; and (ii) appointments with non-Department health care providers. (3) Submittal to Congress The Secretary shall submit to the appropriate committees of Congress the market area assessments established in paragraph (1). (4) Use of market area assessments for integrated health care delivery (A) In general The Secretary shall use the market area assessments established under paragraph (1) in determining the capacity of the health care provider networks established under section 1703(j) of title 38, United States Code, as amended by section 101(a)(1). (B) Budget The Secretary shall ensure that the Department budget for any fiscal year (as submitted with the budget of the President under section 1105(a) of title 31, United States Code) reflects the findings of the Secretary with respect to the most recent market area assessments under paragraph (1). (5) Effective date The amendments made by subsection (a) shall take effect on September 30, 2018. (b) Strategic plan To meet health care demand (1) In general Not later than one year after the date of the enactment of this Act and not less frequently than once every four years thereafter, the Secretary shall submit to the appropriate committees of Congress a strategic plan that specifies a four-year forecast of— (A) the demand for health care from the Department, disaggregated by geographic area as determined by the Secretary; (B) the health care capacity to be provided at each medical center of the Department; and (C) the health care capacity to be provided through community care providers. (2) Elements In preparing the strategic plan under paragraph (1), the Secretary shall— (A) consider the access guidelines and standards for quality established under section 1703(h) of title 38, United States Code, as amended by section 101(a)(1); (B) consider the market area assessments established under subsection (a)