{ "id": "R43704", "type": "CRS Report", "typeId": "REPORTS", "number": "R43704", "active": true, "source": "EveryCRSReport.com, University of North Texas Libraries Government Documents Department", "versions": [ { "source": "EveryCRSReport.com", "id": 444855, "date": "2015-08-27", "retrieved": "2016-04-06T18:30:03.254132", "title": "Veterans Access, Choice, and Accountability Act of 2014 (H.R. 3230; P.L. 113-146)", "summary": "Congressional Research Service\n7-5700\nwww.crs.gov\nR43704\nSummary\nOn August 7, 2014, President Obama signed the Veterans Access, Choice, and Accountability Act of 2014 (H.R. 3230; H.Rept. 113-564; P.L. 113-146). The Department of Veterans Affairs Expiring Authorities Act of 2014 (H.R. 5404; P.L. 113-175), the Consolidated and Further Continuing Appropriations Act, 2015 (H.R. 83; P.L. 113-235), the Construction Authorization and Choice Improvement Act (H.R. 2496; P.L. 114-19), and the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015 (H.R. 3236; P.L. 114-41) made amendments to some provisions in P.L. 113-146. The act, as amended, makes a number of changes to programs and policies of the Veterans Health Administration (VHA) within the Department of Veterans Affairs (VA) that aim to increase access to care outside the VA health care system. Among other things, the act establishes a new program (the Veterans Choice Program) that would allow the VA to authorize care for enrolled veterans through the Veterans Choice Program if they meet the following eligibility requirements: \nattempts, or has attempted to schedule an appointment for the receipt of hospital care or medical services but is unable to schedule an appointment: \nI.\twithin the wait-time goals of the VHA for the furnishing of care or services; or \nII.\twithin a clinically appropriate period if such time frame is shorter than the wait-time goals of the VHA; or \nresides more than 40 miles (based on distance traveled): \nI.\tif seeking primary care, from a VA medical facility including a community-based outpatient clinic (CBOC) that is able to provide the care sought and provided by a full-time primary care physician; or \nII.\tif not seeking primary care, from any VA medical facility including a community-based outpatient clinic (CBOC); or \nresides in a state without a VA medical facility that provides (a) hospital care; (b) emergency medical services; and (c) surgical care, or more than 20 miles away from such a VA medical facility; or \nresides within 40 miles of a VA medical facility and is required to travel by air, boat, or ferry to access such a facility; or faces a travel burden based on geographical challenges; or inaccessible roads or hazardous weather; or a medical condition that would prevent the veteran from travelling; or any other factor as determined by the VHA. \nThis report offers an overview of the provisions in the law, which requires, among other things: \nincreased collaboration between the VA and facilities operated by the Indian Health Service or the Native Hawaiian Health Care System and requiring increased funding for graduate medical education training at the VA; \nthe extension of Project ARCH (Access Received Closer to Home) within specified Veterans Integrated Service Networks (VISNs) for veterans in highly rural areas who are enrolled in VA health care for an additional two years;\nseveral studies to examine a variety of issues pertaining to VA\u2019s health care delivery system, and to explore ideas on how best to reform the system;\nimposition of penalties on VA employees who knowingly falsify data on patient wait times or health care quality measures; and limitations on VA employee and bonuses. \nContents\nIntroduction\t1\nBrief Legislative History\t1\nProvisions in the Veterans Access, Choice, and Accountability Act of 2014\t2\nSec. 1. Short Title\t3\nSec. 2. Definitions\t3\nTitle I: Improvement of Access to Care from Non-Department of Veterans Affairs Providers\t3\nSec. 101. Availability of Hospital Care and Medical Services through the Use of Non-VA Entities\t3\nEligibility\t3\nChoice of Provider\t5\nCoordination of Care with Non-VA Entities\t5\nAuthorization of Care by the VA\t6\nElectronic Waiting List\t6\nCare and Services Through Agreements\t6\nRates of Reimbursement\t6\nVA as the Secondary Payer of Care\t7\nVeterans Choice Card\t7\nInformation on Availability of Care\t8\nFollow-Up Care\t8\nCredentials of Providers\t8\nCopayments\t8\nHealth Care Claims Processing\t8\nMedical Records\t8\nTracking Missed Appointments\t9\nImplementing Regulations\t9\nOffice of the Inspector General (OIG) Report\t9\nEnd Date of the Expanded Authority for Non-VA Care\t9\nReports to Congress\t9\nFilling Prescription Medications\t9\nWait-Time Goals of the VHA\t9\nWaiver of Certain Printing Requirements\t10\nSec. 102. Enhancement of Collaboration between the VA and Indian Health Service\t10\nSec. 103. Enhancement of Collaboration between the VA and the Native Hawaiian Health Care System\t11\nSec. 104. Reauthorization and Modification of Project ARCH (Access Received Closer to Home)\t11\nSec. 105. Prompt Payment\t11\nSec. 106. Reimbursement of Non-VA Providers Assigned to the Chief Business Office (CBO)\t12\nTitle II: Health Care Administrative Matters\t12\nSec. 201. Independent Assessment of the VA Health Care Delivery Systems and Management Processes\t12\nSec. 202. Commission on Care\t12\nSec. 203. Technology Task Force on Review of Scheduling System and Software of the VA\t13\nSec. 204. Improving Access to Mobile Vet Centers and Mobile Medical Centers\t13\nSec. 205. Improved Performance Metrics for Health Care Provided by the VA\t14\nSec. 206. Improved Transparency Concerning Health Care Provided by the VA\t14\nSec. 207. Information for Veterans on the Credentials of VA Physicians\t14\nSec. 208. Information in Annual Budget of the President on Hospital Care and Medical Services Furnished through the Expanded use of Contracts\t15\nSec. 209. Prohibition on Falsification of Data Concerning Wait Times and Quality Measures at the VA\t15\nTitle III: Health Care Staffing, Recruitment, and Training Matters\t15\nSec. 301. Treatment of Staffing Shortage and Biennial Report on Staffing of VA Medical Facilities\t15\nSec. 302. Extension and Modification of Certain Programs within the VA\u2019s Health Professionals Educational Assistance Program\t16\nSec. 303. Clinic Management Training for Employees at VA Medical Facilities\t17\nTitle IV: Health Care Related to Sexual Trauma\t17\nSec. 401. Expansion of Eligibility for Sexual Trauma Counseling and Treatment to Veterans on Inactive Duty Training\t17\nSec. 402. Provision of Counseling and Treatment for Sexual Trauma by the VA to Members of the Armed Forces\t17\nSec. 403. Reports on Military Sexual Trauma\t17\nTitle V: Other Health Care Matters\t18\nSec. 501. Extension of Pilot Program on Assisted Living Services for Veterans with Traumatic Brain Injury\t18\nTitle VI: Major Medical Facility Leases\t18\nSec. 601. Authorization of Major Medical Facility Leases\t18\nSec. 602. Budgetary Treatment of VA Major Medical Facilities Leases\t19\nTitle VII: Other Veterans Matters\t19\nSec. 701. Expansion of Marine Gunnery Sergeant John David Fry Scholarship\t19\nSec. 702. Approval of Courses of Education Provided by Public Institutions of Higher Learning for Purposes of All-Volunteer Force Educational Assistance Program and Post-9/11 Educational Assistance Conditional on In-State Tuition Rate for Veterans\t20\nSecs. 703, 704, 705, and 706\t20\nSec. 707. Removal of Senior Executives of the VA for Performance or Misconduct\t20\nTitle VIII: Other Matters\t22\nSec. 801. Appropriation of Amounts\t22\nSec. 802. Veterans Choice Fund\t22\nSec. 803. Emergency Designations\t22\n\nAppendixes\nAppendix. Veterans Access, Choice, and Accountability Act of 2014: Implementation and Reporting Deadlines\t23\n\nContacts\nAuthor Contact Information\t29\n\nIntroduction\nIn April 2014, Congress became aware of issues pertaining to delays in patient care and patient wait time manipulation at various Department of Veterans Affairs (VA) health care system facilities. In response to these issues, in August 2014 Congress passed the Veterans Access, Choice, and Accountability Act of 2014 (P.L. 113-146). At the heart of this legislation is a temporary new program known as the \u201cVeterans Choice Program,\u201d intended to increase eligible veterans\u2019 access to care through eligible non-VA providers and facilities. In addition, P.L. 113-146, as amended, provides additional funding to improve VA\u2019s physical infrastructure and to hire physicians and other medical professionals, including nurses, mental health professionals, and social workers. Lastly, among other things, the Veterans Access, Choice, and Accountability Act of 2014 requires the VA to enter into one or more contracts with a private sector entity or entities for an independent assessment in order to comprehensively examine the VA\u2019s ability to deliver high-quality health care to veterans now and into the future. As discussed in the next section, the act (P.L. 113-146) has been amended several times since it was enacted on August 7, 2014. This report begins with a brief overview of the legislative history that lead up to the enactment of the Veterans Access, Choice, and Accountability Act of 2014, and subsequent amendments to the act. \nBrief Legislative History \nIn an attempt to address delays in patient care provided by the VA health care system and to provide veterans with timely access to care, among other things, the Senate and House introduced and passed several measures in May and June of 2014. Initially, on June 9, 2014, the Veterans\u2019 Access to Care through Choice, Accountability, and Transparency Act of 2014 (S. 2450) was introduced in the Senate, and the Veteran Access to Care Act of 2014 (H.R. 4810) was introduced in the House. The House passed its measure on June 10, but the Senate chose to act on its proposal by substituting the text of S. 2450 for that of H.R. 3230, a measure previously received from the House. The House then amended the Senate substitute for H.R. 3230 by substituting the text of H.R. 4810 and also that of the Department of Veterans Affairs Management Accountability Act of 2014 (H.R. 4031), a measure it had previously passed on May 21. This action enabled the two chambers to proceed to conference on their respective versions of H.R. 3230. \nOn July 28, the Co-Chairmen of the Conference Committee, Senator Bernie Sanders and Representative Jeff Miller, announced that an agreement had been reached, and reported the measure. The conferees voted on the conference report (H.Rept. 113-564) on the same day. The full House passed the Veterans Access, Choice, and Accountability Act of 2014 (H.R. 3230; H.Rept. 113-564) on July 30, and the Senate passed the conference measure on July 31. President Barack Obama signed the Veterans Access, Choice, and Accountability Act of 2014 into law (P.L. 113-146) on August 7, 2014. \nOn September 26, 2014, the Department of Veterans Affairs Expiring Authorities Act of 2014 (H.R. 5404; P.L. 113-175) was signed into law. Sections 408 and 409 of P.L. 113-175 made minor amendments to Sections 101, 102, 104, 105, 204, 206, 207, 301, 302, and 702 of the Veterans Access, Choice, and Accountability Act of 2014. On December 16, 2014, President Barack Obama signed into law the Consolidated and Further Continuing Appropriations Act, 2015 (H.R. 83; P.L. 113-235). Division I of this act contained the Military Construction and Veterans Affairs, and Related Agencies Appropriations Act, 2015. Section 242 of this act amended Section 101 of the Veterans Access, Choice, and Accountability Act of 2014. On May 22, 2015, the Construction Authorization and Choice Improvement Act (H.R. 2496; P.L. 114-19) was enacted into law. Section 3 of this act amended Section 101(b)(2)of the Veterans Access, Choice, and Accountability Act of 2014, as amended. Lastly, on July 31, 2015, the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015 (H.R. 3236; P.L. 114-41) was enacted into law. Title IV of this act contained the VA Budget and Choice Improvement Act. Sections 4004 and 4005 of this act amended and modified Sections 101 and 802 of the Veterans Access, Choice, and Accountability Act of 2014. The summary of selected provisions of the Veterans Access, Choice, and Accountability Act of 2014 (P.L. 113-146) provided in this report incorporates these amendments made by P.L. 113-175, P.L. 113-235, P.L. 114-19, and P.L. 114-41. \nProvisions in the Veterans Access, Choice, and Accountability Act of 2014\nThe rest of this report provides a summary of selected provisions in the Veterans Access, Choice, and Accountability Act of 2014 (P.L. 113-146)\u2014as amended by the Department of Veterans Affairs Expiring Authorities Act of 2014 (H.R. 5404; P.L. 113-175); the Consolidated and Further Continuing Appropriations Act, 2015 (H.R. 83; P.L. 113-235); the Construction Authorization and Choice Improvement Act (H.R. 2496; P.L. 114-19); and the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015 (H.R. 3236; P.L. 114-41)\u2014by title and section. It does not attempt to analyze each of the provisions in the act in depth, but provides brief outlines of the matters addressed. The Appendix provides a table showing the numerous implementing and reporting deadlines required by P.L. 113-146 as amended by P.L. 113-175. Throughout this report, unless otherwise stated, the \u201cSecretary\u201d means the Secretary of Veterans Affairs, and the \u201cVA\u201d means the same. In addition, \u201cthis section\u201d refers to matters addressed under that specific section of the act. \nThis report uses a number of acronyms, which are listed below.\nCBOChief Business Office of the Veterans Health Administration \nCBOCCommunity Based Outpatient Clinic\nDODDepartment of Defense\nFQHCs\nFederally Qualified Health Centers\n\nGAO\nGovernment Accountability Office \n\nHHS\nDepartment of Health and Human Services\n\nIHS \nIndian Health Service\n\nMST\nMilitary Sexual Trauma\n\nNVCC\nNon-VA Care Coordination\n\nProject ARCH\nAccess Received Closer to Home\n\nU.S.C.\nUnited States Code \n\nVA\nDepartment of Veterans Affairs\n\nVAMC\nVA Medical Center\n\nVHA\nVeterans Health Administration \n\nVISNs \nVeterans Integrated Service Networks\n\nSec. 1. Short Title \nThis section provides the title of the bill as the \u201cVeterans Access, Choice, and Accountability Act of 2014.\u2019\u2019\nSec. 2. Definitions \nThis section provides definitions of the terms used for the purposes of this act. These definitions refer to current law definitions provided in Title 38 U.S.C. for the terms \u201cfacilities of the Department,\u201d \u201chospital care,\u201d and \u201cmedical services.\u201d\nTitle I: Improvement of Access to Care from Non-Department of Veterans Affairs Providers\nAt the core of this title is a new temporary program (the Veterans Choice Program) to provide hospital care and medical services to certain eligible veterans in non-VA facilities or through non-VA providers. The VA has 90 days from the date of enactment (i.e., November 5, 2014) to issue interim final regulations to implement major provisions of Section 101. \nSec. 101. Availability of Hospital Care and Medical Services through the Use of Non-VA Entities\nEligibility\nThis section requires the VA to authorize non-VA care to veterans who are enrolled in the VA health care system, including a veteran enrolled in the VA health care system who has not received hospital care or medical services from the VA and has contacted the VA seeking an initial appointment for the receipt of such care or services; \nIf a veteran is enrolled in the VA health system, then veterans are eligible for Veterans Choice Program authorization if they meet one of the following four criteria:\n(A) attempts, or has attempted to schedule an appointment for the receipt of hospital care or medical services but is unable to schedule an appointment \nwithin the wait-time goals of the VHA for the furnishing of care or services; or \nwithin a clinically appropriate period if such time frame is shorter than the wait-time goals of the VHA;\nor \n(B) resides more than 40 miles (based on distance traveled), \nif seeking primary care, from a VA medical facility including a community-based outpatient clinic (CBOC) that is able to provide the care sought and provided by a full-time primary care physician; or \nif not seeking primary care, from any VA medical facility including a community-based outpatient clinic (CBOC); \nor \n(C) resides in a state without a VA medical facility that provides (I) hospital care, and (II) emergency medical services, and (III) surgical care rated by the Secretary as having a surgical complexity standard; and more than 20 miles from a VA medical facility that provides hospital care; and (II) emergency medical services; and (III) surgical care rated by the Secretary as having a surgical complexity standard; \n\nor\n(D) resides in a location, (not including a location in Guam, American Samoa or the Republic of the Philippines), that is 40 miles or less from a VA medical facility, including a CBOC;\nand\n(1) is required to travel by air, boat, or ferry to reach each VA medical facility, including a CBOC, that is 40 miles or less from the veteran\u2019s residence\nor \n(2) resides in a location, (not including a location in Guam, American Samoa, or the Republic of the Philippines), that is 40 miles or less from a VA medical facility, including a CBOC, and faces an unusual or excessive burden in accessing such a VA medical facility due to geographical challenges; or environmental factors, such as roads that are not accessible to the public, because of traffic, or hazardous weather; or a medical condition that impacts the veteran\u2019s ability to travel; or other factors, as determined by the VA.\nChoice of Provider\nEligible veterans authorized to receive care under this section could choose to receive care through any of the following non-VA entities or providers: Medicare providers, including any physician furnishing services under such program; FQHCs; DOD medical facilities; IHS facilities; and other health care providers that meets criteria established by the Secretary.\nCoordination of Care with Non-VA Entities \nThis section requires the VA to use the Non-VA Care Coordination (NVCC) program to coordinate care of eligible veterans with non-VA providers. It also requires the VA to ensure that appointments are scheduled within the wait-time goals of the VA. \nAuthorization of Care by the VA \nThis section requires the VA to authorize care to eligible veterans. It also allows the veteran to elect whether he or she wants to receive care from non-VA entities. If the veteran does not elect to receive care from non-VA entities, the veteran could be provided with an appointment that exceeds the wait-time goals of the VA, or the veteran will be placed on an electronic waiting list\u2014which may be viewed by the veteran\u2014maintained by the VA for an appointment for hospital care or medical services. If the veteran chooses to be seen by non-VA entities, the VA is required to authorize such care or services to the eligible veteran for a period of time specified by the Secretary; and notify the eligible veteran by electronic communication or in writing, describing the care or services that the veteran is eligible to receive. \nElectronic Waiting List\nThis section requires the VA to maintain an electronic waiting list and allow each eligible veteran access to it either through the www.myhealth.va.gov or any successor website (or other digital channel). The veteran could use the electronic waiting list to determine the average length of time an individual spends on the waiting list at each specific VA medical facility. The veteran could use this information to decide if they want to seek care from a non-VA entity. \nCare and Services Through Agreements\nThis section requires the VA to enter into agreements for furnishing care and services to eligible veterans with the following entities: Medicare providers, including any physician furnishing services under such program; FQHCs; DOD medical facilities; IHS facilities; and other health care providers that meets criteria established by the Secretary. This section defines the term agreement\u2019\u2019 to include contracts, intergovernmental agreements, and provider agreements, as appropriate. Furthermore, this section stipulates that an agreement entered for furnishing care and services to eligible veterans cannot be treated as a federal contract for the acquisition of goods or services. This section also requires the Secretary to the maximum extent practicable to furnish care and services to eligible veterans using existing contracts or other processes available at VAMCs prior to entering into new agreements. \nRates of Reimbursement\nThis section requires the Secretary to negotiate reimbursement rates for the furnishing of care and services with non-VA entities. Furthermore, this section places a limit on the reimbursement rate with several exceptions. In general, negotiated rates must be no more than the payment rate under the Medicare program under Title XVIII of the Social Security Act, set by the Centers for Medicare & Medicaid Services. However, the VA may negotiate a higher rate than the Medicare reimbursement rate if the provider is furnishing care or services to an eligible veteran who resides in a highly rural area (defined as an area located in a county that has fewer than seven individuals residing in that county per square mile). Furthermore, in the State of Alaska, VA will be able to reimburse providers under the VA Alaska Fee Schedule, and in states with an \u201cAll-Payer Model\u201d agreement, VA will calculate Medicare payments based on payment rates under such \u201cAll-Payer Model\u201d agreements. This section also exempts Medicare and Medicaid providers\u2014during the period they are furnishing care to eligible veterans\u2014from Federal Contract Compliance Programs of the Department of Labor that apply to federal contractors and subcontractors. Furthermore, this section stipulates that a non-VA health care entity may not collect an amount that is greater than the rate that was negotiated with the VA for care to eligible veterans. It also requires that the Secretary provide non-VA health care entities and providers with required information on policies and procedures with regard to billing, claims submission, and care authorization, among other things. \nVA as the Secondary Payer of Care \nThis section of the act stipulates that the VA will generally be the secondary payer for eligible veterans receiving care for nonservice-connected disabilities or conditions from specified non-VA health care entities. It further stipulates that the VA will pay for care or services that are not covered by the veteran\u2019s health insurance plan at an amount not to exceed the Medicare rate or a negotiated rate. Furthermore, before receiving hospital care or medical services, an eligible veteran is required to provide the Secretary information on any insurance policy or contract that the veteran has. For those veterans who are only enrolled in Medicare, Medicaid, or TRICARE, the VA will be the primary payer for care and services for nonservice-connected disabilities or conditions.\nVeterans Choice Card\nThis section stipulates that not later than 90 days after enactment the VA is required to provide each enrolled veteran with a card known as a \u201cVeterans Choice Card.\u201d Among other things, as specified, the following statement will be printed on the card: \u201cThis card is for qualifying medical care outside the Department of Veterans Affairs. Please call the Department of Veterans Affairs phone number specified on this card to ensure that treatment has been authorized.\u2019\u2019 Furthermore, the act stipulates that the Secretary provide the eligible veteran with information clearly stating the circumstances under which the veteran may be eligible for care or services.\nInformation on Availability of Care\nThis section requires the Secretary to provide information on non-VA care to veterans when they enroll in the VA health care system, when the veteran attempts to schedule an appointment for the receipt of hospital care or medical services from the VA but is unable to schedule an appointment within the current wait-time goals of the VHA for the delivery of such care or services, and when the veteran becomes eligible for hospital care or medical services under this act.\nFollow-Up Care \nThis section requires non-VA care authorizations to include a complete episode of care, including all specialty and ancillary services deemed necessary as part of an episode of recommended treatment.\nCredentials of Providers\nThis section of the act requires participating non-VA providers to maintain the same or similar credentials and licenses as required of VA health care providers, and to submit verification at least annually.\nCopayments \nThis section of the act requires veterans who are authorized to receive non-VA care to pay applicable copayment just as they would be assessed a copayment if treatment was provided in a VA facility. The non-VA health care provider or entity that furnishes the care or service will be required to collect the copayment directly from the eligible veteran. \nHealth Care Claims Processing \nThis section requires the Secretary to establish an efficient nationwide system for processing and paying non-VA care bills or claims, and the Chief Business Office (CBO) of the VHA will oversee the implementation and maintenance of the claims processing system. Regulations implementing such a claims processing system are to be published no later than 90 days after enactment of this act.\nMedical Records \nThis section requires the VA to ensure that non-VA providers submit to the VA a copy of any medical record information related to the care and services provided to an eligible veteran for inclusion in the veteran\u2019s Computerized Patient Record System (CPRS) maintained by the VA. It further stipulates that to the greatest extent possible the medical records submitted by non-VA providers or entities should be in an electronic format. \nTracking Missed Appointments\nThis section of the act requires the Secretary to implement a mechanism to track missed appointments authorized under this section for eligible veterans to ensure that the VA does not pay for such care or services that were not furnished to an eligible veteran.\nImplementing Regulations\nThis section of the act requires the VA to prescribe and publish interim final regulations no later than 90 days after the date of the enactment on the implementation of the new program to provide eligible veterans with care in non-VA facilities.\nOffice of the Inspector General (OIG) Report\nThis section of the act requires the VA Inspector General to issue an audit of care report to the Secretary on the expanded non-VA care authority. The report is required to be submitted no later than 30 days after the Secretary determines that 75% of amounts deposited in the \u201cVeterans Choice Fund\u201d (see section on \u201cSec. 802. Veterans Choice Fund\u201d later in this report) have been exhausted. \nEnd Date of the Expanded Authority for Non-VA Care\nThis section stipulates that the authority for the new expanded non-VA care program will end on a date when all the funds deposited in the \u201cVeterans Choice Fund\u201d (see section on \u201cSec. 802. Veterans Choice Fund\u201d later in this report) are exhausted or on a date that is three years after the date of enactment, whichever comes first. \nReports to Congress\nThis section of the act requires the VA to submit reports to Congress on the expanded non-VA care authority. The Secretary is required to submit an interim report to Congress, not later than 90 days after the publication of interim final regulations. The interim report must include information on the number of eligible veterans and a description of the type of care and services furnished to eligible veterans. A final report is required no later than 30 days after the date on which the Secretary determines that 75% of the amounts deposited in the \u201cVeterans Choice Fund\u201d are exhausted. The final report must include, among other things, an assessment and recommendations regarding the continuation of non-VA care and services under the new expanded authority. \nFilling Prescription Medications\nThis section specifies that VA\u2019s current practice of filling prescriptions of veterans at VA pharmacies and/or Consolidated Mail Order Pharmacies (CMOPs), and the policies that allow the VA to pay for prescribed drugs provided for certain eligible veterans, will continue without any changes. \nWait-Time Goals of the VHA\nThis section of the act defines \u201cwait time goals of the Veterans Health Administration\u201d as an appointment date that is not more than 30 days from the date that the veteran requested an appointment for care. If the Secretary notifies Congress no later than 60 days after enactment that the \u201cwait-time goals of the Veterans Health Administration\u201d are different than what is defined in this section, then the new wait time goals of the VHA will be the ones defined by the Secretary. \nWaiver of Certain Printing Requirements \nThis section allows the Secretary to print material related to the Veterans Choice Program other than through the Government Printing Office (GPO). \nSec. 102. Enhancement of Collaboration between the VA and Indian Health Service\nThis section requires the Secretary (in consultation with the IHS Director) to conduct outreach to each medical facility operated by an Indian Tribe or Tribal Organization to make these facilities aware that they can enter into agreements with the VA under which the VA will reimburse these facilities for care provided to IHS beneficiaries who are also VA-enrolled veterans. This section also requires the Secretary and the IHS director to jointly establish and implement performance metrics that examine whether the existing MOU between the VA and IHS\u2014\u201cMemorandum of Understanding\u201d between the Department of Veterans Affairs (VA) and the Indian Health Service (IHS)\u2014is effective at, among other things, increasing access, improving quality and care coordination, and determining whether health promotion and disease prevention services are funded and available to beneficiaries under both health care systems. The section further requires that the Secretary and the IHS Director submit a report to Congress on the (1) feasibility of including Urban Indian Organizations in the current VA-IHS reimbursement agreement, (2) feasibility of including the direct care costs of treating non-American Indian veterans in agreements between the VA and IHS facilities or medical facilities operated by an Indian Tribe or Tribal Organization, and (3) possible effects of an agreement between the IHS-VA agreement to provide care to veterans at IHS facilities on access to services by IHS-beneficiaries. This report is due no later than 180 days after enactment.\nSec. 103. Enhancement of Collaboration between the VA and the Native Hawaiian Health Care System\nThis section requires the VA, in consultation with Papa Ola Lokahi and such other organizations involved in the delivery of health care to Native Hawaiians, to enter into contracts or agreements with Native Hawaiian health care systems, receiving funds from the Secretary of Health and Human Services (HHS), to reimburse such systems for direct care services provided to eligible veterans (as specified in the particular contract or agreement).\nSec. 104. Reauthorization and Modification of Project ARCH (Access Received Closer to Home)\nThis section reauthorizes and modifies the pilot program known as Project ARCH, which was established under Section 403 of the Veterans\u2019 Mental Health and Other Care Improvements Act of 2008 (P.L. 110-387). The three-year pilot program was set to expire on August 29, 2014. This section authorizes Project ARCH for two years from the date of enactment of the act. This section stipulates in law the pilot sites as: VISN 1; VISN 6; VISN 15; VISN 18; and VISN 19. This section of the act further stipulates that the Secretary must ensure that medical appointments for those veterans eligible to participate in Project ARCH are scheduled not later than 5 days after the date on which the appointment is requested and occur no later than 30 days after such date. This section allows the Secretary to use existing Project ARCH contracts or enter into new contracts. \nSec. 105. Prompt Payment\nThis section states that it is the sense of Congress that the VA must comply with the Prompt Payment rule, and requires VA to establish and implement a system to process and pay claims from non-VA providers for hospital care, medical services, and other health care services provided to eligible veterans. Furthermore, it requires the Government Accountability Office (GAO) to submit a report, no later than one year after the date of enactment, to Congress on the timeliness of payments by the VA to non-VA providers, among other things.\nSec. 106. 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