilot program to test innovative payment models

involving payment bundling for integrated care during an

episode of care authorized under the Veterans Community Care

Program under section 1703 of title 38, United States Code,

to improve the coordination, quality, and efficiency of

health care delivery under such program.

(f) Modification of Independent Assessments of Health Care

Delivery Systems and Management Processes.—Section 1704A of

title 38, United States Code, is amended—

(1) in subsection (a)(2)(I), by adding at the end the

following new clause:

“(vi) To identify proven management and payment best

practices of the Federal Government used under the Medicare

program under title XVIII of the Social Security Act (42

U.S.C. 1395 et seq.), the Medicaid program under title XIX of

such Act (42 U.S.C. 1396 et seq.), and the TRICARE program

(as defined in section 1072 of title 10).”; and

(2) in subsection (d), by inserting “or federally funded

research and development center” after “private entity”.

SEC. 675. REPORT ON IMPROVEMENTS TO CLINICAL APPEALS PROCESS.

(a) In General.—Not later than two years after the date of

the enactment of this Act, the Secretary of Veterans Affairs,

in consultation with veterans service organizations,

veterans, caregivers of veterans, employees of the Department

of Veterans Affairs, and other stakeholders as determined by

the Secretary, shall submit to the Committee on Veterans'

Affairs of the Senate and the Committee on Veterans' Affairs

of the House of Representatives a report containing

recommendations for legislative or administrative action to

improve the clinical appeals process of the Department with

respect to timeliness, transparency, objectivity,

consistency, and fairness.

(b) Inapplicability of Requirements Relating to Federal

Advisory Committees.—Chapter 10 of title 5, United States

Code, shall not apply to the consultation required by

subsection (a).

section, the term “veterans service organization” means any

organization recognized by the Secretary under section 5902

of title 38, United States Code.

SEC. 676. PLAN ON INCREASING ACCESSIBILITY OF CARE FOR

VETERANS WITH SPINAL CORD INJURY OR DISORDER.

(a) In General.—Not later than one year after the date of

the enactment of this Act, the Secretary of Veterans Affairs

shall submit to the Committee on Veterans' Affairs of the

Senate and the Committee on Veterans' Affairs of the House of

Representatives a plan on improving disability-related access

to care from facilities of the Department and from non-

Department facilities and providers through which the

Secretary furnishes care and services under section 1703 of

title 38, United States Code, for veterans with spinal cord

injury or disorder.

(b) Consultation.—In developing the plan required under

subsection (a), the Secretary shall consult with relevant

stakeholders, including veterans service organizations who

serve veterans with spinal cord injury or disorder.

include an assessment of disability-related barriers to care

at medical facilities of the Department of Veterans Affairs

and through community care networks of non-Department

providers for veterans with spinal cord injury or disorder

and a description of the actions needed to overcome such

barriers, including cost estimates, timelines for corrective

action, and requests for legislative action, if any.

(d) Veterans Service Organization Defined.—In this

section, the term “veterans service organization” means any

organization recognized by the Secretary under section 5902

of title 38, United States Code.

The SPEAKER pro tempore. The bill, as amended, shall be debatable for 1 hour, equally divided and controlled by the chair and ranking minority member of the Committee on Veterans' Affairs, or their respective designees.

The gentleman from Illinois (Mr. Bost) and the gentleman from California (Mr. Takano) each will control 30 minutes.

The Chair recognizes the gentleman from Illinois.

General Leave

Mr. BOST. Mr. Speaker, I ask unanimous consent that all Members have 5 legislative days in which to revise and extend their remarks and insert extraneous material into the Record on H.R. 9237.

The SPEAKER pro tempore. Is there objection to the request of the gentleman from Illinois?

There was no objection.

Mr. BOST. Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I rise today in strong support of my bill, H.R. 9237, the Take Care of America's Veterans Act.

As a veteran of the United States Marine Corps, for me, this bill is

personal. When a young man or woman raises their right hand and agrees to serve this country, America makes a promise. That promise does not end when a servicemember is wounded. It is my goal—and the goal of my friend, Senator Jerry Moran—to deliver on that promise.

This bill would be one of the most comprehensive veteran packages

considered by Congress in a decade. This bill includes more than 60 bipartisan provisions that would improve healthcare, benefits, operations, and accountability across the VA.

Mr. Speaker, I would like to tell you more about some of those important provisions. One is the Major Richard Star Act. For decades, medically retired, combat-injured veterans have had their military retirement offset dollar-for-dollar by their VA disability. While some disabled veterans who served 20 years receive both, there are tens of thousands of combat-injured veterans who currently do not. Many combat- injured veterans would have served longer if their injuries had not taken that opportunity from them.

H.R. 9237 would help end that injustice. It would end that offset for combat-injured veterans, allowing them to receive both benefits up to what a 20-year retiree with the same disabilities would receive.

Members on both sides of the aisle and veterans service organizations

support this and have for years. A press release, a handshake, or a discharge petition does not end the wounded warrior tax. This bill will.

The Love Lives On Act is another important provision included in this

bill. Currently, surviving spouses lose their benefits if they remarry before age 55, but those benefits were earned by their spouse's sacrifice for this country. The Love Lives On Act would allow surviving spouses to remarry at any age.

Another important provision in this bill is the Sharri Briley and

Eric Edmundson Veterans Benefits Expansion Act. This bill would provide long-awaited increases to catastrophically disabled veterans and surviving spouses.

Eric was 25 years old when an IED left him with a fractured spine and

a traumatic brain injury. H.R. 9237 would increase benefits for catastrophically disabled veterans like Eric by $10,000 a year.

It would also increase benefits for surviving spouses. These American families have not seen a meaningful increase in decades.

Mr. Speaker, this bill also includes the Veterans' ACCESS Act. Veterans should be able to access healthcare in their own communities. Too many veterans still face delays, confusion, and barriers when trying to use VA community care.

This bill would also improve mental health care and community-based

suicide prevention. A veteran's healthcare should be driven by the veteran's needs, not by government control.

H.R. 9237 would improve education benefits and vocational training to help veterans transition into civilian life. It would modernize the VA's claims and appeals process so veterans have a system that works for them. It would streamline the way VA handles construction, leasing, contracting, IT, and finances.

The Take Care of America's Veterans Act would expand benefits and

push VA to do better.

Mr. Speaker, I also want to address how this bill is funded, as I have heard a lot of misinformation about this point. H.R. 9237 would codify VA's own pending regulation on how to evaluate sleep apnea and tinnitus' effect on a veteran's workplace earnings. This regulation was proposed by the Biden-era VA in 2022, created by VA's team of doctors and researchers. It was part of VA's efforts to modernize its disability rating schedule created in the 1940s.

President Biden's Under Secretary for Benefits, Josh Jacobs,

testified in favor of these changes at his confirmation hearing.

Earlier this year, VA's executive director of compensation confirmed

plans to finalize these changes this year. These are not new ideas, and there is nothing unprecedented about this. This bill would not eliminate disability ratings for sleep apnea or tinnitus. It would not automatically reduce any veteran's current disability rating. Future veterans with sleep apnea will still get treatment through VA healthcare, but if a CPAP eliminates your symptoms, VA would compensate you less.

Currently, the amount of compensation for sleep apnea is often more

than the amount that a veteran receives if they lose a limb.

This change is just common sense. It is why VA has worked hard to propose changes like these, which reflect modern medicine. For tinnitus, VA has found it is best understood as a symptom of another condition such as hearing loss or TBI.

Under the proposed change, tinnitus would still be rated as part of

another underlying condition. This is not about denying these conditions exist. Let's be clear. This is not cutting benefits. No one will lose their benefits who are receiving them.

{time} 0920

It is about making sure the VA rating schedule follows modern science

and using those savings to fund the expansion of benefits and other VA programs.

Mr. Speaker, if we don't pass H.R. 9237 today, VA can make these rating changes as planned but the savings would go back to one place: Big Government. I want those savings to go instead into the pockets and the benefits for millions of veterans and their families.

Mr. Speaker, as a United States Marine Corps veteran, you can bet your bottom dollar that I believe that this bill would not harm a single veteran, and I would not bring it forward to this floor if I thought it would. Veterans do not need a bill that makes Members feel good for a day and then dies in the Senate. They need legislation that can pass.

Mr. Speaker, veterans groups agree. I include in the Record a letter from 20 different veterans organizations in support of this legislation.

Richard Star Act would be funded through the defense

authorizing committees and fu11y end the unjust wounded

veteran tax on combat-injured warriors. Pay-as-you-go rules

would be waived for these earned benefits. There would be

complete clarity from the Administration and VA about whether

long-anticipated VASRD changes will proceed independently of

this bill. Unfortunately, the current environment is far from

ideal, and veterans, families, survivors, and caregivers have

already waited years across multiple Congresses and

administrations for action on provisions that maintain strong

bipartisan support.

The Administration must also provide immediate clarity on

whether these rating-schedule changes are intended to proceed

independently of the Take Care of America's Veterans Act

through VA regulation, White House direction, or other

administrative action. That clarity is essential because the

bill's financing rests on assumptions that remain unresolved.

If similar VASRD changes are implemented outside this

legislation, the resulting savings could revert to the

Treasury rather than be reinvested in veterans, families,

survivors, and caregivers.

Given that reality, we believe the practical question

before Congress is whether this process should continue so

these resources can be reinvested in veterans, caregivers,

families, and survivors, or whether the opportunity to enact

this package is lost while unresolved funding questions

remain. We support advancing the Take Care of America's

Veterans Act because the bill represents a net expansion of

benefits and support for the veteran community and contains

protections intended to prevent reductions for current

beneficiaries. The goodness and positive impact of this

package should not be lost in the debate over its financing.

As Congress continues its consideration of this

legislation, we urge Members to preserve and strengthen key

protections: no retroactive harm to veterans currently

receiving compensation; prospective application only to

future claims or future requests for increased ratings; full

transparency from VA, the White House, and the Administration

regarding any independent regulatory or policy action; and a

final package that ensures expanded benefits are delivered

responsibly and effectively. We are committed to working with

Congress, VA, the Administration, coalition partners, and the

broader veteran community to improve the pay-for, identify

any credible alternative path forward, and secure the

strongest possible outcome.

This moment presents a clear test of whether Congress can

translate long-standing bipartisan agreement into meaningful

action. We support the Take Care of America's Veterans Act so

the process can continue and so Congress can deliver lasting

results for veterans, their families, caregivers, and

survivors. We urge swift action to advance this legislation

and stand ready to work with lawmakers in both chambers to

honor our commitments to all who have served.

Sincerely,

The American Legion, Military Officers Association of

America (MOAA), Wounded

Warrior Project, Elizabeth Dole Foundation, Tragedy

Assistance Program for Survivors (TAPS), American Veterans

(AMVETS), Air Force Sergeants Association, American

Optometric Association, Avalon Action Alliance, Commissioned

Officers Association of the USPHS (COA).

Gold Star Spouses of America, K9s For Warriors, Korean War

Veterans Association, Military Chaplains Association,

Military Order of the Purple Heart (MOPH), Mission Roll Call,

National Defense Committee, National Military Family

Association (NMFA), USCG Chief Petty Officers Association

(CPOA), Vietnam Veterans of America.

Mr. BOST. Mr. Speaker, veterans groups from The American Legion to the Wounded Warrior Project support this bill. Survivor groups like the Tragedy Assistance Program for Survivors support this bill. Caregiver organizations, like the Elizabeth Dole Foundation, support this bill. They all want this bill to pass.

Chairman Moran and I have worked for months to try to enact a law

that will help the greatest number of veterans. I believe we have offered that kind of package today.

veterans. Mission Roll Call, a national nonpartisan organization dedicated to serving veterans and their families, recently conducted a survey on my bill. They found 71 percent of veterans support the bill. I think that is a clear choice.

Mr. Speaker, as our Nation observes its 250th birthday, H.R. 9237 asks a simple question: Do we have veterans' backs? Do we have the backs of fellow Americans who raise their right hand to serve in defense of this great country, the Gold Star families who carry the cost of their loved one's sacrifice, or caregivers who every single day care for a disabled veteran family member? For me, the answer will always be “yes,” both during service and after.

Mr. Speaker, I urge all my colleagues to support the Take Care of America's Veterans Act, and I reserve the balance of my time.

Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I rise today in strong opposition to H.R. 9237. It is a beautiful day here in Washington, D.C., but Republicans are casting a dark cloud over all of us and especially over America's veterans.

We have before us today a bill that, despite its name, does the exact

opposite of taking care of veterans. It enshrines into law the largest cut to veterans' benefits ever in the history of this Nation.

The premise of this bill is that some veterans must be made worse off

in order to make others better off. Mr. Speaker, I reject that premise, I reject this bill, and I encourage others to do the same.

Here is the core issue: The majority treats veterans as a zero-sum
game: cut disability pay for some to find benefits for others. That is
not governing. That is rationing suffering among our Nation's heroes.

With this bill, the majority would, for the first time ever, have

Congress interfere in the scientific process that the determines veterans' disability ratings, overriding the expertise of medical professionals at the Department of Veterans Affairs. I respect that Chairman Bost is a military veteran, but he is not a medical professional.

The majority, for the first time ever, would have us cut tens of

billions of dollars from veteran disability compensation to pay for the Department of Defense obligations. This is absolutely unconscionable.

Consider the math. Republicans are discussing nearly $70 billion in new Pentagon spending without offsets. They vote enthusiastically for $1.5 trillion in annual defense budgets. Yet, they insist on paying for veterans' priorities by cutting benefits with the two most common service-connected conditions. Apparently, there is no problem sending veterans the bill for the wars that Congress funds.

This is a massive 600-page bill--crafted behind closed doors and

brought to the floor without careful consideration—packed with harmful provisions designed to boost a few vulnerable Members' electoral prospects.

Mr. Speaker, for those reasons and many, many more, I cannot in good conscience support this legislation.

More important than my opposition is the opposition of the very

people whom the majority claims to help, the veterans themselves. Over 30 Veteran Service Organizations and advocates oppose this legislation, including many of the largest, like the Veterans of Foreign Wars, Disabled American Veterans, Iraq and Afghanistan Veterans of America, and numerous others. They know that reaching into the pockets of one set of veterans to provide for another is morally wrong. Creating tiers of veterans based on their period of service and treating tomorrow's veterans worse than today's is morally wrong. They will not stand for it, and neither should we.

In addition to the numerous VSOs and over two dozen labor unions

opposed to this bill, including the Union of Veterans Council, American Federation of Government Employees, and AFL-CIO, so do professional associations like the American Psychological Association and the Nurses Organization of VA. They all recognize the devastating effect this legislation will have on VA's workforce and their ability to deliver high-quality care.

Even the Mortgage Bankers Association has expressed opposition to

this bill. The majority has decided that, during a housing affordability crisis, it makes sense to raise costs on struggling veteran homeowners who are desperately trying to avoid foreclosure.

This package contains multiple harmful provisions. It would accelerate the privatization of veteran healthcare—creating new grant programs for private providers that divert resources from VA mental health and PTSD programs—and steer veterans into more expensive community-based care, even where VA services remain available, and strip VA psychologists of their collective bargaining rights.

This bill also contains numerous sections opposed by key

stakeholders, like Student Veterans of America, Veterans Education Success, and the American Federation of Teachers, that would direct GI Bill funding toward low-quality, for-profit, unaccredited online programs.

This bill contains provisions that would allow GI benefits to be used

for online welding courses. Can you believe it? Explain to me how you can teach someone online how to weld.

Inexplicably, H.R. 9237 even includes a $500 million IT slush fund that VA will use to enrich contractors and reward the President's cronies. The list goes on and on.

We are going to hear arguments from the majority today about all the

good things this bill attempts to do. If we exist in a vacuum, I would say that I agree. There are parts of this bill with broad bipartisan support: long overdue increases to dependency and indemnity compensation and a special monthly compensation, for example.

We do not exist in isolation here, and we must take the bill as the

total sum of its parts, especially since the majority has blocked amendments to this bill, as they have done so often in this Congress.

{time} 0930

Regrettably, we will also hear the chairman say that cutting

veterans' benefits is the only way that we can get them done. This is patently false, and the chairman knows it. Everyone in this Chamber knows it, and everyone in America knows it, as well. There are any number of other places we can find money for these priorities.

We don't lack money around here. What is in short supply, at least on the other side of the aisle, is the political will to use some of it on behalf of America's veterans. There is $1.5 trillion for the Department of Defense, $70 billion for the Department of Homeland Security, and hundreds of millions of dollars for permanent tax cuts for the wealthy, none of it offset, and all of which the chairman voted for enthusiastically.

Just 10 days of President Trump's folly in Iran would pay for 10

years of benefits under the Major Richard Star Act.

Let me say that again. Just 10 days of President Trump's folly in Iran would pay for 10 years of benefits under the Major Richard Star Act.

The question we have before us today is this: Why do you insist on offsets now? Why only now when we are trying to do work on behalf of our Nation's veterans do you care about the deficit? Why are Republicans holding veterans' priorities hostage, including the overwhelming top priority of veterans, the Major Richard Star Act, in exchange

for multibillion-dollar cuts to veterans' benefits?

That is a mystery to me, and it is a question that Chairman Bost and

Republicans will struggle to answer, as well.

I will point to this chart here.

Mr. Speaker, let me finish with a quote from just one veteran in opposition to this legislation: “I am a disabled Michigan veteran and lifelong conservative. Please pass the Major Richard Star Act as a stand-alone bill. We do not support the Take Care of America's Veterans Act, H.R. 9237, and we will never elect Representatives who want to cut veterans' benefits. How could Republicans propose this.”

I couldn't have said it any better, and there are thousands more

comments just like this as you can see here.

Mr. Speaker, I reserve the balance of my time.

The SPEAKER pro tempore. Members are reminded to direct their remarks to the Chair.

Mr. BOST. Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, the ranking member knows VA has an obligation to update disability conditions based on the latest science and medicine. In his opening, he said that I am not a doctor. He is right. I am a marine. I am a truck driver, and somehow I have been blessed to serve our veterans as the chairman of the committee. He is not a doctor either. Likewise, he has been blessed by his community to be here, but what I do want to say is, for the record, the proposed changes for sleep apnea and tinnitus aren't developed by Congress.

They were developed by VA physicians. They are doctors—medical experts, doctors—and researchers under the Biden administration as part of the ongoing disability rating modernization efforts.

In testimony before the House Veterans' Affairs Committee in January

2026, VA officials stated that the Department intended to continue moving forward with respiratory ear-body system, rulemaking, and anticipated completing those efforts by the end of year 2026. That testimony was not given by career staff acting alone.

In fact, just this morning, VA officials confirmed that they are

planning to move forward with the proposed rule on sleep apnea and tinnitus.

The testimony represents the official position of the Department at

the time it was delivered to Congress. The question before us is not whether Congress created these proposed changes. We did not. VA's announcement makes their intention clear. This is moving forward regardless, but Ranking Member Takano would rather play politics.

The question is whether the savings associated with the proposed

deployment and changes by the VA should remain in their control and the bureaucrats' control, or do we make it through our Article I power to reinvest into our veterans and their families. H.R. 9237 chooses veterans.

Mr. Speaker, I ask you to look at the testimony of Josh Jacobs, Biden Under Secretary for Benefits, and Nina Tann, President Trump's Executive Director of the Compensation Service at the Department of Veterans Affairs.

Mr. Speaker, I yield 3 minutes to the gentleman from Ohio (Mr.
Taylor), a good friend.

Mr. TAYLOR. Mr. Speaker, I thank Chairman Bost for yielding me the time.

Mr. Speaker, I rise today in support of the Take Care of America's Veterans Act. America's veterans represent the best our country has to offer, and it is time for Congress to deliver meaningful reforms to our veterans' benefit programs that improve the quality of life for America's warfighters.

That is why I am proud to be an original cosponsor of the Take Care

of America's Veterans Act, which will modernize and enhance the delivery of VA benefits for veterans across our country.

As we continue to celebrate America's 250th anniversary, it is

important that we realize that freedom is not free, and we wouldn't have this amazing country without the sacrifices of countless servicemembers and their families.

Now is the time to reaffirm Congress' support of our veteran

community and put veterans first by passing this legislation.

I am particularly proud that this legislation includes the expansion

of GI Bill benefits, increases benefits for severely disabled veterans and their families, and ends the wounded veterans tax, thanks to the inclusion of the Major Richard Star Act.

These reforms are long overdue, and I applaud Chairman Bost and the

work of the House Veterans' Affairs Committee for their role in crafting this legislation.

This bill upholds the promise we made to our Nation's veterans that

upon completion of their service, we would take care of them and their families.

It is our duty as temporary caretakers of our Republic to fight for

those who keep us safe, and veterans are at the top of that list.

Mr. Speaker, on behalf of southern Ohio, I thank all our veterans and their families for the countless sacrifices they have made to keep our Nation safe. This vote is for them.

Mr. Speaker, I urge all my colleagues to support this bill.

Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, the chairman has said several times that the disability changes this bill makes are coming anyway. That is simply not true. He is counting on a golden egg that the VA has simply not laid yet.

The first Trump administration floated changes to conditions like

sleep apnea and tinnitus beginning in 2019. Then 4 years ago, when VA sought public comment on a notice of proposed rulemaking, the 2022 changes during the Biden administration, VSOs and many Members of this body spoke loudly and clearly and unanimously in opposition to them, and what he doesn't mention is that the Biden administration walked away from those proposed rule changes.

The VA listened to those voices in 2022, and as a result, the

proposed rule has been on a shelf since then. Just a few short weeks ago, VA clarified that it is not planning to take any action on this proposed rule. That was from a VA spokesperson in public. There is nothing inevitable about these rule changes, which are going to bring about the golden egg of savings, the $57 billion that the chairman is counting on in order to pay for this bill. The savings will come from cuts to veterans disability benefits. Their tweet that he is referring to this morning quoting an unnamed source is not the same as rulemaking.

This is simply the majority trying to find any excuse possible to cut

benefits they view as overly generous, which has long been their goal.
That is why Americans for Prosperity has endorsed this bill.

The architects of Project 2025 have been desperate to cut benefits

for years, and they have been trying to find a way to touch veterans benefits. I am not going to let them do that. They even showed up at the majority's press conference to cheer on their efforts just a few short days ago, and now they finally have a majority who is willing to bow to their demands to harm veterans.

{time} 0940

My majority counterparts have picked an interesting time to care

about science again. Their remarks today attempt to demonstrate that they are working to align themselves with the best science to update and modernize the disability ratings schedule.

Yet, my majority colleagues fail to see the irony in legislating away

veteran benefits before VA completes a thorough review of the best science. They are substituting their own judgment for that of VA clinicians and researchers who actually understand the medical evidence related to these disabilities.

If this bill is passed, the expertise of VA and the years of work

that go into clinical determinations become moot.

If you don't believe me, just listen to what one of VA's top doctors,

former VA Secretary and Under Secretary for Health David Shulkin, stated regarding this bill's proposed changes to disability ratings: “Any modernization of the VA Schedule for Rating Disabilities should be instead conducted through an independent, evidence-based medical review led by the Department of Veterans Affairs, with opportunities for public comment and

congressional oversight. Any savings resulting from that process should be reinvested in improving disability evaluations, rehabilitation services, and veterans' healthcare—not used to finance unrelated provisions of the legislation.”

If my colleagues are suddenly interested in following that science,

they should let the experts continue their work independently without the political pressure that passage of this bill will inevitably create.

Mr. Speaker, I yield 2 minutes to the gentlewoman from Illinois (Ms. Underwood), my good friend. She is a former member of this committee who currently serves on the House Committee on Appropriations.

Ms. UNDERWOOD. Mr. Speaker, I rise today in support of my bill, the Lactation Spaces for Veteran Moms Act.

Serving veterans is one of the greatest privileges we have as Members

of Congress, and we must do everything that we can to ensure not only that they receive the benefits that they have earned through their service and sacrifice, but also that they can access those benefits with the dignity that they deserve.

That is why I am so proud to lead the bipartisan Lactation Spaces for

Veteran Moms Act with Congresswoman Ashley Hinson.

As a nurse, I have seen firsthand the benefits of breastfeeding for

moms and babies. My bill will ensure that every VA medical center contains a clean, private space specifically designed for nursing and pumping.

Our veterans and their families have given so much in service to our

country, and they deserve the same level of support and respect when they seek care.

For VA medical centers to meet the needs of young families,

caregivers, and our hardworking VA employees, they need to be equipped with proper facilities.

In the VA medical centers that lack a dedicated lactation space, moms

are forced to use unsanitary places like bathrooms or struggle to find a private corner. That is unacceptable. Our veterans deserve better.

That is why we must pass the Lactation Spaces for Veteran Moms Act

now.

Mr. BOST. Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I don't think that the ranking member is caught up on current events. Just recently, just to confirm what we already knew, the VA officials confirmed that they are moving ahead with the changes on tinnitus, sleep apnea, and disability benefits.

VA has made no move to withdraw the sleep apnea and/or those from the

changes that will then save the money that then the bureaucrats will control.

So as we are moving forward--I mean, the ranking member can keep

saying things that aren't true, or he can admit this is an issue, and that is where we are coming up with the revenue.

That being said, let me tell you the next person I want to yield time

to has worked on the Major Richard Star Act for years, as did his father before him.

With that, Mr. Speaker, I yield 2 minutes to the gentleman from Florida (Mr. Bilirakis), the Representative from Florida's 12th District.

Mr. BILIRAKIS. Mr. Speaker, I thank the chairman for his leadership and thank him for this great package that will support our veterans.

Mr. Speaker, I rise today in strong support of the Take Care of America's Veterans Act.

First and foremost, this legislation delivers long-overdue justice by

including key provisions of my Major Richard Star Act. I promised Richard Star that we would get this done, and we are in the process of doing it, again, on behalf of our true American heroes, which I remain committed to achieving full concurrent receipt. Anything that is not included in this bill, we are going to pursue for the benefit of our veterans.

This package takes a major step forward by providing immediate relief

to nearly 60,000 combat-injured veterans, Mr. Speaker. For far too long, medically retired servicemembers wounded in combat have been forced to forfeit a portion of the retirement pay they earned simply because they also receive VA disability compensation, and that is wrong. That is the so-called wounded veteran tax, and it is fundamentally unjust.

These men and women sacrificed their health in defense of our Nation.
They earned both benefits, and they deserve to receive both.

This legislation also strengthens veterans' access to healthcare by

expanding choice, improves the VA claims and appeals process, and increases support for catastrophically disabled veterans, caregivers, and surviving spouses.

Republicans have been working on these issues for many years, Mr. Speaker, and it looks like it is going to come to fruition. I appreciate it so very much, and I thank the chairman for his leadership.

It enhances mental health services, expands care in rural

communities, improves transition assistance for servicemembers entering civilian life, and modernizes VA facilities to better serve future generations.

The SPEAKER pro tempore. The time of the gentleman has expired.

Mr. BOST. Mr. Speaker, I yield an additional 1 minute to the gentleman from Florida.

Mr. BILIRAKIS. Most importantly, this bill honors the legacy of Major Richard Star, who fought tirelessly to correct this injustice before his passing. His determination has brought us to this moment, and today, we have the opportunity to continue that fight on behalf of thousands of deserving veterans.

Mr. TAKANO. Mr. Speaker, I include in the Record a coalition letter from 10 veterans service organizations; a resolution from The American Legion Department of Texas; a statement from The American Legion, Trujillo-Sheets Post 28, in Durango, Colorado; and emails from Minnesota Blue Earth Post 89 of The American Legion and American Legion Post 58 in Belleville, Illinois, all in opposition to this bill.

June 24, 2026.

Hon. Jerry Moran,

Chairman, Committee on Veterans' Affairs,

U.S. Senate, Washington, DC.

Hon. Richard Blumenthal,

Ranking Member, Committee on Veterans' Affairs, U.S. Senate,

Washington, DC.

Hon. Mike Bost,

Chairman, Committee on Veterans' Affairs,

House of Representatives, Washington, DC.

Hon. Mark Takano,

Ranking Member, Committee on Veterans' Affairs, House of

Representatives, Washington, DC.

Dear Chairmen Moran and Bost, and Ranking Members

Blumenthal and Takano: As organizations representing millions

of veterans, service members, survivors, caregivers, and

military families of all generations, we have long worked

with Congress to protect and strengthen the benefits and

services earned through military service. For that reason, we

do not support the funding mechanism within the Take Care of

America's Veterans Act (H.R. 9237/S. 4744) that would

significantly reduce future benefits for more than a million

disabled veterans.

The Veterans Affairs Schedule for Rating Disabilities is

intended to reflect medical evidence, functional impairment,

and scientific expertise, not serve as a budgetary offset. If

Congress establishes the precedent that disability ratings

may be rewritten through statute to generate “savings”,

future Congresses will have a ready-made roadmap for reducing

earned benefits whenever fiscal pressures arise. Disability

compensation is not a government program to be trimmed when

convenient. It is earned compensation for injuries and

illnesses incurred in service to our nation.

Some supporters argue that Congress is simply implementing

changes previously proposed by the Department of Veterans

Affairs. However, VA never finalized those proposals, largely

due to receiving more than 2,600 comments raising concerns

about the medical justification for the changes and their

impact on future veterans. In fact, VA spokesman Quinn Slaven

recently stated, “No changes are planned or imminent,” and

noted that the agency is still reviewing the proposed rule,

which “would need to undergo significant changes [emphasis

added] prior to being finalized” before any implementation

could occur (Slaven, quoted in GovExec, June 16, 2026).

We are also troubled that reductions to future VA

disability compensation are being used to finance provisions

such as the Major Richard Star Act, which addresses a

military retirement inequity rooted in Department of Defense

policy. Correcting a Title 10 obligation should not come at

the expense of Title 38 benefits. We continue to support

enactment of a clean and complete Major Richard Star Act that

delivers full concurrent receipt to combat-injured retirees

without reducing earned benefits for future veterans.

Congress can and should address these priorities without

reducing compensation for future disabled veterans, bypassing

the regulatory process, or undermining confidence in the

disability compensation system.

We respectfully urge Congress to find a different path

forward for these important benefit increases, including a

clean and complete Major Richard Star Act, that does not

force one generation of veterans to bear the cost for

another.

Sincerely,

DAV (Disabled American Veterans), Iraq and Afghanistan

Veterans of America, Jewish War Veterans, Marine Corps

League, National Organization of Veterans' Advocates,

National Veterans Legal Services Program, Reserve

Organization of America, Veterans of Foreign Wars,

54kVeterans.

The American Legion

DEPARTMENT OF TEXAS

Resolution No: 8-26

Title: Equal Advocacy for all Veterans and Equitable Funding

of earned Veterans' Benefits

Origin: American Legion Post 300

Assigned To: Legislative Convention Committee

Whereas, William J Bordelon Post 300 believes that future

changes to disability compensation policies governing sleep

apnea and tinnitus would result in similarly situated

veterans receiving different compensation based solely upon

when they entered military service or became eligible to file

their claims; and

Whereas, William J Bordelon Post 300 further believes that

every veteran who honorably serves the United States deserves

equal advocacy from The American Legion regardless of

generation, era of service, or date of military service, and

that Congress should fully fund veterans' benefits without

relying upon offsets affecting future veterans; now,

therefore, be it

Resolved, By the American Legion Department of Texas in

Annual Convention assembled in Austin, Texas, July 10-12,

2026; That The American Legion reaffirms its unwavering

support for passage of the Major Richard Star Act and

restoration of full concurrent receipt for eligible combat-

disabled military retirees; and, be it further

Resolved, That The American Legion, Department of Texas

respectfully petition the National Convention of The American

Legion to establish as national policy that The American

Legion continue supporting legislation benefiting veterans

while opposing any legislative funding mechanism that

finances earned veterans' benefits through future reductions,

limitations, or policy changes affecting Department of

Veterans Affairs disability compensation; and, be it further

Resolved, That The American Legion reaffirm its commitment

that benefits earned through honorable military service are

obligations of the Nation and should be fully funded by

Congress without creating disparities in compensation policy

between current and future veterans; and, be it finally

Resolved, That copies of this resolution be forwarded to

the National Convention of The American Legion for

consideration and appropriate action.

American Legion Trujillo-Sheets Post 28 Durango, CO's Post

Last night all members at the post meeting voted

unanimously that the post is NOT SUPPORTING the TCAVA.

At the 2022 American Legion convention resolution 33 was

approved which clearly describes the feeling of the

membership of the legion. This is the guidance that the

leadership should be using to determine our support for bills

that affect our VA benefits. You can read it here from the

National Archives. https://archive.legion.org/node/8419

From: Paul Kafka

Sent: Tuesday, July 14, 2026 11:30:06 AM

To: Shane Junkert

Subject: TCAVA opposition

Tonight 07/13/2026 at the Blue Earth Post 89 American

Legion Department of Minnesota meeting, a motion was made to

disapprove of National's position on the TCAVA. After

discussion, a vote was held, and it was unanimous. Blue Earth

Post 89 is in disagreement with Department and National on

this issue. We fully support the original MAJ Richard Star

act, but can not abide by taking from one group of veterans

to pay another.

Paul J. Kafka,

Past Commander, American Legion Post 89.

Bill Enyart.

Here is the email American Legion Post 58, Belleville, IL,

sent Mike Bost tonight:

Re TCAVA HR 9237 Section 108

Congressman Bost: American Legion Post 58 voted unanimously

at tonight's meeting to indicate our disagreement with TCAVA

Section 108 in its entirety. And further to voice our

disagreement with the position taken by the American Legion

National Commander in support of this legislation as

currently written. He does not speak for us.

Located in Belleville, about half of our members reside in

your district, most of the balance in Congresswoman

Budzinski's. We will be watching your vote on this carefully.

We urge you to change your position on this. Do not strip

benefits from future and current veterans.

Respectfully,

Bill Enyart, Post Commander; Rodney Buhr, Senior Vice-

commander; Marvin Hammel, Junior Vice-commander; April

Tarbill, Finance Pio Officer.

We sent similar letters to Congresswoman Budzinski, and

Senators Durbin and Duckworth.

Mr. TAKANO. Mr. Speaker, the chairman has made the claim that VA is going to move forward with taking away sleep apnea and tinnitus as conditions that veterans may claim disability ratings for. I would like to ask the chairman who at VA has made that commitment. He has tweeted out this morning that this is the case.

Mr. Speaker, I yield 15 seconds to the gentleman from Illinois (Mr. Bost) for the purpose of a colloquy to tell me the name of the person at VA who has confirmed that the VA is moving forward with these changes to disability ratings.

Mr. BOST. We have heard from the opening statement that came out of the VA, from the leadership at VA—

Mr. TAKANO. The Secretary?

Mr. BOST.—and that was sent out this morning under the approval of the Secretary.

Mr. TAKANO. So the gentleman is saying that a Secretary who backed away from changes to disability ratings in terms of medication—the intent was to say that if veterans take medication or get some sort of treatment, that if their conditions improve, that their disability ratings could then be lowered. He backed away from that after immense protest and opposition from veterans and veterans organizations.

{time} 0950

You are telling me that this very same Secretary is telling you that

he is moving forward with a $57 billion cut to disability ratings?

Mr. Speaker, I yield to the gentleman for the purposes of a colloquy.

Mr. BOST. That is exactly the position of the VA and their administration. That was said this morning. It was sent out this morning. It is now being reported in the news.

Mr. TAKANO. Mr. Speaker, I reclaim my time.

Mr. BOST. You can reclaim your time, but you asked the question.

Mr. TAKANO. The time is mine. I am reclaiming my time.

Mr. Speaker, there has been no public statement by the Secretary. There has been no named official from VA today. I defy the chairman to produce such a name. He is making a claim, but, again, I will contend that they are counting on a golden egg in disability cuts, savings on the backs of veterans, that has not been laid yet and that I contend will not be.

Mr. Speaker, I yield 2 minutes to the gentleman from Pennsylvania (Mr. Deluzio), a veteran of the U.S. Navy, a former member of this committee and who now serves on the House Armed Services Committee and the House Transportation Committee.

Mr. DELUZIO. Mr. Speaker, I thank the gentleman from California for yielding.

Mr. Speaker, I rise in opposition to this bill. I rise in opposition to any effort to cut veterans' benefits.

Let's be clear. This bill raises the cost of the VA Home Loan Program during a housing crisis, and this program and this bill cuts VA benefits for current veterans who don't have them and for troops downrange right now for two of the most common conditions they may experience: sleep apnea and tinnitus.

This bill sells off more VA and veterans' care to the private sector. It continues the privatization push of the Trump administration and so many congressional Republicans. I am not going to take a lecture on fiscal responsibility or accept this argument from the Republicans and the Trump administration that you have to fund veterans' programs by cutting care or benefits for other veterans.

The same people who have funded an Iran war at the tune of billions

and billions of dollars, the same people who added nearly $5 trillion to the debt through their One Big Beautiful Bill Act, which, by the way, has a new name now, I guess. We have lost track of that. That new bill, by the way, would also add $19 trillion over 30 years.

Mr. Speaker, there is no problem on the Republican side with adding to the debt when it comes time to give tax breaks and tax giveaways to the ultrarich and to corporations, but when it comes time to care of veterans, now they are counting pennies.

Let's be crystal clear about what this bill does. It says to troops downrange right now who are in harm's way that they have to have worse benefits than veterans have today to pay for benefits and care that other veterans have earned.

That is ridiculous. It is why groups like the VFW, the IAVA, and others oppose this bill. It is why I think Democrats and Republicans should oppose this bill on the floor today.

For this reason and many others, at the appropriate time, I will

offer a motion to recommit this bill back to committee. If the House Rules permitted, I would have offered the motion with an amendment to this bill.

The amendment would change the offsets used in the bill. Instead of reducing the VA home loan benefit and cutting disability benefits for sleep apnea and tinnitus, it takes unobligated, appropriated but not committed, funding given to the DOD in the One Big Beautiful Bill Act and uses it as a pay-for.

The SPEAKER pro tempore. The time of the gentleman has expired.

Mr. TAKANO. Mr. Speaker, I yield an additional 15 seconds to the gentleman from Pennsylvania.

Mr. DELUZIO. Mr. Speaker, I ask unanimous consent to insert the text of my amendment into the Record immediately prior to the vote on the motion to recommit.

The SPEAKER pro tempore. Is there objection to the request of the gentleman from Pennsylvania?

There was no objection.

Mr. DELUZIO. Mr. Speaker, I hope my colleagues will join me in voting for the motion to recommit.

Mr. BOST. Mr. Speaker, I yield 2 minutes to the gentleman from Michigan (Mr. Barrett), my good friend from the Seventh District.

Mr. BARRETT. Mr. Speaker, I rise today in support of the Take Care of America's Veterans Act.

This package includes more than 60 bipartisan bills that modernize,

enhance, and reform the delivery of healthcare and benefits for the entire veteran community.

It also delivers numerous bills that veterans and VSOs across America

have been vocal about, like the Major Richard Star Act, the Love Lives On Act, the ACCESS Act, the TAP Promotion and Expansion Act, and more.

It also includes eight of my own specific bill priorities, including:

The ASSIST Act and CRUISE Act, which will help disabled veterans and

businesses make necessary and timely modifications to vehicles, ensuring that veterans have accessibility to move about.

The Sharri Briley & Eric Edmundson Veterans Benefits Expansion Act

will finally deliver the first notable increase in over 30 years to our most severely disabled veterans and our Gold Star families who have sacrificed so much.

My Clear Communication for Veterans Claims Act and my Delivering

Digitally to Our Veterans Act, which will ensure that every veteran can understand the messages and communications they receive from the VA in a simplified manner and even opt in to get them electronically.

My Veterans Community Care Scheduling Improvement Act, which will

make it easier for veterans to schedule medical appointments closer to home and easier to access.

The Acquisition Reform and Cost Assessment Act to strengthen

oversight of VA acquisitions with the ginormous contracts that they often enter into.

And, finally, my Home Affordability for Guard and Reserve Act to

empower more of our National Guard and reservists to take advantage of the VA Home Loan Program. Today, they would wait 6 years to qualify for the VA Home Loan Program. Under this bill, they will qualify once they return home from their training and are in good standing with their unit.

Mr. Speaker, I worked hard on these bills for nearly 2 years, and they and more than 50 other bipartisan bills just like them are all major wins that will improve the lives of our Nation's heroes.

I thank Chairman Bost for his work on this legislation, and I look

forward to the passage of this bill. I urge my colleagues to vote “yes.”

Mr. TAKANO. Mr. Speaker, there is overwhelming opposition to cutting veterans' disability benefits to offset the cost of this bill.

Major VSOs, like the Veterans of Foreign Wars, Disabled American

Veterans, Iraq and Afghanistan Veterans of America, along with numerous others, all oppose this bill due to the offset.

More importantly, veterans themselves are overwhelmingly opposed, as

well. Check out any online veteran forum, and you will find thousands of comments from both veterans and Active-Duty servicemembers decrying these proposed cuts.

Veterans of all eras agree that their receipt of benefits should not

be predicated on cuts to benefits for another generation of veterans. It is our job to listen to them. There are other ways to fund this bill's provisions. We just need to have the political courage to stand up and do what is right for our veterans.

Mr. Speaker, I yield 2 minutes to the gentleman from Texas (Mr. Menefee), my good friend who serves on the House Committee on Science, Space, and Technology and the House Committee on Oversight and Government Reform.

Mr. MENEFEE. Mr. Speaker, I rise today to oppose H.R. 9237, which, if we are being clear, cuts veterans' benefits.

The President and my colleagues on the Republican side in Congress

have no problem sending our men and women off to war, but the real measure of a nation is not just how it treats their servicemembers when they are on Active Duty. It is how it treats them when they are no longer dodging the bombs, the bullets, and the storms at sea and when they are no longer serving in war.

As a Congress, we have to do right by our veterans, and this bill

simply does not do it with $57 billion in cuts for disability benefits for veterans. It raises home loan refinancing fees $4 billion on veteran borrowers.

Mr. Speaker, I am the son of two veterans, and we would have never purchased our first home when I was in high school were it not for a VA home assistance loan. That is to say not just for me but for so many folks across the 18th Congressional District of Texas.

I keep hearing my colleagues on the other side of the aisle saying

that we have to find money to offset to be able to pay for some of the other benefits in this bill. Yet, if we are pinching pennies, let's tell the President to end his war in Iran, which has cost taxpayers billions and billions of dollars. It is time for this Congress to do right by our veterans.

Mr. Speaker, I urge my colleagues on both sides of the aisle to vote against H.R. 9237.

Mr. BOST. Mr. Speaker, I yield 2 minutes to the gentleman from Pennsylvania (Mr. Meuser), from the Ninth District.

{time} 1000

Mr. MEUSER. Mr. Speaker, I thank Chairman Bost for his leadership.

Mr. Speaker, I rise today in support of the Take Care of America's Veterans Act. Our veterans answered the call to serve, sacrificed on behalf of this country, and defended the freedoms every American enjoys.

They have earned a Department of Veterans Affairs that delivers the

care, benefits, and support that they were promised without unnecessary delays or bureaucratic obstacles, and that includes community care, Mr. Speaker. That is one of the aversions and obstacles and reasons for opposition because Democrats are pretty much against community care initiatives.

This bipartisan package brings together more than 60 commonsense

proposals that truly make this happen. And by the way, it is supported by The American Legion, Military Officers Association of America, Wounded Warrior Project, Elizabeth Dole Foundation, Korean War Veterans Association, Vietnam Veterans of America, AMVETS, Gold Star Spouses of America, and the list goes on.

Very importantly, it includes the Major Richard Star Act. Voting against this bill is voting against the Major Richard Star Act, which ends the unfair wounded veterans tax for eligible combat-injured retirees. These veterans were medically retired because their service was cut short by injuries sustained defending our country. They should not be forced to give up a portion of their military retirement pay simply because they also receive VA disability compensation. This bill corrects that injustice.

It also strengthens access to community care, as mentioned, and

mental health treatment. It allows military widows to remarry and maintain their benefits. It cuts through the VA red

tape and strengthens the claims appeals processes. This is not about a cutting of benefits. It is about advancing services with some modernization initiatives, as well.

We owe our veterans more than the words of gratitude. We owe them this action. We owe them the Take Care of America's Veterans Act.

Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.

I will point out that yesterday, House Republicans released a $95 billion supplemental for the reconciliation bill they want to bring forward next week for Pentagon spending, farm assistance, and intelligence operations all without offsets. We are talking about $95 billion—none of them with an offset. Yet, we are asking our veterans to pay for this bill. Only in the case of veterans is the chairman looking for an offset.

I defy the chairman to tell me whether he will ask for an offset for

the $95 billion supplemental that goes to Pentagon spending, farm assistance, and intelligence operations. I eagerly await to hear his answer.

Mr. Speaker, I reserve the balance of my time.

Mr. BOST. Mr. Speaker, I yield 2 minutes to the gentlewoman from the Northern Mariana Islands (Ms. King-Hinds), my good friend.

Ms. KING-HINDS. Mr. Speaker, I rise before you today to lend my voice in strong support of H.R. 9237, the Take Care of America's Veterans Act.

This comprehensive package is designed to address the critical needs

of our Nation's veterans.

The legislation represents a meaningful step forward closing resource

gaps that have persisted for far too long. Among its provisions are vital improvements for veterans affected by traumatic brain injuries, expanded survivor benefits, and increased access to medical care in the U.S. territories and the Freely Associated States.

I am proud to note that two bills I authored are included in this

package. First is the Territorial Response and Access to Veterans' Essential Lifecare, or TRAVEL Act. This provision, which already passed in the House, establishes a VA program enabling physicians to travel to the U.S. territories and deliver essential medical care directly to veterans.

The second bill, the U.S. Vets of the Freely Associated States Act, empowers the VA to provide telehealth services and mail prescriptions to veterans residing in the Republic of the Marshall Islands, the Federated States of Micronesia, and Palau. These Pacific Island countries are among our closest allies whose citizens serve in our military at exceptionally high rates, yet they lack access to basic care and benefits. This legislation will help remedy that inequity.

The Take Care of America's Veterans Act is not just important. It is urgent. Our veterans deserve the best we can offer, and this package delivers on that promise.

I thank Chairman Bost for his leadership and dedication to veterans

everywhere. I urge my colleagues to join me in supporting the passage of H.R. 9237.

Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.

I continue to ask the chairman in advance of a $95 billion supplemental for Pentagon spending, farm assistance, and intelligence operation, on none of this are the Republicans seeking an offset? Only the chairman in this particular case when it comes to our veterans is demanding that veterans pay for veterans.

We could pass this bill without having to ask veterans to pay for

veterans—actually, for disabled veterans to pay for veterans.

Mr. Speaker, I would ask the chairman again: Does he plan to seek an offset or demand an offset for the $95 billion supplemental for Pentagon spending, farm assistance, and intelligence operations, none of which Republicans are intending to pay for? Their rules and their policy is to make veterans pay for veterans.

Mr. Speaker, I reserve the balance of my time.

Mr. BOST. Mr. Speaker, I have no further speakers, and I am ready to close.

I reserve the balance of my time.

Mr. TAKANO. I yield myself such time as I may consume.

In listening to the chairman today and at the Rules Committee several

weeks ago, it is clear to me that he has been picking his words very carefully. He has been very specific that this bill, the so-called Take Care of America's Veterans Act, would not impair current veterans.

I am not sure if the chairman fully understands how the disability

benefits system works or if he truly believes what he is saying, but what he is saying isn't even remotely the full truth.

The bill can and will lead to cuts for those who already have

service-connected disability ratings for sleep apnea and tinnitus. This is because anytime a veteran applies for a rating increase or applies for a new rating for some other condition, VA can and does review previous ratings, sometimes even lowering them.

It is foolish to think that VA won't apply the new rules for sleep

apnea and tinnitus when veterans have their ratings reviewed.

Further, his remarks fail to take into consideration two other

critically important populations here. First, these cuts would make servicemembers currently serving who may be incurring these injuries right now ineligible to receive compensation for service-connected tinnitus or sleep apnea. Those servicemembers President Trump keeps sending into harm's way in this foolish war with Iran would be ineligible for these benefits. That should give us all pause.

Let me just say a “yes” vote on this bill is a message that we are sending to the servicemembers currently serving in and around the waters of Iran and the Strait of Hormuz and our servicemembers that are stationed at bases who have already faced incoming missile fire and have been subjected to the blasts that have surely affected their eardrums, we are saying to them that they will not be able to apply to make claims based on tinnitus, much less sleep apnea. That is the message a “yes” vote will send to them. That is why I say vote “no.”

In addition, the chairman and his colleagues fail to acknowledge that

the existing veterans who have yet to file a claim for tinnitus or sleep apnea—I am talking about a group of people not the current servicemembers, but veterans who have yet to apply for a rating—these two groups of veterans, that is, current servicemembers and veterans who have yet to file, will be treated worse than those that came before them.

This contract will unilaterally be changed on them and for the worse. How my Republican colleagues are okay with treating two veterans with the same exact condition differently is beyond me.

Mr. Speaker, this is the largest cut to veterans' disability benefits in history being used to pay for this bill when Republicans are not demanding offsets for $95 billion next week. I don't know how you all can live with yourselves.

Mr. Speaker, I reserve the balance of my time.

Mr. BOST. Mr. Speaker, I am prepared to close, and I reserve the balance of my time.

{time} 1010

Mr. TAKANO. Mr. Speaker, I yield myself the balance of my time to close.

Throughout this process, I have tried to stay up to date on what

veterans are saying online about the so-called Take Care of America's Veterans Act. I found the discussions to be enlightening.

Before my colleagues say I have cherry-picked those comments, I urge

them to pull out their phones and take a look at the comment sections on any social media post discussing this bill. It will become clear to you that opposition to this legislation is coming from veterans on both sides of the aisle. Let's take a look. I am quoting from the comments:

“This creates two tiers of veterans.”

“Veterans should not have to take a reduced amount to provide savings to pay for fellow veterans. The U.S. Government should honor their commitment to us.”

“This is a false choice. Find the funds without making veterans literally pay the cost.”

“If they truly cared, they wouldn't rob all veterans to pay for this as there are plenty of other ways to fund this act.”

“Pitting veterans against veterans.”

“You taught us to take care of each other; this bill contradicts that.”

There are thousands more just like this from veterans in each of our

districts telling us to vote “no” on this bad bill. If my colleagues won't listen to my concerns here, I urge them to listen to the veterans, dependents, caregivers, survivors, and advocates in their districts.

We cannot today, tomorrow, or ever balance budgets on the backs of

veterans who have already sacrificed so much for their country. Instead, we must honor the contract we made with our Nation's veterans and reject the false choice Chairman Bost has foisted upon us.

I join the millions of veterans across the country who vehemently

oppose H.R. 9237, the Take Care of America's Veterans Act, and urge everyone to do the same.

Mr. Speaker, I yield back the balance of my time.

Mr. BOST. Mr. Speaker, I yield myself the balance of my time to close.

I will respond to a few claims that the veterans do not want this

package. It is just not true. The ranking member can disagree on the bill. He can disagree on the offset. He can argue that they would have written the package differently, but I do not think it is accurate to suggest the veterans' community, as a whole, is somehow united against this legislative package.

The package has support from a wide range of organizations, including

The American Legion, Vietnam Veterans of America, Mission Roll Call, Wounded Warrior Project, Military Officers Association of America, AMVETS, Concerned Veterans for America, Tragedy Assistance Programs for Survivors, Gold Star Spouses of America, the Veterans Survivor Coalition, the Military Order of the Purple Heart, Veterans Justice Alliance, the National Association of State Approving Agencies, the ALS Association, Elizabeth Dole Foundation, Air Force Sergeants Association, American Optometric Association, Avalon Action Alliance, Career Education Colleges and Universities, Commissioned Officers Association of the USPHS, K9s for Warriors, Korean War Veterans Association, Military Chaplains Association, National Defense Committee, National Military Family Association, USCG Chief Petty Officers Association, Americans for Prosperity, National Federal Development Association, National Taxpayers Union, and the Association of Mature American Citizens.

Those organizations represent veterans, survivors, Gold Star

families, wounded veterans, military families, advocates, and professionals who work directly with the people this bill would help.

When the ranking member claims that veterans do not want this

package, that ignores millions of voices in the veterans' community who are asking Congress to act.

This bill includes longstanding priorities for veterans and,

importantly, it does so in a way that is paid for and capable of actually moving from here to the Senate and to the President's desk.

At some point, we have to decide whether we are going to keep talking

about these promises or actually move a package that can become law. I believe that this package is a serious, responsible step forward, and I reject the idea that veterans do not want this Congress to act on this bill.

Also, whether they want to admit it or not, the problem with most of

these organizations that were in opposition is because they didn't want the offset. That offset, as I have told you this morning, as the VA has said exactly what we said, they are going to implement it.

The question for my colleagues is very simple: Do they want to use their Article I power to make decisions, as we should in Congress, to direct that money to our veterans and where they need it? We have sat and looked at these over and over again. We have also passed some of these bills and sent them over to the Senate to die because they don't have an offset.

This isn't an easy game, and it is not a game. If you don't believe this marine is serious about helping veterans—and I am telling you I took a lot of crap this week—I can tell you this: I will stand and always stand for my veterans.

I am the son of a veteran. I am the grandson of a veteran. I am the nephew of a veteran. I am the father of a veteran, and I am the grandfather of two of them.

Mr. Speaker, I have heard a lot this week. I am going to tell you, we have worked hard and did the best we can to put the best bill forward. It is the best bill that has been around in decades.

Do we want the bureaucrats to make the decision and not support those

areas where we are trying to help our veterans? You can love it. You can hate it, but I am telling you, this is the best thing we can do for veterans right now. I would encourage all of my colleagues to support this legislation, and I yield back the balance of my time.

The SPEAKER pro tempore (Mr. Hurd). All time for debate has now expired.

Pursuant to House Resolution 1423, the previous question is ordered

on the bill, as amended.

The question is on the engrossment and third reading of the bill.

The bill was ordered to be engrossed and read a third time, and was

read the third time.

Motion to Recommit

Mr. DELUZIO. Mr. Speaker, I have a motion to recommit at the desk.

The SPEAKER pro tempore. The Clerk will report the motion to recommit.

The Clerk read as follows:

Mr. Deluzio of Pennsylvania moves to recommit the bill H.R.

9237 to the Committee on Veterans' Affairs.

The material previously referred to by Mr. Deluzio is as follows:

Mr. Deluzio moves to recommit the bill H.R. 9237 to the

Committee on Veterans' Affairs with instructions to report

the same back to the House forthwith, with the following

amendments:

Page 17, strike lines 9 through 17.

Page 17, line 18, redesignate subsection (c) as subsection

(b).

Strike section 108 and insert the following new section:

SEC. 108. RESCISSION OF ONE BIG BEAUTIFUL BILL ACT FUNDS FOR

DEPARTMENT OF DEFENSE.

Notwithstanding any other provision of law, of the

unobligated balances of amounts made available under title II

of the Act entitled “An Act to provide for reconciliation

pursuant to title II of H. Con. Res. 14”, approved July 4,

2025 (Public Law 119-21; 139 Stat. 112) (commonly known as

the “One Big Beautiful Bill Act”), an amount sufficient to

offset the costs of carrying out the amendments made by this

Act is hereby rescinded.

The SPEAKER pro tempore. Pursuant to clause 2(b) of rule XIX, the previous question is ordered on the motion to recommit.

The question is on the motion to recommit.

The question was taken; and the Speaker pro tempore announced that the noes appeared to have it.

Mr. DELUZIO. Mr. Speaker, on that I demand the yeas and nays.

The yeas and nays were ordered.

The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further proceedings on this question are postponed.

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