Mike Bost
Representative for Illinois · Republican · United States
“(B) Elements.--The Secretary, in coordination with participating critical access hospitals, shall ensure that any contract, agreement, or other arrangement entered into under subparagraph (A) establishes criteria, as the Secretary considers appropriate, to ensure-- (i) the provision of timely, safe, and high-quality health care services t…”
“(B) Elements.--The Secretary, in coordination with participating critical access hospitals, shall ensure that any contract, agreement, or other arrangement entered into under subparagraph (A) establishes criteria, as the Secretary considers appropriate, to ensure-- (i) the provision of timely, safe, and high-quality health care services t…”
“(a) In General.--Paragraph (2) of section 2306(h) of title 38, United States Code, is amended to read as follows: ``(2) If the Secretary furnishes an urn or commemorative plaque for an individual under paragraph (1), the Secretary may not provide for such individual a headstone or marker under this section, or any interment benefit under…”
“(a) In General.--Paragraph (2) of section 2306(h) of title 38, United States Code, is amended to read as follows: ``(2) If the Secretary furnishes an urn or commemorative plaque for an individual under paragraph (1), the Secretary may not provide for such individual a headstone or marker under this section, or any interment benefit under…”
“(d) Update of Information on Providers.--Not later than one year after the date of the enactment of this Act, the Secretary, through the Office of Integrated Veteran Care or successor office, shall develop a process to ensure that third party administrators regularly, not less frequently than quarterly-- (1) update their lists of communit…”
“(d) Update of Information on Providers.--Not later than one year after the date of the enactment of this Act, the Secretary, through the Office of Integrated Veteran Care or successor office, shall develop a process to ensure that third party administrators regularly, not less frequently than quarterly-- (1) update their lists of communit…”
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“``(g) Expansion of Successful Models.-- ``(1) In general.--Except as provided in paragraph (2), the Secretary may, through rulemaking, expand the duration and scope of a model tested under this section to the extent that-- ``(A) the Secretary determines such expansion is expected to-- ``(i) reduce program expenditures without reducing quality of care; or ``(ii) improve quality of care without increasing program expenditures; and ``(B) the Chief Financial Officer of the Department certifies that such expansion will maintain budget neutrality. ``(2) Limitation.--The Secretary shall not expand a model unless the results of the evaluation of the model under subsection (e) demonstrate that the requirements of paragraph (1) are satisfied.”
“``(2) Final report on models.--Not later than 180 days after completing each model under this section, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a final report on such model, including-- ``(A) findings from the evaluation of such model; ``(B) updated findings under paragraph (1) with respect to such model; ``(C) an assessment of the fiscal impact of such model; and ``(D) recommendations for expansion or termination of the use of such model.”
“``(f) Reporting.-- ``(1) Annual report.--Not less frequently than annually, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on models being tested under this section and their preliminary results, including-- ``(A) a brief narrative description of the model explaining its intent and the proposed manner in which it is supposed to reduce expenditures and increase quality of or access to care for veterans; ``(B) the number of veterans and providers participating in the model, broken down by demographics such as age, race or ethnicity, geographic location, and other characteristics as chosen by the Secretary; ``(C) gross and net savings or increases to the medical services account of the Department, including in comparison to baseline budgetary assumptions in the absence of the model; ``(D) an assessment of the utilization of the model, including the proportion of providers choosing to participate in the model and the proportion of veterans choosing to participate in the model, as the case may be; ``(E) an assessment of quality of care and patient outcomes as measured by discrete objective metrics, including changes to morbidity and mortality, changes to admission rates, changes to readmission rates, changes to population health metrics such as average blood pressure, A1C levels, body mass index, or other relevant health metrics, or other relevant clinical outcome metrics; ``(F) a description of provider, stakeholder, and veteran experiences; and ``(G) such other matters as the Secretary may consider relevant.”
“``(e) Testing and Evaluation.-- ``(1) In general.--The Secretary shall design and test each model under this section in a manner that allows for the evaluation of-- ``(A) changes in program expenditures; ``(B) changes in quality and outcomes of care for veterans; and ``(C) other factors the Secretary determines relevant to care coordination, access, and equity. ``(2) Evaluation.--The Secretary shall evaluate each model under this section using scientifically valid methodologies, including control or comparison groups if practicable.”
“``(C) Chronic care coordination models. ``(d) Selection of Models.-- ``(1) In general.--The Secretary, acting through the Center, shall select models to be tested under subsection (c) from among those that-- ``(A) address a defined population for which there are demonstrated deficits in care leading to poor clinical outcomes or potentially avoidable expenditures; and ``(B) are expected to reduce program costs while preserving or enhancing the quality of care furnished to veterans. ``(2) Criteria.--In selecting models under paragraph (1), the Secretary shall apply criteria consistent with the model selection framework used in evidence-based criteria that the Secretary determines appropriate.”
“``(c) Identification and Testing of Models.-- ``(1) In general.--The Center shall-- ``(A) identify and test health care payment and service delivery models under this title, including care from non- Department providers under subchapter I of chapter 17 of this title, that have the potential to-- ``(i) reduce program expenditures; and ``(ii) preserve or enhance the quality of care furnished to veterans; ``(B) give preference to models that improve the coordination, quality, and efficiency of health care services furnished under this title; and ``(C) evaluate the effect of applying such models on program expenditures and quality outcomes under this title. ``(2) Included models.--The models identified and tested under paragraph (1) may include the following: ``(A) Bundled payment arrangements. ``(B) Preventive care initiatives.”
“(a) In General.--Chapter 3 of title 38, United States Code, is amended by adding at the end the following new section: ``Sec. 326. Center for Innovation ``(a) Establishment.--There is established in the Department, within the Office of the Secretary, a Center for Innovation (in this section referred to as the `Center'). ``(b) Purpose.--The purpose of the Center is to test innovative payment and service delivery models to reduce program expenditures of the Department under chapter 17 of this title while preserving or enhancing the quality of care furnished to veterans and other eligible individuals.”
“(b) Submittal of Plan.-- (1) Initial plan.--Not later than 180 days after the date of the enactment of this Act, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives the plan developed under subsection (a). (2) Biannual update.--Not less frequently than once every 180 days during the two-year period beginning on the submittal of the plan under paragraph (1), the Secretary shall brief the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives on any updates on the implementation of such plan. SEC. 674. MODIFICATION OF REQUIREMENTS FOR CENTER FOR INNOVATION FOR CARE AND PAYMENT OF THE DEPARTMENT OF VETERANS AFFAIRS AND TRANSFER OF AUTHORITY.”
“(a) In General.--The Secretary of Veterans Affairs shall develop and implement a plan to establish, to the greatest extent practicable, an interactive, online self-service module-- [[Page H4604]] (1) to allow veterans enrolled in the system of annual patient enrollment of the Department of Veterans Affairs established and operated under section 1705(a) of title 38, United States Code-- (A) to request appointments, track referrals for health care under the laws administered by the Secretary, whether at a facility of the Department of Veterans Affairs or through a non-Department provider, and receive appointment reminders; (B) to appeal and track decisions relating to-- (i) denials of requests for authorization for care or services under section 1703 of title 38, United States Code; or (ii) denials of requests for care or services at facilities of the Department, including under section 1710 of such title; (C) to compare the average wait times for appointments for the type of care sought by the veteran at facilities of the Department and with non-Department facilities and providers through which the Secretary furnishes care and services under section 1703 of such title; (D) to compare average driving times between their residence and the nearest facility of the Department that provides the care they are seeking and between their residence and the closest non-Department provider that provides the care they are seeking and through which the Secretary furnishes care and services under section 1703 of such title; and (E) to view a provider directory, information regarding pending medical claims, and explanations of benefits; and (2) to implement such other matters as determined appropriate by the Secretary.”
“Paragraph (4) of section 1722A(a) of title 38, United States Code, is amended to read as follows: ``(4) Paragraph (1) does not apply-- ``(A) to opioid antagonists furnished under this chapter to a veteran who is at high risk for overdose of a specific medication or substance in order to reverse the effect of such an overdose; and ``(B) to any limited supply prescription for medication, up to a 30-day supply of such medication, under section 1730D(b) of this title if the covered health care professional would have prescribed, delivered, distributed, or dispensed a supply for more than seven days if not for the restrictions under such section.''. SEC. 673. PLAN ON ESTABLISHMENT OF INTERACTIVE, ONLINE SELF- SERVICE MODULE FOR CARE.”
“(b) Clerical Amendment.--The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1730C the following new item: ``1730D. Prescription, delivery, distribution, and dispensation of controlled substance medications via telemedicine.''. SEC. 672. COPAYMENTS FOR LIMITED SUPPLIES OF MEDICATIONS.”
“``(2) The term `covered health care professional' means-- ``(A) a health care professional who-- ``(i) is-- ``(I) an employee of the Department appointed under section 7306, 7401, 7405, 7406, or 7408 of this title or under title 5; or ``(II) operating from a facility of the Department, including a clinic of the Department; ``(ii) is authorized by the Secretary to provide health care under this chapter; ``(iii) is required to adhere to all standards for quality relating to the provision of health care in accordance with applicable policies of the Department; ``(iv) has an active, current, full, and unrestricted license, registration, or certification or meets qualification standards set forth by the Secretary within a specified time frame; and ``(v) with respect to a health care profession listed under section 7402(b) of this title, has the qualifications for such profession as set forth by the Secretary; and ``(B) a health professions trainee who-- ``(i) is appointed under section 7405 of this title; and ``(ii) is under the clinical supervision of a health care professional described in subparagraph (A).''.”
“``(g) Duration.--The authority under this section shall terminate on September 30, 2031. ``(h) Definitions.-- In this section: ``(1) The terms `controlled substance', `deliver', `dispense', and `distribute' have the meanings given those terms in section 102 of the Controlled Substances Act (21 U.S.C. 802).”
“``(2) Elements.--Each report under paragraph (1) shall indicate, at a minimum-- ``(A) how many patients received prescriptions for controlled substance medications through telemedicine under this section; ``(B) which controlled substances are being prescribed under this section and how many prescriptions were written for each such substance; ``(C) the number of individuals who received a controlled substance medication that was prescribed, delivered, distributed, or dispensed under this section without evidence of an in-person medical evaluation within the previous two years by a health care professional described in subsection (a)(1)(C); and ``(D) the barriers that exist to reviewing prescription drug monitoring programs of States and how often those barriers occur.”
“``(f) Reporting.-- ``(1) In general.--Not later than one year after the date of the enactment of the Take Care of America's Veterans Act, and not less frequently than annually thereafter until the termination date under subsection (g), the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report that addresses the use of the authority under this section during the fiscal year preceding the date of submission of the report in each Veterans Integrated Service Network.”
“812) unless the covered health care professional is providing treatment-- ``(i) for opioid use disorder; ``(ii) for a patient receiving palliative care or enrolled in hospice care; or ``(iii) for a patient who is physically located in a medical facility where the patient is receiving in-person care. ``(B) Exception.--The prohibition under subparagraph (A) shall not apply to renewal or maintenance of a previously prescribed medication described in such subparagraph.”
“``(2) Elements.--The Secretary shall ensure the guidelines and process described in paragraph (1)-- ``(A) do not restrict access of a patient to in-person care; and ``(B) provide for the collection and analysis of data to determine if an individual has evidence of a prior in-person medical evaluation by a health care professional described in subsection (a)(1)(C) who would reasonably be expected to have prescribing authority based on their credential or organizational role. ``(3) Initiating treatment.-- ``(A) In general.--The guidelines established by paragraph (1) shall prohibit a covered health care professional from initiating treatment with an opioid medication listed in schedule II or III under section 202 of the Controlled Substances Act (21 U.S.C.”
“``(c) Maximum Supply.--The authority under this section may be used to supply a controlled substance for not more than a six-month period. ``(d) Use of Authority.--The Secretary shall ensure that the authority under this section is used to prevent interruptions to patient care and not as a replacement for routine in-person patient care. ``(e) Regulations.-- ``(1) In general.--The Secretary shall establish in regulations guidelines and a process for the prescription, delivery, distribution, and dispensation of a controlled substance pursuant to subsection (a).”
“``(b) Authority for Limited Supply.-- ``(1) In general.--If the databases and program described in subsection (a)(1)(D) are unavailable or inaccessible at the time of a telemedicine encounter conducted by a covered health care professional, the covered health care professional may not prescribe, deliver, distribute, or dispense more than a seven-day supply of a controlled substance until the covered health care professional is able to review such databases and program. ``(2) Databases unavailable or inaccessible.--If a database or program required to be reviewed under subsection (a)(1)(D) is unavailable or inaccessible for an extended period, as determined by the Secretary, a covered health care professional may provide additional seven-day supplies of a controlled substance until such database or program is accessible.”
“823(f)); ``(C) has access to medical documentation from an in-person medical evaluation of such patient in the past two years by-- ``(i) a covered health care professional; ``(ii) a health care professional who furnished care and services under the Veterans Community Care Program under section 1703 of this title; or ``(iii) a health care professional of the Department of Defense; and ``(D) at the time of the telemedicine visit of the patient-- ``(i) has reviewed the prescription data of the individual from the electronic health record database of the Department and data from the prescription drug monitoring program for the State in which the patient is located at the time of the telemedicine encounter (if such a program exists) for at least the one-year period preceding the date of the visit or, if less than one year of data is available, for the entire period available; and ``(ii) provides documentation of-- ``(I) such review; ``(II) all successful attempts to access such databases and program; and ``(III) all unsuccessful attempts to access such databases and program that resulted in the prescription of a limited supply under subsection (b); and ``(2) such substance is delivered, distributed, or dispensed for a legitimate medical purpose.”
“301 et seq.), regardless of whether such covered health care professional has conducted an in-person medical examination of such patient, if-- ``(1) such covered health care professional-- ``(A) is acting in the usual course of professional practice; ``(B) is registered pursuant to section 303(g) of the Controlled Substances Act (21 U.S.C. 823(g)) in any State or is utilizing the registration of a facility of the Department registered pursuant to section 303(f) of such Act (21 U.S.C.”
“Prescription, delivery, distribution, and dispensation of controlled substance medications via telemedicine ``(a) In General.--Notwithstanding sections 102(54) and 309(e) of the Controlled Substances Act (21 U.S.C. 802(54) and 829(e)), a covered health care professional may prescribe, deliver, distribute, and dispense a controlled substance if the covered health care professional is using telemedicine through the use of an interactive telecommunications system, including an audio-only telecommunications system when necessary, to prescribe, deliver, distribute, or dispense to a patient eligible to receive hospital care or medical services under this chapter a controlled substance that is a prescription drug as determined under the Federal Food, Drug, and Cosmetic Act (21 U.S.C.”
“[[Page H4603]] (d) Indication of Types of Projects.--In the report required under subsection (a), the Secretary shall indicate the projects that can be most efficiently and effectively accomplished through smaller individual infrastructure projects or through a larger medical facility replacement or new site of care, as determined by the Secretary. Subtitle F--Other Health Care Matters SEC. 671. PRESCRIPTION, DELIVERY, DISTRIBUTION, AND DISPENSATION OF CONTROLLED SUBSTANCE MEDICATIONS BY COVERED HEALTH CARE PROFESSIONALS OF DEPARTMENT OF VETERANS AFFAIRS VIA TELEMEDICINE. (a) In General.--Subchapter III of chapter 17 of title 38, United States Code, is amended by adding at the end the following new section: ``Sec. 1730D.”
“(c) Development of Report.--In developing the report required under subsection (a), the Secretary shall consult with relevant regional and national program offices of the Veterans Health Administration with responsibility for managing the various health care services covered by the report, including long-term care and care relating to spinal cord injuries and diseases, to ensure that the report contains a holistic, comprehensive, and integrated plan to address the capital asset and other space needs for the population of veterans who require those services.”
“(b) Inclusion of Information Regarding Prioritization of Certain Projects.--The Secretary shall include in the report required under subsection (a) information regarding how the infrastructure prioritization processes of the Department, such as the Strategic Capital Investment Planning process, or successor process, could be modified to include higher prioritization of projects that support the provision of a health care service that is not widely available, or is not available in compliance with appropriate quality or access standards, from non-Department providers.”
“(a) In General.--Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the appropriate committees of Congress a report, disaggregated by medical center or other relevant health care facility of the Department of Veterans Affairs, identifying the physical infrastructure needs of the Department to support current and future anticipated long- term care needs and models of care for veterans, including-- (1) infrastructure needed to support the delivery of long- term care for women veterans, veterans with spinal cord injuries and diseases, veterans with traumatic brain injury, veterans with unique behavioral health needs, veterans with memory loss, and other population groups with unique needs or projected future needs; (2) information regarding the plans of the Department to provide such care as the Department builds internal capacity but space is not yet available to meet the demand for such care; and (3) with respect to any projects needed to provide the infrastructure specified under paragraph (1)-- (A) the estimated individual project cost and total cost to accomplish those projects; and (B) the estimated individual project timeline to accomplish each such project upon receipt of appropriate funding.”
“(2) Recommendations for such legislative and administrative action as the Secretary determines appropriate to improve the prevention, detection, and reporting of waste, fraud, and abuse. (3) Such other matters as the Secretary considers appropriate. (c) Consultation.--In carrying out subsection (a), the Secretary-- (1) shall consult with the Inspector General of the Department of Veterans Affairs and the Comptroller General of the United States on matters relating to best practices and strategies to improve detection and prevention by the Department of waste, fraud, and abuse in capital asset projects and management; and (2) may consult with such other persons and entities on such matters as the Secretary considers appropriate. SEC. 664. REPORT ON LONG-TERM CARE PHYSICAL INFRASTRUCTURE NEEDS OF DEPARTMENT OF VETERANS AFFAIRS.”
“(a) Report Required.--Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the appropriate committees of Congress a report on actions the Department of Veterans Affairs is taking or plans to take to enhance the ability of the Department to prevent, detect, and report waste, fraud, and abuse occurring in capital asset projects of the Department, whether by employees, contractors, or other relevant persons or entities involved with the Department. (b) Elements.--The report required by subsection (a) shall include the following: (1) An assessment of whether new training or enhancements to existing training should be undertaken to improve the prevention, detection, and reporting of waste, fraud, and abuse.”
“(c) Considerations.--In preparing the report required by subsection (a), the Secretary may consider the following: (1) The findings of the 2012 final report of the Research Infrastructure Program of the Department. (2) Current and updated data providing the most accurate and holistic presentation of the physical infrastructure, information technology, and other relevant support function needs of the research and development program of the Department. (3) Such other matters as the Secretary considers appropriate. SEC. 663. IMPROVING PREVENTION, DETECTION, AND REPORTING OF WASTE, FRAUD, AND ABUSE IN DEPARTMENT OF VETERANS AFFAIRS CAPITAL ASSET PROJECTS AND ACTIVITIES.”
“(B) Information technology.--In providing information under paragraph (1)(B), the Secretary shall provide estimated summaries for each project or investment with individual and total cost data as well as a realistic multi-year plan to develop relevant requirements and acquire and deploy the relevant information technology services, projects, equipment, and related matters. (C) Scope.--The scope of the report submitted under subsection (a) is on the capital asset, information technology, and other related critical support functions, excluding human capital related needs, needed for the Department to perform research and development in an effective and efficient manner.”
“(2) Requirements.-- (A) Facilities.-- (i) Summaries by project.--In providing information under paragraph (1)(A), the Secretary shall provide estimated summaries for each project with cost data as well as a realistic multi-year plan to design and deliver the capital asset projects, assuming required funding is provided. (ii) Identification of projects.--The Secretary shall identify each project under paragraph (1)(A) by its project type, such as major construction, minor construction, nonrecurring maintenance, major lease, minor lease, or such other category as the Secretary determines may be appropriate.”
“(B) Detailed information on the information technology resources, projects, equipment, and related information technology needs, disaggregated by type of information technology funding categories, such as development or operations and maintenance, the Department requires in order to make the research and development program and activities of the Department functional and high-performing in the short-, medium-, and long-term, and those needed to enable employees of the Department to perform their research and development activities in an effective and efficient manner. (C) Such matters as the Secretary determines relevant to maintain and further improve and advance the research and development functions of the Department through improved capital asset and information technology support.”
“(b) Contents.-- (1) In general.--The report required by subsection (a) shall include the following: (A) A comprehensive summary of new facilities, renovations of existing facilities, leasing of facilities, and any other such facilities or physical infrastructure the Department requires to effectively perform its research and development functions, including projected functions.”
“Congressional notification and plan required for cost estimates exceeding approved prospectus amounts''. SEC. 662. REPORT ON CAPITAL ASSET AND INFORMATION TECHNOLOGY NEEDS OF THE RESEARCH AND DEVELOPMENT PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS. (a) Report Required.--Not later than two years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to Congress a report on the capital asset and information technology needs of the research and development program of the Department of Veterans Affairs.”
“``(d) Limitation on Further Action.--If the Secretary is required to submit a notification under subsection (b), the Secretary may not issue a request for lease proposals for the applicable major medical facility lease until the date on which the Secretary submits the plan required under subsection (c). ``(e) Rule of Construction.--Nothing in this section shall be construed to authorize the Secretary to exceed any amount authorized in an approved prospectus or any amount provided in advance in an appropriations Act.''. (c) Clerical Amendment.--The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 8104 the following new items: ``8104A. Submission of cost estimates for major medical facility leases with President's budget request ``8104B.”
“``(c) Plan Required.-- ``(1) In general.--Not later than 60 days after notification under subsection (b) with respect to a major medical facility lease, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a plan to address the cost discrepancy for such lease, which may include scope adjustment, value engineering, requesting additional authority, or other appropriate measures. ``(2) Limitation on award.--The Secretary shall not award a major medical facility lease until the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives have received the plan required under paragraph (1) with respect to such lease.”
“``(b) Notification Required.--If the lowest responsive offer for a major medical facility lease exceeds the unserviced shell rent authorized in the approved prospectus by more than 10 percent, the Secretary shall notify the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives not later than 45 days after the date on which the Secretary determines that such offer exceeds such authorized amount.”
“(b) Congressional Notification and Plan Required for Cost Estimates Exceeding Approved Prospectus Amounts.--Subchapter I of such chapter is further amended [[Page H4602]] by inserting after section 8104A the following new section: ``Sec. 8104B. Congressional notification and plan required for cost estimates exceeding approved prospectus amounts ``(a) Price Estimates Required During Solicitation Phase.-- As part of the request for lease proposals (or equivalent formal solicitation) for a major medical facility lease, the Secretary shall require offerors to provide detailed price proposals, including the cost of land (if applicable), to enable evaluation against the authorized prospectus amount.”
“``(e) Rules of Construction.-- ``(1) Budgetary treatment.--Nothing in this section shall be construed to alter, supersede, waive, or otherwise affect the application of the scorekeeping guidelines, including the budgetary treatment of leases under Office of Management and Budget Circular A-11 or any successor guidance. ``(2) Preservation of existing budget authority requirements.--Nothing in this section shall be construed to authorize the Secretary to enter into a lease, incur an obligation, or make an expenditure except to the extent and in the amount provided in advance in appropriations Acts. ``(f) Definitions.--In this section, the term `major medical facility lease' has the meaning given that term in section 8104(a)(3)(B) of this title.''.”
“``(d) Annual Adjustment.-- ``(1) In general.--To reflect inflation and market escalation, the Secretary shall annually adjust each cost estimate for a lease submitted to Congress for authorization, appropriations, or prospectus approval during the period beginning on the date on which the Secretary first includes such cost estimate in the budget justification materials described in subsection (a) and ending on the projected award date for the lease. ``(2) Indices.--In adjusting a cost estimate under paragraph (1), the Secretary shall use such medical construction or real estate indices as the Secretary determines appropriate.”
“``(2) Required elements.--The methodology required under paragraph (1) shall include, at a minimum-- ``(A) base rent projections over the full lease term; ``(B) tenant improvement and buildout costs based on current medical facility standards; ``(C) estimated operating expenses, including utilities, maintenance, and security; ``(D) annual escalation factors tied to construction cost indices, labor rates, and market trends; ``(E) cost assumptions for option periods or potential renewal terms; and ``(F) geographic adjustments using current regional market data to reflect location-specific construction and leasing conditions.”
“``(b) Market-based Cost Estimate.--Each market-based cost estimate required under subsection (a) shall include an evaluation of-- ``(1) local land values; ``(2) applicable construction costs; and ``(3) other cost factors the Secretary determines relevant to build-to-suit facilities. ``(c) Standardized Methodology.-- ``(1) In general.--The Secretary shall adopt and apply a standardized methodology for estimating under subsection (a) the full life-cycle cost of major medical facility leases and prospectus-level leases.”
“(a) Submission of Cost Estimates for Major Medical Facility Leases With Presidential Budget Request.--Subchapter I of chapter 81 of title 38, United States Code, is amended by inserting after section 8104 the following new section: ``Sec. 8104A. Submission of cost estimates for major medical facility leases with president's budget request ``(a) In General.--For each major medical facility lease or prospectus-level lease for which the Secretary seeks authorization, appropriations, or prospectus approval, the Secretary shall include in the budget justification materials submitted to Congress in connection with the budget of the Department for the applicable fiscal year (as submitted with the budget of the President under section 1105(a) of title 31) a market-based cost estimate and full life-cycle cost estimate for such lease.”
“Not later than 180 days after the date of enactment of this Act, the Secretary of Veterans Affairs, in consultation with the Comptroller General of the United States, the Director of the Office of Management and Budget, and private sector stakeholders, shall develop a revised process for the procurement of major medical facility leases under chapter 81 of title 38, United States Code, and submit to the Committees on Veterans' Affairs of the House of Representatives and the Senate a report that includes a description of such revised process. SEC. 661. SUBMISSION AND NOTIFICATION OF COST ESTIMATES FOR MEDICAL FACILITY LEASES.”
“``(2) Capital asset project.--The term `capital asset project' means a capital asset investment or activity of the Department. ``(3) Super construction project.--The term `super construction project' has the meaning given such term in section 8103(e)(3) of this title.''. (b) Clerical Amendment.--The table of sections at the beginning of chapter 81 of title 38, United States Code, is amended by striking the item relating to section 8120 and inserting the following new item: ``8120. Reports on key capital asset investments, activities, and performance.''. SEC. 660. DEVELOPMENT OF STREAMLINED PROCUREMENT MODEL; REPORT.”
“``(2) Elements.--Each report required under paragraph (1) shall include, for each project described in such paragraph-- ``(A) the budgetary and scheduling status of the project, as of the last day of the most recent fiscal quarter ending before the date on which the report is required to be submitted; and ``(B) the actual cost and schedule variances of the project, as of such day, compared to the planned cost and schedules for the project. ``(c) Definitions.--In this section: ``(1) Appropriate committees of congress.--The term `appropriate committees of Congress' means-- ``(A) the Committee on Appropriations and the Committee on Veterans' Affairs of the Senate; and ``(B) the Committee on Appropriations and the Committee on Veterans' Affairs of the House of Representatives.”
“``(3) Matters relating to reporting costs.--In each report under paragraph (1), when reporting on costs for capital asset projects, the Secretary may include information regarding Federal requirements, including those specific to the Department, that may not exist in the non-Federal construction sector that may increase costs for capital asset projects. ``(b) Super Construction Projects.-- ``(1) In general.--Not later than 30 days after the end of each fiscal year, and every 60 days thereafter until the end of that fiscal year, the Secretary shall submit to the appropriate committees of Congress a report on the super construction projects carried out by the appropriate non- Department Federal entity described in section 8103(e)(1) of this title during such year.”
“``(ix) Such observations of best practices, impediments, and accomplishments related to the capital asset management and performance of the Department, including any legislative or administrative action, as the Secretary considers appropriate with respect to such practices, impediments, and accomplishments. ``(x) Meaningful metrics that show the progress of the Department toward meeting relevant goals of the Department relating to capital asset management. ``(xi) Such other matters as the Secretary considers appropriate. ``(B) Subsequent reports.--Each report in a fiscal year after the first report shall include, at a minimum, relevant updates on any capital asset projects that are ongoing during that fiscal year, including any updates to information provided with respect to such projects under subparagraph (A).”
“``(V) The fiscal quarter the project is expected to begin, the fiscal quarter the project is expected to be completed, and the fiscal quarter the facility in connection to such project is expected to be in use by veterans, employees of the Department, or other relevant users, as the case may be. ``(viii) Projected total obligations for capital asset projects for the current fiscal year, broken out by major construction, minor construction, nonrecurring maintenance, and leases, from the medical facilities appropriation account of the Department.”
“``(vii) A projected list of capital asset projects, broken out by type of project under subclause (I), that are expected to be initiated during the current fiscal year and those that are expected to be completed during the current fiscal year, which shall include the following: ``(I) The type of project (major construction, minor construction, nonrecurring maintenance, leases, or other category, including disposals). ``(II) The estimated total cost of the project. ``(III) A description of the project. ``(IV) The location and facility with respect to which the project was carried out or is expected to be carried out.”