[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3520 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 3520
To improve the provision of care and services under the Veterans
Community Care Program of the Department of Veterans Affairs, and for
other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 18, 2023
Mrs. Miller-Meeks (for herself, Mr. Bost, Mr. Bergman, Mrs. Radewagen,
Mrs. Kiggans of Virginia, Ms. Mace, Mr. Murphy, and Mr. Van Orden)
introduced the following bill; which was referred to the Committee on
Veterans' Affairs
_______________________________________________________________________
A BILL
To improve the provision of care and services under the Veterans
Community Care Program of the Department of Veterans Affairs, and for
other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Veteran Care Improvement Act of
2023''.
SEC. 2. CODIFICATION OF ACCESS STANDARDS FOR COMMUNITY CARE FURNISHED
BY THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Access Standards.--Section 1703B of title 38, United States
Code, is amended--
(1) by striking subsections (a) through (e) and inserting
the following:
``(a) Access Standards for Community Care.--(1) A covered veteran
may receive hospital care, medical services, or extended care services
under section 1703(d)(1)(D) of this title if the Secretary determines
the following:
``(A) With respect to primary care, mental health care, or
extended care services, the Secretary cannot schedule an in-
person appointment for the covered veteran with a health care
provider of the Department for such care or services--
``(i) at a facility of the Department that is
located less than a 30-minute drive from the residence
of the covered veteran; or
``(ii) during the 20-day period after the date on
which the covered veteran requests such appointment.
``(B) With respect to specialty care, the Secretary cannot
schedule an in-person appointment for the covered veteran with
a health care provider of the Department who can provide such
care--
``(i) at a facility of the Department that is
located less than a 60-minute drive from the residence
of the covered veteran; or
``(ii) during the 28-day period after the date on
which the covered veteran requests such appointment.
``(C) With respect to residential treatment and
rehabilitative services for alcohol or drug dependence, the
Secretary cannot provide the covered veteran such services at a
facility of the Department--
``(i) that is located less than a 30-minute drive
from the residence of the covered veteran; or
``(ii) during the 10-day period after the date on
which the covered veteran requests such services.
``(2)(A) The Secretary may prescribe regulations that establish a
shorter drive or time period than those established by paragraph (1).
``(B) A covered veteran may consent to a longer drive or time
period than established by paragraph (1) (or pursuant to regulations
prescribed under paragraph (2)). If a covered veteran so consents, the
Secretary shall document such consent in the electronic health record
of the covered veteran and provide the covered veteran with a copy of
such documentation in writing or through electronic means.
``(3) In making any determination under paragraph (1), the
Secretary may not consider--
``(A) a telehealth appointment; or
``(B) the cancellation of an appointment unless such
cancellation was at the request of the covered veteran.
``(b) Applicability.--The Secretary shall ensure that the access
standards established under subsection (a) apply--
``(1) to all care and services (except nursing home care)
within the medical benefits package of the Department to which
a covered veteran is eligible under section 1703 of this title;
and
``(2) to all covered veterans.
``(c) Periodic Review of Access Standards.--Not later than three
years after the date of the enactment of the Veteran Care Improvement
Act of 2023, and not less frequently than once every three years
thereafter, the Secretary shall--
``(1) conduct a review of the access standards under
subsection (a) in consultation with--
``(A) Federal entities (including the Department of
Defense, the Department of Health and Human Services,
and the Centers for Medicare & Medicaid Services) that
the Secretary determines appropriate;
``(B) entities and individuals in the private
sector, including--
``(i) veterans who receive hospital care,
medical services, and extended care services
furnished by the Secretary;
``(ii) veterans service organizations; and
``(iii) health care providers participating
in the Veterans Community Care Program under
section 1703 of this title; and
``(C) other entities that are not part of the
Federal Government; and
``(2) submit to the appropriate committees of Congress a
report on--
``(A) the findings of the Secretary under such
review; and
``(B) recommendations of the Secretary regarding
such access standards.'';
(2) by striking subsection (g);
(3) by redesignating subsections (f), (h), and (i) as
subsections (d), (e), and (f), respectively;
(4) in subsection (d), as redesignated by paragraph (3)--
(A) by striking ``established'' each place it
appears; and
(B) in paragraph (1), by striking ``(1) Subject
to'' and inserting ``Compliance by Community Care
Providers With Access Standards.--(1) Subject to'';
(5) in subsection (e), as so redesignated--
(A) in paragraph (1)--
(i) by striking ``(1) Consistent with'' and
inserting ``Determination Regarding
Eligibility.--(1) Consistent with''; and
(ii) by striking ``designated access
standards established under this section'' and
inserting ``access standards under subsection
(a)''; and
(B) in paragraph (2)(B), by striking ``designated
access standards established under this section'' and
inserting ``access standards under subsection (a)'';
and
(6) in subsection (f), as redesignated by paragraph (2)--
(A) in the matter preceding paragraph (1), by
striking ``In this section'' and inserting
``Definitions.--In this section''; and
(B) in paragraph (2)--
(i) by striking ``covered veterans'' and
inserting ``covered veteran''; and
(ii) by striking ``veterans described'' and
inserting ``a veteran described''.
(b) Conforming Amendments.--Subsection (d) of section 1703 of such
title is amended--
(1) in paragraph (1)(D), by striking ``designated access
standards developed by the Secretary under section 1703B of
this title'' and inserting ``access standards under section
1703B(a) of this title''; and
(2) in paragraph (3), by striking ``designated access
standards developed by the Secretary under section 1703B of
this title'' and inserting ``access standards under section
1703B(a) of this title''.
SEC. 3. REQUIREMENT THAT SECRETARY NOTIFY VETERANS OF ELIGIBILITY FOR
CARE UNDER VETERANS COMMUNITY CARE PROGRAM.
Section 1703 of title 38, United States Code, is further amended,
in subsection (a), by adding at the end the following new paragraph:
``(5)(A) The Secretary shall notify a covered veteran in writing of
the eligibility of such veteran for care or services under this section
not later than two business days after the date on which--
``(i) the veteran seeks care or services under this
chapter; and
``(ii) the Secretary determines that the veteran is a
covered veteran.
``(B) The Secretary may provide a covered veteran with a periodic
notification of the eligibility of such covered veteran for care under
subsection (d).
``(C) Any notification under this paragraph may be provided through
electronic means.''.
SEC. 4. CONSIDERATION UNDER VETERANS COMMUNITY CARE PROGRAM OF VETERAN
PREFERENCE FOR CARE AND NEED FOR CAREGIVER OR ATTENDANT.
Section 1703 of title 38, United States Code, is further amended,
in subsection (d)(2), by adding at the end the following new
subparagraphs:
``(F) The preference of the covered veteran regarding
where, when, and how to seek hospital care, medical services,
or extended care services.
``(G) Whether the covered veteran requests or requires the
assistance of a caregiver or attendant when seeking hospital
care, medical services, or extended care services.''.
SEC. 5. NOTIFICATION OF DENIAL OF REQUEST FOR CARE UNDER VETERANS
COMMUNITY CARE PROGRAM.
Section 1703 of title 38, United States Code, is further amended--
(1) by redesignating subsection (o) as subsection (p); and
(2) by inserting after subsection (n) the following new
subsection (o):
``(o) Notification of Denial of Request for Care and How To
Appeal.--(1) If a request by a veteran for care or services under this
section is denied, the Secretary shall notify the veteran in writing as
soon as possible, but not later than two business days, after the
denial is made--
``(A) of the reason for the denial; and
``(B) with instructions on how to appeal such denial using
the clinical appeals process of the Veterans Health
Administration.
``(2) If a denial under paragraph (1) is because the Secretary
determines that access standards under section 1703B(a) of this title
are not met, notice under such paragraph shall include an explanation
of such determination.
``(3) Any notification under this subsection may be provided
electronically.''.
SEC. 6. PROVISION OF INFORMATION REGARDING OPTION FOR TELEHEALTH UNDER
VETERANS COMMUNITY CARE PROGRAM.
Section 1703 of title 38, United States Code, is further amended--
(1) by redesignating subsection (p) as subsection (q); and
(2) by inserting after subsection (o) the following new
subsection (p):
``(p) Provision of Information Regarding Option for Telehealth.--
With regards to options for care or services for a covered veteran
under this section, the Secretary shall ensure that the veteran is
informed that the veteran may elect to seek care or services via
telehealth, either through a medical facility of the Department or
under this section, if--
``(1) a health care provider described in subsection (c)
provides such care or services via telehealth; and
``(2) the Secretary determines telehealth is appropriate
for the type of care or services the veteran seeks; and''.
SEC. 7. FINALITY OF DECISION BY VETERAN AND VETERAN'S REFERRING
PROVIDER.
(a) In General.--Section 1703 of title 38, United States Code, is
further amended--
(1) by redesignating subsection (q) as subsection (r); and
(2) by inserting after subsection (p) the following new
subsection (q):
``(q) Finality of Agreement Between Covered Veteran and Referring
Provider.--The Secretary may not override an agreement under subsection
(d)(1)(E) unless the Secretary notifies the covered veteran and
referring provider in writing that the Secretary may not provide the
care or services described in such agreement.''.
(b) Conforming Amendment.--Subsection (d)(1)(E) such section is
amended by striking ``referring clinician'' and inserting ``referring
provider''.
SEC. 8. OUTREACH REGARDING CARE AND SERVICES UNDER VETERANS COMMUNITY
CARE PROGRAM.
(a) Requirement.--Section 1703 of title 38, United States Code, is
further amended--
(1) by redesignating subsection (r) as subsection (s); and
(2) by inserting after subsection (q) the following new
subsection (r):
``(r) Outreach Regarding Availability of Care and Services.--(1)
The Secretary shall conduct outreach to inform veterans of the
following:
``(A) The conditions for care or services under subsections
(d) and (e).
``(B) How to request such care or services.
``(C) How to appeal a denial of a request for such care or
services using the clinical appeals process of the Veterans
Health Administration.
``(2) Upon enrollment of a veteran in the system of annual patient
enrollment established and operated under section 1705 of this title,
and not less frequently than every two years thereafter, the Secretary
shall inform the veteran of information described in paragraph (1).
``(3) The Secretary shall ensure that information described in
paragraph (1) is--
``(A) publicly displayed in each medical facility of the
Department;
``(B) prominently displayed on a website of the Department;
and
``(C) included in other outreach campaigns and activities
conducted by the Secretary.''.
(b) Solid Start Program.--Section 6320(a)(2)(A) of title 38, United
States Code, is amended by inserting ``, including how to enroll in the
system of annual patient enrollment established and operated under
section 1705 of this title and the ability to seek care and services
under sections 1703 and 1710 of this title'' before the semicolon.
SEC. 9. USE OF VALUE-BASED REIMBURSEMENT MODELS UNDER VETERANS
COMMUNITY CARE PROGRAM.
(a) Mandatory Use.--Section 1703 of title 38, United States Code,
is further amended, in paragraph (5) of subsection (i), by striking
``may'' and inserting``shall''.
(b) Negotiation of Terms.--The Secretary of Veterans Affairs shall
negotiate with third party administrators to establish the use of
value-based reimbursement models under the Veterans Community Care
Program under such paragraph, as amended by this section.
(c) Report on Value-Based Reimbursement Models.--Not later than one
year after negotiating under subsection (b) terms to establish the use
of value-based reimbursement models under the Veterans Community Care
Program under such section, the Secretary, in consultation with the
Center for Innovation for Care and Payment of the Department of
Veterans Affairs under section 1703E of title 38, United States Code,
and the Office of Integrated Veteran Care of the Department, or
successor office, shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the House of
Representatives a report containing--
(1) an assessment of the efforts of the Department pursuant
to section 1703(i)(5) of such title, as amended by subsection
(a), to incorporate value-based reimbursement models to promote
the provision of high-quality care to veterans; and
(2) such recommendations for legislative or administrative
action as the Secretary considers appropriate to increase the
use of value-based reimbursement models throughout the Veterans
Community Care Program under section 1703 of such title.
(d) Rule of Construction.--This section shall not be construed to
be a pilot program subject to the requirements of section 1703E of
title 38, United States Code.
(e) Third Party Administrator Defined.--In this section, the term
``third party administrator'' means an entity that manages a provider
network and performs administrative services related to such network
under section 1703 of title 38, United States Code.
SEC. 10. EXTENSION OF DEADLINE FOR SUBMISSION OF CLAIMS BY HEALTH CARE
ENTITIES AND PROVIDERS UNDER PROMPT PAYMENT STANDARD.
Subsection (b) of section 1703D of title 38, United States Code, is
amended--
(1) by striking ``180 days'' and inserting ``one year'';
and
(2) in the heading, by striking ``Submittal'' and inserting
``Submission''.
SEC. 11. TREATMENT AND REHABILITATIVE SERVICES FOR VETERANS WITH DRUG
OR ALCOHOL DEPENDENCY.
Section 1720A of title 38, United States Code, is amended by adding
at the end the following new subsection:
``(e) The Secretary shall determine whether a veteran who requests
residential treatment and rehabilitative services for alcohol or drug
dependence under this section requires such services not later than 72
hours after receipt of such request.''.
SEC. 12. PILOT PROGRAM TO IMPROVE ADMINISTRATION OF CARE UNDER VETERANS
COMMUNITY CARE PROGRAM.
(a) Establishment.--Pursuant to section 1703E of title 38, United
States Code, the Secretary of Veterans Affairs, acting through the
Center for Innovation for Care and Payment of the Department of
Veterans Affairs, shall seek to develop and implement a plan with a
third party administrator--
(1) to provide incentives to a covered health care
provider, pursuant to an agreement with such third party
administrator--
(A) to allow the Secretary and the third party
administrator to see the scheduling system of the
provider, to assess the availability of, and to assist
in scheduling appointments for, veterans under the
Veterans Community Care Program under section 1703 of
such title, including through synchronous,
asynchronous, and asynchronous assisted digital
scheduling;
(B) to complete continuing professional educational
training regarding veteran cultural competency and
other subjects determined appropriate by the Secretary;
(C) to improve the rate of the timely return to the
Secretary of medical record documentation for care or
services provided under such program;
(D) to improve the timeliness and quality of the
delivery of care and services to veterans under such
program; and
(E) to achieve other objectives determined
appropriate by the Secretary in consultation with third
party administrators;
(2) to decrease the rate of no-show appointments under such
program and consider the feasibility and advisability of
appropriately compensating such health care providers for no-
show appointments under such program; and
(3) within each region in which such program is carried
out, to assess needed specialties and to provide incentives to
community providers in such specialties to participate in such
program.
(b) Value-Based Reimbursement Models.--In developing a plan under
subsection (a), the Secretary and third party administrators shall
consider value-based reimbursement models under section 1703(i)(5) of
such title, as amended by section 9, to achieve the goals under such
subsection.
(c) Reporting.--
(1) Progress report.--Not later than 180 days after the
date of the enactment of this Act, the Secretary shall submit
to the Committees on Veterans' Affairs of the Senate and House
of Representatives a report on progress in developing the plan
under subsection (a).
(2) Submission.--Not later than 90 days after completing
development of a plan under subsection (a), the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate and
House of Representatives a copy of such plan.
(3) Quarterly update.--Not less frequently than quarterly
during the term of the pilot program, the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate and
House of Representatives a report containing any updates on the
implementation of such plan.
(4) Use of value-based reimbursement models.--The Secretary
shall include with a plan submitted under paragraph (2) and any
report submitted under paragraph (3)--
(A) a complete list of the value-based
reimbursement models considered under the plan;
(B) an indication of whether any such model has
been implemented; and
(C) with respect to any such model that was
considered but not implemented, a description of the
reasons such model was not implemented.
(d) No Penalty for Not Meeting Objectives.--No health care provider
or third party administrator may be penalized for not carrying out any
part of a plan under subsection (a).
(e) Termination.--The pilot program under this section shall
terminate five years after the date of the enactment of this Act.
(f) Definitions.--In this section:
(1) The term ``covered health care provider'' means a
health care provider--
(A) described in subsection (c) of section 1703 of
such title;
(B) that furnishes care or services under the
Veterans Community Care Program under such section; and
(C) that is served by third party administrator.
(2) The term ``third party administrator'' means an entity
that manages a network of health care providers and performs
administrative services related to such network under section
1703 of such title.
SEC. 13. INSPECTOR GENERAL ASSESSMENT OF IMPLEMENTATION OF VETERANS
COMMUNITY CARE PROGRAM.
(a) In General.--Not later than three years after the date of the
enactment of this Act, and periodically thereafter as the Inspector
General of the Department of Veterans Affairs determines appropriate,
the Inspector General shall assess the performance of each medical
center of the Department of Veterans Affairs in--
(1) appropriately identifying veterans eligible for care
and services under section 1703 of title 38, United States
Code;
(2) informing veterans of their eligibility for such care
and services, including, if appropriate and applicable, the
availability of such care and services via telehealth;
(3) delivering such care and services in a timely manner;
and
(4) appropriately coordinating such care and services.
(b) Commencement of Assessment.--Not later than one year after the
date of the enactment of this Act, the Inspector General shall commence
the initial assessment required by subsection (a).
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