§ 1701. Definitions

For the purposes of this chapter—

• (1) The term “disability” means a disease, injury, or other physical or mental defect.
• (2) The term “veteran of any war” includes any veteran awarded the Medal of Honor.
• (3) The term “facilities of the Department” means—
  • (A) facilities over which the Secretary has direct jurisdiction;
  • (B) Government facilities for which the Secretary contracts; and
  • (C) public or private facilities at which the Secretary provides recreational activities for patients receiving care under section 1710 of this title .
• (4) The term “non-Department facilities” means facilities other than Department facilities.
• (5) The term “hospital care” includes—
  • (A)
    • (i) medical services rendered in the course of the hospitalization of any veteran, and (ii) travel and incidental expenses pursuant to the provisions of section 111 of this title ;
  • (B) such mental health services, consultation, professional counseling, marriage and family counseling, and training for the members of the immediate family or legal guardian of a veteran, or the individual in whose household such veteran certifies an intention to live, as the Secretary considers appropriate for the effective treatment and rehabilitation of a veteran or dependent or survivor of a veteran receiving care under the last sentence of section 1781(b) of this title ; and
  • (C)
    • (i) medical services rendered in the course of the hospitalization of a dependent or survivor of a veteran receiving care under the last sentence of section 1781(b) of this title , and (ii) travel and incidental expenses for such dependent or survivor under the terms and conditions set forth in section 111 of this title .
• (6) The term “medical services” includes, in addition to medical examination, treatment, and rehabilitative services, the following:
  • (A) Surgical services.
  • (B) Dental services and appliances as described in sections 1710 and 1712 of this title.
  • (C) Optometric and podiatric services.
  • (D) Preventive health services.
  • (E) Noninstitutional extended care services, including alternatives to institutional extended care that the Secretary may furnish directly, by contract, or through provision of case management by another provider or payer.
  • (F) In the case of a person otherwise receiving care or services under this chapter—
    • (i) wheelchairs, artificial limbs, trusses, and similar appliances;
    • (ii) special clothing made necessary by the wearing of prosthetic appliances; and
    • (iii) such other supplies or services as the Secretary determines to be reasonable and necessary.
  • (G) Travel and incidental expenses pursuant to section 111 of this title .
  • (H) Chiropractic services.
• (7) The term “domiciliary care” includes necessary medical services and travel and incidental expenses pursuant to the provisions of section 111 of this title .
• (8) The term “rehabilitative services” means such professional, counseling, chiropractic, and guidance services and treatment programs as are necessary to restore, to the maximum extent possible, the physical, mental, and psychological functioning of an ill or disabled person.
• (9) The term “preventive health services” means—
  • (A) periodic medical and dental examinations;
  • (B) patient health education (including nutrition education);
  • (C) maintenance of drug use profiles, patient drug monitoring, and drug utilization education;
  • (D) mental health preventive services;
  • (E) substance abuse prevention measures;
  • (F) chiropractic examinations and services;
  • (G) immunizations against infectious diseases, including each immunization on the recommended adult immunization schedule at the time such immunization is indicated on that schedule;
  • (H) prevention of musculoskeletal deformity or other gradually developing disabilities of a metabolic or degenerative nature;
  • (I) genetic counseling concerning inheritance of genetically determined diseases;
  • (J) routine vision testing and eye care services;
  • (K) periodic reexamination of members of likely target populations (high-risk groups) for selected diseases and for functional decline of sensory organs, together with attendant appropriate remedial intervention; and
  • (L) such other health-care services as the Secretary may determine to be necessary to provide effective and economical preventive health care.
• (10) The term “recommended adult immunization schedule” means the schedule established (and periodically reviewed and, as appropriate, revised) by the Advisory Committee on Immunization Practices established by the Secretary of Health and Human Services and delegated to the Centers for Disease Control and Prevention.

§ 1702. Presumptions: psychosis after service in World War II and following periods of war; mental illness after service in the Persian Gulf War

• (a) For the purposes of this chapter, any veteran of World War II, the Korean conflict, the Vietnam era, or the Persian Gulf War who developed an active psychosis (1) within two years after discharge or release from the active military, naval, or air service, and (2) before July 26, 1949 , in the case of a veteran of World War II, before February 1, 1957 , in the case of a veteran of the Korean conflict, before May 8, 1977 , in the case of a Vietnam era veteran, or before the end of the two-year period beginning on the last day of the Persian Gulf War, in the case of a veteran of the Persian Gulf War, shall be deemed to have incurred such disability in the active military, naval, or air service.
• (b) For purposes of this chapter, any veteran of the Persian Gulf War who develops an active mental illness (other than psychosis) shall be deemed to have incurred such disability in the active military, naval, or air service if such veteran develops such disability—
  • (1) within two years after discharge or release from the active military, naval, or air service; and
  • (2) before the end of the two-year period beginning on the last day of the Persian Gulf War.

§ 1703. Veterans Community Care Program

• (a)
  • (1) There is established a program to furnish hospital care, medical services, and extended care services to covered veterans through health care providers specified in subsection (c).
  • (2) The Secretary shall coordinate the furnishing of hospital care, medical services, and extended care services under this section to covered veterans, including coordination of, at a minimum, the following:
    • (A) Ensuring the scheduling of medical appointments in a timely manner and the establishment of a mechanism to receive medical records from non-Department providers.
    • (B) Ensuring continuity of care and services.
    • (C) Ensuring coordination among regional networks if the covered veteran accesses care and services in a different network than the regional network in which the covered veteran resides.
    • (D) Ensuring that covered veterans do not experience a lapse in care resulting from errors or delays by the Department or its contractors or an unusual or excessive burden in accessing hospital care, medical services, or extended care services.
  • (3) A covered veteran may only receive care or services under this section upon the authorization of such care or services by the Secretary.
• (b) For purposes of this section, a covered veteran is any veteran who—
  • (1) is enrolled in the system of annual patient enrollment established and operated under section 1705 of this title ; or
  • (2) is not enrolled in such system but is otherwise entitled to hospital care, medical services, or extended care services under subsection (c)(2) of such section.
• (c) Health care providers specified in this subsection are the following:
  • (1) Any health care provider that is participating in the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq.), including any physician furnishing services under such a program.
  • (2) The Department of Defense.
  • (3) The Indian Health Service.
  • (4) Any Federally-qualified health center (as defined in section 1905( l )(2)(B) of the Social Security Act ( 42 U.S.C. 1396d ( l )(2)(B))).
  • (5) Any health care provider not otherwise covered under any of paragraphs (1) through (4) that meets criteria established by the Secretary for purposes of this section.
• (d)
  • (1) The Secretary shall, subject to the availability of appropriations, furnish hospital care, medical services, and extended care services to a covered veteran through health care providers specified in subsection (c) if—
    • (A) the Department does not offer the care or services the veteran requires;
    • (B) the Department does not operate a full-service medical facility in the State in which the covered veteran resides;
    • (C)
      • (i) the covered veteran was an eligible veteran under section 101(b)(2)(B) of the Veterans Access, Choice, and Accountability Act of 2014 ( Public Law 113–146 ; 38 U.S.C. 1701 note) as of the day before the date of the enactment of the Caring for Our Veterans Act of 2018;
      • (ii) continues to reside in a location that would qualify the veteran for eligibility under such section; and
      • (iii) either—
        • (I) resides in one of the five States with the lowest population density as determined by data from the 2010 decennial census; or
        • (II) resides in a State not described in subclause (I) and—
    • (D) the covered veteran has contacted the Department to request care or services and the Department is not able to furnish such care or services in a manner that complies with designated access standards developed by the Secretary under section 1703B of this title ; or
    • (E) the covered veteran and the covered veteran’s referring clinician agree that furnishing care and services through a non-Department entity or provider would be in the best medical interest of the covered veteran based upon criteria developed by the Secretary.
  • (2) The Secretary shall ensure that the criteria developed under paragraph (1)(E) include consideration of the following:
    • (A) The distance between the covered veteran and the facility that provides the hospital care, medical services, or extended care services the veteran needs.
    • (B) The nature of the hospital care, medical services, or extended care services required.
    • (C) The frequency that the hospital care, medical services, or extended care services needs to be furnished.
    • (D) The timeliness of available appointments for the hospital care, medical services, or extended care services the veteran needs.
    • (E) Whether the covered veteran faces an unusual or excessive burden to access hospital care, medical services, or extended care services from the Department medical facility where a covered veteran seeks hospital care, medical services, or extended care services, which shall include consideration of the following:
      • (i) Whether the covered veteran faces an excessive driving distance, geographical challenge, or environmental factor that impedes the access of the covered veteran.
      • (ii) Whether the hospital care, medical services, or extended care services sought by the veteran is provided by a medical facility of the Department that is reasonably accessible to a covered veteran.
      • (iii) Whether a medical condition of the covered veteran affects the ability of the covered veteran to travel.
      • (iv) Whether there is compelling reason, as determined by the Secretary, that the veteran needs to receive hospital care, medical services, or extended care services from a medical facility other than a medical facility of the Department.
      • (v) Such other considerations as the Secretary considers appropriate.
  • (3) If the Secretary has determined that the Department does not offer the care or services the covered veteran requires under subparagraph (A) of paragraph (1), that the Department does not operate a full-service medical facility in the State in which the covered veteran resides under subparagraph (B) of such paragraph, that the covered veteran is described under subparagraph (C) of such paragraph, or that the Department is not able to furnish care or services in a manner that complies with designated access standards developed by the Secretary under section 1703B of this title under subparagraph (D) of such paragraph, the decision to receive hospital care, medical services, or extended care services under such subparagraphs from a health care provider specified in subsection (c) shall be at the election of the veteran.
• (e)
  • (1)
    • (A) The Secretary may furnish hospital care, medical services, or extended care services through a health care provider specified in subsection (c) to a covered veteran served by a medical service line of the Department that the Secretary has determined is not providing care that complies with the standards for quality the Secretary shall establish under section 1703C.
    • (B) In carrying out subparagraph (A), the Secretary shall—
      • (i) measure timeliness of the medical service line at a facility of the Department when compared with the same medical service line at different Department facilities; and
      • (ii) measure quality at a medical service line of a facility of the Department by comparing it with two or more distinct and appropriate quality measures at non-Department medical service lines.
    • (C)
      • (i) The Secretary may not concurrently furnish hospital care, medical services, or extended care services under subparagraph (A) with respect to more than three medical service lines described in such subparagraph at any one health care facility of the Department.
      • (ii) The Secretary may not concurrently furnish hospital care, medical services, or extended care services under subparagraph (A) with respect to more than 36 medical service lines nationally described in such subparagraph.
  • (2) The Secretary may limit the types of hospital care, medical services, or extended care services covered veterans may receive under paragraph (1) in terms of the length of time such care and services will be available, the location at which such care and services will be available, and the clinical care and services that will be available.
  • (3)
    • (A) Except as provided for in subparagraph (B), the hospital care, medical services, and extended care services authorized under paragraph (1) with respect to a medical service line shall cease when the remediation described in section 1706A with respect to such medical service line is complete.
    • (B) The Secretary shall ensure continuity and coordination of care for any veteran who elects to receive care or services under paragraph (1) from a health care provider specified in subsection (c) through the completion of an episode of care.
  • (4) The Secretary shall publish in the Federal Register, and shall take all reasonable steps to provide direct notice to covered veterans affected under this subsection, at least once each year stating the time period during which such care and services will be available, the location or locations where such care and services will be available, and the clinical services available at each location under this subsection in accordance with regulations the Secretary shall prescribe.
  • (5) When the Secretary exercises the authority under paragraph (1), the decision to receive care or services under such paragraph from a health care provider specified in subsection (c) shall be at the election of the covered veteran.
• (f) The review of any decision under subsection (d) or (e) shall be subject to the Department’s clinical appeals process, and such decisions may not be appealed to the Board of Veterans’ Appeals.
• (g)
  • (1) To promote the provision of high-quality and high-value hospital care, medical services, and extended care services under this section, the Secretary may develop a tiered provider network of eligible providers based on criteria established by the Secretary for purposes of this section.
  • (2) In developing a tiered provider network of eligible providers under paragraph (1), the Secretary shall not prioritize providers in a tier over providers in any other tier in a manner that limits the choice of a covered veteran in selecting a health care provider specified in subsection (c) for receipt of hospital care, medical services, or extended care services under this section.
• (h)
  • (1)
    • (A) The Secretary shall enter into consolidated, competitively bid contracts to establish networks of health care providers specified in paragraphs (1) and (5) of subsection (c) for purposes of providing sufficient access to hospital care, medical services, or extended care services under this section.
    • (B) For purposes of subparagraph (A), the requirement to enter into consolidated, competitively bid contracts shall not restrict the authority of the Secretary under other provisions of law when modifying such a contract after entering into the contract.
  • (2)
    • (A) The Secretary shall, to the extent practicable, ensure that covered veterans are able to make their own appointments using advanced technology.
    • (B) To the extent practicable, the Secretary shall be responsible for the scheduling of appointments for hospital care, medical services, and extended care services under this section.
  • (3)
    • (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—
        • (I) failed to comply substantially with the provisions of the contract or with the provisions of this section and the regulations prescribed under this section;
        • (II) failed to comply with the access standards or the standards for quality established by the Secretary;
        • (III) 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);
        • (IV) is identified as an excluded source on the list maintained in the System for Award Management, or any successor system; or
        • (V) 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;
      • (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) Nothing in subparagraph (A) may be construed to restrict the authority of the Secretary to terminate a contract entered into under paragraph (1) under any other provision of law.
  • (4) Whenever the Secretary provides notice to an entity that the entity is failing to meet contractual obligations entered into 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 such failure. Such report shall include the following:
    • (A) An explanation of the reasons for providing such notice.
    • (B) A description of the effect of such failure, including with respect to cost, schedule, and requirements.
    • (C) A description of the actions taken by the Secretary to mitigate such failure.
    • (D) A description of the actions taken by the contractor to address such failure.
    • (E) A description of any effect on the community provider market for veterans in the affected area.
  • (5)
    • (A) The Secretary shall instruct each entity awarded a contract under paragraph (1) to recognize and accept, on an interim basis, the credentials and qualifications of health care providers who are authorized to furnish hospital care and medical services to veterans under a community care program of the Department in effect as of the day before the effective date specified in section 101(b) of the Caring for Our Veterans Act of 2018, including under the Patient-Centered Community Care Program and the Veterans Choice Program under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 ( Public Law 113–146 ; 38 U.S.C. 1701 note), as qualified providers under the program established under this section.
    • (B) The interim acceptance period under subparagraph (A) shall be determined by the Secretary based on the following criteria:
      • (i) With respect to a health care provider, when the current certification agreement for the health care provider expires.
      • (ii) Whether the Department has enacted certification and eligibility criteria and regulatory procedures by which non-Department providers will be authorized under this section.
  • (6) The Secretary shall establish a system or systems for monitoring the quality of care provided to covered veterans through a network under this subsection and for assessing the quality of hospital care, medical services, and extended care services furnished through such network before the renewal of the contract for such network.
• (i)
  • (1) Except as provided in paragraph (2), and to the extent practicable, the rate paid for hospital care, medical services, or extended care services under any provision in this title may not exceed the rate paid by the United States to a provider of services (as defined in section 1861(u) of the Social Security Act ( 42 U.S.C. 1395x(u) )) or a supplier (as defined in section 1861(d) of such Act ( 42 U.S.C. 1395x(d) )) under the Medicare program under title XI or title XVIII of the Social Security Act ( 42 U.S.C. 1301 et seq.), including section 1834 of such Act ( 42 U.S.C. 1395m ), for the same care or services.
  • (2)
    • (A) A higher rate than the rate paid by the United States as described in paragraph (1) may be negotiated with respect to the furnishing of care or services to a covered veteran who resides in a highly rural area.
    • (B) In this paragraph, the term “highly rural area” means an area located in a county that has fewer than seven individuals residing in that county per square mile.
  • (3) With respect to furnishing care or services under this section in Alaska, the Alaska Fee Schedule of the Department of Veterans Affairs shall be followed, except for when another payment agreement, including a contract or provider agreement, is in effect.
  • (4) With respect to furnishing hospital care, medical services, or extended care services under this section in a State with an All-Payer Model Agreement under section 1814(b)(3) of the Social Security Act ( 42 U.S.C. 1395f(b)(3) ) that became effective on or after January 1, 2014 , the Medicare payment rates under paragraph (2)(A) shall be calculated based on the payment rates under such agreement.
  • (5) Notwithstanding paragraph (1), the Secretary may incorporate, to the extent practicable, the use of value-based reimbursement models to promote the provision of high-quality care.
  • (6) With respect to hospital care, medical services, or extended care services for which there is not a rate paid under the Medicare program as described in paragraph (1), the rate paid for such care or services shall be determined by the Secretary.
• (j) In any case in which a covered veteran is furnished hospital care, medical services, or extended care services under this section for a non-service-connected disability described in subsection (a)(2) of section 1729 of this title , the Secretary shall recover or collect reasonable charges for such care or services from a health plan contract described in section 1729 in accordance with such section.
• (k) A covered veteran shall not pay a greater amount for receiving care or services under this section than the amount the veteran would pay for receiving the same or comparable care or services at a medical facility of the Department or from a health care provider of the Department.
• (l)
  • (1) In the case of a covered veteran described in paragraph (2), the Secretary shall determine whether to authorize an organ or bone marrow transplant for that covered veteran at a non-Department facility.
  • (2) A covered veteran described in this paragraph—
    • (A) requires an organ or bone marrow transplant; and
    • (B) has, in the opinion of the primary care provider of the veteran, a medically compelling reason to travel outside the region of the Organ Procurement and Transplantation Network, established under section 372 of the National Organ Transplantation Act 1 1 See References in Text note below. ( Public Law 98–507 ; 42 U.S.C. 274 ), in which the veteran resides, to receive such transplant.
• (m)
  • (1)
    • (A) Not later than 540 days after the date of the enactment of the Caring for Our Veterans Act of 2018, and not less frequently than annually thereafter, the Secretary shall submit to appropriate committees of Congress a review of the types and frequency of care sought under subsection (d).
    • (B) The review submitted under subparagraph (A) shall include an assessment of the following:
      • (i) The top 25 percent of types of care and services most frequently provided under subsection (d) due to the Department not offering such care and services.
      • (ii) The frequency such care and services were sought by covered veterans under this section.
      • (iii) An analysis of the reasons the Department was unable to provide such care and services.
      • (iv) Any steps the Department took to provide such care and services at a medical facility of the Department.
      • (v) The cost of such care and services.
  • (2) In monitoring the hospital care, medical services, and extended care services furnished under this section, the Secretary shall do the following:
    • (A) With respect to hospital care, medical services, and extended care services furnished through provider networks established under subsection (i)—
      • (i) compile data on the types of hospital care, medical services, and extended care services furnished through such networks and how many patients used each type of care and service;
      • (ii) identify gaps in hospital care, medical services, or extended care services furnished through such networks;
      • (iii) identify how such gaps may be fixed through new contracts within such networks or changes in the manner in which hospital care, medical services, or extended care services are furnished through such networks;
      • (iv) assess the total amounts spent by the Department on hospital care, medical services, and extended care services furnished through such networks;
      • (v) assess the timeliness of the Department in referring hospital care, medical services, and extended care services to such networks; and
      • (vi) assess the timeliness of such networks in—
        • (I) accepting referrals; and
        • (II) scheduling and completing appointments.
    • (B) Report the number of medical service lines the Secretary has determined under subsection (e)(1) not to be providing hospital care, medical services, or extended care services that comply with the standards for quality established by the Secretary.
    • (C) Assess the use of academic affiliates and centers of excellence of the Department to furnish hospital care, medical services, and extended care services to covered veterans under this section.
    • (D) Assess the hospital care, medical services, and extended care services furnished to covered veterans under this section by medical facilities operated by Federal agencies other than the Department.
  • (3) Not later than 540 days after the date of the enactment of the Caring for Our Veterans Act of 2018 and not less frequently than once each year 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 on the information gathered under paragraph (2).
• (n)
  • (1) The Secretary shall not limit the types of hospital care, medical services, or extended care services covered veterans may receive under this section if it is in the best medical interest of the veteran to receive such hospital care, medical services, or extended care services, as determined by the veteran and the veteran’s health care provider.
  • (2) No provision in this section may be construed to alter or modify any other provision of law establishing specific eligibility criteria for certain hospital care, medical services, or extended care services.
• (o) 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 “medical service line” means a clinic within a Department medical center.

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

• (a)
  • (1)
    • (A) When hospital care, a medical service, or an extended care service required by a covered individual who is entitled to such care or service under this chapter is not feasibly available to the covered individual from a facility of the Department or through a contract or sharing agreement entered into pursuant to another provision of law, the Secretary may furnish such care or service to such covered individual through an agreement under this section with an eligible entity or provider to provide such hospital care, medical service, or extended care service.
    • (B) An agreement entered into under this section to provide hospital care, a medical service, or an extended care service shall be known as a “Veterans Care Agreement”.
    • (C) For purposes of subparagraph (A), hospital care, a medical service, or an extended care service may be considered not feasibly available to a covered individual from a facility of the Department or through a contract or sharing agreement described in such subparagraph when the Secretary determines the covered individual’s medical condition, the travel involved, the nature of the care or services required, or a combination of these factors make the use of a facility of the Department or a contract or sharing agreement described in such subparagraph impracticable or inadvisable.
    • (D) A Veterans Care Agreement may be entered into by the Secretary or any Department official authorized by the Secretary.
  • (2)
    • (A) Subject to subparagraph (B), the Secretary shall review each Veterans Care Agreement of material size, as determined by the Secretary or set forth in paragraph (3), for hospital care, a medical service, or an extended care service to determine whether it is feasible and advisable to provide such care or service within a facility of the Department or by contract or sharing agreement entered into pursuant to another provision of law and, if so, take action to do so.
    • (B)
      • (i) The Secretary shall review each Veterans Care Agreement of material size that has been in effect for at least 6 months within the first 2 years of its taking effect, and not less frequently than once every 4 years thereafter.
      • (ii) If a Veterans Care Agreement has not been in effect for at least 6 months by the date of the review required by subparagraph (A), the agreement shall be reviewed during the next cycle required by subparagraph (A), and such review shall serve as its review within the first 2 years of its taking effect for purposes of clause (i).
  • (3)
    • (A) In fiscal year 2019 and in each fiscal year thereafter, in addition to such other Veterans Care Agreements as the Secretary may determine are of material size, a Veterans Care Agreement for the purchase of extended care services that exceeds $5,000,000 annually shall be considered of material size.
    • (B) From time to time, the Secretary may publish a notice in the Federal Register to adjust the dollar amount specified in subparagraph (A) to account for changes in the cost of health care based upon recognized health care market surveys and other available data.
• (b) For purposes of this section, an eligible entity or provider is—
  • (1) any provider of services that has enrolled and entered into a provider agreement under section 1866(a) of the Social Security Act ( 42 U.S.C. 1395cc(a) ) and any physician or other supplier who has enrolled and entered into a participation agreement under section 1842(h) of such Act ( 42 U.S.C. 1395u(h) );
  • (2) any provider participating under a State plan under title XIX of such Act ( 42 U.S.C. 1396 et seq.);
  • (3) an Aging and Disability Resource Center, an area agency on aging, or a State agency (as defined in section 102 of the Older Americans Act of 1965 ( 42 U.S.C. 3002 ));
  • (4) a center for independent living (as defined in section 702 of the Rehabilitation Act of 1973 ( 29 U.S.C. 796a )); or
  • (5) any entity or provider not described in paragraph (1) or (2) of this subsection that the Secretary determines to be eligible pursuant to the certification process described in subsection (c).
• (c) The Secretary shall establish by regulation a process for the certification of eligible entities or providers or recertification of eligible entities or providers under this section. Such a process shall, at a minimum—
  • (1) establish deadlines for actions on applications for certification;
  • (2) set forth standards for an approval or denial of certification, duration of certification, revocation of an eligible entity or provider’s certification, and recertification of eligible entities or providers;
  • (3) require the denial of certification if the Secretary determines the eligible entity or provider is excluded from participation in a Federal health care program under section 1128 or section 1128A of the Social Security Act ( 42 U.S.C. 1320a–7 or 1320a–7a) or is currently identified as an excluded source on the System for Award Management Exclusions list described in part 9 of title 48, Code of Federal Regulations, and part 180 of title 2 of such Code, or successor regulations;
  • (4) establish procedures for screening eligible entities or providers according to the risk of fraud, waste, and abuse that are similar to the standards under section 1866(j)(2)(B) of the Social Security Act ( 42 U.S.C. 1395cc(j)(2)(B) ) and section 9.104 of title 48, Code of Federal Regulations, or successor regulations; and
  • (5) incorporate and apply the restrictions and penalties set forth in chapter 21 of title 41 and treat this section as a procurement program only for purposes of applying such provisions.
• (d) To the extent practicable, the rates paid by the Secretary for hospital care, medical services, and extended care services provided under a Veterans Care Agreement shall be in accordance with the rates paid by the United States under section 1703(i) of this title .
• (e)
  • (1) Pursuant to regulations promulgated under subsection (k), the Secretary may define the requirements for providers and entities entering into agreements under this section based upon such factors as the number of patients receiving care or services, the number of employees employed by the entity or provider furnishing such care or services, the amount paid by the Secretary to the provider or entity, or other factors as determined by the Secretary.
  • (2) To furnish hospital care, medical services, or extended care services under this section, an eligible entity or provider shall agree—
    • (A) to accept payment at the rates established in regulations prescribed under this section;
    • (B) that payment by the Secretary under this section on behalf of a covered individual to a provider of services or care shall, unless rejected and refunded by the provider within 30 days of receipt, constitute payment in full and extinguish any liability on the part of the covered individual for the treatment or care provided, and no provision of a contract, agreement, or assignment to the contrary shall operate to modify, limit, or negate this requirement;
    • (C) to provide only the care and services authorized by the Department under this section and to obtain the prior written consent of the Department to furnish care or services outside the scope of such authorization;
    • (D) to bill the Department in accordance with the methodology outlined in regulations prescribed under this section;
    • (E) to not seek to recover or collect from a health plan contract or third party, as those terms are defined in section 1729 of this title , for any care or service that is furnished or paid for by the Department;
    • (F) to provide medical records to the Department in the time frame and format specified by the Department; and
    • (G) to meet such other terms and conditions, including quality of care assurance standards, as the Secretary may specify in regulation.
• (f)
  • (1) An eligible entity or provider may discontinue a Veterans Care Agreement at such time and upon such notice to the Secretary as may be provided in regulations prescribed under this section.
  • (2) The Secretary may discontinue a Veterans Care Agreement with an eligible entity or provider at such time and upon such reasonable notice to the eligible entity or provider as may be specified in regulations prescribed under this section, if an official designated by the Secretary—
    • (A) has determined that the eligible entity or provider failed to comply substantially with the provisions of the Veterans Care Agreement, or with the provisions of this section or regulations prescribed under this section;
    • (B) has determined the eligible entity or provider is excluded from participation in a Federal health care program under section 1128 or section 1128A of the Social Security Act ( 42 U.S.C. 1320a–7 or 1320a–7a) or is identified on the System for Award Management Exclusions list as provided in part 9 of title 48, Code of Federal Regulations, and part 180 of title 2 of such Code, or successor regulations;
    • (C) has ascertained that the eligible entity or provider has been convicted of a felony or other serious offense under Federal or State law and determines the eligible entity or provider’s continued participation would be detrimental to the best interests of covered individuals or the Department; or
    • (D) has determined that it is reasonable to terminate the agreement based on the health care needs of a covered individual.
• (g) The Secretary shall establish a system or systems for monitoring the quality of care provided to covered individuals through Veterans Care Agreements and for assessing the quality of hospital care, medical services, and extended care services furnished by eligible entities and providers before the renewal of Veterans Care Agreements.
• (h)
  • (1) The Secretary shall promulgate administrative procedures for eligible entities and providers to present all disputes arising under or related to Veterans Care Agreements.
  • (2) Such procedures constitute the eligible entities’ and providers’ exhaustive and exclusive administrative remedies.
  • (3) Eligible entities or providers must first exhaust such administrative procedures before seeking any judicial review under section 1346 of title 28 (known as the “Tucker Act”).
  • (4) Disputes under this section must pertain to either the scope of authorization under the Veterans Care Agreement or claims for payment subject to the Veterans Care Agreement and are not claims for the purposes of such laws that would otherwise require application of sections 7101 through 7109 of title 41.
• (i)
  • (1) A Veterans Care Agreement may be authorized by the Secretary or any Department official authorized by the Secretary, and such action shall not be treated as—
    • (A) an award for the purposes of such laws that would otherwise require the use of competitive procedures for the furnishing of care and services; or
    • (B) a Federal contract for the acquisition of goods or services for purposes of any provision of Federal law governing Federal contracts for the acquisition of goods or services except section 4706(d) of title 41 .
  • (2)
    • (A) Except as provided in the agreement itself, in subparagraph (B), and unless otherwise provided in this section or regulations prescribed pursuant to this section, an eligible entity or provider that enters into an agreement under this section is not subject to, in the carrying out of the agreement, any law to which providers of services and suppliers under the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq.) are not subject.
    • (B) An eligible entity or provider that enters into an agreement under this section is subject to—
      • (i) all laws regarding integrity, ethics, or fraud, or that subject a person to civil or criminal penalties; and
      • (ii) all laws that protect against employment discrimination or that otherwise ensure equal employment opportunities.
  • (3) Notwithstanding paragraph (2)(B)(i), an eligible entity or provider that enters into an agreement under this section shall not be treated as a Federal contractor or subcontractor for purposes of chapter 67 of title 41 (commonly known as the “McNamara-O’Hara Service Contract Act of 1965”).
• (j) Eligibility for hospital care, medical services, and extended care services furnished to any covered individual pursuant to a Veterans Care Agreement shall be subject to the same terms as though provided in a facility of the Department, and provisions of this chapter applicable to covered individuals receiving such care and services in a facility of the Department shall apply to covered individuals treated under this section.
• (k) The Secretary shall promulgate regulations to carry out this section.
• (l) In this section, the term “covered individual” means any individual eligible for hospital care, medical services, or extended care services under this title or any other law administered by the Secretary.

§ 1703B. Access standards

• (a)
  • (1) The Secretary shall establish access standards for furnishing hospital care, medical services, or extended care services to covered veterans for the purposes of section 1703(d).
  • (2) The Secretary shall ensure that the access standards established under paragraph (1) define such categories of care to cover all care and services within the medical benefits package of the Department of Veterans Affairs.
• (b) The Secretary shall ensure that the access standards provide covered veterans, employees of the Department, and health care providers in the network established under section 1703(h) with relevant comparative information that is clear, useful, and timely, so that covered veterans can make informed decisions regarding their health care.
• (c) The Secretary shall consult with all pertinent Federal entities (including the Department of Defense, the Department of Health and Human Services, and the Centers for Medicare & Medicaid Services), entities in the private sector, and other nongovernmental entities in establishing access standards.
• (d)
  • (1) Not later than 270 days after the date of the enactment of the Caring for Our Veterans Act of 2018, the Secretary shall submit to the appropriate committees of Congress a report detailing the access standards.
  • (2)
    • (A) Before submitting the report required under paragraph (1), the Secretary shall provide periodic updates to the appropriate committees of Congress to confirm the Department’s progress towards developing the access standards required by this section.
    • (B) The first update under subparagraph (A) shall occur no later than 120 days from the date of the enactment of the Caring for Our Veterans Act of 2018.
  • (3) Not later than 540 days after the date on which the Secretary implements the access standards established under subsection (a), the Secretary shall submit to the appropriate committees of Congress a report detailing the implementation of and compliance with such access standards by Department and non-Department entities or providers.
• (e) Not later than 3 years after the date on which the Secretary establishes access standards under subsection (a) and not less frequently than once every 3 years thereafter, the Secretary shall—
  • (1) conduct a review of such standards; and
  • (2) submit to the appropriate committees of Congress a report on the findings and any modification to the access standards with respect to the review conducted under paragraph (1).
• (f) The Secretary shall ensure health care providers specified under section 1703(c) are able to comply with the applicable access standards established by the Secretary.
• (g) The Secretary shall publish in the Federal Register and on an internet website of the Department the designated access standards established under this section for purposes of section 1703(d)(1)(D).
• (h)
  • (1) Consistent with paragraphs (1)(D) and (3) of section 1703(d), covered veterans may contact the Department at any time to request a determination regarding whether they are eligible to receive care and services from a non-Department entity or provider based on the Department being unable to furnish such care and services in a manner that complies with the designated access standards established under this section.
  • (2) The Secretary shall establish a process to review such requests from covered veterans to determine whether—
    • (A) the requested care is clinically necessary; and
    • (B) the Department is able to provide such care in a manner that complies with designated access standards established under this section.
  • (3) The Secretary shall promptly respond to any such request by a covered veteran.
• (i) 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 “covered veterans” means veterans described in section 1703(b) of this title .

§ 1703C. Standards for quality

• (a)
  • (1) The Secretary shall establish standards for quality regarding hospital care, medical services, and extended care services furnished by the Department pursuant to this title, including through non-Department health care providers pursuant to section 1703 of this title .
  • (2) In establishing standards for quality under paragraph (1), the Secretary shall consider existing health quality measures that are applied to public and privately sponsored health care systems with the purpose of providing covered veterans relevant comparative information to make informed decisions regarding their health care.
  • (3) The Secretary shall collect and consider data for purposes of establishing the standards under paragraph (1). Such data collection shall include—
    • (A) after consultation with veterans service organizations and other key stakeholders on survey development or modification of an existing survey, a survey of veterans who have used hospital care, medical services, or extended care services furnished by the Veterans Health Administration during the most recent 2-year period to assess the satisfaction of the veterans with service and quality of care; and
    • (B) datasets that include, at a minimum, elements relating to the following:
      • (i) Timely care.
      • (ii) Effective care.
      • (iii) Safety, including, at a minimum, complications, readmissions, and deaths.
      • (iv) Efficiency.
  • (4) The Secretary shall consult with all pertinent Federal entities (including the Department of Defense, the Department of Health and Human Services, and the Centers for Medicare & Medicaid Services), entities in the private sector, and other nongovernmental entities in establishing standards for quality.
  • (5)
    • (A) Not later than 270 days after the date of the enactment of the Caring for Our Veterans Act of 2018, the Secretary shall submit to the appropriate committees of Congress a report detailing the standards for quality.
    • (B)
      • (i) Before submitting the report required under subparagraph (A), the Secretary shall provide periodic updates to the appropriate committees of Congress to confirm the Department’s progress towards developing the standards for quality required by this section.
      • (ii) The first update under clause (i) shall occur no later than 120 days from the date of the enactment of the Caring for Our Veterans Act of 2018.
• (b)
  • (1) Not later than 1 year after the date on which the Secretary establishes standards for quality under subsection (a), the Secretary shall publish the quality rating of medical facilities of the Department in the publicly available Hospital Compare website through the Centers for Medicare & Medicaid Services for the purpose of providing veterans with information that allows them to compare performance measure information among Department and non-Department health care providers.
  • (2) Not later than 2 years after the date on which the Secretary establishes standards for quality under subsection (a), the Secretary shall consider and solicit public comment on potential changes to the measures used in such standards to ensure that they include the most up-to-date and applicable industry measures for veterans.
• (c) 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 “covered veterans” means veterans described in section 1703(b) of this title .

§ 1703D. Prompt payment standard

• (a)
  • (1) Notwithstanding any other provision of this title or of any other provision of law, the Secretary shall pay for hospital care, medical services, or extended care services furnished by health care entities or providers under this chapter within 45 calendar days upon receipt of a clean paper claim or 30 calendar days upon receipt of a clean electronic claim.
  • (2) If a claim is denied, the Secretary shall, within 45 calendar days of denial for a paper claim and 30 calendar days of denial for an electronic claim, notify the health care entity or provider of the reason for denying the claim and what, if any, additional information is required to process the claim.
  • (3) Upon the receipt of the additional information, the Secretary shall ensure that the claim is paid, denied, or otherwise adjudicated within 30 calendar days from the receipt of the requested information.
  • (4) This section shall only apply to payments made on an invoice basis and shall not apply to capitation or other forms of periodic payment to entities or providers.
• (b) A health care entity or provider that furnishes hospital care, a medical service, or an extended care service under this chapter shall submit to the Secretary a claim for payment for furnishing the hospital care, medical service, or extended care service not later than 180 days after the date on which the entity or provider furnished the hospital care, medical service, or extended care service.
• (c)
  • (1) Sections 3729 through 3733 of title 31 shall apply to fraudulent claims for payment submitted to the Secretary by a health care entity or provider under this chapter.
  • (2) Pursuant to regulations prescribed by the Secretary, the Secretary shall bar a health care entity or provider from furnishing hospital care, medical services, and extended care services under this chapter when the Secretary determines the entity or provider has submitted to the Secretary fraudulent health care claims for payment by the Secretary.
• (d)
  • (1) Any claim that has not been denied with notice, made pending with notice, or paid to the health care entity or provider by the Secretary shall be overdue if the notice or payment is not received by the entity provider within the time periods specified in subsection (a).
  • (2)
    • (A) If a claim is overdue under this subsection, the Secretary may, under the requirements established by subsection (a) and consistent with the provisions of chapter 39 of title 31 (commonly referred to as the “Prompt Payment Act”), require that interest be paid on clean claims.
    • (B) Interest paid under subparagraph (A) shall be computed at the rate of interest established by the Secretary of the Treasury under section 3902 of title 31 and published in the Federal Register.
  • (3) Not less frequently than annually, the Secretary shall submit to Congress a report on payment of overdue claims under this subsection, disaggregated by paper and electronic claims, that includes the following:
    • (A) The amount paid in overdue claims described in this subsection, disaggregated by the amount of the overdue claim and the amount of interest paid on such overdue claim.
    • (B) The number of such overdue claims and the average number of days late each claim was paid, disaggregated by facility of the Department and Veterans Integrated Service Network region.
• (e)
  • (1) The Secretary may deduct the amount of any overpayment from payments due a health care entity or provider under this chapter and may use any other means authorized by another provision of law to correct or recover overpayments.
  • (2) Deductions may not be made under this subsection unless the Secretary has made reasonable efforts to notify a health care entity or provider of the right to dispute the existence or amount of such indebtedness and the right to request a compromise of such indebtedness.
  • (3) The Secretary shall make a determination with respect to any such dispute or request prior to deducting any overpayment unless the time required to make such a determination before making any deductions would jeopardize the Secretary’s ability to recover the full amount of such indebtedness.
• (f)
  • (1) The Secretary shall provide to all health care entities and providers participating in a program to furnish hospital care, medical services, or extended care services under this chapter a list of information and documentation that is required to establish a clean claim under this section.
  • (2) The Secretary shall consult with entities in the health care industry, in the public and private sector, to determine the information and documentation to include in the list under paragraph (1).
  • (3) If the Secretary modifies the information and documentation included in the list under paragraph (1), the Secretary shall notify all health care entities and providers described in paragraph (1) not later than 30 days before such modifications take effect.
• (g)
  • (1) In processing a claim for compensation for hospital care, medical services, or extended care services furnished by a non-Department health care entity or provider under this chapter, the Secretary may act through—
    • (A) a non-Department entity that is under contract or agreement for the program established under section 1703(a) of this title ; or
    • (B) a non-Department entity that specializes in such processing for other Federal agency health care systems.
  • (2) The Secretary shall seek to contract with a third party to conduct a review of claims described in paragraph (3) that includes—
    • (A) a feasibility assessment to determine the capacity of the Department to process such claims in a timely manner; and
    • (B) a cost benefit analysis comparing the capacity of the Department to a third party entity capable of processing such claims.
  • (3) The review required under paragraph (2) shall apply to claims for hospital care, medical services, or extended care services furnished under section 1703 of this title that are processed by the Department.
• (h)
  • (1) Not later than 90 days after the date of the enactment of the Caring for Our Veterans Act of 2018, the Secretary shall submit to the appropriate committees of Congress a report on the feasibility and advisability of adopting a funding mechanism similar to what is utilized by other Federal agencies to allow a contracted entity to act as a fiscal intermediary for the Federal Government to distribute, or pass through, Federal Government funds for certain non-underwritten hospital care, medical services, or extended care services.
  • (2) The Secretary may coordinate with the Department of Defense, the Department of Health and Human Services, and the Department of the Treasury in developing the report required by paragraph (1).
• (i) 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 “clean electronic claim” means the transmission of data for purposes of payment of covered health care expenses that is submitted to the Secretary which contains substantially all of the required data elements necessary for accurate adjudication, without obtaining additional information from the entity or provider that furnished the care or service, submitted in such format as prescribed by the Secretary in regulations for the purpose of paying claims for care or services.
  • (3) The term “clean paper claim” means a paper claim for payment of covered health care expenses that is submitted to the Secretary which contains substantially all of the required data elements necessary for accurate adjudication, without obtaining additional information from the entity or provider that furnished the care or service, submitted in such format as prescribed by the Secretary in regulations for the purpose of paying claims for care or services.
  • (4) The term “fraudulent claims” means the knowing misrepresentation of a material fact or facts by a health care entity or provider made to induce the Secretary to pay a claim that was not legally payable to that provider.
  • (5) The term “health care entity or provider” includes any non-Department health care entity or provider, but does not include any Federal health care entity or provider.

§ 1703E. Center for Innovation for Care and Payment

• (a)
  • (1) There is established within the Department a Center for Innovation for Care and Payment (in this section referred to as the “Center”).
  • (2) The Secretary, acting through the Center, may carry out such pilot programs the Secretary determines to be appropriate to develop innovative approaches to testing payment and service delivery models in order to reduce expenditures while preserving or enhancing the quality of care furnished by the Department.
  • (3) The Secretary, acting through the Center, shall test payment and service delivery models to determine whether such models—
    • (A) improve access to, and quality, timeliness, and patient satisfaction of care and services; and
    • (B) create cost savings for the Department.
  • (4)
    • (A) The Secretary shall test a model in a location where the Secretary determines that the model will addresses 1 1 So in original. deficits in care (including poor clinical outcomes or potentially avoidable expenditures) for a defined population.
    • (B) The Secretary shall focus on models the Secretary expects to reduce program costs while preserving or enhancing the quality of care received by individuals receiving benefits under this chapter.
    • (C) The models selected may include those described in section 1115A(b)(2)(B) of the Social Security Act ( 42 U.S.C. 1315a(b)(2)(B) ).
  • (5) In selecting a model for testing, the Secretary may consider, in addition to other factors identified in this subsection, the following factors:
    • (A) Whether the model includes a regular process for monitoring and updating patient care plans in a manner that is consistent with the needs and preferences of individuals receiving benefits under this chapter.
    • (B) Whether the model places the individual receiving benefits under this chapter (including family members and other caregivers of such individual) at the center of the care team of such individual.
    • (C) Whether the model uses technology or new systems to coordinate care over time and across settings.
    • (D) Whether the model demonstrates effective linkage with other public sector payers, private sector payers, or statewide payment models.
  • (6)
    • (A) Models tested under this section may not be designed in such a way that would allow the United States to recover or collect reasonable charges from a Federal health care program for care or services furnished by the Secretary to a veteran under pilot programs carried out under this section.
    • (B) In this paragraph, the term “Federal health care program” means—
      • (i) an insurance program described in section 1811 of the Social Security Act ( 42 U.S.C. 1395c ) or established by section 1831 of such Act ( 42 U.S.C. 1395j );
      • (ii) a State plan for medical assistance approved under title XIX of such Act ( 42 U.S.C. 1396 et seq.); or
      • (iii) a TRICARE program operated under sections 1075, 1075a, 1076, 1076a, 1076c, 1076d, 1076e, or 1076f of title 10.
• (b) Each pilot program carried out by the Secretary under this section shall terminate no later than 5 years after the date of the commencement of the pilot program.
• (c) The Secretary shall ensure that each pilot program carried out under this section occurs in an area or areas appropriate for the intended purposes of the pilot program. To the extent practicable, the Secretary shall ensure that the pilot programs are located in geographically diverse areas of the United States.
• (d) Funding for each pilot program carried out by the Secretary under this section shall come from appropriations—
  • (1) provided in advance in appropriations acts for the Veterans Health Administration; and
  • (2) provided for information technology systems.
• (e) The Secretary shall—
  • (1) publish information about each pilot program under this section in the Federal Register; and
  • (2) take reasonable actions to provide direct notice to veterans eligible to participate in such pilot programs.
• (f)
  • (1) Subject to reporting under paragraph (2) and approval under paragraph (3), in implementing a pilot program under this section, the Secretary may waive such requirements in subchapters I, II, and III of this chapter as the Secretary determines necessary solely for the purposes of carrying out this section with respect to testing models described in subsection (a).
  • (2) Before waiving any authority under paragraph (1), the Secretary shall submit to the Speaker of the House of Representatives, the minority leader of the House of Representatives, the majority leader of the Senate, the minority leader of the Senate, and each standing committee with jurisdiction under the rules of the Senate and of the House of Representatives to report a bill to amend the provision or provisions of law that would be waived by the Department, a report on a request for waiver that describes in detail the following:
    • (A) The specific authorities to be waived under the pilot program.
    • (B) The standard or standards to be used in the pilot program in lieu of the waived authorities.
    • (C) The reasons for such waiver or waivers.
    • (D) A description of the metric or metrics the Secretary will use to determine the effect of the waiver or waivers upon the access to and quality, timeliness, or patient satisfaction of care and services furnished through the pilot program.
    • (E) The anticipated cost savings, if any, of the pilot program.
    • (F) The schedule for interim reports on the pilot program describing the results of the pilot program so far and the feasibility and advisability of continuing the pilot program.
    • (G) The schedule for the termination of the pilot program and the submission of a final report on the pilot program describing the result of the pilot program and the feasibility and advisability of making the pilot program permanent.
    • (H) The estimated budget of the pilot program.
  • (3)
    • (A) Upon receipt of a report submitted under paragraph (2), each House of Congress shall provide copies of the report to the chairman and ranking member of each standing committee with jurisdiction under the rules of the House of Representatives or the Senate to report a bill to amend the provision or provisions of law that would be waived by the Department under this subsection.
    • (B) The waiver requested by the Secretary under paragraph (2) shall be considered approved under this paragraph if there is enacted into law a joint resolution approving such request in its entirety.
    • (C) For purposes of this paragraph, the term “joint resolution” means only a joint resolution which is introduced within the period of five legislative days beginning on the date on which the Secretary transmits the report to the Congress under such paragraph (2), and—
      • (i) which does not have a preamble; and
      • (ii) the matter after the resolving clause of which is as follows: “that Congress approves the request for a waiver under section 1703E(f) of title 38 , United States Code, as submitted by the Secretary on __________”, the blank space being filled with the appropriate date.
    • (D)
      • (i) Any committee of the House of Representatives to which a joint resolution is referred shall report it to the House without amendment not later than 15 legislative days after the date of introduction thereof. If a committee fails to report the joint resolution within that period, the committee shall be discharged from further consideration of the joint resolution.
      • (ii) It shall be in order at any time after the third legislative day after each committee authorized to consider a joint resolution has reported or has been discharged from consideration of a joint resolution, to move to proceed to consider the joint resolution in the House. All points of order against the motion are waived. Such a motion shall not be in order after the House has disposed of a motion to proceed on a joint resolution addressing a particular submission. The previous question shall be considered as ordered on the motion to its adoption without intervening motion. The motion shall not be debatable. A motion to reconsider the vote by which the motion is disposed of shall not be in order.
      • (iii) The joint resolution shall be considered as read. All points of order against the joint resolution and against its consideration are waived. The previous question shall be considered as ordered on the joint resolution to its passage without intervening motion except two hours of debate equally divided and controlled by the proponent and an opponent. A motion to reconsider the vote on passage of the joint resolution shall not be in order.
    • (E)
      • (i) A joint resolution introduced in the Senate shall be referred to the Committee on Veterans’ Affairs.
      • (ii) Any committee of the Senate to which a joint resolution is referred shall report it to the Senate without amendment not later than 15 session days after the date of introduction of a joint resolution described in paragraph (C). If a committee fails to report the joint resolution within that period, the committee shall be discharged from further consideration of the joint resolution and the joint resolution shall be placed on the calendar.
      • (iii)
        • (I) Notwithstanding Rule XXII of the Standing Rules of the Senate, it is in order at any time after the third session day on which the Committee on Veterans’ Affairs has reported or has been discharged from consideration of a joint resolution described in paragraph (C) (even though a previous motion to the same effect has been disagreed to) to move to proceed to the consideration of the joint resolution, and all points of order against the joint resolution (and against consideration of the joint resolution) are waived. The motion to proceed is not debatable. The motion is not subject to a motion to postpone. A motion to reconsider the vote by which the motion is agreed to or disagreed to shall not be in order. If a motion to proceed to the consideration of the resolution is agreed to, the joint resolution shall remain the unfinished business until disposed of.
        • (II) Consideration of the joint resolution, and on all debatable motions and appeals in connection therewith, shall be limited to not more than two hours, which shall be divided equally between the majority and minority leaders or their designees. A motion further to limit debate is in order and not debatable. An amendment to, or a motion to postpone, or a motion to proceed to the consideration of other business, or a motion to recommit the joint resolution is not in order.
        • (III) If the Senate has voted to proceed to a joint resolution, the vote on passage of the joint resolution shall occur immediately following the conclusion of consideration of the joint resolution, and a single quorum call at the conclusion of the debate if requested in accordance with the rules of the Senate.
        • (IV) Appeals from the decisions of the Chair relating to the application of the rules of the Senate, as the case may be, to the procedure relating to a joint resolution shall be decided without debate.
    • (F) A joint resolution considered pursuant to this paragraph shall not be subject to amendment in either the House of Representatives or the Senate.
    • (G)
      • (i) If, before the passage by one House of the joint resolution of that House, that House receives the joint resolution from the other House, then the following procedures shall apply:
        • (I) The joint resolution of the other House shall not be referred to a committee.
        • (II) With respect to the joint resolution of the House receiving the joint resolution—
      • (ii) If the Senate fails to introduce or consider a joint resolution under this paragraph, the joint resolution of the House shall be entitled to expedited floor procedures under this subparagraph.
      • (iii) If, following passage of the joint resolution in the Senate, the Senate then receives the companion measure from the House of Representatives, the companion measure shall not be debatable.
    • (H) This subparagraph is enacted by Congress—
      • (i) as an exercise of the rulemaking power of the Senate and House of Representatives, respectively, and as such it is deemed a part of the rules of each House, respectively, but applicable only with respect to the procedure to be followed in that House in the case of a joint resolution, and it supersedes other rules only to the extent that it is inconsistent with such rules; and
      • (ii) with full recognition of the constitutional right of either House to change the rules (so far as relating to the procedure of that House) at any time, in the same manner, and to the same extent as in the case of any other rule of that House.
• (g)
  • (1) The Secretary may not carry out more than 10 pilot programs concurrently.
  • (2)
    • (A) Subject to subparagraph (B), the Secretary may not expend more than $50,000,000 in any fiscal year from amounts under subsection (d).
    • (B) The Secretary may expend more than the amount in subparagraph (A) if—
      • (i) the Secretary determines that the additional expenditure is necessary to carry out pilot programs under this section;
      • (ii) the Secretary submits to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report setting forth the amount of the additional expenditure and a justification for the additional expenditure; and
      • (iii) the Chairmen of the Committees on Veterans’ Affairs of the Senate and the House of Representatives transmit to the Secretary a letter approving of the additional expenditure.
  • (3) The waiver provisions in subsection (f) shall not apply unless the Secretary, in accordance with the requirements in subsection (f), submits the first proposal for a pilot program not later than 18 months after the date of the enactment of the Caring for Our Veterans Act of 2018.
  • (4) Notwithstanding section 502 of this title , decisions by the Secretary under this section shall, consistent with section 511 of this title , be final and conclusive and may not be reviewed by any other official or by any court, whether by an action in the nature of mandamus or otherwise.
  • (5)
    • (A) If the Secretary determines that a pilot program is not improving the quality of care or producing cost savings, the Secretary shall—
      • (i) propose a modification to the pilot program in the interim report that shall also be considered a report under subsection (f)(2) and shall be subject to the terms and conditions of subsection (f)(2); or
      • (ii) terminate such pilot program not later than 30 days after submitting the interim report to Congress.
    • (B) If the Secretary terminates a pilot program under subparagraph (A)(ii), for purposes of subparagraphs (F) and (G) of subsection (f)(2), such interim report will also serve as the final report for that pilot program.
• (h)
  • (1) The Secretary shall conduct an evaluation of each model tested, which shall include, at a minimum, an analysis of—
    • (A) the quality of care furnished under the model, including the measurement of patient-level outcomes and patient-centeredness criteria determined appropriate by the Secretary; and
    • (B) the changes in spending by reason of that model.
  • (2) The Secretary shall make the results of each evaluation under this subsection available to the public in a timely fashion and may establish requirements for other entities participating in the testing of models under this section to collect and report information that the Secretary determines is necessary to monitor and evaluate such models.
• (i)
  • (1) The Secretary shall obtain advice from the Under Secretary for Health and the Special Medical Advisory Group established pursuant to section 7312 of this title in the development and implementation of any pilot program operated under this section.
  • (2) In carrying out the duties under this section, the Secretary shall consult representatives of relevant Federal agencies, and clinical and analytical experts with expertise in medicine and health care management. The Secretary shall use appropriate mechanisms to seek input from interested parties.
• (j) Taking into account the evaluation under subsection (f), the Secretary may, through rulemaking, expand (including implementation on a nationwide basis) the duration and the scope of a model that is being tested under subsection (a) to the extent determined appropriate by the Secretary, if—
  • (1) the Secretary determines that such expansion is expected to—
    • (A) reduce spending without reducing the quality of care; or
    • (B) improve the quality of patient care without increasing spending; and
  • (2) the Secretary determines that such expansion would not deny or limit the coverage or provision of benefits for individuals receiving benefits under this chapter.

§ 1704. Preventive health services: annual report

Not later than October 31 each year, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives a report on preventive health services. Each such report shall include the following:

• (1) A description of the programs and activities of the Department with respect to preventive health services during the preceding fiscal year, including a description of the following:
  • (A) The programs conducted by the Department—
    • (i) to educate veterans with respect to health promotion and disease prevention;
    • (ii) to provide veterans with preventive health screenings and other clinical services, with such description setting forth the types of resources used by the Department to conduct such screenings and services and the number of veterans reached by such screenings and services; and
    • (iii) to provide veterans each immunization on the recommended adult immunization schedule at the time such immunization is indicated on that schedule.
  • (B) The means by which the Secretary addressed the specific preventive health services needs of particular groups of veterans (including veterans with service-connected disabilities, elderly veterans, low-income veterans, women veterans, institutionalized veterans, and veterans who are at risk for mental illness).
  • (C) The manner in which the provision of such services was coordinated with the activities of the Medical and Prosthetic Research Service of the Department and the National Center for Preventive Health.
  • (D) The manner in which the provision of such services was integrated into training programs of the Department, including initial and continuing medical training of medical students, residents, and Department staff.
  • (E) The manner in which the Department participated in cooperative preventive health efforts with other governmental and private entities (including State and local health promotion offices and not-for-profit organizations).
  • (F) The specific research carried out by the Department with respect to the long-term relationships among screening activities, treatment, and morbidity and mortality outcomes.
  • (G) The cost effectiveness of such programs and activities, including an explanation of the means by which the costs and benefits (including the quality of life of veterans who participate in such programs and activities) of such programs and activities are measured.
• (2) A specific description of research activities on preventive health services carried out during that period using employees, funds, equipment, office space, or other support services of the Department, with such description setting forth—
  • (A) the source of funds for those activities;
  • (B) the articles or publications (including the authors of the articles and publications) in which those activities are described;
  • (C) the Federal, State, or local governmental entity or private entity, if any, with which such activities were carried out; and
  • (D) the clinical, research, or staff education projects for which funding applications were submitted (including the source of the funds applied for) and upon which a decision is pending or was denied.
• (3) An accounting of the expenditure of funds during that period by the National Center for Preventive Health under section 7318 of this title .

§ 1705. Management of health care: patient enrollment system

• (a) In managing the provision of hospital care and medical services under section 1710(a) of this title , the Secretary, in accordance with regulations the Secretary shall prescribe, shall establish and operate a system of annual patient enrollment. The Secretary shall manage the enrollment of veterans in accordance with the following priorities, in the order listed:
  • (1) Veterans with service-connected disabilities rated 50 percent or greater and veterans who were awarded the medal of honor under section 7271, 8291, or 9271 of title 10 or section 491 1 1 See References in Text note below. of title 14.
  • (2) Veterans with service-connected disabilities rated 30 percent or 40 percent.
  • (3) Veterans who are former prisoners of war or who were awarded the Purple Heart, veterans with service-connected disabilities rated 10 percent or 20 percent, and veterans described in subparagraphs (B) and (C) of section 1710(a)(2) of this title .
  • (4) Veterans who are in receipt of increased pension based on a need of regular aid and attendance or by reason of being permanently housebound and other veterans who are catastrophically disabled.
  • (5) Veterans not covered by paragraphs (1) through (4) who are unable to defray the expenses of necessary care as determined under section 1722(a) of this title .
  • (6) All other veterans eligible for hospital care, medical services, and nursing home care under section 1710(a)(2) of this title .
  • (7) Veterans described in section 1710(a)(3) of this title who are eligible for treatment as a low-income family under section 3(b) of the United States Housing Act of 1937 ( 42 U.S.C. 1437a(b) ) for the area in which such veterans reside, regardless of whether such veterans are treated as single person families under paragraph (3)(A) of such section 3(b) or as families under paragraph (3)(B) of such section 3(b).
  • (8) Veterans described in section 1710(a)(3) of this title who are not covered by paragraph (7).
• (b) In the design of an enrollment system under subsection (a), the Secretary—
  • (1) shall ensure that the system will be managed in a manner to ensure that the provision of care to enrollees is timely and acceptable in quality;
  • (2) may establish additional priorities within each priority group specified in subsection (a), as the Secretary determines necessary; and
  • (3) may provide for exceptions to the specified priorities where dictated by compelling medical reasons.
• (c)
  • (1) The Secretary may not provide hospital care or medical services to a veteran under paragraph (2) or (3) of section 1710(a) of this title unless the veteran enrolls in the system of patient enrollment established by the Secretary under subsection (a).
  • (2) The Secretary shall provide hospital care and medical services under section 1710(a)(1) of this title , and under subparagraph (B) of section 1710(a)(2) of this title , for the 12-month period following such veteran’s discharge or release from service, to any veteran referred to in such sections for a disability specified in the applicable subparagraph of such section, notwithstanding the failure of the veteran to enroll in the system of patient enrollment referred to in subsection (a) of this section.

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

• (a)
  • (1) Any individual who seeks hospital care or medical services under this chapter shall provide to the Secretary such current information as the Secretary may require to identify any health-plan contract under which such individual is covered.
  • (2) The information required to be provided to the Secretary under paragraph (1) with respect to a health-plan contract shall include, as applicable, the following:
    • (A) The name of the entity providing coverage under the health-plan contract.
    • (B) If coverage under the health-plan contract is in the name of an individual other than the individual required to provide information under this section, the name of the policy holder of the health-plan contract.
    • (C) The identification number for the health-plan contract.
    • (D) The group code for the health-plan contract.
• (b) The Secretary may take such action as the Secretary considers appropriate to collect the information required under subsection (a).
• (c) The Secretary may not deny any services under this chapter to an individual solely due to the fact that the individual fails to provide information required under subsection (a).
• (d) In this section, the term “health-plan contract” has the meaning given that term in section 1725(f) of this title .

§ 1706. Management of health care: other requirements

• (a) In managing the provision of hospital care and medical services under section 1710(a) of this title , the Secretary shall, to the extent feasible, design, establish and manage health care programs in such a manner as to promote cost-effective delivery of health care services in the most clinically appropriate setting.
• (b)
  • (1) In managing the provision of hospital care and medical services under such section, the Secretary shall ensure that the Department (and each geographic service area of the Veterans Health Administration) maintains its capacity to provide for the specialized treatment and rehabilitative needs of disabled veterans (including veterans with spinal cord dysfunction, blindness, amputations, and mental illness) within distinct programs or facilities of the Department that are dedicated to the specialized needs of those veterans in a manner that (A) affords those veterans reasonable access to care and services for those specialized needs, and (B) ensures that overall capacity of the Department (and each geographic service area of the Veterans Health Administration) to provide such services is not reduced below the capacity of the Department, nationwide, to provide those services, as of October 9, 1996 . The Secretary shall carry out this paragraph in consultation with the Advisory Committee on Prosthetics and Special Disabilities Programs and the Committee on Care of Severely Chronically Mentally Ill Veterans.
  • (2) For purposes of paragraph (1), the capacity of the Department (and each geographic service area of the Veterans Health Administration) to provide for the specialized treatment and rehabilitative needs of disabled veterans (including veterans with spinal cord dysfunction, traumatic brain injury, blindness, prosthetics and sensory aids, and mental illness) within distinct programs or facilities shall be measured for seriously mentally ill veterans as follows (with all such data to be provided by geographic service area and totaled nationally):
    • (A) For mental health intensive community-based care, the number of discrete intensive care teams constituted to provide such intensive services to seriously mentally ill veterans and the number of veterans provided such care.
    • (B) For opioid substitution programs, the number of patients treated annually and the amounts expended.
    • (C) For dual-diagnosis patients, the number treated annually and the amounts expended.
    • (D) For substance-use disorder programs—
      • (i) the number of beds (whether hospital, nursing home, or other designated beds) employed and the average bed occupancy of such beds;
      • (ii) the percentage of unique patients admitted directly to outpatient care during the fiscal year who had two or more additional visits to specialized outpatient care within 30 days of their first visit, with a comparison from 1996 until the date of the report;
      • (iii) the percentage of unique inpatients with substance-use disorder diagnoses treated during the fiscal year who had one or more specialized clinic visits within three days of their index discharge, with a comparison from 1996 until the date of the report;
      • (iv) the percentage of unique outpatients seen in a facility or geographic service area during the fiscal year who had one or more specialized clinic visits, with a comparison from 1996 until the date of the report; and
      • (v) the rate of recidivism of patients at each specialized clinic in each geographic service area of the Veterans Health Administration.
    • (E) For mental health programs, the number and type of staff that are available at each facility to provide specialized mental health treatment, including satellite clinics, outpatient programs, and community-based outpatient clinics, with a comparison from 1996 to the date of the report.
    • (F) The number of such clinics providing mental health care, the number and type of mental health staff at each such clinic, and the type of mental health programs at each such clinic.
    • (G) The total amounts expended for mental health during the fiscal year.
  • (3) For purposes of paragraph (1), the capacity of the Department (and each geographic service area of the Veterans Health Administration) to provide for the specialized treatment and rehabilitative needs of disabled veterans within distinct programs or facilities shall be measured for veterans with spinal cord dysfunction, traumatic brain injury, blindness, or prosthetics and sensory aids as follows (with all such data to be provided by geographic service area and totaled nationally):
    • (A) For spinal cord injury and dysfunction specialized centers and for blind rehabilitation specialized centers, the number of staffed beds and the number of full-time equivalent employees assigned to provide care at such centers.
    • (B) For prosthetics and sensory aids, the annual amount expended.
    • (C) For traumatic brain injury, the number of patients treated annually and the amounts expended.
  • (4) In carrying out paragraph (1), the Secretary may not use patient outcome data as a substitute for, or the equivalent of, compliance with the requirement under that paragraph for maintenance of capacity.
  • (5)
    • (A) Not later than April 1 of each year, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives a report on the Secretary’s compliance, by facility and by service-network, with the requirements of this subsection. Each such report shall include information on recidivism rates associated with substance-use disorder treatment.
    • (B) In preparing each report under subparagraph (A), the Secretary shall use standardized data and data definitions.
    • (C) Each report under subparagraph (A) shall be audited by the Inspector General of the Department, who shall submit to Congress a certification as to the accuracy of each such report.
  • (6)
    • (A) To ensure compliance with paragraph (1), the Under Secretary for Health shall prescribe objective standards of job performance for employees in positions described in subparagraph (B) with respect to the job performance of those employees in carrying out the requirements of paragraph (1). Those job performance standards shall include measures of workload, allocation of resources, and quality-of-care indicators.
    • (B) Positions described in this subparagraph are positions in the Veterans Health Administration that have responsibility for allocating and managing resources applicable to the requirements of paragraph (1).
    • (C) The Under Secretary shall develop the job performance standards under subparagraph (A) in consultation with the Advisory Committee on Prosthetics and Special Disabilities Programs and the Committee on Care of Severely Chronically Mentally Ill Veterans.
• (c) The Secretary shall ensure that each primary care health care facility of the Department develops and carries out a plan to provide mental health services, either through referral or direct provision of services, to veterans who require such services.

§ 1706A. Remediation of medical service lines

• (a) Not later than 30 days after determining under section 1703(e)(1) of this title that a medical service line of the Department is providing hospital care, medical services, or extended care services that does not comply with the standards for quality established by the Secretary, the Secretary shall submit to Congress an assessment of the factors that led the Secretary to make such determination and a plan with specific actions, and the time to complete them, to be taken to comply with such standards for quality, including the following:
  • (1) Increasing personnel or temporary personnel assistance, including mobile deployment teams.
  • (2) Special hiring incentives, including the Education Debt Reduction Program under subchapter VII of chapter 76 of this title and recruitment, relocation, and retention incentives.
  • (3) Utilizing direct hiring authority.
  • (4) Providing improved training opportunities for staff.
  • (5) Acquiring improved equipment.
  • (6) Making structural modifications to the facility used by the medical service line.
  • (7) Such other actions as the Secretary considers appropriate.
• (b) In each assessment submitted under subsection (a) with respect to a medical service line, the Secretary shall identify the individuals at the Central Office of the Veterans Health Administration, the facility used by the medical service line, and the central office of the relevant Veterans Integrated Service Network who are responsible for overseeing the progress of that medical service line in complying with the standards for quality established by the Secretary.
• (c) Not later than 180 days after submitting an assessment under subsection (a) with respect to a medical service line, the Secretary shall submit to Congress a report on the progress of that medical service line in complying with the standards for quality established by the Secretary and any other measures the Secretary will take to assist the medical service line in complying with such standards for quality.
• (d) Not less frequently than once each year, the Secretary shall—
  • (1) submit to Congress an analysis of the remediation actions and costs of such actions taken with respect to each medical service line with respect to which the Secretary submitted an assessment and plan under subsection (a) in the preceding year, including an update on the progress of each such medical service line in complying with the standards for quality and timeliness established by the Secretary and any other actions the Secretary is undertaking to assist the medical service line in complying with standards for quality as established by the Secretary; and
  • (2) publish such analysis on the internet website of the Department.

§ 1707. Limitations

• (a) Funds appropriated to carry out this chapter may not be used for purposes that are inconsistent with the Assisted Suicide Funding Restriction Act of 1997 ( 42 U.S.C. 14401 et seq.).
• (b) The Secretary may furnish sensori-neural aids only in accordance with guidelines prescribed by the Secretary.

§ 1708. Temporary lodging

• (a) The Secretary may furnish persons described in subsection (b) with temporary lodging in a Fisher house or other appropriate facility in connection with the examination, treatment, or care of a veteran under this chapter or, as provided for under subsection (e)(5), in connection with benefits administered under this title.
• (b) Persons to whom the Secretary may provide lodging under subsection (a) are the following:
  • (1) A veteran who must travel a significant distance to receive care or services under this title.
  • (2) A member of the family of a veteran and others who accompany a veteran and provide the equivalent of familial support for such veteran.
• (c) In this section, the term “Fisher house” means a housing facility that—
  • (1) is located at, or in proximity to, a Department medical facility;
  • (2) is available for residential use on a temporary basis by patients of that facility and others described in subsection (b)(2); and
  • (3) is constructed by, and donated to the Secretary by, the Zachary and Elizabeth M. Fisher Armed Services Foundation.
• (d) The Secretary may establish charges for providing lodging under this section. The proceeds from such charges shall be credited to the medical services account and shall be available until expended for the purposes of providing such lodging.
• (e) The Secretary shall prescribe regulations to carry out this section. Such regulations shall include provisions—
  • (1) limiting the duration of lodging provided under this section;
  • (2) establishing standards and criteria under which charges are established for such lodging under subsection (d);
  • (3) establishing criteria for persons considered to be accompanying a veteran under subsection (b)(2);
  • (4) establishing criteria for the use of the premises of temporary lodging facilities under this section; and
  • (5) establishing any other limitations, conditions, and priorities that the Secretary considers appropriate with respect to lodging under this section.

§ 1709. Comprehensive policy on reporting and tracking sexual assault incidents and other safety incidents

• (a)
  • (1) Not later than September 30, 2012 , the Secretary shall develop and implement a centralized and comprehensive policy on the reporting and tracking of sexual assault incidents and other safety incidents that occur at each medical facility of the Department, including—
    • (A) suspected, alleged, attempted, or confirmed cases of sexual assault, regardless of whether such assaults lead to prosecution or conviction;
    • (B) criminal and purposefully unsafe acts;
    • (C) alcohol or substance abuse related acts (including by employees of the Department); and
    • (D) any kind of event involving alleged or suspected abuse of a patient.
  • (2) In developing and implementing a policy under paragraph (1), the Secretary shall consider the effects of such policy on—
    • (A) the use by veterans of mental health care and substance abuse treatments; and
    • (B) the ability of the Department to refer veterans to such care or treatment.
• (b) The policy required by subsection (a) shall cover each of the following:
  • (1) For purposes of reporting and tracking sexual assault incidents and other safety incidents, definitions of the terms—
    • (A) “safety incident”;
    • (B) “sexual assault”; and
    • (C) “sexual assault incident”.
  • (2)
    • (A) The development and use of specific risk-assessment tools to examine any risks related to sexual assault that a veteran may pose while being treated at a medical facility of the Department, including clear and consistent guidance on the collection of information related to—
      • (i) the legal history of the veteran; and
      • (ii) the medical record of the veteran.
    • (B) In developing and using tools under subparagraph (A), the Secretary shall consider the effects of using such tools on the use by veterans of health care furnished by the Department.
  • (3) The mandatory training of employees of the Department on security issues, including awareness, preparedness, precautions, and police assistance.
  • (4) The mandatory implementation, use, and regular testing of appropriate physical security precautions and equipment, including surveillance camera systems, computer-based panic alarm systems, stationary panic alarms, and electronic portable personal panic alarms.
  • (5) Clear, consistent, and comprehensive criteria and guidance with respect to an employee of the Department communicating and reporting sexual assault incidents and other safety incidents to—
    • (A) supervisory personnel of the employee at—
      • (i) a medical facility of the Department;
      • (ii) an office of a Veterans Integrated Service Network; and
      • (iii) the central office of the Veterans Health Administration; and
    • (B) a law enforcement official of the Department.
  • (6) Clear and consistent criteria and guidelines with respect to an employee of the Department referring and reporting to the Office of Inspector General of the Department sexual assault incidents and other safety incidents that meet the regulatory criminal threshold prescribed under sections 901 and 902 of this title.
  • (7) An accountable oversight system within the Veterans Health Administration that includes—
    • (A) systematic information sharing of reported sexual assault incidents and other safety incidents among officials of the Administration who have programmatic responsibility; and
    • (B) a centralized reporting, tracking, and monitoring system for such incidents.
  • (8) Consistent procedures and systems for law enforcement officials of the Department with respect to investigating, tracking, and closing reported sexual assault incidents and other safety incidents.
  • (9) Clear and consistent guidance for the clinical management of the treatment of sexual assaults that are reported more than 72 hours after the assault.
• (c) The Secretary shall review and revise the policy required by subsection (a) on a periodic basis as the Secretary considers appropriate and in accordance with best practices.
• (d)
  • (1) Not later than 60 days after the date on which the Secretary develops the policy required by subsection (a) and not later than October 1 of each year 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 on the implementation of the policy.
  • (2) The report required by paragraph (1) shall include—
    • (A) the number and type of sexual assault incidents and other safety incidents reported by each medical facility of the Department;
    • (B) a detailed description of the implementation of the policy required by subsection (a), including any revisions made to such policy from the previous year; and
    • (C) the effectiveness of such policy on improving the safety and security of the medical facilities of the Department, including the performance measures used to evaluate such effectiveness.

§ 1709A. Teleconsultation

• (a)
  • (1) The Secretary shall carry out an initiative of teleconsultation for the provision of remote mental health and traumatic brain injury assessments in facilities of the Department that are not otherwise able to provide such assessments without contracting with third-party providers or reimbursing providers through a fee basis system.
  • (2) The Secretary shall, in consultation with appropriate professional societies, promulgate technical and clinical care standards for the use of teleconsultation services within facilities of the Department.
  • (3) In carrying out an initiative under paragraph (1), the Secretary shall ensure that facilities of the Department are able to provide a mental health or traumatic brain injury assessment to a veteran through contracting with a third-party provider or reimbursing a provider through a fee basis system when—
    • (A) such facilities are not able to provide such assessment to the veteran without—
      • (i) such contracting or reimbursement; or
      • (ii) teleconsultation; and
    • (B) providing such assessment with such contracting or reimbursement is more clinically appropriate for the veteran than providing such assessment with teleconsultation.
• (b) In this section, the term “teleconsultation” means the use by a health care specialist of telecommunications to assist another health care provider in rendering a diagnosis or treatment.

§ 1709B. Evaluations of mental health care and suicide prevention programs

• (a)
  • (1) Not less frequently than once during each period specified in paragraph (3), the Secretary shall provide for the conduct of an evaluation of the mental health care and suicide prevention programs carried out under the laws administered by the Secretary.
  • (2) Each evaluation conducted under paragraph (1) shall—
    • (A) use metrics that are common among and useful for practitioners in the field of mental health care and suicide prevention, including metrics applicable specifically to women;
    • (B) identify the most effective mental health care and suicide prevention programs conducted by the Secretary, including such programs conducted at a Center of Excellence;
    • (C) identify the cost-effectiveness of each program identified under subparagraph (B);
    • (D) measure the satisfaction of patients with respect to the care provided under each such program;
    • (E) propose best practices for caring for individuals who suffer from mental health disorders or are at risk of suicide, including such practices conducted or suggested by other departments or agencies of the Federal Government, including the Substance Abuse and Mental Health Services Administration of the Department of Health and Human Services; and
    • (F) identify the mental health care and suicide prevention programs conducted by the Secretary that are most effective for women veterans and such programs with the highest satisfaction rates among women veterans.
  • (3) The periods specified in this paragraph are the following:
    • (A) The period beginning on the date on which the Secretary awards the contract under paragraph (4) and ending on September 30, 2018 .
    • (B) Each fiscal year beginning on or after October 1, 2018 .
  • (4) Not later than 180 days after the date of the enactment of this section, the Secretary shall seek to enter into a contract with an independent third party unaffiliated with the Department of Veterans Affairs to conduct evaluations under paragraph (1).
  • (5) The independent third party that is awarded the contract under paragraph (4) shall submit to the Secretary each evaluation conducted under paragraph (1).
• (b) Not later than December 1, 2018 , and each year 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 that contains the following:
  • (1) The most recent evaluations submitted to the Secretary under subsection (a)(5) that the Secretary has not previously submitted to such Committees.
  • (2) Any recommendations the Secretary considers appropriate.

§ 1710. Eligibility for hospital, nursing home, and domiciliary care

• (a)
  • (1) The Secretary (subject to paragraph (4)) shall furnish hospital care and medical services which the Secretary determines to be needed—
    • (A) to any veteran for a service-connected disability; and
    • (B) to any veteran who has a service-connected disability rated at 50 percent or more.
  • (2) The Secretary (subject to paragraph (4)) shall furnish hospital care and medical services, and may furnish nursing home care, which the Secretary determines to be needed to any veteran—
    • (A) who has a compensable service-connected disability rated less than 50 percent or, with respect to nursing home care during any period during which the provisions of section 1710A(a) of this title are in effect, a compensable service-connected disability rated less than 70 percent;
    • (B) whose discharge or release from active military, naval, or air service was for a disability that was incurred or aggravated in the line of duty;
    • (C) who is in receipt of, or who, but for a suspension pursuant to section 1151 of this title (or both a suspension and the receipt of retired pay), would be entitled to disability compensation, but only to the extent that such veteran’s continuing eligibility for such care is provided for in the judgment or settlement provided for in such section;
    • (D) who is a former prisoner of war, who was awarded the medal of honor under section 7271, 8291, or 9271 of title 10 or section 491 1 1 See References in Text note below. of title 14, or who was awarded the Purple Heart;
    • (E) who is a veteran of the Mexican border period or of World War I;
    • (F) who was exposed to a toxic substance, radiation, or other conditions, as provided in subsection (e); or
    • (G) who is unable to defray the expenses of necessary care as determined under section 1722(a) of this title .
  • (3) In the case of a veteran who is not described in paragraphs (1) and (2), the Secretary may, to the extent resources and facilities are available and subject to the provisions of subsections (f) and (g), furnish hospital care, medical services, and nursing home care which the Secretary determines to be needed.
  • (4) The requirement in paragraphs (1) and (2) that the Secretary furnish hospital care and medical services, the requirement in section 1710A(a) of this title that the Secretary provide nursing home care, the requirement in section 1710B of this title that the Secretary provide a program of extended care services, and the requirement in section 1745 of this title to provide nursing home care and prescription medicines to veterans with service-connected disabilities in State homes shall be effective in any fiscal year only to the extent and in the amount provided in advance in appropriations Acts for such purposes.
  • (5) During any period during which the provisions of section 1710A(a) of this title are not in effect, the Secretary may furnish nursing home care which the Secretary determines is needed to any veteran described in paragraph (1), with the priority for such care on the same basis as if provided under that paragraph.
• (b)
  • (1) The Secretary may furnish to a veteran described in paragraph (2) of this subsection such domiciliary care as the Secretary determines is needed for the purpose of the furnishing of medical services to the veteran.
  • (2) This subsection applies in the case of the following veterans:
    • (A) Any veteran whose annual income (as determined under section 1503 of this title ) does not exceed the maximum annual rate of pension that would be applicable to the veteran if the veteran were eligible for pension under section 1521(d) of this title .
    • (B) Any veteran who the Secretary determines has no adequate means of support.
• (c) While any veteran is receiving hospital care or nursing home care in any Department facility, the Secretary may, within the limits of Department facilities, furnish medical services to correct or treat any non-service-connected disability of such veteran, in addition to treatment incident to the disability for which such veteran is hospitalized, if the veteran is willing, and the Secretary finds such services to be reasonably necessary to protect the health of such veteran. The Secretary may furnish dental services and treatment, and related dental appliances, under this subsection for a non-service-connected dental condition or disability of a veteran only (1) to the extent that the Secretary determines that the dental facilities of the Department to be used to furnish such services, treatment, or appliances are not needed to furnish services, treatment, or appliances for dental conditions or disabilities described in section 1712(a) of this title , or (2) if (A) such non-service-connected dental condition or disability is associated with or aggravating a disability for which such veteran is receiving hospital care, or (B) a compelling medical reason or a dental emergency requires furnishing dental services, treatment, or appliances (excluding the furnishing of such services, treatment, or appliances of a routine nature) to such veteran during the period of hospitalization under this section.
• (d) In no case may nursing home care be furnished in a hospital not under the direct jurisdiction of the Secretary except as provided in section 1720 of this title .
• (e)
  • (1)
    • (A) A Vietnam-era herbicide-exposed veteran is eligible (subject to paragraph (2)) for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any disability, notwithstanding that there is insufficient medical evidence to conclude that such disability may be associated with such exposure.
    • (B) A radiation-exposed veteran is eligible for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any disease suffered by the veteran that is—
      • (i) a disease listed in section 1112(c)(2) of this title ; or
      • (ii) any other disease for which the Secretary, based on the advice of the Advisory Committee on Environmental Hazards, determines that there is credible evidence of a positive association between occurrence of the disease in humans and exposure to ionizing radiation.
    • (C) Subject to paragraph (2) of this subsection, a veteran who served on active duty between August 2, 1990 , and November 11, 1998 , in the Southwest Asia theater of operations during the Persian Gulf War is eligible for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any disability, notwithstanding that there is insufficient medical evidence to conclude that such disability may be associated with such service.
    • (D) Subject to paragraphs (2) and (3), a veteran who served on active duty in a theater of combat operations (as determined by the Secretary in consultation with the Secretary of Defense) during a period of war after the Persian Gulf War, or in combat against a hostile force during a period of hostilities after November 11, 1998 , is eligible for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any illness, notwithstanding that there is insufficient medical evidence to conclude that such condition is attributable to such service.
    • (E) Subject to paragraph (2), a veteran who participated in a test conducted by the Department of Defense Deseret Test Center as part of a program for chemical and biological warfare testing from 1962 through 1973 (including the program designated as “Project Shipboard Hazard and Defense (SHAD)” and related land-based tests) is eligible for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any illness, notwithstanding that there is insufficient medical evidence to conclude that such illness is attributable to such testing.
    • (F) Subject to paragraph (2), a veteran who served on active duty in the Armed Forces at Camp Lejeune, North Carolina, for not fewer than 30 days during the period beginning on August 1, 1953 , and ending on December 31, 1987 , is eligible for hospital care and medical services under subsection (a)(2)(F) for any of the following illnesses or conditions, notwithstanding that there is insufficient medical evidence to conclude that such illnesses or conditions are attributable to such service:
      • (i) Esophageal cancer.
      • (ii) Lung cancer.
      • (iii) Breast cancer.
      • (iv) Bladder cancer.
      • (v) Kidney cancer.
      • (vi) Leukemia.
      • (vii) Multiple myeloma.
      • (viii) Myelodysplastic syndromes.
      • (ix) Renal toxicity.
      • (x) Hepatic steatosis.
      • (xi) Female infertility.
      • (xii) Miscarriage.
      • (xiii) Scleroderma.
      • (xiv) Neurobehavioral effects.
      • (xv) Non-Hodgkin’s lymphoma.
  • (2)
    • (A) In the case of a veteran described in paragraph (1)(A), hospital care, medical services, and nursing home care may not be provided under subsection (a)(2)(F) with respect to—
      • (i) a disability that is found, in accordance with guidelines issued by the Under Secretary for Health, to have resulted from a cause other than an exposure described in paragraph (4)(A)(ii); or
      • (ii) a disease for which the National Academy of Sciences, in a report issued in accordance with section 3 of the Agent Orange Act of 1991, has determined that there is limited or suggestive evidence of the lack of a positive association between occurrence of the disease in humans and exposure to a herbicide agent.
    • (B) In the case of a veteran described in subparagraph (C), (D), (E), or (F) of paragraph (1), hospital care, medical services, and nursing home care may not be provided under subsection (a)(2)(F) with respect to a disability that is found, in accordance with guidelines issued by the Under Secretary for Health, to have resulted from a cause other than the service or testing described in such subparagraph.
  • (3) In the case of care for a veteran described in paragraph (1)(D), hospital care, medical services, and nursing home care may be provided under or by virtue of subsection (a)(2)(F) only during the following periods:
    • (A) Except as provided by subparagraph (B), with respect to a veteran described in paragraph (1)(D) who is discharged or released from the active military, naval, or air service after January 27, 2003 , the five-year period beginning on the date of such discharge or release.
    • (B) With respect to a veteran described in paragraph (1)(D) who is discharged or released from the active military, naval, or air service after January 1, 2009 , and before January 1, 2011 , but did not enroll to receive such hospital care, medical services, or nursing home care pursuant to such paragraph during the five-year period described in subparagraph (A), the one-year period beginning on the date of the enactment of the Clay Hunt Suicide Prevention for American Veterans Act.
    • (C) With respect to a veteran described in paragraph (1)(D) who is discharged or released from the active military, naval, or air service on or before January 27, 2003 , and did not enroll in the patient enrollment system under section 1705 of this title on or before such date, the three-year period beginning on January 27, 2008 .
  • (4) For purposes of this subsection—
    • (A) The term “Vietnam-era herbicide-exposed veteran” means a veteran (i) who served on active duty in the Republic of Vietnam (including offshore of such Republic as described in section 1116A(d) of this title ) during the period beginning on January 9, 1962 , and ending on May 7, 1975 , and (ii) who the Secretary finds may have been exposed during such service to dioxin or was exposed during such service to a toxic substance found in a herbicide or defoliant used for military purposes during such period.
    • (B) The term “radiation-exposed veteran” has the meaning given that term in section 1112(c)(3) of this title .
  • (5) When the Secretary first provides care for veterans using the authority provided in paragraph (1)(D), the Secretary shall establish a system for collection and analysis of information on the general health status and health care utilization patterns of veterans receiving care under that paragraph. Not later than 18 months after first providing care under such authority, the Secretary shall submit to Congress a report on the experience under that authority. The Secretary shall include in the report any recommendations of the Secretary for extension of that authority.
• (f)
  • (1) The Secretary may not furnish hospital care or nursing home care (except if such care constitutes hospice care) under this section to a veteran who is eligible for such care under subsection (a)(3) of this section unless the veteran agrees to pay to the United States the applicable amount determined under paragraph (2) or (4) of this subsection.
  • (2) A veteran who is furnished hospital care or nursing home care under this section and who is required under paragraph (1) of this subsection to agree to pay an amount to the United States in order to be furnished such care shall be liable to the United States for an amount equal to—
    • (A) the lesser of—
      • (i) the cost of furnishing such care, as determined by the Secretary; or
      • (ii) the amount determined under paragraph (3) of this subsection; and
    • (B) before September 30, 2022 , an amount equal to $10 for every day the veteran receives hospital care and $5 for every day the veteran receives nursing home care.
  • (3)
    • (A) In the case of hospital care furnished during any 365-day period, the amount referred to in paragraph (2)(A)(ii) of this subsection is—
      • (i) the amount of the inpatient Medicare deductible, plus
      • (ii) one-half of such amount for each 90 days of care (or fraction thereof) after the first 90 days of such care during such 365-day period.
    • (B) In the case of nursing home care furnished during any 365-day period, the amount referred to in paragraph (2)(A)(ii) of this subsection is the amount of the inpatient Medicare deductible for each 90 days of such care (or fraction thereof) during such 365-day period.
    • (C)
      • (i) Except as provided in clause (ii) of this subparagraph, in the case of a veteran who is admitted for nursing home care under this section after being furnished, during the preceding 365-day period, hospital care for which the veteran has paid the amount of the inpatient Medicare deductible under this subsection and who has not been furnished 90 days of hospital care in connection with such payment, the veteran shall not incur any liability under paragraph (2) of this subsection with respect to such nursing home care until—
        • (I) the veteran has been furnished, beginning with the first day of such hospital care furnished in connection with such payment, a total of 90 days of hospital care and nursing home care; or
        • (II) the end of the 365-day period applicable to the hospital care for which payment was made,
      • (ii) In the case of a veteran who is admitted for nursing home care under this section after being furnished, during any 365-day period, hospital care for which the veteran has paid an amount under subparagraph (A)(ii) of this paragraph and who has not been furnished 90 days of hospital care in connection with such payment, the amount of the liability of the veteran under paragraph (2) of this subsection with respect to the number of days of such nursing home care which, when added to the number of days of such hospital care, is 90 or less, is the difference between the inpatient Medicare deductible and the amount paid under such subparagraph until—
        • (I) the veteran has been furnished, beginning with the first day of such hospital care furnished in connection with such payment, a total of 90 days of hospital care and nursing home care; or
        • (II) the end of the 365-day period applicable to the hospital care for which payment was made,
    • (D) In the case of a veteran who is admitted for hospital care under this section after having been furnished, during the preceding 365-day period, nursing home care for which the veteran has paid the amount of the inpatient Medicare deductible under this subsection and who has not been furnished 90 days of nursing home care in connection with such payment, the veteran shall not incur any liability under paragraph (2) of this subsection with respect to such hospital care until—
      • (i) the veteran has been furnished, beginning with the first day of such nursing home care furnished in connection with such payment, a total of 90 days of nursing home care and hospital care; or
      • (ii) the end of the 365-day period applicable to the nursing home care for which payment was made,
    • (E) A veteran may not be required to make a payment under this subsection for hospital care or nursing home care furnished under this section during any 90-day period in which the veteran is furnished medical services under paragraph (3) of subsection (a) to the extent that such payment would cause the total amount paid by the veteran under this subsection for hospital care and nursing home care furnished during that period and under subsection (g) for medical services furnished during that period to exceed the amount of the inpatient Medicare deductible in effect on the first day of such period.
    • (F) A veteran may not be required to make a payment under this subsection or subsection (g) for any days of care in excess of 360 days of care during any 365-calendar-day period.
  • (4) In the case of a veteran covered by this subsection who is also described by section 1705(a)(7) of this title , the amount for which the veteran shall be liable to the United States for hospital care under this subsection shall be an amount equal to 20 percent of the total amount for which the veteran would otherwise be liable for such care under subparagraphs (2)(B) and (3)(A) but for this paragraph.
  • (5) For the purposes of this subsection, the term “inpatient Medicare deductible” means the amount of the inpatient hospital deductible in effect under section 1813(b) of the Social Security Act ( 42 U.S.C. 1395e(b) ) on the first day of the 365-day period applicable under paragraph (3) of this subsection.
• (g)
  • (1) The Secretary may not furnish medical services (except if such care constitutes hospice care) under subsection (a) of this section (including home health services under section 1717 of this title ) to a veteran who is eligible for hospital care under this chapter by reason of subsection (a)(3) of this section unless the veteran agrees to pay to the United States in the case of each outpatient visit the applicable amount or amounts established by the Secretary by regulation.
  • (2) A veteran who is furnished medical services under subsection (a) of this section and who is required under paragraph (1) of this subsection to agree to pay an amount to the United States in order to be furnished such services shall be liable to the United States, in the case of each visit in which such services are furnished to the veteran, for an amount which the Secretary shall establish by regulation.
  • (3) This subsection does not apply with respect to the following:
    • (A) Home health services under section 1717 of this title to the extent that such services are for improvements and structural alterations.
    • (B) Education on the use of opioid antagonists to reverse the effects of overdoses of specific medications or substances.
• (h) Nothing in this section requires the Secretary to furnish care to a veteran to whom another agency of Federal, State, or local government has a duty under law to provide care in an institution of such government.

§ 1710A. Required nursing home care

• (a) The Secretary (subject to section 1710(a)(4) of this title ) shall provide nursing home care which the Secretary determines is needed (1) to any veteran in need of such care for a service-connected disability, and (2) to any veteran who is in need of such care and who has a service-connected disability rated at 70 percent or more.
• (b)
  • (1) The Secretary shall ensure that a veteran described in subsection (a) who continues to need nursing home care is not, after placement in a Department nursing home, transferred from the facility without the consent of the veteran, or, in the event the veteran cannot provide informed consent, the representative of the veteran.
  • (2) Nothing in subsection (a) may be construed as authorizing or requiring that a veteran who is receiving nursing home care in a Department nursing home on the date of the enactment of this section be displaced, transferred, or discharged from the facility.
• (c) The Secretary shall ensure that nursing home care provided under subsection (a) is provided in an age-appropriate manner.
• (d) The provisions of subsection (a) shall terminate on September 30, 2022 .

§ 1710B. Extended care services

• (a) The Secretary (subject to section 1710(a)(4) of this title and subsection (c) of this section) shall operate and maintain a program to provide extended care services to eligible veterans in accordance with this section. Such services shall include the following:
  • (1) Geriatric evaluation.
  • (2) Nursing home care (A) in facilities operated by the Secretary, and (B) in community-based facilities through contracts under section 1720 of this title .
  • (3) Domiciliary services under section 1710(b) of this title .
  • (4) Adult day health care under section 1720(f) of this title .
  • (5) Such other noninstitutional alternatives to nursing home care as the Secretary may furnish as medical services under section 1701(10) 1 1 See References in Text note below. of this title.
  • (6) Respite care under section 1720B of this title .
• (b) The Secretary shall ensure that the staffing and level of extended care services provided by the Secretary nationally in facilities of the Department during any fiscal year is not less than the staffing and level of such services provided nationally in facilities of the Department during fiscal year 1998.
• (c)
  • (1) Except as provided in paragraph (2), the Secretary may not furnish extended care services for a non-service-connected disability other than in the case of a veteran who has a compensable service-connected disability unless the veteran agrees to pay to the United States a copayment (determined in accordance with subsection (d)) for any period of such services in a year after the first 21 days of such services provided that veteran in that year.
  • (2) Paragraph (1) shall not apply—
    • (A) to a veteran whose annual income (determined under section 1503 of this title ) is less than the amount in effect under section 1521(b) of this title ;
    • (B) to a veteran being furnished hospice care under this section;
    • (C) with respect to an episode of extended care services that a veteran is being furnished by the Department on November 30, 1999 ; or
    • (D) to a veteran who was awarded the medal of honor under section 7271, 8291, or 9271 of title 10 or section 491 1 of title 14.
• (d)
  • (1) A veteran who is furnished extended care services under this chapter and who is required under subsection (c) to pay an amount to the United States in order to be furnished such services shall be liable to the United States for that amount.
  • (2) In implementing subsection (c), the Secretary shall develop a methodology for establishing the amount of the copayment for which a veteran described in subsection (c) is liable. That methodology shall provide for—
    • (A) establishing a maximum monthly copayment (based on all income and assets of the veteran and the spouse of such veteran);
    • (B) protecting the spouse of a veteran from financial hardship by not counting all of the income and assets of the veteran and spouse (in the case of a spouse who resides in the community) as available for determining the copayment obligation; and
    • (C) allowing the veteran to retain a monthly personal allowance.
• (e)
  • (1) There is established in the Treasury of the United States a revolving fund known as the Department of Veterans Affairs Extended Care Fund (hereinafter in this section referred to as the “fund”). Amounts in the fund shall be available, without fiscal year limitation and without further appropriation, exclusively for the purpose of providing extended care services under subsection (a).
  • (2) All amounts received by the Department under this section shall be deposited in or credited to the fund.

§ 1710C. Traumatic brain injury: plans for rehabilitation and reintegration into the community

• (a) The Secretary shall, for each individual who is a veteran or member of the Armed Forces who receives inpatient or outpatient rehabilitative hospital care or medical services provided by the Department for a traumatic brain injury—
  • (1) develop an individualized plan for the rehabilitation and reintegration of the individual into the community with the goal of maximizing the individual’s independence; and
  • (2) provide such plan in writing to the individual—
    • (A) in the case of an individual receiving inpatient care, before the individual is discharged from inpatient care or after the individual’s transition from serving on active duty as a member of the Armed Forces to receiving outpatient care provided by the Department; or
    • (B) as soon as practicable following a diagnosis of traumatic brain injury by a Department health care provider.
• (b) Each plan developed under subsection (a) shall include, for the individual covered by such plan, the following:
  • (1) Rehabilitation objectives for improving (and sustaining improvement in) the physical, cognitive, behavioral, and vocational functioning of the individual with the goal of maximizing the independence and reintegration of such individual into the community.
  • (2) Access, as warranted, to all appropriate rehabilitative services and rehabilitative components of the traumatic brain injury continuum of care, and where appropriate, to long-term care services.
  • (3) A description of specific rehabilitative services and other services to achieve the objectives described in paragraph (1), which shall set forth the type, frequency, duration, and location of such services.
  • (4) The name of the case manager designated in accordance with subsection (d) to be responsible for the implementation of such plan.
  • (5) Dates on which the effectiveness of such plan will be reviewed in accordance with subsection (f).
• (c)
  • (1) Each plan developed under subsection (a) shall be based on a comprehensive assessment, developed in accordance with paragraph (2), of—
    • (A) the physical, cognitive, vocational, and neuropsychological and social impairments of the individual; and
    • (B) the family education and family support needs of the individual after the individual is discharged from inpatient care or at the commencement of and during the receipt of outpatient care and services.
  • (2) The comprehensive assessment required under paragraph (1) with respect to an individual is a comprehensive assessment of the matters set forth in that paragraph by a team, composed by the Secretary for purposes of the assessment, of individuals with expertise in traumatic brain injury, including any of the following:
    • (A) A neurologist.
    • (B) A rehabilitation physician.
    • (C) A social worker.
    • (D) A neuropsychologist.
    • (E) A physical therapist.
    • (F) A vocational rehabilitation specialist.
    • (G) An occupational therapist.
    • (H) A speech language pathologist.
    • (I) A rehabilitation nurse.
    • (J) An educational therapist.
    • (K) An audiologist.
    • (L) A blind rehabilitation specialist.
    • (M) A recreational therapist.
    • (N) A low vision optometrist.
    • (O) An orthotist or prosthetist.
    • (P) An assistive technologist or rehabilitation engineer.
    • (Q) An otolaryngology physician.
    • (R) A dietician.
    • (S) An ophthalmologist.
    • (T) A psychiatrist.
• (d)
  • (1) The Secretary shall designate a case manager for each individual described in subsection (a) to be responsible for the implementation of the plan developed for that individual under that subsection and the coordination of the individual’s medical care.
  • (2) The Secretary shall ensure that each case manager has specific expertise in the care required by the individual for whom the case manager is designated, regardless of whether the case manager obtains such expertise through experience, education, or training.
• (e)
  • (1) The Secretary shall involve each individual described in subsection (a), and the family or legal guardian of such individual, in the development of the plan for such individual under that subsection to the maximum extent practicable.
  • (2) The Secretary shall collaborate in the development of a plan for an individual under subsection (a) with a State protection and advocacy system if—
    • (A) the individual covered by the plan requests such collaboration; or
    • (B) in the case of such an individual who is incapacitated, the family or guardian of the individual requests such collaboration.
  • (3) In the case of a plan required by subsection (a) for a member of the Armed Forces who is serving on active duty, the Secretary shall collaborate with the Secretary of Defense in the development of such plan.
  • (4) In developing vocational rehabilitation objectives required under subsection (b)(1) and in conducting the assessment required under subsection (c), the Secretary shall act through the Under Secretary for Health in coordination with the Vocational Rehabilitation and Employment Service of the Department of Veterans Affairs.
• (f)
  • (1) The Secretary shall periodically review the effectiveness of each plan developed under subsection (a). The Secretary shall refine each such plan as the Secretary considers appropriate in light of such review.
  • (2) In addition to the periodic review required by paragraph (1), the Secretary shall conduct a review of the plan for an individual under paragraph (1) at the request of the individual, or in the case of an individual who is incapacitated, at the request of the guardian or designee of the individual.
• (g) In this section, the term “State protection and advocacy system” means a system established in a State under subtitle C of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 ( 42 U.S.C. 15041 et seq.) to protect and advocate for the rights of persons with development disabilities.
• (h) For purposes of this section, and sections 1710D and 1710E of this title, the term “rehabilitative services” includes—
  • (1) rehabilitative services, as defined in section 1701 of this title ;
  • (2) treatment and services (which may be of ongoing duration) to sustain, and prevent loss of, functional gains that have been achieved; and
  • (3) any other rehabilitative services or supports that may contribute to maximizing an individual’s independence.

§ 1710D. Traumatic brain injury: comprehensive program for long-term rehabilitation

• (a) In developing plans for the rehabilitation and reintegration of individuals with traumatic brain injury under section 1710C of this title , the Secretary shall develop and carry out a comprehensive program of long-term care and rehabilitative services (as defined in section 1710C of this title ) for post-acute traumatic brain injury rehabilitation that includes residential, community, and home-based components utilizing interdisciplinary teams.
• (b) The Secretary shall carry out the program developed under subsection (a) in each Department polytrauma rehabilitation center designated by the Secretary.
• (c) A veteran is eligible for care under the program developed under subsection (a) if the veteran is otherwise eligible to receive hospital care and medical services under section 1710 of this title and—
  • (1) served on active duty in a theater of combat operations (as determined by the Secretary in consultation with the Secretary of Defense) during a period of war after the Persian Gulf War, or in combat against a hostile force during a period of hostilities after November 11, 1998 ;
  • (2) is diagnosed as suffering from moderate to severe traumatic brain injury; and
  • (3) is unable to manage routine activities of daily living without supervision or assistance, as determined by the Secretary.
• (d) Not later than one year after the date of the enactment of this section, and annually thereafter, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report containing the following information:
  • (1) A description of the operation of the program.
  • (2) The number of veterans provided care under the program during the year preceding such report.
  • (3) The cost of operating the program during the year preceding such report.

§ 1710E. Traumatic brain injury: use of non-Department facilities for rehabilitation

• (a) The Secretary, in implementing and carrying out a plan developed under section 1710C of this title , may provide hospital care and medical services, including rehabilitative services (as defined in section 1710C of this title ), through cooperative agreements with appropriate public or private entities that have established long-term neurobehavioral rehabilitation and recovery programs.
• (b) The care and services provided under subsection (a) shall be made available to an individual—
  • (1) who is described in section 1710C(a) of this title ; and
  • (2)
    • (A) to whom the Secretary is unable to provide such treatment or services at the frequency or for the duration prescribed in such plan; or
    • (B) for whom the Secretary determines that it is optimal with respect to the recovery and rehabilitation for such individual.
• (c) Nothing in subtitle C of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 shall be construed as preventing a State protection and advocacy system (as defined in section 1710C(g) of this title ) from exercising the authorities described in such subtitle with respect to individuals provided rehabilitative treatment or services under section 1710C of this title in a non-Department facility.
• (d) The Secretary may not provide treatment or services as described in subsection (a) at a non-Department facility under such subsection unless such facility maintains standards for the provision of such treatment or services established by an independent, peer-reviewed organization that accredits specialized rehabilitation programs for adults with traumatic brain injury.

§ 1711. Care during examinations and in emergencies

• (a) The Secretary may furnish hospital care incident to physical examinations where such examinations are necessary in carrying out the provisions of other laws administered by the Secretary.
• [(b) Repealed. Pub. L. 107–135, title II, § 208(d) , Jan. 23, 2002 , 115 Stat. 2463 .]
• (c)
  • (1) The Secretary may contract with any organization named in, or approved by the Secretary under, section 5902 of this title to provide for the furnishing by the Secretary, on a reimbursable basis (as prescribed by the Secretary), of emergency medical services to individuals attending any national convention of such organization, except that reimbursement shall not be required for services furnished under this subsection to the extent that the individual receiving such services would otherwise be eligible under this chapter for medical services.
  • (2) The authority of the Secretary to enter into contracts under this subsection shall be effective for any fiscal year only to such extent or in such amounts as are provided in appropriation Acts.

§ 1712. Dental care; drugs and medicines for certain disabled veterans; vaccines

• (a)
  • (1) Outpatient dental services and treatment, and related dental appliances, shall be furnished under this section only for a dental condition or disability—
    • (A) which is service-connected and compensable in degree;
    • (B) which is service-connected, but not compensable in degree, but only if—
      • (i) the dental condition or disability is shown to have been in existence at the time of the veteran’s discharge or release from active military, naval, or air service;
      • (ii) the veteran had served on active duty for a period of not less than 180 days or, in the case of a veteran who served on active duty during the Persian Gulf War, 90 days immediately before such discharge or release;
      • (iii) application for treatment is made within 180 days after such discharge or release, except that (I) in the case of a veteran who reentered active military, naval, or air service within 90 days after the date of such veteran’s prior discharge or release from such service, application may be made within 180 days from the date of such veteran’s subsequent discharge or release from such service, and (II) if a disqualifying discharge or release has been corrected by competent authority, application may be made within 180 days after the date of correction; and
      • (iv) the veteran’s certificate of discharge or release from active duty does not bear a certification that the veteran was provided, within the 90-day period immediately before the date of such discharge or release, a complete dental examination (including dental X-rays) and all appropriate dental services and treatment indicated by the examination to be needed;
    • (C) which is a service-connected dental condition or disability due to combat wounds or other service trauma, or of a former prisoner of war;
    • (D) which is associated with and is aggravating a disability resulting from some other disease or injury which was incurred in or aggravated by active military, naval, or air service;
    • (E) which is a non-service-connected condition or disability of a veteran for which treatment was begun while such veteran was receiving hospital care under this chapter and such services and treatment are reasonably necessary to complete such treatment;
    • (F) from which a veteran who is a former prisoner of war is suffering;
    • (G) from which a veteran who has a service-connected disability rated as total is suffering; or
    • (H) the treatment of which is medically necessary (i) in preparation for hospital admission, or (ii) for a veteran otherwise receiving care or services under this chapter.
  • (2) The Secretary concerned shall at the time a member of the Armed Forces is discharged or released from a period of active military, naval, or air service of not less than 180 days or, in the case of a veteran who served on active duty during the Persian Gulf War, 90 days provide to such member a written explanation of the provisions of clause (B) of paragraph (1) of this subsection and enter in the service records of the member a statement signed by the member acknowledging receipt of such explanation (or, if the member refuses to sign such statement, a certification from an officer designated for such purpose by the Secretary concerned that the member was provided such explanation).
  • (3) The total amount which the Secretary may expend for furnishing, during any twelve-month period, outpatient dental services, treatment, or related dental appliances to a veteran under this section through private facilities for which the Secretary has contracted or entered an agreement may not exceed $1,000 unless the Secretary determines, prior to the furnishing of such services, treatment, or appliances and based on an examination of the veteran by a dentist employed by the Department (or, in an area where no such dentist is available, by a dentist conducting such examination under a contract or fee arrangement), that the furnishing of such services, treatment, or appliances at such cost is reasonably necessary.
  • (4)
    • (A) Except as provided in subparagraph (B) of this paragraph, in any year in which the President’s Budget for the fiscal year beginning October 1 of such year includes an amount for expenditures for contract dental care during such fiscal year in excess of the level of expenditures made for such purpose during fiscal year 1978, the Secretary shall, not later than February 15 of such year, submit a report to the appropriate committees of the Congress justifying the requested level of expenditures for contract dental care and explaining why the application of the criteria prescribed in section 1703 of this title for contracting with private facilities and in the second sentence of section 1710(c) of this title for furnishing incidental dental care to hospitalized veterans will not preclude the need for expenditures for contract dental care in excess of the fiscal year 1978 level of expenditures for such purpose. In any case in which the amount included in the President’s Budget for any fiscal year for expenditures for contract dental care under such provisions is not in excess of the level of expenditures made for such purpose during fiscal year 1978 and the Secretary determines after the date of submission of such budget and before the end of such fiscal year that the level of expenditures for such contract dental care during such fiscal year will exceed the fiscal year 1978 level of expenditures, the Secretary shall submit a report to the appropriate committees of the Congress containing both a justification (with respect to the projected level of expenditures for such fiscal year) and an explanation as required in the preceding sentence in the case of a report submitted pursuant to such sentence. Any report submitted pursuant to this paragraph shall include a comment by the Secretary on the effect of the application of the criteria prescribed in the second sentence of section 1710(c) of this title for furnishing incidental dental care to hospitalized veterans.
    • (B) A report under subparagraph (A) of this paragraph with respect to a fiscal year is not required if, in the documents submitted by the Secretary to the Congress in justification for the amounts included for Department programs in the President’s Budget, the Secretary specifies with respect to contract dental care described in such subparagraph—
      • (i) the actual level of expenditures for such care in the fiscal year preceding the fiscal year in which such Budget is submitted;
      • (ii) a current estimate of the level of expenditures for such care in the fiscal year in which such Budget is submitted; and
      • (iii) the amount included in such Budget for such care.
• (b) Dental services and related appliances for a dental condition or disability described in paragraph (1)(B) of subsection (a) shall be furnished on a one-time completion basis, unless the services rendered on a one-time completion basis are found unacceptable within the limitations of good professional standards, in which event such additional services may be afforded as are required to complete professionally acceptable treatment.
• (c) Dental appliances, wheelchairs, artificial limbs, trusses, special clothing, and similar appliances to be furnished by the Secretary under this section may be procured by the Secretary either by purchase or by manufacture, whichever the Secretary determines may be advantageous and reasonably necessary.
• (d) The Secretary shall furnish to each veteran who is receiving additional compensation or allowance under chapter 11 of this title, or increased pension as a veteran of a period of war, by reason of being permanently housebound or in need of regular aid and attendance, such drugs and medicines as may be ordered on prescription of a duly licensed physician as specific therapy in the treatment of any illness or injury suffered by such veteran. The Secretary shall continue to furnish such drugs and medicines so ordered to any such veteran in need of regular aid and attendance whose pension payments have been discontinued solely because such veteran’s annual income is greater than the applicable maximum annual income limitation, but only so long as such veteran’s annual income does not exceed such maximum annual income limitation by more than $1,000.
• (e) In order to assist the Secretary of Health and Human Services in carrying out national immunization programs under other provisions of law, the Secretary may authorize the administration of immunizations to eligible veterans who voluntarily request such immunizations in connection with the provision of care for a disability under this chapter in any Department health care facility. Any such immunization shall be made using vaccine furnished by the Secretary of Health and Human Services at no cost to the Department. For such purpose, notwithstanding any other provision of law, the Secretary of Health and Human Services may provide such vaccine to the Department at no cost. Section 7316 of this title shall apply to claims alleging negligence or malpractice on the part of Department personnel granted immunity under such section.

§ 1712A. Eligibility for readjustment counseling and related mental health services

• (a)
  • (1)
    • (A) Upon the request of any individual referred to in subparagraph (C), the Secretary shall furnish counseling, including by furnishing counseling through a Vet Center, to the individual—
      • (i) in the case of an individual referred to in clauses (i) through (vi) of subparagraph (C), to assist the individual in readjusting to civilian life; and
      • (ii) in the case of an individual referred to in clause (vii) of such subparagraph who is a family member of a veteran or member described in such clause—
        • (I) in the case of a member who is deployed in a theater of combat operations or an area at a time during which hostilities are occurring in that area, during such deployment to assist such individual in coping with such deployment; and
        • (II) in the case of a veteran or member who is readjusting to civilian life, to the degree that counseling furnished to such individual is found to aid in the readjustment of such veteran or member to civilian life.
    • (B) Counseling furnished to an individual under subparagraph (A) may include a comprehensive individual assessment of the individual’s psychological, social, and other characteristics to ascertain whether—
      • (i) in the case of an individual referred to in clauses (i) through (vi) of subparagraph (C), such individual has difficulties associated with readjusting to civilian life; and
      • (ii) in the case of an individual referred to in clause (vii) of such subparagraph, such individual has difficulties associated with—
        • (I) coping with the deployment of a member described in subclause (I) of such clause; or
        • (II) readjustment to civilian life of a veteran or member described in subclause (II) of such clause.
    • (C) Subparagraph (A) applies to the following individuals:
      • (i) Any individual who is a veteran or member of the Armed Forces, including a member of a reserve component of the Armed Forces, who served on active duty in a theater of combat operations or an area at a time during which hostilities occurred in that area.
      • (ii) Any individual who is a veteran or member of the Armed Forces, including a member of a reserve component of the Armed Forces, who provided direct emergency medical or mental health care, or mortuary services to the causalities of combat operations or hostilities, but who at the time was located outside the theater of combat operations or area of hostilities.
      • (iii) Any individual who is a veteran or member of the Armed Forces, including a member of a reserve component of the Armed Forces, who engaged in combat with an enemy of the United States or against an opposing military force in a theater of combat operations or an area at a time during which hostilities occurred in that area by remotely controlling an unmanned aerial vehicle, notwithstanding whether the physical location of such veteran or member during such combat was within such theater of combat operations or area.
      • (iv) Any individual who is a veteran or member of the Armed Forces, including a member of a reserve component of the Armed Forces, who served—
        • (I) on active service in response to a national emergency or major disaster declared by the President; or
        • (II) in the National Guard of a State under orders of the chief executive of that State in response to a disaster or civil disorder in such State.
      • (v) Any individual who participated in a drug interdiction operation as a member of the Coast Guard, regardless of the location of that operation.
      • (vi) Any individual who received counseling under this section before the date of the enactment of the National Defense Authorization Act for Fiscal Year 2013.
      • (vii) Any individual who is a family member of any—
        • (I) member of the Armed Forces, including a member of a reserve component of the Armed Forces, who is serving on active duty in a theater of combat operations or in an area at a time during which hostilities are occurring in that area; or
        • (II) veteran or member of the Armed Forces described in this subparagraph.
  • (2) Upon request of an individual described in paragraph (1)(C), the Secretary shall provide the individual a comprehensive individual assessment as described in paragraph (1)(B) as soon as practicable after receiving the request, but not later than 30 days after receiving the request.
• (b)
  • (1) If, on the basis of the assessment furnished under subsection (a) of this section, a licensed or certified mental health care provider employed by the Department (or, in areas where no such licensed or certified mental health care provider is available, a licensed or certified mental health care provider carrying out such function under a contract or fee arrangement with the Secretary) determines that the provision of mental health services to such veteran is necessary to facilitate the successful readjustment of the veteran to civilian life, such veteran shall, within the limits of Department facilities, be furnished such services on an outpatient basis. For the purposes of furnishing such mental health services, the counseling furnished under subsection (a) of this section shall be considered to have been furnished by the Department as a part of hospital care. Any hospital care and other medical services considered necessary on the basis of the assessment furnished under subsection (a) of this section shall be furnished only in accordance with the eligibility criteria otherwise set forth in this chapter (including the eligibility criteria set forth in section 1784 of this title ).
  • (2) Mental health services furnished under paragraph (1) of this subsection may, if determined to be essential to the effective treatment and readjustment of the veteran, include such consultation, counseling, training, services, and expenses as are described in sections 1782 and 1783 of this title.
• (c) Upon receipt of a request for counseling under this section from any individual who has been discharged or released from active military, naval, or air service but who is not otherwise eligible for such counseling, the Secretary shall—
  • (1) provide referral services to assist such individual, to the maximum extent practicable, in obtaining mental health care and services from sources outside the Department; and
  • (2) if pertinent, advise such individual of such individual’s rights to apply to the appropriate military, naval, or air service, and to the Department, for review of such individual’s discharge or release from such service.
• (d) The Under Secretary for Health may provide for such training of professional, paraprofessional, and lay personnel as is necessary to carry out this section effectively, and, in carrying out this section, may utilize the services of paraprofessionals, individuals who are volunteers working without compensation, and individuals who are veteran-students (as described in section 3485 of this title ) in initial intake and screening activities.
• (e)
  • (1) In furnishing counseling and related mental health services under subsections (a) and (b) of this section, the Secretary shall have available the same authority to enter into contracts or agreements with private facilities that is available to the Secretary in furnishing medical services to veterans suffering from total service-connected disabilities.
  • (2) Before furnishing counseling or related mental health services described in subsections (a) and (b) of this section through a contract facility, as authorized by this subsection, the Secretary shall approve (in accordance with criteria which the Secretary shall prescribe by regulation) the quality and effectiveness of the program operated by such facility for the purpose for which the counseling or services are to be furnished.
  • (3) The authority of the Secretary to enter into contracts under this subsection shall be effective for any fiscal year only to such extent or in such amounts as are provided in appropriation Acts.
• (f) The Secretary, in cooperation with the Secretary of Defense, shall take such action as the Secretary considers appropriate to notify veterans who may be eligible for assistance under this section of such potential eligibility.
• (g) In carrying out this section and in furtherance of the Secretary’s responsibility to carry out outreach activities under chapter 63 of this title, the Secretary may provide for and facilitate the participation of personnel employed by the Secretary to provide services under this section in recreational programs that are—
  • (1) designed to encourage the readjustment of veterans described in subsection (a)(1)(C); and
  • (2) operated by any organization named in or approved under section 5902 of this title .
• (h) For the purposes of this section:
  • (1) The term “Vet Center” means a facility which is operated by the Department for the provision of services under this section and which is situated apart from Department general health care facilities.
  • (2) The term “Department general health-care facility” means a health-care facility which is operated by the Department for the furnishing of health-care services under this chapter, not limited to services provided through the program established under this section.
  • (3) The term “family member”, with respect to a veteran or member of the Armed Forces, means an individual who—
    • (A) is a member of the family of the veteran or member, including—
      • (i) a parent;
      • (ii) a spouse;
      • (iii) a child;
      • (iv) a step-family member; and
      • (v) an extended family member; or
    • (B) lives with the veteran or member but is not a member of the family of the veteran or member.
  • (4) The term “active service” has the meaning given that term in section 101 of title 10 .
  • (5) The term “civil disorder” has the meaning given that term in section 232 of title 18 .

§ 1712B. Counseling for former prisoners of war

The Secretary may establish a program under which, upon the request of a veteran who is a former prisoner of war, the Secretary, within the limits of Department facilities, furnishes counseling to such veteran to assist such veteran in overcoming the psychological effects of the veteran’s detention or internment as a prisoner of war.

§ 1712C. Dental insurance plan for veterans and survivors and dependents of veterans

• (a) The Secretary shall establish and administer a dental insurance plan for veterans and survivors and dependents of veterans described in subsection (b).
• (b) The veterans and survivors and dependents of veterans described in this subsection are as follows:
  • (1) Any veteran who is enrolled in the system of annual patient enrollment under section 1705 of this title .
  • (2) Any survivor or dependent of a veteran who is eligible for medical care under section 1781 of this title .
• (c) The Secretary shall contract with a dental insurer to administer the dental insurance plan under this section.
• (d) The dental insurance plan under this section shall provide such benefits for dental care and treatment as the Secretary considers appropriate for the dental insurance plan, including diagnostic services, preventative services, endodontics and other restorative services, surgical services, and emergency services.
• (e)
  • (1) Enrollment in the dental insurance plan under this section shall be voluntary.
  • (2) Enrollment in the dental insurance plan shall be for such minimum period as the Secretary shall prescribe for purposes of this section.
• (f)
  • (1) Premiums for coverage under the dental insurance plan under this section shall be in such amount or amounts as the Secretary shall prescribe to cover all costs associated with carrying out this section.
  • (2) The Secretary shall adjust the premiums payable under this section for coverage under the dental insurance plan on an annual basis. Each individual covered by the dental insurance plan at the time of such an adjustment shall be notified of the amount and effective date of such adjustment.
  • (3) Each individual covered by the dental insurance plan shall pay the entire premium for coverage under the dental insurance plan, in addition to the full cost of any copayments.
• (g)
  • (1) With respect to enrollment in the dental insurance plan under this section, the Secretary shall—
    • (A) permit the voluntary disenrollment of an individual in the dental insurance plan if the disenrollment occurs during the 30-day period beginning on the date of the enrollment of the individual in the dental insurance plan; and
    • (B) permit the voluntary disenrollment of an individual in the dental insurance plan for such circumstances as the Secretary shall prescribe for purposes of this subsection, but only to the extent such disenrollment does not jeopardize the fiscal integrity of the dental insurance plan.
  • (2) The circumstances prescribed under paragraph (1)(B) shall include the following:
    • (A) If an individual enrolled in the dental insurance plan relocates to a location outside the jurisdiction of the dental insurance plan that prevents use of the benefits under the dental insurance plan.
    • (B) If an individual enrolled in the dental insurance plan is prevented by a serious medical condition from being able to obtain benefits under the dental insurance plan.
    • (C) Such other circumstances as the Secretary shall prescribe for purposes of this subsection.
  • (3) The Secretary shall establish procedures for determinations on the permissibility of voluntary disenrollments under paragraph (1)(B). Such procedures shall ensure timely determinations on the permissibility of such disenrollments.
• (h) Nothing in this section shall affect the responsibility of the Secretary to provide dental care under section 1712 of this title , and the participation of an individual in the dental insurance plan under this section shall not affect the entitlement of the individual to outpatient dental services and treatment, and related dental appliances, under such section 1712.
• (i) The dental insurance plan under this section shall be administered under such regulations as the Secretary shall prescribe.
• (j) This section terminates on December 31, 2021 .

§ 1714. Fitting and training in use of prosthetic appliances; guide dogs; service dogs

• (a) Any veteran who is entitled to a prosthetic appliance shall be furnished such fitting and training, including institutional training, in the use of such appliance as may be necessary, whether in a Department facility or other training institution, or by outpatient treatment, including such service under contract, and including travel and incidental expenses (under the terms and conditions set forth in section 111 of this title ) to and from such veteran’s home to such hospital or training institution.
• (b) The Secretary may provide guide dogs trained for the aid of the blind to veterans who are enrolled under section 1705 of this title . The Secretary may also provide such veterans with mechanical or electronic equipment for aiding them in overcoming the disability of blindness.
• (c) The Secretary may, in accordance with the priority specified in section 1705 of this title , provide—
  • (1) service dogs trained for the aid of the hearing impaired to veterans who are hearing impaired and are enrolled under section 1705 of this title ;
  • (2) service dogs trained for the aid of persons with spinal cord injury or dysfunction or other chronic impairment that substantially limits mobility to veterans with such injury, dysfunction, or impairment who are enrolled under section 1705 of this title ; and
  • (3) service dogs trained for the aid of persons with mental illnesses, including post-traumatic stress disorder, to veterans with such illnesses who are enrolled under section 1705 of this title .
• (d) In the case of a veteran provided a dog under subsection (b) or (c), the Secretary may pay travel and incidental expenses for that veteran under the terms and conditions set forth in section 111 of this title to and from the veteran’s home for expenses incurred in becoming adjusted to the dog.

§ 1715. Tobacco for hospitalized veterans

The Secretary may furnish tobacco to veterans receiving hospital or domiciliary care.

§ 1716. Hospital care by other agencies of the United States

When so specified in an appropriation or other Act, the Secretary may make allotments and transfers to the Departments of Health and Human Services (Public Health Service), the Army, Navy, Air Force, or Interior, for disbursement by them under the various headings of their appropriations, of such amounts as are necessary for the care and treatment of veterans entitled to hospitalization from the Department under this chapter. The amounts to be charged the Department for care and treatment of veterans in hospitals shall be calculated on the basis of a per diem rate approved by the Office of Management and Budget.

§ 1717. Home health services; invalid lifts and other devices

• (a)
  • (1) As part of medical services furnished to a veteran under section 1710(a) of this title , the Secretary may furnish such home health services as the Secretary finds to be necessary or appropriate for the effective and economical treatment of the veteran.
  • (2) Improvements and structural alterations may be furnished as part of such home health services only as necessary to assure the continuation of treatment for the veteran’s disability or to provide access to the home or to essential lavatory and sanitary facilities. The cost of such improvements and structural alterations (or the amount of reimbursement therefor) under this subsection may not exceed—
    • (A) in the case of medical services furnished under section 1710(a)(1) of this title , or for a disability described in section 1710(a)(2)(C) of this title —
      • (i) in the case of a veteran who first applies for benefits under this paragraph before May 5, 2010 , $4,100; or
      • (ii) in the case of a veteran who first applies for benefits under this paragraph on or after May 5, 2010 , $6,800; and
    • (B) in the case of medical services furnished under any other provision of section 1710(a) of this title —
      • (i) in the case of a veteran who first applies for benefits under this paragraph before May 5, 2010 , $1,200; or
      • (ii) in the case of a veteran who first applies for benefits under this paragraph on or after May 5, 2010 , $2,000.
  • (3) The Secretary may furnish home health services to a veteran in any setting in which the veteran is residing. The Secretary may not furnish such services in such a manner as to relieve any other person or entity of a contractual obligation to furnish services to the veteran. When home health services are furnished in a setting other than the veteran’s home, such services may not include any structural improvement or alteration.
• (b) The Secretary may furnish an invalid lift, or any type of therapeutic or rehabilitative device, as well as other medical equipment and supplies (excluding medicines), if medically indicated, to any veteran who is receiving (1) compensation under section 1114( l )–(p) of this title (or the comparable rates provided pursuant to section 1134 of this title ), or (2) pension under chapter 15 of this title by reason of being in need of regular aid and attendance.
• (c) The Secretary may furnish devices for assisting in overcoming the handicap of deafness (including telecaptioning television decoders) to any veteran who is profoundly deaf and is entitled to compensation on account of hearing impairment.
• (d)
  • (1) In the case of a member of the Armed Forces who, as determined by the Secretary, has a disability permanent in nature incurred or aggravated in the line of duty in the active military, naval, or air service, the Secretary may furnish improvements and structural alterations for such member for such disability or as otherwise described in subsection (a)(2) while such member is hospitalized or receiving outpatient medical care, services, or treatment for such disability if the Secretary determines that such member is likely to be discharged or released from the Armed Forces for such disability.
  • (2) The furnishing of improvements and alterations under paragraph (1) in connection with the furnishing of medical services described in subparagraph (A) or (B) of subsection (a)(2) shall be subject to the limitation specified in the applicable subparagraph.

§ 1718. Therapeutic and rehabilitative activities

• (a) In providing rehabilitative services under this chapter, the Secretary, upon the recommendation of the Under Secretary for Health, may use the services of patients and members in Department health care facilities for therapeutic and rehabilitative purposes. Such patients and members shall not under these circumstances be held or considered as employees of the United States for any purpose. The Secretary shall prescribe the conditions for the use of such services.
• (b)
  • (1) In furnishing rehabilitative services under this chapter, the Secretary, upon the recommendation of the Under Secretary for Health, may enter into a contract or other arrangement with any appropriate source (whether or not an element of the Department of Veterans Affairs or of any other Federal entity) to provide for therapeutic work for patients and members in Department health care facilities.
  • (2) Notwithstanding any other provision of law, the Secretary may also furnish rehabilitative services under this subsection through contractual arrangements with nonprofit entities to provide for such therapeutic work for such patients. The Secretary shall establish appropriate fiscal, accounting, management, recordkeeping, and reporting requirements with respect to the activities of any such nonprofit entity in connection with such contractual arrangements.
• (c)
  • (1) There is hereby established in the Treasury of the United States a revolving fund known as the Department of Veterans Affairs Special Therapeutic and Rehabilitation Activities Fund (hereinafter in this section referred to as the “fund”) for the purpose of furnishing rehabilitative services authorized in subsection (b) or (d). Such amounts of the fund as the Secretary may determine to be necessary to establish and maintain operating accounts for the various rehabilitative services activities may be deposited in checking accounts in other depositaries selected or established by the Secretary.
  • (2) All funds received by the Department under contractual arrangements made under subsection (b) or (d), or by nonprofit entities described in subsection (b)(2), shall be deposited in or credited to the fund, and the Secretary shall distribute out of the fund moneys to participants at rates not less than the wage rates specified in the Fair Labor Standards Act of 1938 ( 29 U.S.C. 201 et seq.) and regulations prescribed thereunder for work of similar character.
  • (3) The Under Secretary for Health shall prepare, for inclusion in the annual report submitted to Congress under section 529 of this title , a description of the scope and achievements of activities carried out under this section (including pertinent data regarding productivity and rates of distribution) during the prior twelve months and an estimate of the needs of the program of therapeutic and rehabilitation activities to be carried out under this section for the ensuing fiscal year.
• (d) In providing to a veteran rehabilitative services under this chapter, the Secretary may furnish the veteran with the following:
  • (1) Work skills training and development services.
  • (2) Employment support services.
  • (3) Job development and placement services.
• (e) In providing rehabilitative services under this chapter, the Secretary shall take appropriate action to make it possible for the patient to take maximum advantage of any benefits to which such patient is entitled under chapter 31, 34, or 35 of this title, and, if the patient is still receiving treatment of a prolonged nature under this chapter, the provision of rehabilitative services under this chapter shall be continued during, and coordinated with, the pursuit of education and training under such chapter 31, 34, or 35.
• (f) The Secretary shall prescribe regulations to ensure that the priorities set forth in section 1705 of this title shall be applied, insofar as practicable, to participation in therapeutic and rehabilitation activities carried out under this section.
• (g)
  • (1) The Secretary may not consider any of the matters stated in paragraph (2) as a basis for the denial or discontinuance of a rating of total disability for purposes of compensation or pension based on the veteran’s inability to secure or follow a substantially gainful occupation as a result of disability.
  • (2) Paragraph (1) applies to the following:
    • (A) A veteran’s participation in an activity carried out under this section.
    • (B) A veteran’s receipt of a distribution as a result of participation in an activity carried out under this section.
    • (C) A veteran’s participation in a program of rehabilitative services that (i) is provided as part of the veteran’s care furnished by a State home and (ii) is approved by the Secretary as conforming appropriately to standards for activities carried out under this section.
    • (D) A veteran’s receipt of payment as a result of participation in a program described in subparagraph (C).
  • (3) A distribution of funds made under this section and a payment made to a veteran under a program of rehabilitative services described in paragraph (2)(C) shall be considered for the purposes of chapter 15 of this title to be a donation from a public or private relief or welfare organization.

§ 1719. Repair or replacement of certain prosthetic and other appliances

The Secretary may repair or replace any artificial limb, truss, brace, hearing aid, spectacles, or similar appliance (not including dental appliances) reasonably necessary to a veteran and belonging to such veteran which was damaged or destroyed by a fall or other accident caused by a service-connected disability for which such veteran is in receipt of, or but for the receipt of retirement pay would be entitled to, disability compensation.

§ 1720. Transfers for nursing home care; adult day health care

• (a)
  • (1) Subject to subsection (b) of this section, the Secretary may transfer to a non-Department nursing home, for care at the expense of the United States—
    • (A) a veteran—
      • (i) who has been furnished care by the Secretary in a facility under the direct jurisdiction of the Secretary; and
      • (ii) who the Secretary determines—
        • (I) requires a protracted period of nursing home care which can be furnished in the non-Department nursing home; and
        • (II) in the case of a veteran who has been furnished hospital care in a facility under the direct jurisdiction of the Secretary, has received maximum benefits from such care; and
    • (B) a member of the Armed Forces—
      • (i) who has been furnished care in a hospital of the Armed Forces;
      • (ii) who the Secretary concerned determines has received maximum benefits from such care but requires a protracted period of nursing home care; and
      • (iii) who upon discharge from the Armed Forces will become a veteran.
  • (2) The Secretary may transfer a person to a nursing home under this subsection only if the Secretary determines that the cost to the United States of the care of such person in the nursing home will not exceed—
    • (A) the amount equal to 45 percent of the cost of care furnished by the Department in a general hospital under the direct jurisdiction of the Secretary (as such cost may be determined annually by the Secretary); or
    • (B) the amount equal to 50 percent of such cost, if such higher amount is determined to be necessary by the Secretary (upon the recommendation of the Under Secretary for Health) to provide adequate care.
  • (3) Nursing home care may not be furnished under this subsection at the expense of the United States for more than six months in the aggregate in connection with any one transfer except—
    • (A) in the case of a veteran—
      • (i) who is transferred to a non-Department nursing home from a hospital under the direct jurisdiction of the Secretary; and
      • (ii) whose hospitalization was primarily for a service-connected disability;
    • (B) in a case in which the nursing home care is required for a service-connected disability; or
    • (C) in a case in which, in the judgment of the Secretary, a longer period of nursing home care is warranted.
  • (4) A veteran who is furnished care by the Secretary in a hospital or domiciliary facility in Alaska or Hawaii may be furnished nursing home care at the expense of the United States under this subsection even if such hospital or domiciliary facility is not under the direct jurisdiction of the Secretary.
• (b) No veteran may be transferred or admitted to any institution for nursing home care under this section, unless such institution is determined by the Secretary to meet such standards as the Secretary may prescribe. The standards prescribed and any report of inspection of institutions furnishing care to veterans under this section made by or for the Secretary shall, to the extent possible, be made available to all Federal, State, and local agencies charged with the responsibility of licensing or otherwise regulating or inspecting such institutions.
• (c)
  • (1)
    • (A) In furnishing nursing home care, adult day health care, or other extended care services under this section, the Secretary may enter into agreements for furnishing such care or services with—
      • (i) in the case of the medicare program, a provider of services that has entered into a provider agreement under section 1866(a) of the Social Security Act ( 42 U.S.C. 1395cc(a) );
      • (ii) in the case of the medicaid program, a provider participating under a State plan under title XIX of such Act ( 42 U.S.C. 1396 et seq.); and
      • (iii) a provider of services eligible to enter into a contract pursuant to section 1745(a) of this title that is not otherwise described in clause (i) or (ii).
    • (B) In entering into an agreement under subparagraph (A) with a provider of services described in clause (i) of that subparagraph or a provider described in clause (ii) of that subparagraph, the Secretary may use the procedures available for entering into provider agreements under section 1866(a) of the Social Security Act.
  • (2) In applying the provisions of section 6704(a) of title 41 with respect to any contract entered into under this section to provide nursing home care of veterans, the payment of wages not less than those specified in section 6(b) of the Fair Labor Standards Act of 1938 ( 29 U.S.C. 206(b) ) shall be deemed to constitute compliance with such provisions.
• (d)
  • (1) Subject to subsection (b) of this section, the Secretary may authorize for any veteran requiring nursing home care for a service-connected disability direct admission for such care at the expense of the United States to any non-Department nursing home. The Secretary may also authorize a direct admission to such a nursing home for nursing home care for any veteran who has been discharged from a hospital under the direct jurisdiction of the Secretary and who is currently receiving medical services as part of home health services from the Department.
  • (2) Direct admission authorized by paragraph (1) of this subsection may be authorized upon determination of need therefor—
    • (A) by a physician employed by the Department; or
    • (B) in areas where no such physician is available, by a physician carrying out such function under contract or fee arrangement,
  • (3) The amount which may be paid for such care and the length of care available under this subsection shall be the same as authorized under subsection (a) of this section.
• (e)
  • (1) The cost of intermediate care for purposes of payment by the United States pursuant to subsection (a)(2)(B) of this section shall be determined by the Secretary except that the rate of reimbursement shall be commensurately less than that provided for nursing home care.
  • (2) For the purposes of this section, the term “non-Department nursing home” means a public or private institution not under the direct jurisdiction of the Secretary which furnishes nursing home care.
• (f)
  • (1)
    • (A) The Secretary may furnish adult day health care services to a veteran enrolled under section 1705(a) of this title who would otherwise require nursing home care.
    • (B) The Secretary may provide in-kind assistance (through the services of Department employees and the sharing of other Department resources) to a facility furnishing care to veterans under subparagraph (A) of this paragraph. Any such in-kind assistance shall be provided under a contract or agreement between the Secretary and the facility concerned. The Secretary may provide such assistance only for use solely in the furnishing of adult day health care and only if, under such contract or agreement, the Department receives reimbursement for the full cost of such assistance, including the cost of services and supplies and normal depreciation and amortization of equipment. Such reimbursement may be made by reduction in the charges to the United States or by payment to the United States. Any funds received through such reimbursement shall be credited to funds allotted to the Department facility that provided the assistance.
  • (2) The Secretary may conduct, at facilities over which the Secretary has direct jurisdiction, programs for the furnishing of adult day health care to veterans who are eligible for such care under paragraph (1) of this subsection, except that necessary travel and incidental expenses (or transportation in lieu thereof) may be furnished under such a program only under the terms and conditions set forth in section 111 of this title . The furnishing of care under any such program shall be subject to the limitations that are applicable to the duration of adult day health care furnished under paragraph (1) of this subsection.
• (g) The Secretary may contract with appropriate entities to provide specialized residential care and rehabilitation services to a veteran of Operation Enduring Freedom or Operation Iraqi Freedom who the Secretary determines suffers from a traumatic brain injury, has an accumulation of deficits in activities of daily living and instrumental activities of daily living, and because of these deficits, would otherwise require admission to a nursing home even though such care would generally exceed the veteran’s nursing needs.

§ 1720A. Treatment and rehabilitative services for persons with drug or alcohol dependency

• (a) The Secretary, in consultation with the Secretary of Labor and the Director of the Office of Personnel Management, may take appropriate steps to (1) urge all Federal agencies and appropriate private and public firms, organizations, agencies, and persons to provide appropriate employment and training opportunities for veterans who have been provided treatment and rehabilitative services under this title for alcohol or drug dependence or abuse disabilities and have been determined by competent medical authority to be sufficiently rehabilitated to be employable, and (2) provide all possible assistance to the Secretary of Labor in placing such veterans in such opportunities.
• (b) Upon receipt of an application for treatment and rehabilitative services under this title for an alcohol or drug dependence or abuse disability from any individual who has been discharged or released from active military, naval, or air service but who is not eligible for such treatment and services, the Secretary shall—
  • (1) provide referral services to assist such individual, to the maximum extent practicable, in obtaining treatment and rehabilitative services from sources outside the Department; and
  • (2) if pertinent, advise such individual of such individual’s rights to apply to the appropriate military, naval, or air service and the Department for review of such individual’s discharge or release from such service.
• (c)
  • (1) Any person serving in the active military, naval, or air service who is determined by the Secretary concerned to have an alcohol or drug dependence or abuse disability may be transferred to any facility in order for the Secretary to furnish care or treatment and rehabilitative services for such disability. Care and services provided to a member so transferred shall be provided as if such member were a veteran. Any transfer of any such member for such care and services shall be made pursuant to such terms as may be agreed upon by the Secretary concerned and the Secretary, subject to the provisions of sections 1535 and 1536 of title 31.
  • (2) No person serving in the active military, naval, or air service may be transferred pursuant to an agreement made under paragraph (1) of this subsection unless such person requests such transfer in writing for a specified period of time. No such person transferred pursuant to such a request may be furnished such care and services by the Secretary beyond the period of time specified in such request unless such person requests in writing an extension for a further specified period of time and such request is approved by the Secretary.
• (d)
  • (1) The Secretary shall ensure that each medical center of the Department develops and carries out a plan to provide treatment for substance use disorders, either through referral or direct provision of services, to veterans who require such treatment.
  • (2) Each plan under paragraph (1) shall make available clinically proven substance abuse treatment methods, including opioid substitution therapy, to veterans with respect to whom a qualified medical professional has determined such treatment methods to be appropriate.

§ 1720B. Respite care

• (a) The Secretary may furnish respite care services to a veteran who is enrolled to receive care under section 1710 of this title .
• (b) For the purpose of this section, the term “respite care services” means care and services which—
  • (1) are of limited duration;
  • (2) are furnished on an intermittent basis to a veteran who is suffering from a chronic illness and who resides primarily at home; and
  • (3) are furnished for the purpose of helping the veteran to continue residing primarily at home.
• (c) In furnishing respite care services, the Secretary may enter into contract arrangements.

§ 1720C. Noninstitutional alternatives to nursing home care

• (a) The Secretary may furnish medical, rehabilitative, and health-related services in noninstitutional settings for veterans who are eligible under this chapter for, and are in need of, nursing home care. The Secretary shall give priority for participation in such program to veterans who—
  • (1) are in receipt of, or are in need of, nursing home care primarily for the treatment of a service-connected disability; or
  • (2) have a service-connected disability rated at 50 percent or more.
• (b)
  • (1) Under the program conducted pursuant to subsection (a), the Secretary shall (A) furnish appropriate health-related services solely through contracts with appropriate public and private agencies that provide such services, and (B) designate Department health-care employees to furnish case management services to veteran furnished services under the program.
  • (2) For the purposes of paragraph (1), the term “case management services” includes the coordination and facilitation of all services furnished to a veteran by the Department of Veterans Affairs, either directly or through contract, including assessment of needs, planning, referral (including referral for services to be furnished by the Department, either directly or through a contract, or by an entity other than the Department), monitoring, reassessment, and followup.
• (c) The Secretary may provide in-kind assistance (through the services of Department of Veterans Affairs employees and the sharing of other Department resources) to a facility furnishing services to veterans under subsection (b)(1)(A). Any such in-kind assistance shall be provided under a contract between the Department and the facility concerned. The Secretary may provide such assistance only for use solely in the furnishing of appropriate services under this section and only if, under such contract, the Department receives reimbursement for the full cost of such assistance (including the cost of services and supplies and normal depreciation and amortization of equipment). Such reimbursement may be made by reduction in the charges to the United States or by payment to the United States. Any funds received through such reimbursement shall be credited to funds allotted to the Department facility that provided the assistance.
• (d) The total cost of providing services or in-kind assistance in the case of any veteran for any fiscal year under the program may not exceed 65 percent of the cost that would have been incurred by the Department during that fiscal year if the veteran had been furnished, instead, nursing home care under section 1710 of this title during that fiscal year.
• (e) The authority of the Secretary to enter into contracts under this section shall be effective for any fiscal year only to the extent that appropriations are available.

§ 1720D. Counseling and treatment for sexual trauma

• (a)
  • (1) The Secretary shall operate a program under which the Secretary provides counseling and appropriate care and services to veterans who the Secretary determines require such counseling and care and services to overcome psychological trauma, which in the judgment of a mental health professional employed by the Department, resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the veteran was serving on active duty, active duty for training, or inactive duty training.
  • (2)
    • (A) In operating the program required by paragraph (1), the Secretary may, in consultation with the Secretary of Defense, provide counseling and care and services to members of the Armed Forces (including members of the National Guard and Reserves) to overcome psychological trauma described in that paragraph that was suffered by the member while serving on active duty, active duty for training, or inactive duty training.
    • (B) A member described in subparagraph (A) shall not be required to obtain a referral before receiving counseling and care and services under this paragraph.
  • (3) In furnishing counseling to an individual under this subsection, the Secretary may provide such counseling pursuant to a contract with a qualified mental health professional if (A) in the judgment of a mental health professional employed by the Department, the receipt of counseling by that individual in facilities of the Department would be clinically inadvisable, or (B) Department facilities are not capable of furnishing such counseling to that individual economically because of geographical inaccessibility.
• (b)
  • (1) The Secretary shall give priority to the establishment and operation of the program to provide counseling and care and services under subsection (a). In the case of a veteran eligible for counseling and care and services under subsection (a), the Secretary shall ensure that the veteran is furnished counseling and care and services under this section in a way that is coordinated with the furnishing of such care and services under this chapter.
  • (2) In establishing a program to provide counseling under subsection (a), the Secretary shall—
    • (A) provide for appropriate training of mental health professionals and such other health care personnel as the Secretary determines necessary to carry out the program effectively;
    • (B) seek to ensure that such counseling is furnished in a setting that is therapeutically appropriate, taking into account the circumstances that resulted in the need for such counseling; and
    • (C) provide referral services to assist veterans who are not eligible for services under this chapter to obtain those from sources outside the Department.
• (c) The Secretary shall provide information on the counseling and treatment available under this section. Efforts by the Secretary to provide such information—
  • (1) shall include availability of a toll-free telephone number (commonly referred to as an 800 number);
  • (2) shall ensure that information about the counseling and treatment available under this section—
    • (A) is revised and updated as appropriate;
    • (B) is made available and visibly posted at appropriate facilities of the Department; and
    • (C) is made available through appropriate public information services; and
  • (3) shall include coordination with the Secretary of Defense seeking to ensure that members of the Armed Forces and individuals who are being separated from active military, naval, or air service are provided appropriate information about programs, requirements, and procedures for applying for counseling and treatment under this section.
• (d)
  • (1) The Secretary shall carry out a program to provide graduate medical education, training, certification, and continuing medical education for mental health professionals who provide counseling, care, and services under subsection (a).
  • (2) In carrying out the program required by paragraph (1), the Secretary shall ensure that—
    • (A) all mental health professionals described in such paragraph have been trained in a consistent manner; and
    • (B) training described in such paragraph includes principles of evidence-based treatment and care for sexual trauma and post-traumatic stress disorder.
• (e) Each year, the Secretary shall submit to Congress an annual report on the counseling, care, and services provided pursuant to this section. Each report shall include data for the year covered by the report with respect to each of the following:
  • (1) The number of mental health professionals, graduate medical education trainees, and primary care providers who have been certified under the program required by subsection (d) and the amount and nature of continuing medical education provided under such program to such professionals, trainees, and providers who are so certified.
  • (2) The number of individuals who received counseling and care and services under subsection (a) from professionals and providers who received training under subsection (d), disaggregated by—
    • (A) veterans;
    • (B) members of the Armed Forces (including members of the National Guard and Reserves) on active duty; and
    • (C) for each of subparagraphs (A) and (B)—
      • (i) men; and
      • (ii) women.
  • (3) The number of graduate medical education, training, certification, and continuing medical education courses provided by reason of subsection (d).
  • (4) The number of trained full-time equivalent employees required in each facility of the Department to meet the needs of individuals requiring treatment and care for sexual trauma and post-traumatic stress disorder.
  • (5) Such recommendations for improvements in the treatment of individuals with sexual trauma and post-traumatic stress disorder as the Secretary considers appropriate, including specific recommendations for individuals specified in subparagraphs (A), (B), and (C) of paragraph (2).
  • (6) Such other information as the Secretary considers appropriate.
• (f) In this section, the term “sexual harassment” means repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character.

§ 1720E. Nasopharyngeal radium irradiation

• (a) The Secretary may provide any veteran a medical examination, and hospital care, medical services, and nursing home care, which the Secretary determines is needed for the treatment of any cancer of the head or neck which the Secretary finds may be associated with the veteran’s receipt of nasopharyngeal radium irradiation treatments in active military, naval, or air service.
• (b) The Secretary shall provide care and services to a veteran under subsection (a) only on the basis of evidence in the service records of the veteran which document nasopharyngeal radium irradiation treatment in service, except that, notwithstanding the absence of such documentation, the Secretary may provide such care to a veteran who—
  • (1) served as an aviator in the active military, naval, or air service before the end of the Korean conflict; or
  • (2) underwent submarine training in active naval service before January 1, 1965 .

§ 1720F. Comprehensive program for suicide prevention among veterans

• (a) The Secretary shall develop and carry out a comprehensive program designed to reduce the incidence of suicide among veterans incorporating the components described in this section.
• (b) In carrying out the comprehensive program under this section, the Secretary shall provide for mandatory training for appropriate staff and contractors (including all medical personnel) of the Department who interact with veterans. This training shall cover information appropriate to the duties being performed by such staff and contractors. The training shall include information on—
  • (1) recognizing risk factors for suicide;
  • (2) proper protocols for responding to crisis situations involving veterans who may be at high risk for suicide; and
  • (3) best practices for suicide prevention.
• (c) In carrying out the comprehensive program, the Secretary shall direct that medical staff offer mental health in their overall health assessment when veterans seek medical care at a Department medical facility (including a center established under section 1712A of this title ) and make referrals, at the request of the veteran concerned, to appropriate counseling and treatment programs for veterans who show signs or symptoms of mental health problems.
• (d) In carrying out the comprehensive program, the Secretary shall designate a suicide prevention counselor at each Department medical facility other than centers established under section 1712A of this title . Each counselor shall work with local emergency rooms, police departments, mental health organizations, and veterans service organizations to engage in outreach to veterans and improve the coordination of mental health care to veterans.
• (e) In carrying out the comprehensive program, the Secretary shall provide for research on best practices for suicide prevention among veterans. Research shall be conducted under this subsection in consultation with the heads of the following entities:
  • (1) The Department of Health and Human Services.
  • (2) The National Institute of Mental Health.
  • (3) The Substance Abuse and Mental Health Services Administration.
  • (4) The Centers for Disease Control and Prevention.
• (f) In carrying out the comprehensive program, the Secretary shall provide for research on mental health care for veterans who have experienced sexual trauma while in military service. The research design shall include consideration of veterans of a reserve component.
• (g) In carrying out the comprehensive program, the Secretary shall provide for mental health care availability to veterans on a 24-hour basis.
• (h) In carrying out the comprehensive program, the Secretary may provide for a toll-free hotline for veterans to be staffed by appropriately trained mental health personnel and available at all times.
• (i) In carrying out the comprehensive program, the Secretary shall provide for outreach to and education for veterans and the families of veterans, with special emphasis on providing information to veterans of Operation Iraqi Freedom and Operation Enduring Freedom and the families of such veterans. Education to promote mental health shall include information designed to—
  • (1) remove the stigma associated with mental illness;
  • (2) encourage veterans to seek treatment and assistance for mental illness;
  • (3) promote skills for coping with mental illness; and
  • (4) help families of veterans with—
    • (A) understanding issues arising from the readjustment of veterans to civilian life;
    • (B) identifying signs and symptoms of mental illness; and
    • (C) encouraging veterans to seek assistance for mental illness.
• (j)
  • (1) In carrying out the comprehensive program, the Secretary shall establish and carry out a peer support counseling program, under which veterans shall be permitted to volunteer as peer counselors—
    • (A) to assist other veterans with issues related to mental health and readjustment; and
    • (B) to conduct outreach to veterans and the families of veterans.
  • (2) In carrying out the peer support counseling program under this subsection, the Secretary shall provide adequate training for peer counselors, including training carried out under the national program of training required by section 304(c) of the Caregivers and Veterans Omnibus Health Services Act of 2010 ( 38 U.S.C. 1712A note).
  • (3) In addition to other locations the Secretary considers appropriate, the Secretary shall carry out the peer support program under this subsection at each Department medical center.
  • (4)
    • (A) As part of the counseling program under this subsection, the Secretary shall emphasize appointing peer support counselors for women veterans. To the degree practicable, the Secretary shall seek to recruit women peer support counselors with expertise in—
      • (i) female gender-specific issues and services;
      • (ii) the provision of information about services and benefits provided under laws administered by the Secretary; or
      • (iii) employment mentoring.
    • (B) To the degree practicable, the Secretary shall emphasize facilitating peer support counseling for women veterans who are eligible for counseling and services under section 1720D of this title , have post-traumatic stress disorder or suffer from another mental health condition, are homeless or at risk of becoming homeless, or are otherwise at increased risk of suicide, as determined by the Secretary.
    • (C) The Secretary shall conduct outreach to inform women veterans about the program and the assistance available under this paragraph.
    • (D) In carrying out this paragraph, the Secretary shall coordinate with such community organizations, State and local governments, institutions of higher education, chambers of commerce, local business organizations, organizations that provide legal assistance, and other organizations as the Secretary considers appropriate.
    • (E) In carrying out this paragraph, the Secretary shall provide adequate training for peer support counselors, including training carried out under the national program of training required by section 304(c) of the Caregivers and Veterans Omnibus Health Services Act of 2010 ( 38 U.S.C. 1712A note).
• (k) In carrying out the comprehensive program, the Secretary may provide for other actions to reduce the incidence of suicide among veterans that the Secretary considers appropriate.

§ 1720G. Assistance and support services for caregivers

• (a)
  • (1)
    • (A) The Secretary shall establish a program of comprehensive assistance for family caregivers of eligible veterans.
    • (B) The Secretary shall only provide support under the program required by subparagraph (A) to a family caregiver of an eligible veteran if the Secretary determines it is in the best interest of the eligible veteran to do so.
  • (2) For purposes of this subsection, an eligible veteran is any individual who—
    • (A) is a veteran or member of the Armed Forces undergoing medical discharge from the Armed Forces;
    • (B) for assistance provided under this subsection—
      • (i) before the date on which the Secretary submits to Congress a certification that the Department has fully implemented the information technology system required by section 162(a) of the Caring for Our Veterans Act of 2018, has a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service on or after September 11, 2001 ;
      • (ii) during the 2-year period beginning on the date on which the Secretary submitted to Congress the certification described in clause (i), has a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service—
        • (I) on or before May 7, 1975 ; or
        • (II) on or after September 11, 2001 ; or
      • (iii) after the date that is 2 years after the date on which the Secretary submits to Congress the certification described in clause (i), has a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service; and
    • (C) is in need of personal care services because of—
      • (i) an inability to perform one or more activities of daily living;
      • (ii) a need for supervision or protection based on symptoms or residuals of neurological or other impairment or injury;
      • (iii) a need for regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired; or
      • (iv) such other matters as the Secretary considers appropriate.
  • (3)
    • (A) As part of the program required by paragraph (1), the Secretary shall provide to family caregivers of eligible veterans the following assistance:
      • (i) To each family caregiver who is approved as a provider of personal care services for an eligible veteran under paragraph (6)—
        • (I) such instruction, preparation, and training as the Secretary considers appropriate for the family caregiver to provide personal care services to the eligible veteran;
        • (II) ongoing technical support consisting of information and assistance to address, in a timely manner, the routine, emergency, and specialized caregiving needs of the family caregiver in providing personal care services to the eligible veteran;
        • (III) counseling; and
        • (IV) lodging and subsistence under section 111(e) of this title .
      • (ii) To each family caregiver who is designated as the primary provider of personal care services for an eligible veteran under paragraph (7)—
        • (I) the assistance described in clause (i);
        • (II) such mental health services as the Secretary determines appropriate;
        • (III) respite care of not less than 30 days annually, including 24-hour per day care of the veteran commensurate with the care provided by the family caregiver to permit extended respite;
        • (IV) medical care under section 1781 of this title ;
        • (V) a monthly personal caregiver stipend; and
        • (VI) through the use of contracts with, or the provision of grants to, public or private entities—
    • (B) Respite care provided under subparagraph (A)(ii)(III) shall be medically and age-appropriate and include in-home care.
    • (C)
      • (i) The amount of the monthly personal caregiver stipend provided under subparagraph (A)(ii)(V) shall be determined in accordance with a schedule established by the Secretary that specifies stipends based upon the amount and degree of personal care services provided.
      • (ii) The Secretary shall ensure, to the extent practicable, that the schedule required by clause (i) specifies that the amount of the monthly personal caregiver stipend provided to a primary provider of personal care services for the provision of personal care services to an eligible veteran is not less than the monthly amount a commercial home health care entity would pay an individual in the geographic area of the eligible veteran to provide equivalent personal care services to the eligible veteran.
      • (iii) In determining the amount and degree of personal care services provided under clause (i) with respect to an eligible veteran whose need for personal care services is based in whole or in part on a need for supervision or protection under paragraph (2)(C)(ii) or regular instruction or supervision under paragraph (2)(C)(iii), the Secretary shall take into account the following:
        • (I) The assessment by the family caregiver of the needs and limitations of the veteran.
        • (II) The extent to which the veteran can function safely and independently in the absence of such supervision, protection, or instruction.
        • (III) The amount of time required for the family caregiver to provide such supervision, protection, or instruction to the veteran.
      • (iv) If personal care services are not available from a commercial home health entity in the geographic area of an eligible veteran, the amount of the monthly personal caregiver stipend payable under the schedule required by clause (i) with respect to the eligible veteran shall be determined by taking into consideration the costs of commercial providers of personal care services in providing personal care services in geographic areas other than the geographic area of the eligible veteran with similar costs of living.
    • (D) In providing instruction, preparation, and training under subparagraph (A)(i)(I) and technical support under subparagraph (A)(i)(II) to each family caregiver who is approved as a provider of personal care services for an eligible veteran under paragraph (6), the Secretary shall periodically evaluate the needs of the eligible veteran and the skills of the family caregiver of such veteran to determine if additional instruction, preparation, training, or technical support under those subparagraphs is necessary.
  • (4) An eligible veteran and a family member of the eligible veteran seeking to participate in the program required by paragraph (1) shall jointly submit to the Secretary an application therefor in such form and in such manner as the Secretary considers appropriate.
  • (5) For each application submitted jointly by an eligible veteran and family member, the Secretary shall evaluate (in collaboration with the primary care team for the eligible veteran to the maximum extent practicable)—
    • (A) the eligible veteran—
      • (i) to identify the personal care services required by the eligible veteran; and
      • (ii) to determine whether such requirements could be significantly or substantially satisfied through the provision of personal care services from a family member; and
    • (B) the family member to determine the amount of instruction, preparation, and training, if any, the family member requires to provide the personal care services required by the eligible veteran—
      • (i) as a provider of personal care services for the eligible veteran; and
      • (ii) as the primary provider of personal care services for the eligible veteran.
  • (6)
    • (A) The Secretary shall provide each family member of an eligible veteran who makes a joint application under paragraph (4) the instruction, preparation, and training determined to be required by such family member under paragraph (5)(B).
    • (B) Upon the successful completion by a family member of an eligible veteran of instruction, preparation, and training under subparagraph (A), the Secretary shall approve the family member as a provider of personal care services for the eligible veteran.
    • (C) The Secretary shall, subject to regulations the Secretary shall prescribe, provide for necessary travel, lodging, and per diem expenses incurred by a family member of an eligible veteran in undergoing instruction, preparation, and training under subparagraph (A).
    • (D) If the participation of a family member of an eligible veteran in instruction, preparation, and training under subparagraph (A) would interfere with the provision of personal care services to the eligible veteran, the Secretary shall, subject to regulations as the Secretary shall prescribe and in consultation with the veteran, provide respite care to the eligible veteran during the provision of such instruction, preparation, and training to the family member so that the family member can participate in such instruction, preparation, and training without interfering with the provision of such services to the eligible veteran.
  • (7)
    • (A) For each eligible veteran with at least one family member who is described by subparagraph (B), the Secretary shall designate one family member of such eligible veteran as the primary provider of personal care services for such eligible veteran.
    • (B) A primary provider of personal care services designated for an eligible veteran under subparagraph (A) shall be selected from among family members of the eligible veteran who—
      • (i) are approved under paragraph (6) as a provider of personal care services for the eligible veteran;
      • (ii) elect to provide the personal care services to the eligible veteran that the Secretary determines the eligible veteran requires under paragraph (5)(A)(i);
      • (iii) have the consent of the eligible veteran to be the primary provider of personal care services for the eligible veteran; and
      • (iv) are considered by the Secretary as competent to be the primary provider of personal care services for the eligible veteran.
    • (C) An eligible veteran receiving personal care services from a family member designated as the primary provider of personal care services for the eligible veteran under subparagraph (A) may, in accordance with procedures the Secretary shall establish for such purposes, revoke consent with respect to such family member under subparagraph (B)(iii).
    • (D) If a family member designated as the primary provider of personal care services for an eligible veteran under subparagraph (A) subsequently fails to meet any requirement set forth in subparagraph (B), the Secretary—
      • (i) shall immediately revoke the family member’s designation under subparagraph (A); and
      • (ii) may designate, in consultation with the eligible veteran, a new primary provider of personal care services for the eligible veteran under such subparagraph.
    • (E) The Secretary shall take such actions as may be necessary to ensure that the revocation of a designation under subparagraph (A) with respect to an eligible veteran does not interfere with the provision of personal care services required by the eligible veteran.
  • (8) If an eligible veteran lacks the capacity to make a decision under this subsection, the Secretary may, in accordance with regulations and policies of the Department regarding appointment of guardians or the use of powers of attorney, appoint a surrogate for the eligible veteran who may make decisions and take action under this subsection on behalf of the eligible veteran.
  • (9)
    • (A) The Secretary shall monitor the well-being of each eligible veteran receiving personal care services under the program required by paragraph (1).
    • (B) The Secretary shall document each finding the Secretary considers pertinent to the appropriate delivery of personal care services to an eligible veteran under the program.
    • (C) The Secretary shall establish procedures to ensure appropriate follow-up regarding findings described in subparagraph (B). Such procedures may include the following:
      • (i) Visiting an eligible veteran in the eligible veteran’s home to review directly the quality of personal care services provided to the eligible veteran.
      • (ii) Taking such corrective action with respect to the findings of any review of the quality of personal care services provided an eligible veteran as the Secretary considers appropriate, which may include—
        • (I) providing additional training to a family caregiver; and
        • (II) suspending or revoking the approval of a family caregiver under paragraph (6) or the designation of a family caregiver under paragraph (7).
  • (10) The Secretary shall carry out outreach to inform eligible veterans and family members of eligible veterans of the program required by paragraph (1) and the benefits of participating in the program.
  • (11)
    • (A) In providing assistance under this subsection to family caregivers of eligible veterans, the Secretary may enter into contracts, provider agreements, and memoranda of understanding with Federal agencies, States, and private, nonprofit, and other entities to provide such assistance to such family caregivers.
    • (B) The Secretary may provide assistance under this paragraph only if such assistance is reasonably accessible to the family caregiver and is substantially equivalent or better in quality to similar services provided by the Department.
    • (C) The Secretary may provide fair compensation to Federal agencies, States, and other entities that provide assistance under this paragraph.
• (b)
  • (1) The Secretary shall establish a program of support services for caregivers of covered veterans who are enrolled in the health care system established under section 1705(a) of this title (including caregivers who do not reside with such veterans).
  • (2) For purposes of this subsection, a covered veteran is any individual who needs personal care services because of—
    • (A) an inability to perform one or more activities of daily living;
    • (B) a need for supervision or protection based on symptoms or residuals of neurological or other impairment or injury; or
    • (C) such other matters as the Secretary shall specify.
  • (3)
    • (A) The support services furnished to caregivers of covered veterans under the program required by paragraph (1) shall include the following:
      • (i) Services regarding the administering of personal care services, which, subject to subparagraph (B), shall include—
        • (I) educational sessions made available both in person and on an Internet website;
        • (II) use of telehealth and other available technologies; and
        • (III) teaching techniques, strategies, and skills for caring for a disabled veteran;
      • (ii) Counseling and other services under section 1782 of this title .
      • (iii) Respite care under section 1720B of this title that is medically and age appropriate for the veteran (including 24-hour per day in-home care).
      • (iv) Information concerning the supportive services available to caregivers under this subsection and other public, private, and nonprofit agencies that offer support to caregivers.
    • (B) If the Secretary certifies to the Committees on Veterans’ Affairs of the Senate and the House of Representatives that funding available for a fiscal year is insufficient to fund the provision of services specified in one or more subclauses of subparagraph (A)(i), the Secretary shall not be required under subparagraph (A) to provide the services so specified in the certification during the period beginning on the date that is 180 days after the date the certification is received by the Committees and ending on the last day of the fiscal year.
  • (4) In providing information under paragraph (3)(A)(iv), the Secretary shall collaborate with the Assistant Secretary for Aging of the Department of Health and Human Services in order to provide caregivers access to aging and disability resource centers under the Administration on Aging of the Department of Health and Human Services.
  • (5) In carrying out the program required by paragraph (1), the Secretary shall conduct outreach to inform covered veterans and caregivers of covered veterans about the program. The outreach shall include an emphasis on covered veterans and caregivers of covered veterans living in rural areas.
• (c)
  • (1) A decision by the Secretary under this section affecting the furnishing of assistance or support shall be considered a medical determination.
  • (2) Nothing in this section shall be construed to create—
    • (A) an employment relationship between the Secretary and an individual in receipt of assistance or support under this section; or
    • (B) any entitlement to any assistance or support provided under this section.
• (d) In this section:
  • (1) The term “caregiver”, with respect to an eligible veteran under subsection (a) or a covered veteran under subsection (b), means an individual who provides personal care services to the veteran.
  • (2) The term “family caregiver”, with respect to an eligible veteran under subsection (a), means a family member who is a caregiver of the veteran.
  • (3) The term “family member”, with respect to an eligible veteran under subsection (a), means an individual who—
    • (A) is a member of the family of the veteran, including—
      • (i) a parent;
      • (ii) a spouse;
      • (iii) a child;
      • (iv) a step-family member; and
      • (v) an extended family member; or
    • (B) lives with the veteran but is not a member of the family of the veteran.
  • (4) The term “personal care services”, with respect to an eligible veteran under subsection (a) or a covered veteran under subsection (b), means services that provide the veteran the following:
    • (A) Assistance with one or more activities of daily living.
    • (B) Supervision or protection based on symptoms or residuals of neurological or other impairment or injury.
    • (C) Regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired.
    • (D) Any other non-institutional extended care (as such term is used in section 1701(6)(E) of this title ).

§ 1720H. Mental health treatment for veterans who served in classified missions

• (a)
  • (1) The Secretary shall establish standards and procedures to ensure that each eligible veteran may access mental health care furnished by the Secretary in a manner that fully accommodates the obligation of the veteran to not improperly disclose classified information.
  • (2) In establishing standards and procedures under paragraph (1), the Secretary shall consult with the Secretary of Defense to ensure that such standards and procedures are consistent with the policies on classified information of the Department of Defense.
  • (3) The Secretary shall disseminate guidance to employees of the Veterans Health Administration, including mental health professionals, on the standards and procedures established under paragraph (1) and how to best engage eligible veterans during the course of mental health treatment with respect to classified information.
• (b) In carrying out this section, the Secretary shall ensure that a veteran may elect to identify as an eligible veteran on an appropriate form.
• (c) In this section:
  • (1) The term “classified information” means any information or material that has been determined by an official of the United States pursuant to law to require protection against unauthorized disclosure for reasons of national security.
  • (2) The term “eligible veteran” means a veteran who—
    • (A) is eligible to receive health care furnished by the Department under this title;
    • (B) is seeking mental health treatment; and
    • (C) in the course of serving in the Armed Forces, participated in a sensitive mission or served in a sensitive unit.
  • (3) The term “sensitive mission” means a mission of the Armed Forces that, at the time at which an eligible veteran seeks treatment, is classified.
  • (4) The term “sensitive unit” has the meaning given that term in section 130b(c)(4) of title 10 .

§ 1720I. Mental and behavioral health care for certain former members of the Armed Forces

• (a) The Secretary shall furnish to former members of the Armed Forces described in subsection (b)—
  • (1) an initial mental health assessment; and
  • (2) the mental healthcare or behavioral healthcare services authorized under this chapter that are required to treat the mental or behavioral health care needs of the former service members, including risk of suicide or harming others.
• (b) A former member of the Armed Forces described in this subsection is an individual who—
  • (1) is a former member of the Armed Forces, including the reserve components;
  • (2) while serving in the active military, naval, or air service, was discharged or released therefrom under a condition that is not honorable but not—
    • (A) a dishonorable discharge; or
    • (B) a discharge by court-martial;
  • (3) is not enrolled in the health care system established by section 1705 of this title ; and
  • (4)
    • (A)
      • (i) served in the Armed Forces for a period of more than 100 cumulative days; and
      • (ii) was deployed in a theater of combat operations, in support of a contingency operation, or in an area at a time during which hostilities are occurring in that area during such service, including by controlling an unmanned aerial vehicle from a location other than such theater or area; or
    • (B) while serving in the Armed Forces, was the victim of a physical assault of a sexual nature, a battery of a sexual nature, or sexual harassment (as defined in section 1720D(f) of this title ).
• (c)
  • (1) In furnishing mental or behavioral health care services to an individual under this section, the Secretary may provide such mental or behavioral health care services at a non-Department facility if—
    • (A) in the judgment of a mental health professional employed by the Department, the receipt of mental or behavioral health care services by that individual in facilities of the Department would be clinically inadvisable; or
    • (B) facilities of the Department are not capable of furnishing such mental or behavioral health care services to that individual economically because of geographical inaccessibility.
  • (2) The Secretary shall carry out paragraph (1) pursuant to section 1703 of this title or any other provision of law authorizing the Secretary to enter into contracts or agreements to furnish hospital care and medical services to veterans at non-Department facilities.
• (d) In furnishing mental and behavioral health care services to individuals under this section, the Secretary shall—
  • (1) seek to ensure that such services are furnished in settings that are therapeutically appropriate, taking into account the circumstances that resulted in the need for such services; and
  • (2) provide referral services to assist former members who are not eligible for services under this chapter to obtain services from sources outside the Department.
• (e) The Secretary shall provide information on the mental and behavioral health care services available under this section. Efforts by the Secretary to provide such information—
  • (1) shall include notification of each eligible individual described in subsection (b) about the eligibility of the individual for covered mental and behavioral health care under this section not later than the later of—
    • (A) 180 days after the date of the enactment of the Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2018; or
    • (B) 180 days after the date on which the individual was discharged or released from the active military, naval, or air service;
  • (2) shall include availability of a toll-free telephone number (commonly referred to as an 800 number);
  • (3) shall ensure that information about the mental health care services available under this section—
    • (A) is revised and updated as appropriate;
    • (B) is made available and visibly posted at appropriate facilities of the Department; and
    • (C) is made available to State veteran agencies and through appropriate public information services; and
  • (4) shall include coordination with the Secretary of Defense seeking to ensure that members of the Armed Forces and individuals who are being separated from active military, naval, or air service are provided appropriate information about programs, requirements, and procedures for applying for mental health care services under this section.
• (f)
  • (1) Not later than February 15 each year, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the mental and behavioral health care services provided under this section.
  • (2) Each report submitted under paragraph (1) shall include, with respect to the year preceding the submittal of the report, the following:
    • (A) The number of eligible individuals who were furnished mental or behavioral health care services under this section, disaggregated by the number of men who received such services and the number of women who received such services.
    • (B) The number of individuals who requested an initial mental health assessment under subsection (a)(1).
    • (C) The types of mental or behavioral health care needs treated under this section.
    • (D) The demographics of individuals being treated under this section, including—
      • (i) age;
      • (ii) era of service in the Armed Forces;
      • (iii) branch of service in the Armed Forces; and
      • (iv) geographic location.
    • (E) The average number of visits for an individual for mental or behavioral health care under this section.
    • (F) Such other information as the Secretary considers appropriate.

§ 1720J. Emergent suicide care

• (a) Pursuant to this section, the Secretary shall—
  • (1) furnish emergent suicide care to an eligible individual at a medical facility of the Department;
  • (2) pay for emergent suicide care provided to an eligible individual at a non-Department facility; and
  • (3) reimburse an eligible individual for emergent suicide care provided to the eligible individual at a non-Department facility.
• (b) An individual is eligible for emergent suicide care under subsection (a) if the individual is in an acute suicidal crisis and is either of the following:
  • (1) A veteran (as defined in section 101).
  • (2) An individual described in section 1720I(b) of this title .
• (c)
  • (1) Emergent suicide care provided under subsection (a) shall be furnished to an eligible individual—
    • (A) through inpatient or crisis residential care, for a period not to exceed 30 days; or
    • (B) if care under subparagraph (A) is unavailable, or if such care is not clinically appropriate, as outpatient care for a period not to exceed 90 days.
  • (2) If, upon the expiration of a period under paragraph (1), the Secretary determines that the eligible individual remains in an acute suicidal crisis, the Secretary may extend such period as the Secretary determines appropriate.
• (d) An eligible individual who receives emergent suicide care under subsection (a) at a non-Department facility (or a person acting on behalf of the individual) shall notify the Secretary of such care within seven days of admission to such facility.
• (e) During any period when an eligible individual is receiving emergent suicide care under subsection (a), the Secretary shall—
  • (1) ensure that—
    • (A) in the case of an eligible individual whom the Veterans Crisis Line recommends to seek emergent suicide care at a medical facility of the Department, the Veterans Crisis Line notifies the Suicide Prevention Coordinator of such medical facility;
    • (B) in the case of an eligible individual who presents at a medical facility of the Department in an acute suicidal crisis without a recommendation by the Veterans Crisis Line, the Secretary notifies the Suicide Prevention Coordinator;
    • (C) in the case of an eligible individual whom the Veterans Crisis Line recommends to seek treatment at a non-Department facility, the Veterans Crisis Line notifies the Suicide Prevention Coordinator and the Office of Community Care at the medical facility of the Department located nearest to the eligible individual; and
    • (D) in the case of an eligible individual who presents at a non-Department facility in an acute suicidal crisis without a recommendation by the Veterans Crisis Line and for whom the Secretary receives a notification under subsection (d), the Secretary notifies the Suicide Prevention Coordinator and the Office of Community Care at the medical facility of the Department located nearest to the eligible individual;
  • (2) determine the eligibility of the eligible individual for other programs and benefits under the laws administered by the Secretary (or shall make such determination as soon as practicable following the period of such emergent suicide care); and
  • (3) make referrals for care following the period of such emergent suicide care, as the Secretary determines appropriate.
• (f)
  • (1) If the Secretary provides emergent suicide care to an eligible individual under subsection (a), the Secretary—
    • (A) may not charge the eligible individual for any cost of such emergent suicide care; and
    • (B) shall pay for any costs of emergency transportation to a facility for such emergent suicide care (as such costs are determined pursuant to section 1725 of this title , to the extent practicable).
  • (2)
    • (A) In addition to the requirements of paragraph (1), if the Secretary pays for emergent suicide care provided under subsection (a) to an eligible individual at a non-Department facility, the Secretary shall reimburse the facility for the reasonable value of such emergent suicide care.
    • (B)
      • (i) In carrying out subparagraph (A), the Secretary may determine the amount to reimburse a non-Department facility in a similar manner to the manner in which the Secretary determines reimbursement amounts for that non-Department facility for medical care and services provided under another provision of this chapter.
      • (ii) The requiremen.ts of section 1725(c)(3) of this title shall apply with respect to payments made under subparagraph (A) of this paragraph.
  • (3) In the case of an eligible individual who receives emergent suicide care under this section and who is entitled to emergent suicide care (or payment for emergent suicide care) under a health-plan contract, the Secretary may recover the costs of such emergent suicide care provided under this section, other than for such care for a service-connected disability.
  • (4) In carrying out subsection (d), the Secretary may not charge an eligible individual for any cost of emergent suicide care provided under subsection (a) solely by reason of the Secretary not having been notified of such care pursuant to such subsection.
• (g) Not less than once each year, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report on emergent suicide care provided under subsection (a). Each such report shall include, for the year covered by the report—
  • (1) the number of eligible individuals who received emergent suicide care under subsection (a);
  • (2) demographic information regarding eligible individuals described in paragraph (1);
  • (3) the types of care furnished or paid for this section; 1 1 So in original. Probably should be “under this section;”. and
  • (4) the total cost of providing care under subsection (a).
• (h) In this section:
  • (1) The term “acute suicidal crisis” means that an individual was determined to be at imminent risk of self-harm by a trained crisis responder or health care provider.
  • (2) The term “crisis residential care” means crisis stabilization care provided—
    • (A) in a residential setting; and
    • (B) in a facility other than a hospital.
  • (3) The term “crisis stabilization care” includes, with respect to an individual in acute suicidal crisis, care that ensures, to the extent practicable, immediate safety and reduces—
    • (A) the severity of distress;
    • (B) the need for urgent care; or
    • (C) the likelihood that the distress under subparagraph (A) or need under subparagraph (B) will increase during the transfer of that individual from a facility at which the individual has received care for that acute suicidal crisis.
  • (4) The term “emergent suicide care” means crisis stabilization care provided to an eligible individual—
    • (A) pursuant to a recommendation of the eligible individual from the Veterans Crisis Line; or
    • (B) who presents at a medical facility in an acute suicidal crisis.
  • (5) The term “health-plan contract” has the meaning given such term in section 1725 of this title .
  • (6) The term “Veterans Crisis Line” means the hotline under section 1720F(h) of this title .

§ 1721. Power to make rules and regulations

Rules and regulations prescribed under section 501(a) of this title shall include rules and regulations to promote good conduct on the part of persons who are receiving hospital, nursing home, and domiciliary care and medical services in Department facilities. The Secretary may prescribe in rules and regulations under such section limitations in connection with the furnishing of such care and services during a period of national emergency (other than a period of war or an emergency described in section 8111A of this title ).

§ 1722. Determination of inability to defray necessary expenses; income thresholds

• (a) For the purposes of section 1710(a)(2)(G) of this title , a veteran shall be considered to be unable to defray the expenses of necessary care if—
  • (1) the veteran is eligible to receive medical assistance under a State plan approved under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq.);
  • (2) the veteran is in receipt of pension under section 1521 of this title ; or
  • (3) the veteran’s attributable income is not greater than the amount set forth in subsection (b).
• (b)
  • (1) For purposes of subsection (a)(3), the income threshold for the calendar year beginning on January 1, 1990 , is—
    • (A) $17,240 in the case of a veteran with no dependents; and
    • (B) $20,688 in the case of a veteran with one dependent, plus $1,150 for each additional dependent.
  • (2) For a calendar year beginning after December 31, 1990 , the amounts in effect for purposes of this subsection shall be the amounts in effect for the preceding calendar year as adjusted under subsection (c) of this section.
• (c) Effective on January 1 of each year, the amounts in effect under subsection (b) of this section shall be increased by the percentage by which the maximum rates of pension were increased under section 5312(a) of this title during the preceding calendar year.
• (d)
  • (1) Notwithstanding the attributable income of a veteran, the Secretary may refuse to make a determination described in paragraph (2) of this subsection if the corpus of the estate of the veteran is such that under all the circumstances it is reasonable that some part of the corpus of the estate of the veteran be consumed for the veteran’s maintenance.
  • (2) A determination described in this paragraph is a determination that for purposes of subsection (a)(3) of this section a veteran’s attributable income is not greater than the amount determined under subsection (b) of this section.
  • (3) For the purposes of paragraph (1) of this subsection, the corpus of the estate of a veteran shall be determined in the same manner as the manner in which determinations are made of the corpus of the estates of persons under section 1522 of this title .
• (e)
  • (1) In order to avoid a hardship to a veteran described in paragraph (2) of this subsection, the Secretary may deem the veteran to have an attributable income during the previous year not greater than the amount determined under subsection (b) of this section.
  • (2) A veteran is described in this paragraph for the purposes of subsection (a) of this section if—
    • (A) the veteran has an attributable income greater than the amount determined under subsection (b) of this section; and
    • (B) the current projections of such veteran’s income for the current year are that the veteran’s income for such year will be substantially below the amount determined under subsection (b).
• (f) For purposes of this section:
  • (1) The term “attributable income” means the income of a veteran for the most recent year for which information is available determined in the same manner as the manner in which a determination is made of the total amount of income by which the rate of pension for such veteran under section 1521 of this title would be reduced if such veteran were eligible for pension under that section.
  • (2) The term “corpus of the estate of the veteran” includes the corpus of the estates of the veteran’s spouse and dependent children, if any.
  • (3) The term “previous year” means the calendar year preceding the year in which the veteran applies for care or services under section 1710(a) of this title .
• (g) For the purposes of section 1724(c) of this title , the fact that a veteran is—
  • (1) eligible to receive medical assistance under a State plan approved under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq.);
  • (2) a veteran with a service-connected disability; or
  • (3) in receipt of pension under any law administered by the Secretary,

§ 1722A. Copayment for medications

• (a)
  • (1) Subject to paragraph (2), the Secretary shall require a veteran to pay the United States $2 for each 30-day supply of medication furnished such veteran under this chapter on an outpatient basis for the treatment of a non-service-connected disability or condition. If the amount supplied is less than a 30-day supply, the amount of the charge may not be reduced.
  • (2) The Secretary may not require a veteran to pay an amount in excess of the cost to the Secretary for medication described in paragraph (1).
  • (3) Paragraph (1) does not apply—
    • (A) to a veteran with a service-connected disability rated 50 percent or more;
    • (B) to a veteran who is a former prisoner of war;
    • (C) to a veteran whose annual income (as determined under section 1503 of this title ) does not exceed the maximum annual rate of pension which would be payable to such veteran if such veteran were eligible for pension under section 1521 of this title ; or
    • (D) to a veteran who was awarded the medal of honor under section 7271, 8291, or 9271 of title 10 or section 491 1 1 See References in Text note below. of title 14.
  • (4) Paragraph (1) does not apply 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.
• (b) The Secretary, pursuant to regulations which the Secretary shall prescribe, may—
  • (1) increase the copayment amount in effect under subsection (a); and
  • (2) establish a maximum monthly and a maximum annual pharmaceutical copayment amount under subsection (a) for veterans who have multiple outpatient prescriptions.
• (c) Amounts collected under this section shall be deposited in the Department of Veterans Affairs Medical Care Collections Fund.

§ 1722B. Copayments: waiver of collection of copayments for telehealth and telemedicine visits of veterans

The Secretary may waive the imposition or collection of copayments for telehealth and telemedicine visits of veterans under the laws administered by the Secretary.

§ 1723. Furnishing of clothing

• (1) where the furnishing of such clothing to indigent persons is necessary to protect health or sanitation, and
• (2) where the Secretary furnishes veterans with special clothing made necessary by the wearing of prosthetic appliances.

§ 1724. Hospital care, medical services, and nursing home care abroad

• (a) Except as provided in subsections (b) and (c), the Secretary shall not furnish hospital or domiciliary care or medical services outside any State.
• (b)
  • (1) The Secretary may furnish hospital care and medical services outside a State to a veteran who is otherwise eligible to receive hospital care and medical services if the Secretary determines that such care and services are needed for the treatment of a service-connected disability of the veteran or as part of a rehabilitation program under chapter 31 of this title.
  • (2) Care and services for a service-connected disability of a veteran who is not a citizen of the United States may be furnished under this subsection only—
    • (A) if the veteran is in the Republic of the Philippines or in Canada; or
    • (B) if the Secretary determines, as a matter of discretion and pursuant to regulations which the Secretary shall prescribe, that it is appropriate and feasible to furnish such care and services.
• (c) Within the limits of those facilities of the Veterans Memorial Medical Center at Manila, Republic of the Philippines, for which the Secretary may contract, the Secretary may furnish necessary hospital care to a veteran for any non-service-connected disability if such veteran is unable to defray the expenses of necessary hospital care. The Secretary may enter into contracts to carry out this section.
• (d) The Secretary may furnish nursing home care, on the same terms and conditions set forth in section 1720(a) of this title , to any veteran who has been furnished hospital care in the Philippines pursuant to this section, but who requires a protracted period of nursing home care.
• (e) Within the limits of an outpatient clinic in the Republic of the Philippines that is under the direct jurisdiction of the Secretary, the Secretary may furnish a veteran who has a service-connected disability with such medical services as the Secretary determines to be needed.

§ 1725. Reimbursement for emergency treatment

• (a)
  • (1) Subject to subsections (c) and (d), the Secretary shall reimburse a veteran described in subsection (b) for the reasonable value of emergency treatment furnished the veteran in a non-Department facility.
  • (2) In any case in which reimbursement is authorized under subsection (a)(1), the Secretary, in the Secretary’s discretion, may, in lieu of reimbursing the veteran, make payment of the reasonable value of the furnished emergency treatment directly—
    • (A) to a hospital or other health care provider that furnished the treatment; or
    • (B) to the person or organization that paid for such treatment on behalf of the veteran.
• (b)
  • (1) A veteran referred to in subsection (a)(1) is an individual who is an active Department health-care participant who is personally liable for emergency treatment furnished the veteran in a non-Department facility.
  • (2) A veteran is an active Department health-care participant if—
    • (A) the veteran is enrolled in the health care system established under section 1705(a) of this title ; and
    • (B) the veteran received care under this chapter within the 24-month period preceding the furnishing of such emergency treatment.
  • (3) A veteran is personally liable for emergency treatment furnished the veteran in a non-Department facility if the veteran—
    • (A) is financially liable to the provider of emergency treatment for that treatment;
    • (B) has no entitlement to care or services under a health-plan contract (determined, in the case of a health-plan contract as defined in subsection (f)(2)(B) or (f)(2)(C), without regard to any requirement or limitation relating to eligibility for care or services from any department or agency of the United States);
    • (C) has no other contractual or legal recourse against a third party that would, in whole, extinguish such liability to the provider; and
    • (D) is not eligible for reimbursement for medical care or services under section 1728 of this title .
• (c)
  • (1) The Secretary, in accordance with regulations prescribed by the Secretary, shall—
    • (A) establish the maximum amount payable under subsection (a);
    • (B) delineate the circumstances under which such payments may be made, to include such requirements on requesting reimbursement as the Secretary shall establish; and
    • (C) provide that in no event may a payment under that subsection include any amount for which the veteran is not personally liable.
  • (2) Subject to paragraph (1), the Secretary may provide reimbursement under this section only after the veteran or the provider of emergency treatment has exhausted without success all claims and remedies reasonably available to the veteran or provider against a third party for payment of such treatment.
  • (3) Payment by the Secretary under this section on behalf of a veteran to a provider of emergency treatment shall, unless rejected and refunded by the provider within 30 days of receipt, extinguish any liability on the part of the veteran for that treatment. Neither the absence of a contract or agreement between the Secretary and the provider nor any provision of a contract, agreement, or assignment to the contrary shall operate to modify, limit, or negate the requirement in the preceding sentence.
  • (4)
    • (A) If the veteran has contractual or legal recourse against a third party that would only, in part, extinguish the veteran’s liability to the provider of the emergency treatment, and payment for the treatment may be made both under subsection (a) and by the third party, the amount payable for such treatment under such subsection shall be the amount by which the costs for the emergency treatment exceed the amount payable or paid by the third party, except that the amount payable may not exceed the maximum amount payable established under paragraph (1)(A).
    • (B) In any case in which a third party is financially responsible for part of the veteran’s emergency treatment expenses, the Secretary shall be the secondary payer.
    • (C) A payment in the amount payable under subparagraph (A) shall be considered payment in full and shall extinguish the veteran’s liability to the provider.
    • (D) The Secretary may not reimburse a veteran under this section for any copayment or similar payment that the veteran owes the third party or for which the veteran is responsible under a health-plan contract.
• (d)
  • (1) In accordance with regulations prescribed by the Secretary, the United States shall have the independent right to recover any amount paid under this section when, and to the extent that, a third party subsequently makes a payment for the same emergency treatment.
  • (2) Any amount paid by the United States to the veteran (or the veteran’s personal representative, successor, dependents, or survivors) or to any other person or organization paying for such treatment shall constitute a lien in favor of the United States against any recovery the payee subsequently receives from a third party for the same treatment.
  • (3) Any amount paid by the United States to the provider that furnished the veteran’s emergency treatment shall constitute a lien against any subsequent amount the provider receives from a third party for the same emergency treatment for which the United States made payment.
  • (4) The veteran (or the veteran’s personal representative, successor, dependents, or survivors) shall ensure that the Secretary is promptly notified of any payment received from any third party for emergency treatment furnished to the veteran. The veteran (or the veteran’s personal representative, successor, dependents, or survivors) shall immediately forward all documents relating to such payment, cooperate with the Secretary in the investigation of such payment, and assist the Secretary in enforcing the United States right to recover any payment made under subsection (c)(3).
• (e) The Secretary, in the Secretary’s discretion, may waive recovery of a payment made to a veteran under this section that is otherwise required by subsection (d)(1) when the Secretary determines that such waiver would be in the best interest of the United States, as defined by regulations prescribed by the Secretary.
• (f) For purposes of this section:
  • (1) The term “emergency treatment” means medical care or services furnished, in the judgment of the Secretary—
    • (A) when Department or other Federal facilities are not feasibly available and an attempt to use them beforehand would not be reasonable;
    • (B) when such care or services are rendered in a medical emergency of such nature that a prudent layperson reasonably expects that delay in seeking immediate medical attention would be hazardous to life or health; and
    • (C) until—
      • (i) such time as the veteran can be transferred safely to a Department facility or other Federal facility and such facility is capable of accepting such transfer; or
      • (ii) such time as a Department facility or other Federal facility accepts such transfer if—
        • (I) at the time the veteran could have been transferred safely to a Department facility or other Federal facility, no Department facility or other Federal facility agreed to accept such transfer; and
        • (II) the non-Department facility in which such medical care or services was furnished made and documented reasonable attempts to transfer the veteran to a Department facility or other Federal facility.
  • (2) The term “health-plan contract” includes any of the following:
    • (A) An insurance policy or contract, medical or hospital service agreement, membership or subscription contract, or similar arrangement under which health services for individuals are provided or the expenses of such services are paid.
    • (B) An insurance program described in section 1811 of the Social Security Act ( 42 U.S.C. 1395c ) or established by section 1831 of that Act ( 42 U.S.C. 1395j ).
    • (C) A State plan for medical assistance approved under title XIX of such Act ( 42 U.S.C. 1396 et seq.).
    • (D) A workers’ compensation law or plan described in section 1729(a)(2)(A) of this title .
  • (3) The term “third party” means any of the following:
    • (A) A Federal entity.
    • (B) A State or political subdivision of a State.
    • (C) An employer or an employer’s insurance carrier.
    • (D) An automobile accident reparations insurance carrier.
    • (E) A person or entity obligated to provide, or to pay the expenses of, health services under a health-plan contract.

§ 1725A. Access to walk-in care

• (a) The Secretary shall develop procedures to ensure that eligible veterans are able to access walk-in care from qualifying non-Department entities or providers.
• (b) For purposes of this section, an eligible veteran is any individual who—
  • (1) is enrolled in the health care system established under section 1705(a) of this title ; and
  • (2) has received care under this chapter within the 24-month period preceding the furnishing of walk-in care under this section.
• (c) For purposes of this section, a qualifying non-Department entity or provider is a non-Department entity or provider that has entered into a contract, agreement, or other arrangement with the Secretary to furnish services under this section.
• (d) Whenever practicable, the Secretary may use a Federally-qualified health center (as defined in section 1905( l )(2)(B) of the Social Security Act ( 42 U.S.C. 1396d ( l )(2)(B))) to carry out this section.
• (e) The Secretary shall ensure continuity of care for those eligible veterans who receive walk-in care services under this section, including through the establishment of a mechanism to receive medical records from walk-in care providers and provide pertinent patient medical records to providers of walk-in care.
• (f)
  • (1)
    • (A) The Secretary may require an eligible veteran to pay the United States a copayment for each episode of hospital care or medical services provided under this section if the eligible veteran would be required to pay a copayment under this title.
    • (B) An eligible veteran not required to pay a copayment under this title may access walk-in care without a copayment for the first two visits in a calendar year. For any additional visits, a copayment at an amount determined by the Secretary may be required.
    • (C) An eligible veteran required to pay a copayment under this title may be required to pay a regular copayment for the first two walk-in care visits in a calendar year. For any additional visits, a higher copayment at an amount determined by the Secretary may be required.
  • (2) After the first two episodes of care furnished to an eligible veteran under this section, the Secretary may adjust the copayment required of the veteran under this subsection based upon the priority group of enrollment of the eligible veteran, the number of episodes of care furnished to the eligible veteran during a year, and other factors the Secretary considers appropriate under this section.
  • (3) The amount or amounts of the copayments required under this subsection shall be prescribed by the Secretary by rule.
  • (4) Sections 8153(c) and 1703A(j) of this title shall not apply to this subsection.
• (g) Not later than 1 year after the date of the enactment of the Caring for Our Veterans Act of 2018, the Secretary shall promulgate regulations to carry out this section.
• (h) In this section, the term “walk-in care” means non-emergent care provided by a qualifying non-Department entity or provider that furnishes episodic care and not longitudinal management of conditions and is otherwise defined through regulations the Secretary shall promulgate.

§ 1726. Reimbursement for loss of personal effects by natural disaster

The Secretary shall, under regulations which the Secretary shall prescribe, reimburse veterans in Department hospitals and domiciliaries for any loss of personal effects sustained by fire, earthquake, or other natural disaster while such effects were stored in designated locations in Department hospitals or domiciliaries.

§ 1727. Persons eligible under prior law

Persons who have a status which would, under the laws in effect on December 31, 1957 , entitle them to the medical services, hospital and domiciliary care, and other benefits, provided for in this chapter, but who do not meet the service requirements contained in this chapter, shall be entitled to such benefits notwithstanding failure to meet such service requirements.

§ 1728. Reimbursement of certain medical expenses

• (a) The Secretary shall, under such regulations as the Secretary prescribes, reimburse veterans eligible for hospital care or medical services under this chapter for the customary and usual charges of emergency treatment (including travel and incidental expenses under the terms and conditions set forth in section 111 of this title ) for which such veterans have made payment, from sources other than the Department, where such emergency treatment was rendered to such veterans in need thereof for any of the following:
  • (1) An adjudicated service-connected disability.
  • (2) A non-service-connected disability associated with and held to be aggravating a service-connected disability.
  • (3) Any disability of a veteran if the veteran has a total disability permanent in nature from a service-connected disability.
  • (4) Any illness, injury, or dental condition of a veteran who—
    • (A) is a participant in a vocational rehabilitation program (as defined in section 3101(9) of this title ); and
    • (B) is medically determined to have been in need of care or treatment to make possible the veteran’s entrance into a course of training, or prevent interruption of a course of training, or hasten the return to a course of training which was interrupted because of such illness, injury, or dental condition.
• (b) In any case where reimbursement would be in order under subsection (a) of this section, the Secretary may, in lieu of reimbursing such veteran, make payment of the reasonable value of emergency treatment directly—
  • (1) to the hospital or other health facility furnishing the emergency treatment; or
  • (2) to the person or organization making such expenditure on behalf of such veteran.
• (c) In this section, the term “emergency treatment” has the meaning given such term in section 1725(f)(1) of this title .

§ 1729. Recovery by the United States of the cost of certain care and services

• (a)
  • (1) Subject to the provisions of this section, in any case in which the United States is required by law to furnish or pay for care or services under this chapter for a non-service-connected disability described in paragraph (2) of this subsection, the United States has the right to recover or collect from a third party the reasonable charges of care or services so furnished or paid for to the extent that the recipient or provider of the care or services would be eligible to receive payment for such care or services from such third party if the care or services had not been furnished or paid for by a department or agency of the United States.
  • (2) Paragraph (1) of this subsection applies to a non-service-connected disability—
    • (A) that is incurred incident to the individual’s employment and that is covered under a workers’ compensation law or plan that provides for payment for the cost of health care and services provided to the individual by reason of the disability;
    • (B) that is incurred as the result of a motor vehicle accident to which applies a State law that requires the owners or operators of motor vehicles registered in that State to have in force automobile accident reparations insurance;
    • (C) that is incurred as the result of a crime of personal violence that occurred in a State, or a political subdivision of a State, in which a person injured as the result of such a crime is entitled to receive health care and services at such State’s or subdivision’s expense for personal injuries suffered as the result of such crime;
    • (D) that is incurred by an individual who is entitled to care (or payment of the expenses of care) under a health-plan contract; or
    • (E) for which care and services are furnished under this chapter to a veteran who—
      • (i) has a service-connected disability; and
      • (ii) is entitled to care (or payment of the expenses of care) under a health-plan contract.
  • (3) In the case of a health-plan contract that contains a requirement for payment of a deductible or copayment by the individual—
    • (A) the individual’s not having paid such deductible or copayment with respect to care or services furnished under this chapter shall not preclude recovery or collection under this section; and
    • (B) the amount that the United States may collect or recover under this section shall be reduced by the appropriate deductible or copayment amount, or both.
• (b)
  • (1) As to the right provided in subsection (a) of this section, the United States shall be subrogated to any right or claim that the individual (or the individual’s personal representative, successor, dependents, or survivors) may have against a third party.
  • (2)
    • (A) In order to enforce any right or claim to which the United States is subrogated under paragraph (1) of this subsection, the United States may intervene or join in any action or proceeding brought by the individual (or the individual’s personal representative, successor, dependents, or survivors) against a third party.
    • (B) The United States may institute and prosecute legal proceedings against the third party if—
      • (i) an action or proceeding described in subparagraph (A) of this paragraph is not begun within 180 days after the first day on which care or services for which recovery is sought are furnished to the individual by the Secretary under this chapter;
      • (ii) the United States has sent written notice by certified mail to the individual at the individual’s last-known address (or to the individual’s personal representative or successor) of the intention of the United States to institute such legal proceedings; and
      • (iii) a period of 60 days has passed following the mailing of such notice.
    • (C) A proceeding under subparagraph (B) of this paragraph may not be brought after the end of the six-year period beginning on the last day on which the care or services for which recovery is sought are furnished.
• (c)
  • (1) The Secretary may compromise, settle, or waive any claim which the United States has under this section.
  • (2)
    • (A) The Secretary, after consultation with the Comptroller General of the United States, shall prescribe regulations for the purpose of determining reasonable charges for care or services under subsection (a)(1) of this section. Any determination of such charges shall be made in accordance with such regulations.
    • (B) Such regulations shall provide that reasonable charges for care or services sought to be recovered or collected from a third-party liable under a health-plan contract may not exceed the amount that such third party demonstrates to the satisfaction of the Secretary it would pay for the care or services if provided by facilities (other than facilities of departments or agencies of the United States) in the same geographic area.
    • (C) Not later than 45 days after the date on which the Secretary prescribes such regulations (or any amendment to such regulations), the Comptroller General shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives the Comptroller General’s comments on and recommendations regarding such regulations (or amendment).
• (d) Any contract or agreement into which the Secretary enters with a person under section 3718 of title 31 for collection services to recover indebtedness owed the United States under this section shall provide, with respect to such services, that such person is subject to sections 5701 and 7332 of this title.
• (e) An individual eligible for care or services under this chapter—
  • (1) may not be denied such care or services by reason of this section; and
  • (2) may not be required by reason of this section to make any copayment or deductible payment in order to receive such care.
• (f) No law of any State or of any political subdivision of a State, and no provision of any contract or other agreement, shall operate to prevent recovery or collection by the United States under this section or with respect to care or services furnished under section 1784 of this title .
• [(g) Repealed. Pub. L. 105–33, title VIII, § 8023(b)(4) , Aug. 5, 1997 , 111 Stat. 667 .]
• (h)
  • (1) Subject to paragraph (3) of this subsection, the Secretary shall make available medical records of an individual described in paragraph (2) of this subsection for inspection and review by representatives of the third party concerned for the sole purposes of permitting the third party to verify—
    • (A) that the care or services for which recovery or collection is sought were furnished to the individual; and
    • (B) that the provision of such care or services to the individual meets criteria generally applicable under the health-plan contract involved.
  • (2) An individual described in this paragraph is an individual who is a beneficiary of a health-plan contract under which recovery or collection is sought under this section from the third party concerned for the cost of the care or services furnished to the individual.
  • (3) Records shall be made available under this subsection under such conditions to protect the confidentiality of such records as the Secretary shall prescribe in regulations.
• (i) For purposes of this section—
  • (1)
    • (A) The term “health-plan contract” means an insurance policy or contract, medical or hospital service agreement, membership or subscription contract, or similar arrangement, under which health services for individuals are provided or the expenses of such services are paid.
    • (B) Such term does not include—
      • (i) an insurance program described in section 1811 of the Social Security Act ( 42 U.S.C. 1395c ) or established by section 1831 of such Act ( 42 U.S.C. 1395j );
      • (ii) a State plan for medical assistance approved under title XIX of such Act ( 42 U.S.C. 1396 et seq.);
      • (iii) a workers’ compensation law or plan described in subparagraph (A) of subsection (a)(2) of this section; or
      • (iv) a program, plan, or policy under a law described in subparagraph (B) or (C) of such subsection.
  • (2) The term “payment” includes reimbursement and indemnification.
  • (3) The term “third party” means—
    • (A) a State or political subdivision of a State;
    • (B) an employer or an employer’s insurance carrier;
    • (C) an automobile accident reparations insurance carrier; or
    • (D) a person obligated to provide, or to pay the expenses of, health services under a health-plan contract.

§ 1729A. Department of Veterans Affairs Medical Care Collections Fund

• (a) There is in the Treasury a fund to be known as the Department of Veterans Affairs Medical Care Collections Fund.
• (b) Amounts recovered or collected under any of the following provisions of law shall be deposited in the fund:
  • (1) Section 1710(f) of this title .
  • (2) Section 1710(g) of this title .
  • (3) Section 1711 of this title .
  • (4) Section 1722A of this title .
  • (5) Section 1725 of this title .
  • (6) Section 1729 of this title .
  • (7) Section 1784 of this title .
  • (8) Section 8165(a) of this title .
  • (9) Section 113 of the Veterans Millennium Health Care and Benefits Act ( Public Law 106–117 ; 38 U.S.C. 8111 note).
  • (10) Public Law 87–693 , popularly known as the “Federal Medical Care Recovery Act” ( 42 U.S.C. 2651 et seq.), to the extent that a recovery or collection under that law is based on medical care or services furnished under this chapter.
• (c)
  • (1) Subject to the provisions of appropriations Acts, amounts in the fund shall be available, without fiscal year limitation, to the Secretary for the following purposes:
    • (A) Furnishing medical care and services under this chapter, to be available during any fiscal year for the same purposes and subject to the same limitations (other than with respect to the period of availability for obligation) as apply to amounts appropriated from the general fund of the Treasury for that fiscal year for medical care.
    • (B) Expenses of the Department for the identification, billing, auditing, and collection of amounts owed the United States by reason of medical care and services furnished under this chapter.
  • (2) Amounts available under paragraph (1) may not be used for any purpose other than a purpose set forth in subparagraph (A) or (B) of that paragraph.
• (d) Of the total amount recovered or collected by the Department during a fiscal year under the provisions of law referred to in subsection (b) and made available from the fund, the Secretary shall make available to each Department health care facility of the Department an amount that bears the same ratio to the total amount so made available as the amount recovered or collected by such facility during that fiscal year under such provisions of law bears to such total amount recovered or collected during that fiscal year. The Secretary shall make available to each facility the entirety of the amount specified to be made available to such facility by the preceding sentence.
• (e) Amounts recovered or collected under the provisions of law referred to in subsection (b) shall be treated for the purposes of sections 251 and 252 of the Balanced Budget and Emergency Deficit Control Act of 1985 ( 2 U.S.C. 901 , 902) as offsets to discretionary appropriations (rather than as offsets to direct spending) to the extent that such amounts are made available for expenditure in appropriations Acts for the purposes specified in subsection (c).

§ 1729B. Consolidated patient accounting centers

• (a) Not later than five years after the date of the enactment of this section, the Secretary of Veterans Affairs shall establish not more than seven consolidated patient accounting centers for conducting industry-modeled regionalized billing and collection activities of the Department.
• (b) The centers shall carry out the following functions:
  • (1) Reengineer and integrate all business processes of the revenue cycle of the Department.
  • (2) Standardize and coordinate all activities of the Department related to the revenue cycle for all health care services furnished to veterans for non-service-connected medical conditions.
  • (3) Apply commercial industry standards for measures of access, timeliness, and performance metrics with respect to revenue enhancement of the Department.
  • (4) Apply other requirements with respect to such revenue cycle improvement as the Secretary may specify.

§ 1730. Community residential care

• (a) Subject to this section and regulations to be prescribed by the Secretary under this section, the Secretary may assist a veteran by referring such veteran for placement in, and aiding such veteran in obtaining placement in, a community residential-care facility if—
  • (1) at the time of initiating the assistance the Secretary—
    • (A) is furnishing the veteran medical services on an outpatient basis or hospital, domiciliary, or nursing home care; or
    • (B) has furnished the veteran such care or services within the preceding 12 months; and
  • (2) placement of the veteran in a community residential-care facility is appropriate.
• (b)
  • (1) The Secretary may not provide assistance under subsection (a) of this section with respect to a community residential-care facility unless such facility is approved by the Secretary for the purposes of this section.
  • (2) The Secretary’s approval of a facility for the purposes of this section shall be based upon the Secretary’s determination, after inspection of the facility, that the facility meets the standards established in regulations prescribed under this section. Such standards shall include the following:
    • (A) Health and safety criteria, including a requirement of compliance with applicable State laws and local ordinances relating to health and safety.
    • (B) A requirement that the costs charged for care by a facility be reasonable, as determined by the Secretary, giving consideration to such factors as (i) the level of care, supervision, and other services to be provided, (ii) the cost of goods and services in the geographic area in which the facility is located, and (iii) comparability with other facilities in such area providing similar services.
    • (C) Criteria for determining the resources that a facility needs in order to provide an appropriate level of services to veterans.
    • (D) Such other criteria as the Secretary determines are appropriate to protect the welfare of veterans placed in a facility under this section.
  • (3) Payment of the charges of a community residential-care facility for any care or service provided to a veteran whom the Secretary has referred to that facility under this section is not the responsibility of the United States or of the Department.
• (c)
  • (1) In order to determine continued compliance by community residential-care facilities that have been approved under subsection (b) of this section with the standards established in regulations prescribed under this section, the Secretary shall provide for periodic inspection of such facilities.
  • (2) If the Secretary determines that a facility is not in compliance with such standards, the Secretary (in accordance with regulations prescribed under this section)—
    • (A) shall cease to refer veterans to such facility; and
    • (B) may, with the permission of the veteran (or the person or entity authorized by law to give permission on behalf of the veteran), assist in removing a veteran from such fa­cility.
• (d) The Secretary shall prescribe regulations to carry out this section. Such regulations shall include the standards required by subsection (b) of this section.
• (e)
  • (1) To the extent possible, the Secretary shall make available each report of an inspection of a community residential-care facility under subsection (b)(2) or (c)(1) of this section to each Federal, State, and local agency charged with the responsibility of licensing or otherwise regulating or inspecting such facility.
  • (2) The Secretary shall make the standards prescribed in regulations under subsection (d) of this section available to all Federal, State, and local agencies charged with the responsibility of licensing or otherwise regulating or inspecting community residential-care facilities.
• (f) For the purpose of this section, the term “community residential-care facility” means a facility that provides room and board and such limited personal care for and supervision of residents as the Secretary determines, in accordance with regulations prescribed under this section, are necessary for the health, safety, and welfare of residents.

§ 1730A. Prohibition on collection of copayments from catastrophically disabled veterans

• (f) and
• (g) of section 1710 and section 1722A(a) of this title or any other provision of law, the Secretary may not require a veteran who is catastrophically disabled, as defined by the Secretary, to make any copayment for the receipt of hospital care or medical services under the laws administered by the Secretary.

§ 1730B. Access to State prescription drug monitoring programs

• (a)
  • (1) Any licensed health care provider or delegate of such a provider shall be considered an authorized recipient or user for the purpose of querying and receiving data from the national network of State-based prescription drug monitoring programs, or any individual State or regional prescription drug monitoring program, to support the safe and effective prescribing of controlled substances to covered patients.
  • (2) Under the authority granted by paragraph (1)—
    • (A) licensed health care providers or delegates of such providers shall query the national network of State-based prescription monitoring programs, or, if providing care in a State that does not participate in such national network, an individual State or regional prescription drug monitoring program, in accordance with applicable regulations and policies of the Veterans Health Administration; and
    • (B) notwithstanding any general or specific provision of law, rule, or regulation of a State, no State may restrict the access of licensed health care providers or delegates of such providers from accessing that State’s prescription drug monitoring programs.
  • (3) No State shall deny or revoke the license, registration, or certification of a licensed health care provider or delegate who otherwise meets that State’s qualifications for holding the license, registration, or certification on the basis that the licensed health care provider or delegate queried or received data, or attempted to query or receive data, from the national network of State-based prescription drug monitoring programs, or any individual State or regional prescription drug monitoring program, under this section.
• (b) For purposes of this section, a covered patient is a patient who—
  • (1) receives a prescription for a controlled substance; and
  • (2) is not receiving palliative care or enrolled in hospice care.
• (c) In this section:
  • (1) The term “controlled substance” has the meaning given such term in section 102(6) of the Controlled Substances Act ( 21 U.S.C. 802(6) ).
  • (2) The term “delegate” means a person or automated system accessing the national network of State-based prescription monitoring programs, or any individual State or regional prescription drug monitoring program, at the direction or under the supervision of a licensed health care provider.
  • (3) The term “licensed health care provider” means a health care provider employed by the Department who is licensed, certified, or registered within any State to fill or prescribe medications within the scope of his or her practice as a Department employee.
  • (4) The term “national network of State-based prescription monitoring programs” means an interconnected nation-wide system that facilitates the transfer to State prescription drug monitoring program data across State lines.
  • (5) The term “State” means a State, as defined in section 101(20) of this title , or a political subdivision of a State.

§ 1730C. Licensure of health care professionals providing treatment via telemedicine

• (a) Notwithstanding any provision of law regarding the licensure of health care professionals, a covered health care professional may practice the health care profession of the health care professional at any location in any State, 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 to an individual under this chapter.
• (b) For purposes of this section, a covered health care professional is any health care professional who—
  • (1) is an employee of the Department appointed under the authority under section 7306, 7401, 7405, 7406, or 7408 of this title or title 5;
  • (2) is authorized by the Secretary to provide health care under this chapter;
  • (3) is required to adhere to all standards for quality relating to the provision of medicine in accordance with applicable policies of the Department; and
  • (4) 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.
• (c) Subsection (a) shall apply to a covered health care professional providing treatment to a patient regardless of whether the covered health care professional or patient is located in a facility owned by the Federal Government during such treatment.
• (d)
  • (1) The provisions of this section shall supersede any provisions of the law of any State to the extent that such provision of State law are inconsistent with this section.
  • (2) No State shall deny or revoke the license, registration, or certification of a covered health care professional who otherwise meets the qualifications of the State for holding the license, registration, or certification on the basis that the covered health care professional has engaged or intends to engage in activity covered by subsection (a).
• (e) Nothing in this section may be construed to remove, limit, or otherwise affect any obligation of a covered health care professional under the Controlled Substances Act ( 21 U.S.C. 801 et seq.).
• (f) In this section, the term “State” means a State, as defined in section 101(20) of this title , or a political subdivision of a State.

§ 1731. Assistance to the Republic of the Philippines

The President is authorized to assist the Republic of the Philippines in fulfilling its responsibility in providing medical care and treatment for Commonwealth Army veterans and new Philippine Scouts in need of such care and treatment for service-connected disabilities and non-service-connected disabilities under certain conditions.

§ 1732. Contracts and grants to provide for the care and treatment of United States veterans by the Veterans Memorial Medical Center

• (a) The President, with the concurrence of the Republic of the Philippines, may authorize the Secretary to enter into contracts with the Veterans Memorial Medical Center, with the approval of the appropriate department of the Government of the Republic of the Philippines, covering the period beginning on October 1, 1981 , and ending on September 30, 1994 , under which the United States—
  • (1) will provide for payments for hospital care and medical services (including nursing home care) in the Veterans Memorial Medical Center, as authorized by section 1724 of this title and on the terms and conditions set forth in such section, to eligible United States veterans at a per diem rate to be jointly determined for each fiscal year by the two Governments to be fair and reasonable; and
  • (2) may provide that payments for such hospital care and medical services provided to eligible United States veterans may consist in whole or in part of available medicines, medical supplies, and equipment furnished by the Secretary to the Veterans Memorial Medical Center at valuations therefor as determined by the Secretary, who may furnish such medicines, medical supplies, and equipment through the revolving supply fund pursuant to section 8121 of this title .
• (b)
  • (1) To further assure the effective care and treatment of United States veterans in the Veterans Memorial Medical Center, there is authorized to be appropriated for each fiscal year during the period beginning on October 1, 1981 , and ending on September 30, 1990 , the sum of $1,000,000 to be used by the Secretary for making grants to the Veterans Memorial Medical Center for the purpose of assisting the Republic of the Philippines in the replacement and upgrading of equipment and in rehabilitating the physical plant and facilities of such center.
  • (2) Grants under this subsection shall be made on such terms and conditions as prescribed by the Secretary. Such terms and conditions may include a requirement of prior approval by the Secretary of the uses of the funds provided by such grants.
  • (3) Funds for such grants may be provided only from appropriations made to the Department for the specific purpose of making such grants.
• (c) The Secretary may stop payments under a contract or grant under this section upon reasonable notice as stipulated by the contract or grant if the Republic of the Philippines and the Veterans Memorial Medical Center do not maintain the medical center in a well-equipped and effective operating condition as determined by the Secretary.
• (d)
  • (1) The authority of the Secretary to enter into contracts and to make grants under this section is effective for any fiscal year only to the extent that appropriations are available for that purpose.
  • (2) Appropriations made for the purpose of this section shall remain available until expended.

§ 1733. Supervision of program by the President

The President, or any officer of the United States to whom the President may delegate authority under this section, may from time to time prescribe such rules and regulations and impose such conditions on the receipt of financial aid as may be necessary to carry out this subchapter.

§ 1734. Hospital and nursing home care and medical services in the United States

• (a) The Secretary shall furnish hospital and nursing home care and medical services to any individual described in subsection (b) in the same manner, and subject to the same terms and conditions, as apply to the furnishing of such care and services to individuals who are veterans as defined in section 101(2) of this title . Any disability of an individual described in subsection (b) that is a service-connected disability for purposes of this subchapter (as provided for under section 1735(2) of this title ) shall be considered to be a service-connected disability for purposes of furnishing care and services under the preceding sentence.
• (b) Subsection (a) applies to any individual who is a Commonwealth Army veteran or new Philippine Scout and who—
  • (1) is residing in the United States; and
  • (2) is a citizen of the United States or an alien lawfully admitted to the United States for permanent residence.

§ 1735. Definitions

For the purposes of this subchapter—

• (1) The term “Commonwealth Army veterans” means persons who served before July 1, 1946 , in the organized military forces of the Government of the Philippines, while such forces were in the service of the Armed Forces pursuant to the military order of the President dated July 26, 1941 , including among such military forces organized guerrilla forces under commanders appointed, designated, or subsequently recognized by the Commander in Chief, Southwest Pacific Area, or other competent authority in the Army of the United States, and who were discharged or released from such service under conditions other than dishonorable. The term “new Philippine Scouts” means persons who served in the Philippine Scouts under section 14 of the Armed Forces Voluntary Recruitment Act of 1945, and who were discharged or released from such service under conditions other than dishonorable.
• (2) The term “service-connected disabilities” means disabilities determined by the Secretary under laws administered by the Secretary to have been incurred in or aggravated by the service described in paragraph (1) in line of duty.

§ 1741. Criteria for payment

• (a)
  • (1) Except as provided in section 1745 of this title , the Secretary shall pay each State at the per diem rate of—
    • (A) $8.70 for domiciliary care; and
    • (B) $20.35 for nursing home care and hospital care,
  • (2) The Secretary may pay each State per diem at a rate determined by the Secretary for each veteran receiving extended care services described in any of paragraphs (4) through (6) of section 1710B(a) of this title under a program administered by a State home, if such veteran is eligible for such care under laws administered by the Secretary.
• (b) In no case shall the payments made with respect to any veteran under this section exceed one-half of the cost of the veterans’ care in such State home.
• (c) Whenever the Secretary makes a determination pursuant to section 1720(a)(2)(A) of this title that the cost of care furnished by the Department in a general hospital under the direct jurisdiction of the Secretary has increased, the Secretary may, effective no earlier than the date of such determination, increase the rates paid under subsection (a) of this section by a percentage not greater than the percentage by which the Secretary has determined that such cost of care has increased.
• (d) Subject to section 1743 of this title , the payment of per diem for care furnished in a State home facility shall commence on the date of the completion of the inspection for recognition of the facility under section 1742(a) of this title if the Secretary determines, as a result of that inspection, that the State home meets the standards described in such section.
• (e) Payments to States pursuant to this section shall not be considered a liability of a third party, or otherwise be used to offset or reduce any other payment made to assist veterans.
• (f) Any State home that requests payment or reimbursement for services provided to a veteran under this section shall provide to the Secretary such information as the Secretary considers necessary to identify each individual veteran eligible for payment under such section.

§ 1742. Inspections of such homes; restrictions on beneficiaries

• (a) The Secretary may inspect any State home at such times as the Secretary deems necessary. No payment or grant may be made to any home under this subchapter unless such home is determined by the Secretary to meet such standards as the Secretary shall prescribe, which standards with respect to nursing home care shall be no less stringent than those prescribed pursuant to section 1720(b) of this title .
• (b) The Secretary may ascertain the number of persons on account of whom payments may be made under this subchapter on account of any State home, but shall have no authority over the management or control of any State home.

§ 1743. Applications

Payments on account of any veteran cared for in a State home shall be made under this subchapter only from the date the Secretary receives a request for determination of such veteran’s eligibility; however, if such request is received by the Secretary within ten days after care of such veteran begins, payments shall be made on account of such veteran from the date care began.

§ 1744. Hiring and retention of nurses: payments to assist States

• (a) The Secretary shall make payments to States under this section for the purpose of assisting State homes in the hiring and retention of nurses and the reduction of nursing shortages at State homes.
• (b) Payments to a State for a fiscal year under this section shall, subject to submission of an application, be made to any State that during that fiscal year—
  • (1) receives per diem payments under this subchapter for that fiscal year; and
  • (2) has in effect an employee incentive scholarship program or other employee incentive program at a State home designed to promote the hiring and retention of nursing staff and to reduce nursing shortages at that home.
• (c) A State may use an amount received under this section only to provide funds for a program described in subsection (b)(2). Any program shall meet such criteria as the Secretary may prescribe. In prescribing such criteria, the Secretary shall take into consideration the need for flexibility and innovation.
• (d)
  • (1) A payment under this section may not be used to provide more than 50 percent of the costs for a fiscal year of the employee incentive scholarship or other employee incentive program for which the payment is made.
  • (2) The amount of the payment to a State under this section for any fiscal year is, for each State home in that State with a program described in subsection (b)(2), the amount equal to 2 percent of the amount of payments estimated to be made to that State, for that State home, under section 1741 of this title for that fiscal year.
• (e) A payment under this section for any fiscal year with respect to any State home may only be made based upon an application submitted by the State seeking the payment with respect to that State home. Any such application shall describe the nursing shortage at the State home and the employee incentive scholarship program or other employee incentive program described in subsection (c) for which the payment is sought.
• (f) Payments under this section shall be made from funds available for other payments under this subchapter.
• (g) Payments under this section to a State home shall be made as part of the disbursement of payments under section 1741 of this title with respect to that State home.
• (h) The Secretary shall require as a condition of any payment under this section that, in any case in which the State home receives a refund payment made by an employee in breach of the terms of an agreement for employee assistance that used funds provided under this section, the payment shall be returned to the State home’s incentive program account and credited as a non-Federal funding source.
• (i) Any State home receiving a payment under this section for any fiscal year, shall, as a condition of the payment, be required to agree to provide to the Secretary a report setting forth in detail the use of funds received through the payment, including a descriptive analysis of how effective the incentive program has been on nurse staffing in the State home during that fiscal year. The report for any fiscal year shall be provided to the Secretary within 60 days of the close of the fiscal year and shall be subject to audit by the Secretary. Eligibility for a payment under this section for any later fiscal year is contingent upon the receipt by the Secretary of the annual report under this subsection for the previous fiscal year in accordance with this subsection.
• (j) The Secretary shall prescribe regulations to carry out this section. The regulations shall include the establishment of criteria for the award of payments under this section.

§ 1745. Nursing home care, adult day health care, and medications for veterans with service-connected disabilities

• (a)
  • (1) The Secretary shall enter into a contract (or an agreement) with each State home for payment by the Secretary for nursing home care provided in the home, in any case in which such care is provided to any veteran as follows:
    • (A) Any veteran in need of such care for a service-connected disability.
    • (B) Any veteran who—
      • (i) has a service-connected disability rated at 70 percent or more; and
      • (ii) is in need of such care.
  • (2) Payment under each contract (or agreement) between the Secretary and a State home under paragraph (1) shall be based on a methodology, developed by the Secretary in consultation with the State home, to adequately reimburse the State home for the care provided by the State home under the contract (or agreement).
  • (3) Payment by the Secretary under paragraph (1) to a State home for nursing home care provided to a veteran described in that paragraph constitutes payment in full to the State home for such care furnished to that veteran.
  • (4)
    • (A) An agreement under this section may be authorized by the Secretary or any Department official authorized by the Secretary, and any such action is not an award for purposes of such laws that would otherwise require the use of competitive procedures for the furnishing of hospital care, medical services, and extended care services.
    • (B)
      • (i) Except as provided in the agreement itself, in clause (ii), and unless otherwise provided in this section or regulations prescribed pursuant to this section, a State home that enters into an agreement under this section is not subject to, in the carrying out of the agreement, any provision of law to which providers of services and suppliers under the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq.) are not subject.
      • (ii) A State home that enters into an agreement under this section is subject to—
        • (I) all provisions of law regarding integrity, ethics, or fraud, or that subject a person to civil or criminal penalties;
        • (II) all provisions of law that protect against employment discrimination or that otherwise ensure equal employment opportunities; and
        • (III) all provisions in this subchapter.
      • (iii) Notwithstanding subparagraph (B)(ii)(I), a State home that enters into an agreement under this section may not be treated as a Federal contractor or subcontractor for purposes of chapter 67 of title 41 (known as the “McNamara-O’Hara Service Contract Act of 1965”).
• (b) The Secretary shall furnish such drugs and medicines as may be ordered on prescription of a duly licensed physician as specific therapy in the treatment of illness or injury to any veteran as follows:
  • (1) Any veteran who—
    • (A) is not being provided nursing home care for which payment is payable under subsection (a); and
    • (B) is in need of such drugs and medicines for a service-connected disability.
  • (2) Any veteran who—
    • (A) has a service-connected disability rated at 50 percent or more;
    • (B) is not being provided nursing home care for which payment is payable under subsection (a); and
    • (C) is in need of such drugs and medicines.
• (c) Any State home that requests payment or reimbursement for services provided to a veteran under this section shall provide to the Secretary such information as the Secretary considers necessary to identify each individual veteran eligible for payment under such section.
• (d)
  • (1) The Secretary shall enter into an agreement with each State home for payment by the Secretary for medical supervision model adult day health care provided to a veteran described in subsection (a)(1) on whose behalf the State home is not in receipt of payment for nursing home care from the Secretary.
  • (2)
    • (A) Payment under each agreement between the Secretary and a State home under paragraph (1) for each veteran who receives medical supervision model adult day health care under such agreement shall be made at a rate established through regulations prescribed by the Secretary to adequately reimburse the State home for the care provided by the State home, including necessary transportation expenses.
    • (B) The Secretary shall consult with the State homes in prescribing regulations under subparagraph (A).
    • (C) The rate established through regulations under subparagraph (A) shall not take effect until the date that is 30 days after the date on which those regulations are published in the Federal Register.
  • (3) Payment by the Secretary under paragraph (1) to a State home for medical supervision model adult day health care provided to a veteran described in that paragraph constitutes payment in full to the State home for such care furnished to that veteran.
  • (4) In this subsection, the term “medical supervision model adult day health care” means adult day health care that includes the coordination of physician services, dental services, nursing services, the administration of drugs, and such other requirements as determined appropriate by the Secretary.

§ 1751. Screening, counseling, and medical treatment

The Secretary is authorized to carry out a comprehensive program of providing sickle cell anemia screening, counseling, treatment, and information under the provisions of this chapter.

§ 1752. Research

The Secretary is authorized to carry out research and research training in the diagnosis, treatment, and control of sickle cell anemia based upon the screening examinations and treatment provided under this subchapter.

§ 1753. Voluntary participation; confidentiality

• (a) The participation by any person in any program or portion thereof under this subchapter shall be wholly voluntary and shall not be a prerequisite to eligibility for or receipt of any other service or assistance from, or to participation in, any other program under this title.
• (b) Patient records prepared or obtained under this subchapter shall be held confidential in the same manner and under the same conditions prescribed in section 7332 of this title .

§ 1754. Reports

The Secretary shall include in the annual report to the Congress required by section 529 of this title a comprehensive report on the administration of this subchapter, including such recommendations for additional legislation as the Secretary deems necessary.

§ 1781. Medical care for survivors and dependents of certain veterans

• (a) The Secretary is authorized to provide medical care, in accordance with the provisions of subsection (b) of this section, for—
  • (1) the spouse or child of a veteran who has a total disability, permanent in nature, resulting from a service-connected disability,
  • (2) the surviving spouse or child of a veteran who (A) died as a result of a service-connected disability, or (B) at the time of death had a total disability permanent in nature, resulting from a service-connected disability,
  • (3) the surviving spouse or child of a person who died in the active military, naval, or air service in the line of duty and not due to such person’s own misconduct, and
  • (4) an individual designated as a primary provider of personal care services under section 1720G(a)(7)(A) of this title who is not entitled to care or services under a health-plan contract (as defined in section 1725(f) of this title ),
• (b) In order to accomplish the purposes of subsection (a) of this section, the Secretary shall provide for medical care in the same or similar manner and subject to the same or similar limitations as medical care is furnished to certain dependents and survivors of active duty and retired members of the Armed Forces under chapter 55 of title 10 (CHAMPUS), by—
  • (1) entering into an agreement with the Secretary of Defense under which that Secretary shall include coverage for such medical care under the contract, or contracts, that Secretary enters into to carry out such chapter 55, and under which the Secretary of Veterans Affairs shall fully reimburse the Secretary of Defense for all costs and expenditures made for the purposes of affording the medical care authorized pursuant to this section; or
  • (2) contracting in accordance with such regulations as the Secretary shall prescribe for such insurance, medical service, or health plans as the Secretary deems appropriate.
• (c) For the purposes of this section, a child between the ages of eighteen and twenty-three (1) who is eligible for benefits under subsection (a) of this section, (2) who is pursuing a full-time course of instruction at an educational institution approved under chapter 36 of this title, and (3) who, while pursuing such course of instruction, incurs a disabling illness or injury (including a disabling illness or injury incurred between terms, semesters, or quarters or during a vacation or holiday period) which is not the result of such child’s own willful misconduct and which results in such child’s inability to continue or resume such child’s chosen program of education at an approved educational institution shall remain eligible for benefits under this section until the end of the six-month period beginning on the date the disability is removed, the end of the two-year period beginning on the date of the onset of the disability, or the twenty-third birthday of the child, whichever occurs first.
• (d)
  • (1)
    • (A) An individual otherwise eligible for medical care under this section who is also entitled to hospital insurance benefits under part A of the medicare program is eligible for medical care under this section only if the individual is also enrolled in the supplementary medical insurance program under part B of the medicare program.
    • (B) The limitation in subparagraph (A) does not apply to an individual who—
      • (i) has attained 65 years of age as of June 5, 2001 ; and
      • (ii) is not enrolled in the supplementary medical insurance program under part B of the medicare program as of that date.
  • (2) Subject to paragraph (3), if an individual described in paragraph (1) receives medical care for which payment may be made under both this section and the medicare program, the amount payable for such medical care under this section shall be the amount by which (A) the costs for such medical care exceed (B) the sum of—
    • (i) the amount payable for such medical care under the medicare program; and
    • (ii) the total amount paid or payable for such medical care by third party payers other than the medicare program.
  • (3) The amount payable under this subsection for medical care may not exceed the total amount that would be paid under subsection (b) if payment for such medical care were made solely under subsection (b).
  • (4) In this subsection:
    • (A) The term “medicare program” means the program of health insurance administered by the Secretary of Health and Human Services under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq.).
    • (B) The term “third party” has the meaning given that term in section 1729(i)(3) of this title .
• (e) Payment by the Secretary under this section on behalf of a covered beneficiary for medical care shall constitute payment in full and extinguish any liability on the part of the beneficiary for that care.

§ 1782. Counseling, training, and mental health services for immediate family members and caregivers

• (a) In the case of a veteran who is receiving treatment for a service-connected disability pursuant to paragraph (1) or (2) of section 1710(a) of this title , the Secretary shall provide to individuals described in subsection (c) such consultation, professional counseling, marriage and family counseling, training, and mental health services as are necessary in connection with that treatment.
• (b) In the case of a veteran who is eligible to receive treatment for a non-service-connected disability under the conditions described in paragraph (1), (2), or (3) of section 1710(a) of this title , the Secretary may, in the discretion of the Secretary, provide to individuals described in subsection (c) such consultation, professional counseling, marriage and family counseling, training, and mental health services as are necessary in connection with that treatment.
• (c) Individuals who may be provided services under this subsection are—
  • (1) the members of the immediate family or the legal guardian of a veteran;
  • (2) a family caregiver of an eligible veteran or a caregiver of a covered veteran (as those terms are defined in section 1720G of this title ); or
  • (3) the individual in whose household such veteran certifies an intention to live.
• (d) Services provided under subsections (a) and (b) may include, under the terms and conditions set forth in section 111 of this title , travel and incidental expenses of individuals described in subsection (c) in the case of any of the following:
  • (1) A veteran who is receiving care for a service-connected disability.
  • (2) A dependent or survivor receiving care under the last sentence of section 1783(b) of this title .

§ 1783. Bereavement counseling

• (a) In the case of an individual who was a recipient of services under section 1782 of this title at the time of the death of the veteran, the Secretary may provide bereavement counseling to that individual in the case of a death—
  • (1) that was unexpected; or
  • (2) that occurred while the veteran was participating in a hospice program (or a similar program) conducted by the Secretary.
• (b)
  • (1) The Secretary may provide bereavement counseling to an individual who is a member of the immediate family of a member of the Armed Forces who dies in the active military, naval, or air service in the line of duty and under circumstances not due to the person’s own misconduct.
  • (2) For purposes of this subsection, the members of the immediate family of a member of the Armed Forces described in paragraph (1) include the parents of such member.
• (c) Bereavement counseling may be provided under this section through the facilities and personnel of centers for the provision of readjustment counseling and related mental health services under section 1712A of this title .
• (d) For purposes of this section, the term “bereavement counseling” means such counseling services, for a limited period, as the Secretary determines to be reasonable and necessary to assist an individual with the emotional and psychological stress accompanying the death of another individual.

§ 1784. Humanitarian care

The Secretary may furnish hospital care or medical services as a humanitarian service in emergency cases, but the Secretary shall charge for such care and services at rates prescribed by the Secretary.

§ 1784A. Examination and treatment for emergency medical conditions and women in labor

• (a) In the case of a hospital of the Department that has an emergency department, if any individual comes to the hospital or the campus of the hospital and a request is made on behalf of the individual for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists.
• (b)
  • (1) If any individual comes to a hospital of the Department that has an emergency department or the campus of such a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either—
    • (A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition; or
    • (B) for transfer of the individual to another medical facility in accordance with subsection (c).
  • (2) A hospital is deemed to meet the requirement of paragraph (1)(A) with respect to an individual if the hospital offers the individual the further medical examination and treatment described in that paragraph and informs the individual (or a person acting on behalf of the individual) of the risks and benefits to the individual of such examination and treatment, but the individual (or a person acting on behalf of the individual) refuses to consent to the examination and treatment. The hospital shall take all reasonable steps to secure the written informed consent of the individual (or person) to refuse such examination and treatment.
  • (3) A hospital is deemed to meet the requirement of paragraph (1)(B) with respect to an individual if the hospital offers to transfer the individual to another medical facility in accordance with subsection (c) and informs the individual (or a person acting on behalf of the individual) of the risks and benefits to the individual of such transfer, but the individual (or a person acting on behalf of the individual) refuses to consent to the transfer. The hospital shall take all reasonable steps to secure the written informed consent of the individual (or person) to refuse such transfer.
• (c)
  • (1) If an individual at a hospital of the Department has an emergency medical condition that has not been stabilized, the hospital may not transfer the individual unless—
    • (A)
      • (i) the individual (or a legally responsible person acting on behalf of the individual), after being informed of the obligations of the hospital under this section and of the risk of transfer, requests, in writing, transfer to another medical facility;
      • (ii) a physician of the Department has signed a certification that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual and, in the case of labor, to the unborn child from effecting the transfer; or
      • (iii) if a physician of the Department is not physically present in the emergency department at the time an individual is transferred, a qualified medical person (as defined by the Secretary for purposes of this section) has signed a certification described in clause (ii) after a physician of the Department, in consultation with the person, has made the determination described in such clause, and subsequently countersigns the certification; and
    • (B) the transfer is an appropriate transfer to that facility.
  • (2) A certification described in clause (ii) or (iii) of paragraph (1)(A) shall include a summary of the risks and benefits upon which the certification is based.
  • (3) For purposes of paragraph (1)(B), an appropriate transfer to a medical facility is a transfer—
    • (A) in which the transferring hospital provides the medical treatment within its capacity that minimizes the risks to the health of the individual and, in the case of a woman in labor, the health of the unborn child;
    • (B) in which the receiving facility—
      • (i) has available space and qualified personnel for the treatment of the individual; and
      • (ii) has agreed to accept transfer of the individual and to provide appropriate medical treatment;
    • (C) in which the transferring hospital sends to the receiving facility all medical records (or copies thereof) available at the time of the transfer relating to the emergency medical condition for which the individual has presented, including—
      • (i) observations of signs or symptoms;
      • (ii) preliminary diagnosis;
      • (iii) treatment provided;
      • (iv) the results of any tests; and
      • (v) the informed written request or certification (or copy thereof) provided under paragraph (1)(A);
    • (D) in which the transfer is effected through qualified personnel and transportation equipment, including the use of necessary and medically appropriate life support measures during the transfer; and
    • (E) that meets such other requirements as the Secretary considers necessary in the interest of the health and safety of the individual or individuals transferred.
• (d) The Secretary shall charge for any care or services provided under this section in accordance with billing and reimbursement authorities available to the Secretary under other provisions of law.
• (e) In this section:
  • (1) The term “campus” means, with respect to a hospital of the Department—
    • (A) the physical area immediately adjacent to the main buildings of the hospital;
    • (B) other areas and structures that are not strictly contiguous to the main buildings but are located not more than 250 yards from the main buildings; and
    • (C) any other areas determined by the Secretary to be part of the campus of the hospital.
  • (2) The term “emergency medical condition” means—
    • (A) a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in—
      • (i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;
      • (ii) serious impairment to bodily functions; or
      • (iii) serious dysfunction of any bodily organ or part; or
    • (B) in the case of a pregnant woman, a stage of labor that a medical provider determines indicates—
      • (i) that there is inadequate time to effect a safe transfer to another hospital before delivery; or
      • (ii) that transfer may pose a threat to the health or safety of the woman or the unborn child.
  • (3)
    • (A) The term “to stabilize” means—
      • (i) with respect to an emergency medical condition described in paragraph (2)(A), to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility; or
      • (ii) with respect to an emergency medical condition described in paragraph (2)(B), to deliver (including the placenta).
    • (B) The term “stabilized” means—
      • (i) with respect to an emergency medical condition described in paragraph (2)(A), that no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer of the individual from a facility; or
      • (ii) with respect to an emergency medical condition described in paragraph (2)(B), that the woman has delivered (including the placenta).
  • (4) The term “transfer” means the movement (including the discharge) of an individual outside the facilities of a hospital of the Department at the direction of any person employed by (or affiliated or associated, directly or indirectly, with) the hospital, but does not include such a movement of an individual who—
    • (A) has been declared dead; or
    • (B) leaves the facility without the permission of any such person.

§ 1785. Care and services during certain disasters and emergencies

• (a) During and immediately following a disaster or emergency referred to in subsection (b), the Secretary may furnish hospital care and medical services to individuals responding to, involved in, or otherwise affected by that disaster or emergency.
• (b) A disaster or emergency referred to in this subsection is any disaster or emergency as follows:
  • (1) A major disaster or emergency declared by the President under the Robert T. Stafford Disaster Relief and Emergency Assistance Act ( 42 U.S.C. 5121 et seq.).
  • (2) A disaster or emergency in which the National Disaster Medical System established pursuant to section 2812 of the Public Health Service Act ( 42 U.S.C. 300hh ) 1 1 See References in Text note below. is activated by the Secretary of Health and Human Services under that section or as otherwise authorized by law.
• (c) The Secretary may furnish care and services under this section to an individual described in subsection (a) who is a veteran without regard to whether that individual is enrolled in the system of patient enrollment under section 1705 of this title .
• (d)
  • (1) The cost of any care or services furnished under this section to an officer or employee of a department or agency of the United States other than the Department or to a member of the Armed Forces shall be reimbursed at such rates as may be agreed upon by the Secretary and the head of such department or agency or the Secretary concerned, in the case of a member of the Armed Forces, based on the cost of the care or service furnished.
  • (2) Amounts received by the Department under this subsection shall be credited to the Medical Care Collections Fund under section 1729A of this title .
• (e) Within 60 days of the commencement of a disaster or emergency referred to in subsection (b) in which the Secretary furnishes care and services under this section (or as soon thereafter as is practicable), the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report on the Secretary’s allocation of facilities and personnel in order to furnish such care and services.
• (f) The Secretary shall prescribe regulations governing the exercise of the authority of the Secretary under this section.

§ 1786. Care for newborn children of women veterans receiving maternity care

• (a) The Secretary may furnish health care services described in subsection (b) to a newborn child of a woman veteran who is receiving maternity care furnished by the Department for not more than seven days after the birth of the child if the veteran delivered the child in—
  • (1) a facility of the Department; or
  • (2) another facility pursuant to a Department contract for services relating to such delivery.
• (b) Health care services described in this subsection are all post-delivery care services, including routine care services, that a newborn child requires.

§ 1787. Health care of family members of veterans stationed at Camp Lejeune, North Carolina

• (a) Subject to subsection (b), a family member of a veteran described in subparagraph (F) of section 1710(e)(1) of this title who resided at Camp Lejeune, North Carolina, for not fewer than 30 days during the period described in such subparagraph or who was in utero during such period while the mother of such family member resided at such location shall be eligible for hospital care and medical services furnished by the Secretary for any of the illnesses or conditions described in such subparagraph, notwithstanding that there is insufficient medical evidence to conclude that such illnesses or conditions are attributable to such residence.
• (b)
  • (1) The Secretary may only furnish hospital care and medical services under subsection (a) to the extent and in the amount provided in advance in appropriations Acts for such purpose.
  • (2) Hospital care and medical services may not be furnished under subsection (a) for an illness or condition of a family member that is found, in accordance with guidelines issued by the Under Secretary for Health, to have resulted from a cause other than the residence of the family member described in that subsection.
  • (3) The Secretary may provide reimbursement for hospital care or medical services provided to a family member under this section only after the family member or the provider of such care or services has exhausted without success all claims and remedies reasonably available to the family member or provider against a third party (as defined in section 1725(f) of this title ) for payment of such care or services, including with respect to health-plan contracts (as defined in such section).

§ 1788. Transplant procedures with live donors and related services

• (a) Subject to subsections (b) and (c), in a case in which a veteran is eligible for a transplant procedure from the Department, the Secretary may provide for an operation on a live donor to carry out such procedure for such veteran, notwithstanding that the live donor may not be eligible for health care from the Department.
• (b) Subject to the availability of appropriations for such purpose, the Secretary shall furnish to a live donor any care or services before and after conducting the transplant procedure under subsection (a) that may be required in connection with such procedure.
• (c) In carrying out this section, the Secretary may provide for the operation described in subsection (a) on a live donor and furnish to the live donor the care and services described in subsection (b) at a non-Department facility pursuant to an agreement entered into by the Secretary under this title. The live donor shall be deemed to be an individual eligible for hospital care and medical services at a non-Department facility pursuant to such an agreement solely for the purposes of receiving such operation, care, and services at the non-Department facility.