On June 6, 2018, President Donald Trump signed into law the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018, or the VA MISSION Act of 2018 ( S. 2372 ; P.L. 115-251 ), enacted on September 29, 2018, made some changes and technical amendments to the VA MISSION Act. 115-182 ; H.Rept. In addition, Section 802 of VACAA established the Veterans Choice Fund (VCF) and provided $10 billion in mandatory appropriations. The Department of Veterans Affairs Expiring Authorities Act of 2018 ( S. 3479 ; P.L. 115-251 ) made amendments and technical corrections to the VA MISSION Act. It also expands eligibility for veterans to access walk-in care from private community providers. Lastly, Title I liberalizes eligibility for the Program of Comprehensive Assistance for Family Caregivers to pre-9/11 veterans under two phases. Under the first phase, veterans with serious service-connected injuries incurred on or before May 7, 1975, will qualify for benefits over a two-year period beginning on the date when the VA certifies to Congress that it has fully implemented the information technology system required for this program. Under the second phase, those with serious service-connected injuries incurred between May 7, 1975, and September 11, 2001, will qualify for the Comprehensive Assistance for Family Caregivers program two years after the implementation of the first phase. §1703) and establishes a new Veterans Community Care Program (VCCP) to provide hospital care, medical services, and extended care services to eligible veterans through specified non-VA health care providers. Conditions under which care is required to be provided by the VA through VCCP:
An eligible veteran can elect to receive care if he or she meets one of the five major conditions:
1. the VA does not offer the care or services the veteran requires; or 2. the VA does not operate a full-service VA medical facility in the state the veteran resides; or 3. the veteran was eligible for care under the 40-mile distance eligibility criteria under the previous Veterans Choice Program (VCP) on the day before the date of enactment of the Caring for Our Veterans Act of 2018 (i.e., the veteran was eligible on June 5, 2018); and continues to reside in the same location that qualifies the veteran under the 40-mile distance eligibility criteria; and
(a) resides in one of the five states with the lowest population density based on data from the 2010 decennial census or 
(b) resides in a state other than the five states with the lowest population density and 
received care or services through the VA within one year before the enactment of the Caring for Our Veterans Act of 2018 (i.e., June 6, 2018) and is seeking care or services within two years of the date of the enactment of the Caring for Our Veterans Act of 2018 (i.e., June 6, 2018); or 1. the VA is unable to provide care or services that is requested by the veteran in a manner that meets designated access standards for care or services as developed by the Secretary; or 2. the veteran's referring clinician agrees, after consultations with the eligible veteran, that care and services through VCCP would be in the best medical interest of the veteran based on criteria established by the Secretary (see text box below). §1745 to authorize the VA to enter into VCAs with State Veterans Homes. Prior to this, the Secretary is required to provide the first update no later than 120 days after enactment. Subtitle A: Asset and Infrastructure Review

This title establishes a process for realigning and modernizing facilities of the VHA. Under this process, the VA will develop criteria for selecting VHA facilities to dispose of, modernize, or acquire, so as to better meet the health care needs of veterans. The VA must then create a list of recommendations based on those criteria and submit it to a newly created Asset Infrastructure Review Commission (the Commission). This nine-member commission reviews the VA's recommendations but may not alter them, unless it determines that one or more recommendations are inconsistent with the criteria. The Commission submits the list of recommendations to the President, who either approves the list in its entirety or sends it back to the Commission with the reasons for disapproval. The President may approve or disapprove of the revised list. If the President approves of the original or revised list, then VA must begin implementation of the recommendations within three years, unless Congress passes a joint resolution of disapproval, in which case the process terminates. Appointment

This section establishes a nine-member Asset and Infrastructure Review Commission. Designated Scholarships for Physicians and Dentists Under the VA Health Professional Scholarship Program

This section amends 38 U.S.C. Increase in Maximum Amount of Debt That May Be Reduced Under Education Debt Reduction Program (EDRP) of the VA

This section amends 38 U.S.C. §§7691-7697, which authorize the Secretary to create, as part of the VA's Educational Assistance Program, a new program called the "Department of Veterans Affairs Specialty Education Loan Repayment Program." The purpose of the new program is to assist—via an incentive program—in recruiting physicians who are practicing in certain hard-to-recruit medical specialties to work at the VHA. Veterans Healing Veterans Medical Access and Scholarship Program

The section requires the Secretary to establish a pilot program that provides funding for 18 eligible veterans who are enrolled in medical school, with two veterans enrolled at each eligible medical school. Lastly, it authorizes and appropriates $5.2 billion for VCF to continue VCP.
On June 6, 2018, the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018, or the VA MISSION Act of 2018 (S. 2372; P.L. 115-182; H.Rept. 115-671), was signed into law. The Department of Veterans Affairs Expiring Authorities Act of 2018 (S. 3479; P.L. 115-251), enacted on September 29, 2018, made some changes and technical amendments to the VA MISSION Act. This act, as amended, broadly addresses four major areas.
First, it establishes a new permanent Veterans Community Care Program (VCCP), replacing the current Veterans Choice Program (VCP). The VA MISSION Act stipulates that the new program must be operational when regulations are published by the Department of Veterans Affairs (VA) no later than one year after the date of enactment (June 6, 2018), or when the VA determines that 75% of the amounts deposited in the Veterans Choice Fund (VCF) have been exhausted.
Second, it expands the current Program of Comprehensive Assistance for Family Caregivers, in two phases, to all eligible veterans who served prior to September 11, 2001.
Third, it establishes an asset and infrastructure review process by establishing an Asset and Infrastructure Review Commission. The purpose of the commission is to examine the VA's assets and to make recommendations for modernizing and realigning medical facilities.
Fourth, it provides various statutory authorities to the Veterans Health Administration (VHA) of the VA to recruit and retain health care providers.
Veterans Community Care Program (VCCP)
The VA MISSION Act establishes a new permanent discretionary community care program known as VCCP. The act provides conditions under which the VA is required to provide care in the community once the program is established. Generally, all veterans enrolled in the VA health care system would be able to qualify when (1) the VA does not offer the care or service required by the veteran; or (2) the veteran resides in a state without a full-service VA medical facility; or (3) the veteran previously qualified under the 40-mile criterion of the VCP; or (4) the VA cannot provide the veteran with care and services that comply with designated access and quality standards; or (5) the veteran and the veteran's primary care provider agree that it is in the best interest of the veteran to receive care in the community. In addition, the VA is required to enter into contracts to build a network of private community providers.
Expansion of Comprehensive Assistance for Family Caregivers
The VA MISSION Act expands the Program of Comprehensive Assistance for Family Caregivers to pre-9/11 veterans in two phases. Under the first phase, veterans with serious service-connected injuries incurred on or before May 7, 1975, would qualify for benefits over a two-year period beginning on the date when the VA certifies to Congress that it has fully implemented the information technology system required for this program. Under the second phase, those with serious service-connected injuries incurred between May 7, 1975, and September 11, 2001, would qualify for the Comprehensive Assistance for Family Caregivers program two years after implementation of the first phase.
Capital Asset Review
The VA MISSION Act establishes a process for realigning and modernizing facilities of the VHA. Under this process, the VA will develop criteria for selecting VHA facilities to dispose of, modernize, or acquire, so as to better meet the health care needs of veterans. VA must then create a list of recommendations based on those criteria and submit it to a newly created Asset Infrastructure Review (AIR) Commission. The AIR Commission shall review the VA's recommendations but may not alter them, unless it determines that one or more recommendations are inconsistent with the criteria. The commission shall submit the list of recommendations to the President, who shall either approve the list in its entirety or send it back to the AIR Commission. The AIR Commission may change the recommendations and resubmit a revised list to the President for reconsideration. The President may approve or disapprove of the revised list. If the President approves of the original or revised list, then VA must begin implementation of the recommendations within three years, unless Congress passes a joint resolution of disapproval, in which case the asset review process terminates.
Recruiting and Retaining Health Care Providers in the VHA
The VA MISSION Act authorizes or expands several programs, with the intention of recruiting and retaining health care providers in the VHA. Among other things, the act
increases the maximum amount of student loan debt that may be reduced under VA's Education Debt Reduction Program (EDRP); authorizes designated scholarships for physicians and dentists under the VA Health Professional Scholarship Program (HPSP); establishes the VA specialty education loan repayment program to incentivize VHA employees to pursue education and training in medical specialties for which VA determines there is a shortage; establishes a pilot Veterans Healing Veterans Medical Access and Scholarship Program; and extends eligibility for VA's EDRP to clinical staff working at Vet Centers.
The act also requires the VHA to establish a program to deploy mobile health teams to serve in underserved VA medical facilities.
Lastly, the VA MISSION Act authorizes and appropriates $5.2 billion in mandatory funding for the VCP until the VCCP is operational.