The Senate could vote at any time on a committee-passed bill (S-2193) to make wide-ranging changes in VA operations and personnel policies, including authority for more treatment of veterans by outside providers and higher pay in high-demand medical care positions.

The measure would increase the use of community health care and long-term care by broadening eligibility for such care and giving VA more leeway to enter into agreements with health care providers in the private sector.

It would require the VA to establish a Veterans Community Care Program under which VA would establish networks of health care providers outside of VA to furnish hospital care, medical services and extended-care services to veterans. The VA would be required to provide care through those networks, at the veteran’s discretion, if: the department does not offer the care needed; the veteran lives more than 40 miles from a VA medical facility; or if the veteran’s primary care provider and the veteran agree it is in the best medical interest of the veteran to do so.

The increasing use of outside providers under authorities including the 2014 Veterans Choice program has drawn opposition from some members of Congress and from the AFGE union that represents many VA employees involved in medical care, however.

The measure also would: raise the pay cap for the highest-paid nurses by about 6 percent, which in turn is expected to increase average salaries for all nurses by about the same percentage; increase the pay cap for nurse executives; make nurses eligible to be reimbursed for up to $1,000 of the cost of continuing professional education; remove the pay cap for regional and medical facility directors; move podiatrists into a higher pay schedule; and require the VA to increase use of recruitment and other incentives in mental health care positions.

On other matters, it would: allow the VA to enter into agreements with other federal agencies to construct shared medical facilities; expand a program providing stipends, health insurance, respite care, training and other forms of support to family caregivers of veterans; and set new standards for payment of claims for health care provided outside the VA system.