38 U.S.C. § 8110 — Operation of medical facilities

Page 1311 TITLE 38—VETERANS’ BENEFITS § 8110 EFFECTIVE DATE Section effective Oct. 1, 1979, but not applicable with respect to the acquisition, construction, or alteration of any medical facilities if the acquisition, construc- tion, or alteration (not including exchange) was ap- proved by the President before Oct. 1, 1979, see section 302 of Pub. L. 96–22, set out as a note under section 8101 of this title. § 8110. Operation of medical facilities (a)(1) The Secretary shall establish the total number of hospital beds and nursing home beds in medical facilities over which the Secretary has direct jurisdiction for the care and treat- ment of eligible veterans. The Secretary shall establish the total number of such beds so as to maintain a contingency capacity to assist the Department of Defense in time of war or na- tional emergency to care for the casualties of such war or national emergency. Of the number of beds authorized pursuant to the preceding sentence, the Secretary shall maintain the availability of such additional beds and facili- ties in addition to the operating bed level as the Secretary considers necessary for such contin- gency purposes. The President shall include in the Budget transmitted to the Congress for each fiscal year pursuant to section 1105 of title 31, an amount for medical care and amounts for con- struction sufficient to maintain the availability of the contingency capacity referred to in the second sentence of this paragraph. The Sec- retary shall staff and maintain, in such a man- ner as to ensure the immediate acceptance and timely and complete care of patients, and in a manner consistent with the policies of the Sec- retary on overtime, sufficient beds and other treatment capacities to accommodate, and pro- vide such care to, eligible veterans applying for admission and found to be in need of hospital care or medical services. (2) The Secretary shall maintain the bed and treatment capacities of all Department medical facilities, including the staffing required to maintain such capacities, so as to ensure the ac- cessibility and availability of such beds and treatment capacities to eligible veterans in all States, to minimize delays in admissions and in the provision of hospital, nursing home, and domiciliary care, and of medical services fur- nished pursuant to section 1710(a) of this title, and to ensure that eligible veterans are provided such care and services in an appropriate man- ner. (3)(A) The Under Secretary for Health shall at the end of each fiscal year (i) analyze agency- wide admission policies and the records of those eligible veterans who apply for hospital care, medical services, and nursing home care, but are rejected or not immediately admitted or pro- vided such care or services, and (ii) review and make recommendations regarding the adequacy of staff levels for compliance with the policy es- tablished under subparagraph (C), the adequacy of the established operating bed levels, the geo- graphic distribution of operating beds, the de- mographic characteristics of the veteran popu- lation and the associated need for medical care and nursing home facilities and services in each State, and the proportion of the total number of operating beds that are hospital beds and that are nursing home beds. (B) After considering the analyses and rec- ommendations of the Under Secretary for Health pursuant to subparagraph (A) of this paragraph for any fiscal year, the Secretary shall report to the committees, on or before De- cember 1 after the close of such fiscal year, on the results of the analysis of the Under Sec- retary for Health and on the numbers of oper- ating beds and level of treatment capacities re- quired to enable the Department to carry out the primary function of the Veterans Health Ad- ministration. The Secretary shall include in each such report recommendations for (i) the numbers of operating beds and the level of treat- ment capacities required for the health care of veterans and the maintenance of the contin- gency capacity referred to in paragraph (1) of this subsection, and (ii) the appropriate staffing and funds therefor. (C) The Secretary shall, in consultation with the Under Secretary for Health, establish a na- tionwide policy on the staffing of Department medical facilities in order to ensure that such facilities have adequate staff for the provision to veterans of appropriate, high-quality care and services. The policy shall take into account the staffing levels and mixture of staff skills re- quired for the range of care and services pro- vided veterans in Department facilities. (4)(A) With respect to each law making appro- priations for the Department for any fiscal year (or any part of a fiscal year), there shall be pro- vided to the Department the funded personnel ceiling defined in subparagraph (C) of this para- graph and the funds appropriated therefor. (B) In order to carry out the provisions of sub- paragraph (A) of this paragraph, the Director of the Office of Management and Budget shall, with respect to each such law (i) provide to the Department for the fiscal year (or part of a fis- cal year) concerned such funded personnel ceil- ing and the funds necessary to achieve such ceil- ing, and (ii) submit to the appropriate commit- tees of the Congress and to the Comptroller Gen- eral of the United States certification that the Director has so provided such ceiling. Not later than the thirtieth day after the enactment of such a law or, in the event of the enactment of such a law more than thirty days prior to the fiscal year for which such law makes such ap- propriations, not later than the tenth day of such fiscal year, the certification required in the first sentence of this subparagraph shall be sub- mitted, together with a report containing com- plete information on the personnel ceiling that the Director has provided to the Department for the employees described in subparagraph (C) of this paragraph. (C) For the purposes of this paragraph, the term ‘‘funded personnel ceiling’’ means, with re- spect to any fiscal year (or part of a fiscal year), the authorization by the Director of the Office of Management and Budget to employ (under the appropriation accounts for medical care, medical and prosthetic research, and medical administration and miscellaneous operating ex- penses) not less than the number of employees for the employment of which appropriations have been made for such fiscal year (or part of a fiscal year). (5) Notwithstanding any other provision of this title or of any other law, funds appropriated Page 1312 TITLE 38—VETERANS’ BENEFITS § 8110 for the Department under the appropriation ac- counts for medical care, medical and prosthetic research, and medical administration and mis- cellaneous operating expenses may not be used for, and no employee compensated from such funds may carry out any activity in connection with, the conduct of any study comparing the cost of the provision by private contractors with the cost of the provision by the Department of commercial or industrial products and services for the Veterans Health Administration unless such funds have been specifically appropriated for that purpose. (6)(A) Temporary research personnel of the Veterans Health Administration shall be ex- cluded from any ceiling on full-time equivalent employees of the Department or any other per- sonnel ceiling otherwise applicable to employees of the Department. (B) For purposes of subparagraph (A) of this paragraph, the term ‘‘temporary research per- sonnel’’ means personnel who are employed in the Veterans Health Administration in other than a career appointment for work on a re- search activity and who are not paid by the De- partment or are paid from funds appropriated to the Department to support such activity. (b) When the Secretary determines, in accord- ance with regulations which the Secretary shall prescribe, that a Department facility serves a substantial number of veterans with limited English-speaking ability, the Secretary shall es- tablish and implement procedures, upon the rec- ommendation of the Under Secretary for Health, to ensure the identification of sufficient num- bers of individuals on such facility’s staff who are fluent in both the language most appro- priate to such veterans and in English and whose responsibilities shall include providing guidance to such veterans and to appropriate Department staff members with respect to cul- tural sensitivities and bridging linguistic and cultural differences. (c) The Secretary may not in any fiscal year close more than 50 percent of the beds within a bed section (of 20 or more beds) of a Department medical center unless the Secretary first sub- mits to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report providing a justification for the closure. No action to carry out such closure may be taken after the submission of such report until the end of the 21-day period beginning on the date of the submission of the report. (d) The Secretary shall submit to the Commit- tees on Veterans’ Affairs of the Senate and the House of Representatives, not later than Janu- ary 20 of each year, a report documenting by network for the preceding fiscal year the fol- lowing: (1) The number of medical service and sur- gical service beds, respectively, that were closed during that fiscal year and, for each such closure, a description of the changes in delivery of services that allowed such closure to occur. (2) The number of nursing home beds that were the subject of a mission change during that fiscal year and the nature of each such mission change. (e) For purposes of this section: (1) The term ‘‘closure’’, with respect to beds in a medical center, means ceasing to provide staffing for, and to operate, those beds. Such term includes converting the provision of such bed care from care in a Department facility to care under contract arrangements. (2) The term ‘‘bed section’’, with respect to a medical center, means psychiatric beds (in- cluding beds for treatment of substance abuse and post-traumatic stress disorder), inter- mediate, neurology, and rehabilitation medi- cine beds, extended care (other than nursing home) beds, and domiciliary beds. (3) The term ‘‘justification’’, with respect to closure of beds, means a written report that includes the following: (A) An explanation of the reasons for the determination that the closure is appro- priate and advisable. (B) A description of the changes in the functions to be carried out and the means by which such care and services would continue to be provided to eligible veterans. (C) A description of the anticipated effects of the closure on veterans and on their ac- cess to care. (Added Pub. L. 96–22, title III, § 301(a), June 13, 1979, 93 Stat. 59, § 5010; amended Pub. L. 96–151, title III, § 301(a), Dec. 20, 1979, 93 Stat. 1095; Pub. L. 97–66, title VI, § 601(b), Oct. 17, 1981, 95 Stat. 1033; Pub. L. 97–72, title I, § 108, Nov. 3, 1981, 95 Stat. 1053; Pub. L. 97–306, title IV, § 409(b), Oct. 14, 1982, 96 Stat. 1446; Pub. L. 97–452, § 2(e)(4), Jan. 12, 1983, 96 Stat. 2479; Pub. L. 98–160, title VII, § 702(19), Nov. 21, 1983, 97 Stat. 1010; Pub. L. 98–528, title I, § 102, Oct. 19, 1984, 98 Stat. 2688; Pub. L. 99–576, title VII, § 702(15), Oct. 28, 1986, 100 Stat. 3302; Pub. L. 100–322, title II, § 222(a), title IV, § 401(a), May 20, 1988, 102 Stat. 531, 543; re- numbered § 8110 and amended Pub. L. 102–40, title IV, § 402(b)(1), (d)(1), May 7, 1991, 105 Stat. 238, 239; Pub. L. 102–83, §§ 4(a)(3), (4), (b)(1), (2)(E), 5(c)(1), Aug. 6, 1991, 105 Stat. 404–406; Pub. L. 102–405, title III, § 302(c)(1), Oct. 9, 1992, 106 Stat. 1984; Pub. L. 103–446, title XI, § 1103, title XII, § 1201(b)(1), (d)(17), (g)(7), Nov. 2, 1994, 108 Stat. 4681, 4682, 4684, 4687; Pub. L. 104–66, title I, § 1141(c), Dec. 21, 1995, 109 Stat. 726; Pub. L. 104–262, title I, § 101(e)(4), title III, § 305, Oct. 9, 1996, 110 Stat. 3181, 3194; Pub. L. 106–117, title III, § 301, Nov. 30, 1999, 113 Stat. 1571; Pub. L. 107–135, title I, § 124, Jan. 23, 2002, 115 Stat. 2452; Pub. L. 107–314, div. A, title VII, § 726(a), Dec. 2, 2002, 116 Stat. 2599; Pub. L. 115–251, title II, § 207, Sept. 29, 2018, 132 Stat. 3173.) Editorial Notes PRIOR PROVISIONS Provisions similar to those comprising this section were contained in former section 5001(a)(2), (3), (h) of this title prior to the general revision of this sub- chapter by Pub. L. 96–22. AMENDMENTS 2018—Subsecs. (c) to (f). Pub. L. 115–251 redesignated subsecs. (d) to (f) as (c) to (e), respectively, and struck out former subsec. (c) which read as follows: ‘‘The Sec- retary shall include in the materials submitted to Con- gress each year in support of the budget of the Depart- ment for the next fiscal year a report on activities and proposals involving contracting for performance by Page 1313 TITLE 38—VETERANS’ BENEFITS § 8110 contractor personnel of work previously performed by Department employees. The report shall— ‘‘(1) identify those specific activities that are cur- rently performed at a Department facility by more than 10 Department employees which the Secretary proposes to study for possible contracting involving conversion from performance by Department employ- ees to performance by employees of a contractor; and ‘‘(2) identify those specific activities that have been contracted for performance by contractor employees during the prior fiscal year (shown by location, sub- ject, scope of contracts, and savings) and shall de- scribe the effect of such contracts on the quality of delivery of health services during such year.’’ 2002—Subsec. (a)(1). Pub. L. 107–314 struck out ‘‘at not more than 125,000 and not less than 100,000’’ before pe- riod at end of first sentence, ‘‘shall operate and main- tain a total of not less than 90,000 hospital beds and nursing home beds and’’ before ‘‘shall maintain the availability’’ in third sentence, and ‘‘to enable the De- partment to operate and maintain a total of not less than 90,000 hospital and nursing home beds in accord- ance with this paragraph and’’ after ‘‘construction suf- ficient’’ in fourth sentence. Pub. L. 107–135, § 124(a)(1), inserted ‘‘and in a manner consistent with the policies of the Secretary on over- time,’’ after ‘‘complete care of patients,’’ in fifth sen- tence. Subsec. (a)(2). Pub. L. 107–135, § 124(a)(2), inserted ‘‘, including the staffing required to maintain such ca- pacities,’’ after ‘‘all Department medical facilities’’, substituted ‘‘, to minimize’’ for ‘‘and to minimize’’, and inserted before period at end ‘‘, and to ensure that eli- gible veterans are provided such care and services in an appropriate manner’’. Subsec. (a)(3)(A). Pub. L. 107–135, § 124(b)(1), inserted ‘‘the adequacy of staff levels for compliance with the policy established under subparagraph (C),’’ after ‘‘re- garding’’. Subsec. (a)(3)(C). Pub. L. 107–135, § 124(b)(2), added sub- par. (C). 1999—Subsecs. (d) to (f). Pub. L. 106–117 added subsecs. (d) to (f). 1996—Subsec. (a)(2). Pub. L. 104–262, § 101(e)(4), sub- stituted ‘‘section 1710(a)’’ for ‘‘section 1712’’. Subsec. (c). Pub. L. 104–262, § 305, amended subsec. (c) generally, substituting provisions consisting of an in- troductory par. and pars. (1) and (2), relating to reports on activities and proposals involving contracting for performance by contractor personnel of work pre- viously performed by Department employees for provi- sions consisting of pars. (1) to (9), relating to conver- sion of activities at health-care facilities from those performed by Federal employees to those performed by Government contractors. 1995—Subsec. (a)(4). Pub. L. 104–66 substituted ‘‘sub- paragraph (C)’’ for ‘‘subparagraph (D)’’ in subpars. (A) and (B), redesignated subpar. (D) as (C), and struck out former subpar. (C) which read as follows: ‘‘Whenever the Director of the Office of Management and Budget is required to submit a certification under subparagraph (B) of this paragraph, the Comptroller General shall submit to the appropriate committees of the Congress a report stating the Comptroller General’s opinion as to whether the Director has complied with the require- ments of that subparagraph. The Comptroller General shall submit the report not later than fifteen days after the end of the period specified in such subparagraph for the Director to submit the certification.’’ 1994—Subsec. (a)(3)(B), (5), (6). Pub. L. 103–446, § 1201(b)(1), substituted ‘‘Veterans Health Administra- tion’’ for ‘‘Department of Medicine and Surgery’’ wher- ever appearing. Subsec. (c)(3)(B). Pub. L. 103–446, § 1201(d)(17), sub- stituted ‘‘section 513 or 7409’’ for ‘‘section 213 or 4117’’. Subsec. (c)(7). Pub. L. 103–446, § 1201(g)(7), which pro- vided for striking out obsolete or executed provisions and directed the amendment of subsec. (c) by striking out par. (7), was not executed because of the prior amendment of subsec. (c) by Pub. L. 103–446, § 1103. See below. Pub. L. 103–446, § 1103, added par. (7) and struck out former par. (7) which read as follows: ‘‘Not later than February 1, 1984, and February 1 of each of the five suc- ceeding years, the Secretary shall submit a written re- port to Congress describing the extent to which activi- ties at Department health-care facilities were per- formed by contractors during the preceding fiscal year and the actual cost savings resulting from such con- tracts.’’ Subsec. (c)(8), (9). Pub. L. 103–446, § 1103, added pars. (8) and (9). 1992—Subsecs. (a)(3), (b), (c)(1), (3)(B). Pub. L. 102–405 substituted ‘‘Under Secretary for Health’’ for ‘‘Chief Medical Director’’ wherever appearing. 1991—Pub. L. 102–40, § 402(b)(1), renumbered section 5010 of this title as this section. Subsec. (a). Pub. L. 102–83, § 5(c)(1), substituted ‘‘1712’’ for ‘‘612’’ in par. (2). Pub. L. 102–83, § 4(b)(1), (2)(E), substituted ‘‘Sec- retary’’ for ‘‘Administrator’’ wherever appearing. Pub. L. 102–83, § 4(a)(3), (4), substituted ‘‘Department’’ for ‘‘Veterans’ Administration’’ wherever appearing. Subsec. (b). Pub. L. 102–83, § 4(b)(1), (2)(E), substituted ‘‘Secretary’’ for ‘‘Administrator’’ wherever appearing. Pub. L. 102–83, § 4(a)(3), (4), substituted ‘‘Department’’ for ‘‘Veterans’ Administration’’ in two places. Subsec. (c). Pub. L. 102–83, § 4(b)(1), (2)(E), substituted ‘‘Secretary’’ for ‘‘Administrator’’ and ‘‘Secretary’s’’ for ‘‘Administrator’s’’ wherever appearing. Pub. L. 102–83, § 4(a)(3), (4), substituted ‘‘Department’’ for ‘‘Veterans’ Administration’’ wherever appearing. Pub. L. 102–40, § 402(d)(1), substituted ‘‘8111, 8111A, or 8153’’ for ‘‘5011, 5011A, or 5053’’ in par. (3)(A). 1988—Subsec. (a)(6). Pub. L. 100–322, § 222(a), added par. (6). Subsec. (c)(2). Pub. L. 100–322, § 401(a), inserted ‘‘re- sponsive bids are received from at least two respon- sible, financially autonomous bidders and’’ after ‘‘only if’’. 1986—Subsec. (a)(1). Pub. L. 99–576 substituted ‘‘125,000 and not less than 100,000’’ for ‘‘one hundred and twenty- five thousand and not less than one hundred thousand’’ and ‘‘90,000’’ for ‘‘ninety thousand’’ in two places. 1984—Subsec. (a)(4)(C). Pub. L. 98–528 substituted pro- vision requiring the Comptroller General to submit a report stating the Comptroller General’s opinion as to whether the Director has complied with subpar. (B) not later than fifteen days after end of period specified in that subparagraph for Director to submit required cer- tification for provision which had required the Comp- troller General to submit a report stating the Comp- troller General’s opinion as to whether the Director has complied with the requirements of any law making ap- propriations for the Veterans’ Administration for any fiscal year or any part thereof regarding funded per- sonnel ceilings not later than forty-fifth day after en- actment of each such law. 1983—Subsec. (a)(1). Pub. L. 97–452 substituted ‘‘sec- tion 1105 of title 31’’ for ‘‘section 201(a) of the Budget and Accounting Act, 1921 (31 U.S.C. 11(a))’’. Subsec. (c)(2)(B). Pub. L. 98–160 substituted ‘‘quantity and quality’’ for ‘‘quantity or quality’’. 1982—Subsec. (c). Pub. L. 97–306 added subsec. (c). 1981—Subsec. (a)(1). Pub. L. 97–72, § 108(a)(1), struck out provision authorizing the Administrator, subject to the approval of the President to establish and operate not less than 125,000 hospital beds in medical facilities over which the Administrator has direct jurisdiction for the care and treatment of eligible veterans and sub- stituted therefor provisions directing the Adminis- trator to establish a total number of hospital beds and nursing home beds in medical facilities over which the Administrator has direct jurisdiction for the care and treatment of eligible veterans at not more than one hundred and twenty-five thousand and not less than one hundred thousand, and provided that the Adminis- trator establish the total number of such beds so as to maintain a contingency capacity to assist the Depart- ment of Defense in time of war or national emergency to care for the casualties of such war or national emer- Page 1314 TITLE 38—VETERANS’ BENEFITS § 8110 gency, that of the number of beds authorized pursuant to the preceding sentence, the Administrator operate and maintain a total of not less than ninety thousand hospital beds and nursing home beds and maintain the availability of such additional beds and facilities in ad- dition to the operating bed level as the Administrator considers necessary for such contingency purposes, and that the President include in the Budget transmitted to the Congress for each fiscal year pursuant to section 201(a) of the Budget and Accounting Act, 1921 (31 U.S.C. 11(a)), an amount for medical care and amounts for con- struction. Subsec. (a)(3). Pub. L. 97–72, § 108(a)(2), struck out pro- vision requiring that the Chief Medical Director peri- odically analyze agencywide admission policies and the records of those eligible veterans who apply for hos- pital care and medical services and annually advise each committee of the results and the added require- ments which those results indicate and substituted therefor provisions that the Chief Medical Director, at the end of each fiscal year, (i) analyze agencywide ad- mission policies and the records of those eligible vet- erans who apply for hospital care, medical services and nursing home care, but are rejected or not immediately admitted or provided such care or services, and (ii) re- view and made recommendations regarding the ade- quacy of the established operating bed levels, the geo- graphic distribution of operating beds, the demographic characteristics of the veteran population and the asso- ciated need for medical care and nursing home facili- ties and services in each State, and the proportion of the total number of operating beds that are hospital beds and that are nursing home beds, and that, after considering the analyses and recommendations of the Chief Medical Director pursuant to subparagraph (A) of this paragraph for any fiscal year, the Administrator report to the committees, on or before December 1 after the close of such fiscal year, on the results of the anal- ysis of the Chief Medical Director and on the required number of beds and the level of treatment capacities required. Subsec. (a)(4)(A). Pub. L. 97–66, § 601(b)(1)(A), inserted ‘‘for any fiscal year (or any part of a fiscal year)’’ after ‘‘With respect to each law making appropriations for the Veterans’ Administration’’. Subsec. (a)(4)(B). Pub. L. 97–66, § 601(b)(1)(B), inserted ‘‘(or part of a fiscal year)’’ after ‘‘provide to the Vet- erans’ Administration for the fiscal year’’. Subsec. (a)(4)(D). Pub. L. 97–66, § 601(b)(1)(B), inserted ‘‘(or part of a fiscal year)’’ after ‘‘fiscal year’’ in two places. Subsec. (a)(5). Pub. L. 97–66, § 601(b)(2), added par. (5). Subsecs. (b), (c). Pub. L. 97–72, § 108(b), redesignated subsec. (c) as (b). Former subsec. (b), authorizing the Administrator to establish, subject to the approval of the President, not less than twelve thousand beds dur- ing fiscal year 1980, and during each fiscal year there- after, for the furnishing of nursing home care to eligi- ble veterans in facilities over which the Administrator has direct jurisdiction, was struck out. 1979—Subsec. (a)(4). Pub. L. 96–151 added par. (4). Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2002 AMENDMENT Pub. L. 107–314, div. A, title VII, § 726(b), Dec. 2, 2002, 116 Stat. 2599, provided that: ‘‘The amendments made by subsection (a) [amending this section] shall take ef- fect on October 1, 2003.’’ EFFECTIVE DATE OF 1988 AMENDMENT Pub. L. 100–322, title II, § 222(b), May 20, 1988, 102 Stat. 531, provided that: ‘‘The amendment made by sub- section (a) [amending this section] shall apply with re- spect to fiscal years after fiscal year 1987.’’ Pub. L. 100–322, title IV, § 401(b), May 20, 1988, 102 Stat. 543, provided that: ‘‘The amendment made by sub- section (a) [amending this section] shall apply only with respect to the awarding of contracts under solici- tations issued after the date of the enactment of this Act [May 20, 1988].’’ EFFECTIVE DATE OF 1981 AMENDMENT Amendment by section 601(b)(1) of Pub. L. 97–66 effec- tive Oct. 1, 1981, see section 701(b)(4) of Pub. L. 97–66, set out as a note under section 1114 of this title. Amendment by section 601(b)(2) of Pub. L. 97–66 effec- tive Oct. 17, 1981, see section 701(b)(1) of Pub. L. 97–66, set out as a note under section 1114 of this title. EFFECTIVE DATE OF 1979 AMENDMENT Pub. L. 96–151, title III, § 301(b), Dec. 20, 1979, 93 Stat. 1096, provided that: ‘‘The amendment made by sub- section (a) [amending this section] shall take effect with respect to Public Law 96–103 [Nov. 5, 1979, 93 Stat. 771], but, with respect to such Public Law, the certifi- cation and report required by subparagraph (B) of para- graph (4) of section 5010 [now 8110] of title 38, United States Code (as added by such amendment), and the re- port required by subparagraph (C) of such paragraph (as added by such amendment) shall be submitted to the appropriate committees of the Congress not later than January 15, 1980, and February 1, 1980, respectively.’’ EFFECTIVE DATE Section effective Oct. 1, 1979, but not applicable with respect to the acquisition, construction, or alteration of any medical facilities if the acquisition, construc- tion, or alteration (not including exchange) was ap- proved by the President before Oct. 1, 1979, see section 302 of Pub. L. 96–22, set out as a note under section 8101 of this title. REQUIREMENT FOR CERTAIN DEPARTMENT OF VETERANS AFFAIRS MEDICAL FACILITIES TO HAVE PHYSICAL LO- CATION FOR THE DISPOSAL OF CONTROLLED SUB- STANCES MEDICATIONS Pub. L. 116–315, title III, § 3009, Jan. 5, 2021, 134 Stat. 4997, as amended by Pub. L. 117–29, § 1, July 29, 2021, 135 Stat. 306, provided that: ‘‘(a) IN GENERAL.—The Secretary of Veterans Affairs shall ensure that each covered Department medical fa- cility has a physical location where patients may dis- pose of controlled substances medications. ‘‘(b) DESIGNATION OF PERIODS FOR ANY INDIVIDUAL TO DISPOSE OF MEDICATION.— ‘‘(1) IN GENERAL.—The Secretary shall designate pe- riods during which any individual may dispose of con- trolled substances medications at a covered Depart- ment medical facility. ‘‘(2) PUBLIC INFORMATION CAMPAIGNS.—The Sec- retary may carry out public information campaigns regarding the periods designated under paragraph (1). ‘‘(c) COVERED DEPARTMENT MEDICAL FACILITY.—In this section, the term ‘covered Department medical fa- cility’ means a medical facility of the Department of Veterans Affairs with an onsite pharmacy or a physical location dedicated for law enforcement purposes. ‘‘(d) EFFECTIVE DATE.—This section shall take effect on January 1, 2022.’’ WOMEN VETERANS RETROFIT INITIATIVE Pub. L. 116–315, title V, § 5102, Jan. 5, 2021, 134 Stat. 5026, provided that: ‘‘(a) IN GENERAL.—The Secretary of Veterans Affairs shall prioritize the retrofitting of existing medical fa- cilities of the Department of Veterans Affairs with fix- tures, materials, and other outfitting measures to sup- port the provision of care to women veterans at such facilities. ‘‘(b) PLAN.— ‘‘(1) IN GENERAL.—Not later than one year after the date of the enactment of this Act [Jan. 5, 2021], the Secretary shall submit to Congress, the Committee on Veterans’ Affairs of the Senate, and the Com- mittee on Veterans’ Affairs of the House of Rep- resentatives a plan to address deficiencies in environ- ment of care for women veterans at medical facilities of the Department. Page 1315 TITLE 38—VETERANS’ BENEFITS § 8110 ‘‘(2) ELEMENTS.—The plan required by paragraph (1) shall include the following: ‘‘(A) An explanation of the specific environment of care deficiencies that need correcting. ‘‘(B) An assessment of how the Secretary prioritizes retrofitting existing medical facilities to support provision of care to women veterans in comparison to other requirements. ‘‘(C) A five-year strategic plan and cost projection for retrofitting medical facilities of the Depart- ment to support the provision of care to women veterans as required under subsection (a). ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—Subject to appropriations and the plan under (b), there is author- ized to be appropriated to the Secretary $20,000,000 to carry out subsection (a) in addition to amounts other- wise made available to the Secretary for the purposes set forth in such subsection.’’ STAFFING OF WOMEN’S HEALTH PRIMARY CARE PRO- VIDERS AT MEDICAL FACILITIES OF DEPARTMENT OF VETERANS AFFAIRS Pub. L. 116–315, title V, § 5201, Jan. 5, 2021, 134 Stat. 5034, provided that: ‘‘The Secretary of Veterans Affairs shall ensure that each medical facility of the Depart- ment of Veterans Affairs has not fewer than one full- time or part-time women’s health primary care pro- vider whose duties include, to the extent possible, pro- viding training to other health care providers of the Department on the needs of women veterans.’’ PLANNING AND ACTIVATING COMMUNITY BASED OUTPATIENT CLINICS HANDBOOK UPDATE Pub. L. 116–94, div. F, title II, § 252, Dec. 20, 2019, 133 Stat. 2808, provided that: ‘‘(a) Not later than 180 days after the date of the en- actment of this Act [Dec. 20, 2019], and not less fre- quently than once every five-year period thereafter, the Secretary of Veterans Affairs shall update the handbook of the Department of Veterans Affairs titled ‘Planning and Activating Community Based Outpatient Clinics’, or a successor handbook, to reflect current policies, best practices, and clarify the roles and re- sponsibilities of the personnel of the Department in- volved in the leasing projects of the Department. ‘‘(b) The Secretary shall ensure that the handbook specified in subsection (a) defines ‘community based outpatient clinic’ in the same manner as such term is defined in the Veterans Health Administration Site Tracking database (commonly known as ‘VAST’) as of the date of the enactment of this Act. ‘‘(c) The Secretary shall ensure that the Veterans Health Administration incorporates the best practices contained in the handbook specified in subsection (a) in conducting oversight of the medical centers of the De- partment of Veterans Affairs and the Veterans Inte- grated Service Network. ‘‘(d) Not later than 180 days after the date of the en- actment of this Act, the Secretary shall provide guid- ance and training to employees of the Veterans Health Administration for the use of the handbook specified in subsection (a). The Secretary shall update such guid- ance and training together with each update of such handbook.’’ HEALTH CARE IN UNDERSERVED AREAS Pub. L. 115–182, title IV, §§ 401, 402, June 6, 2018, 132 Stat. 1470, 1471, as amended by Pub. L. 115–251, title II, § 211(b)(8), Sept. 29, 2018, 132 Stat. 3177, provided that: ‘‘SEC. 401. DEVELOPMENT OF CRITERIA FOR DES- IGNATION OF CERTAIN MEDICAL FACILITIES OF THE DEPARTMENT OF VETERANS AFFAIRS AS UNDERSERVED FACILITIES AND PLAN TO ADDRESS PROBLEM OF UNDERSERVED FACILI- TIES. ‘‘(a) IN GENERAL.—Not later than 180 days after the date of the enactment of this Act [June 6, 2018], the Secretary of Veterans Affairs shall develop criteria to designate medical centers, ambulatory care facilities, and community based outpatient clinics of the Depart- ment of Veterans Affairs as underserved facilities. ‘‘(b) CONSIDERATION.—Criteria developed under sub- section (a) shall include consideration of the following with respect to a facility: ‘‘(1) The ratio of veterans to health care providers of the Department of Veterans Affairs for a standard- ized geographic area surrounding the facility, includ- ing a separate ratio for general practitioners and spe- cialists. ‘‘(2) The range of clinical specialties covered by such providers in such area. ‘‘(3) Whether the local community is medically un- derserved. ‘‘(4) The type, number, and age of open consults. ‘‘(5) Whether the facility is meeting the wait-time goals of the Department or the applicable access standards developed under section 1703B of title 38, United States Code. ‘‘(6) Such other criteria as the Secretary considers important in determining which facilities are not adequately serving area veterans. ‘‘(c) ANALYSIS OF FACILITIES.—Not less frequently than annually, directors of Veterans Integrated Service Networks of the Department shall perform an analysis to determine which facilities within that Veterans In- tegrated Service Network qualify as underserved facili- ties pursuant to criteria developed under subsection (a). ‘‘(d) ANNUAL PLAN TO ADDRESS UNDERSERVED FACILI- TIES.— ‘‘(1) PLAN REQUIRED.—Not later than 1 year after the date of the enactment of this Act [June 6, 2018] and not less frequently than once each year, the Sec- retary shall submit to Congress a plan to address the problem of underserved facilities of the Department, as designated pursuant to criteria developed under subsection (a). ‘‘(2) CONTENTS.—Each plan submitted under para- graph (1) shall address the following: ‘‘(A) Increasing personnel or temporary personnel assistance, including mobile deployment teams fur- nished under section 402 of this Act. ‘‘(B) Providing special hiring incentives, includ- ing under the Education Debt Reduction Program under subchapter VII of chapter 76 of title 38, United States Code, and recruitment, relocation, and retention incentives. ‘‘(C) Using direct hiring authority. ‘‘(D) Improving training opportunities for staff. ‘‘(E) Such other actions as the Secretary con- siders appropriate. ‘‘SEC. 402. PILOT PROGRAM TO FURNISH MOBILE DEPLOYMENT TEAMS TO UNDERSERVED FA- CILITIES. ‘‘(a) IN GENERAL.—The Secretary of Veterans Affairs shall carry out a pilot program to furnish mobile de- ployment teams of medical personnel to underserved facilities. ‘‘(b) ELEMENTS.—In furnishing mobile deployment teams under subsection (a), the Secretary shall con- sider the following elements: ‘‘(1) The medical positions of greatest need at un- derserved facilities. ‘‘(2) The size and composition of teams to be de- ployed. ‘‘(3) Such other elements as the Secretary considers necessary for effective oversight of the program es- tablished under subsection (a). ‘‘(c) USE OF ANNUAL ANALYSIS.—The Secretary shall use the results of the annual analysis conducted under section 401(c) of this Act to form mobile deployment teams under subsection (a) that are composed of the most needed medical personnel for underserved facili- ties. ‘‘(d) REPORTING.— ‘‘(1) PROGRESS REPORT.—Not later than 1 year after the date of the enactment of this Act [June 6, 2018], Page 1316 TITLE 38—VETERANS’ BENEFITS § 8111 the Secretary shall submit a report to Congress on the implementation of the pilot program under this section. ‘‘(2) FINAL REPORT.—Not later than the termination of the pilot program under this section, the Secretary shall submit a final report to Congress that contains the recommendations of the Secretary regarding the feasibility and advisability of— ‘‘(A) extending or expanding the pilot program; and ‘‘(B) making the pilot program (or any aspect thereof) permanent. ‘‘(e) DURATION.—The pilot program under this section shall terminate 3 years after the date of the enactment of this Act [June 6, 2018]. ‘‘(f) UNDERSERVED FACILITY DEFINED.—In this section, the term ‘underserved facility’ means a medical center, ambulatory care facility, or community based out- patient clinic of the Department of Veterans Affairs designated by the Secretary of Veterans Affairs as un- derserved pursuant to criteria developed under section 401 of this Act.’’ INVENTORY OF MEDICAL WASTE MANAGEMENT ACTIVI- TIES AT DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE FACILITIES Pub. L. 108–422, title VI, § 602, Nov. 30, 2004, 118 Stat. 2397, provided that: ‘‘(a) INVENTORY.—The Secretary of Veterans Affairs shall establish and maintain a national inventory of medical waste management activities in the health care facilities of the Department of Veterans Affairs. The inventory shall include the following: ‘‘(1) A statement of the current national policy of the Department on managing and disposing of med- ical waste, including regulated medical waste in all its forms. ‘‘(2) A description of the program of each geo- graphic service area of the Department to manage and dispose of medical waste, including general med- ical waste and regulated medical waste, with a de- scription of the primary methods used in those pro- grams and the associated costs of those programs, with cost information shown separately for in-house costs (including full-time equivalent employees) and contract costs. ‘‘(b) REPORT.—Not later than June 30, 2005, the Sec- retary of Veterans Affairs shall submit to the Commit- tees on Veterans’ Affairs of the Senate and House of Representatives a report on medical waste manage- ment activities in the facilities of the Department of Veterans Affairs. The report shall include the fol- lowing: ‘‘(1) The inventory established under subsection (a), including all the matters specified in that subsection. ‘‘(2) A listing of each violation of medical waste management and disposal regulations reported at any health care facility of the Department over the pre- ceding five years by any Federal or State agency, along with an explanation of any remedial or other action taken by the Secretary in response to each such reported violation. ‘‘(3) A description of any plans to modernize, con- solidate, or otherwise improve the management of medical waste and disposal programs at health care facilities of the Department, including the projected costs associated with such plans and any barriers to achieving goals associated with such plans. ‘‘(4) An assessment or evaluation of the available methods of disposing of medical waste and identifica- tion of which of those methods are more desirable from an environmental perspective in that they would be least likely to result in contamination of air or water or otherwise cause future cleanup prob- lems.’’ CONVERSION OF UNDERUSED SPACE TO DOMICILIARY- CARE BEDS Pub. L. 100–322, title I, § 136, May 20, 1988, 102 Stat. 507, directed Administrator, not later than June 1, 1988, to convert underused space located in facilities under ju- risdiction of Administrator in urban areas with signifi- cant numbers of homeless veterans into 500 domi- ciliary-care beds to be used for care of veterans in need of domiciliary care, primarily homeless veterans. POLICY OF COMPREHENSIVE VETERANS’ HEALTH-CARE SYSTEM Pub. L. 97–306, title IV, § 409(a), Oct. 14, 1982, 96 Stat. 1446, provided that: ‘‘It is the policy of the United States that the Veterans’ Administration— ‘‘(1) shall maintain a comprehensive, nationwide health-care system for the direct provision of quality health-care services to eligible veterans; and ‘‘(2) shall operate such system through cost-effec- tive means that are consistent with carrying out fully the functions of the Department of Medicine and Surgery of the Veterans’ Administration under title 38, United States Code.’’ § 8111. Sharing of Department of Veterans Affairs and Department of Defense health care re- sources (a) REQUIRED COORDINATION AND SHARING OF HEALTH CARE RESOURCES.—The Secretary of Veterans Affairs and the Secretary of Defense shall enter into agreements and contracts for the mutually beneficial coordination, use, or ex- change of use of the health care resources of the Department of Veterans Affairs and the Depart- ment of Defense with the goal of improving the access to, and quality and cost effectiveness of, the health care provided by the Veterans Health Administration and the Military Health System to the beneficiaries of both Departments. (b) JOINT REQUIREMENTS FOR SECRETARIES OF VETERANS AFFAIRS AND DEFENSE.—To facilitate the mutually beneficial coordination, use, or ex- change of use of the health care resources of the two Departments, the two Secretaries shall carry out the following functions: (1) Develop and publish a joint strategic vi- sion statement and a joint strategic plan to shape, focus, and prioritize the coordination and sharing efforts among appropriate ele- ments of the two Departments and incorporate the goals and requirements of the joint shar- ing plan into the strategic plan of each De- partment under section 306 of title 5 and the performance plan of each Department under section 1115 of title 31. (2) Jointly fund the Department of Veterans Affairs-Department of Defense Joint Execu- tive Committee under section 320 of this title. (3) Continue to facilitate and improve shar- ing between individual Department of Vet- erans Affairs and Department of Defense health care facilities, but giving priority of ef- fort to initiatives (A) that improve sharing and coordination of health resources at the intraregional and nationwide levels, and (B) that improve the ability of both Departments to provide coordinated health care. (4) Establish a joint incentive program under subsection (d). [(c) Repealed. Pub. L. 108–136, div. A, title V, § 583(b)(1), Nov. 24, 2003, 117 Stat. 1491.] (d) JOINT INCENTIVES PROGRAM.—(1) Pursuant to subsection (b)(4), the two Secretaries shall carry out a program to identify, provide incen- tives to, implement, fund, and evaluate creative coordination and sharing initiatives at the facil-