[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1315 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
1st Session
S. 1315
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 SENATE OF THE UNITED STATES
April 26, 2023
Mr. Moran (for himself and Ms. Sinema) introduced the following bill;
which was read twice and 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; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Veterans' Health
Empowerment, Access, Leadership, and Transparency for our Heroes
(HEALTH) Act of 2023''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--IMPROVEMENT OF VETERANS COMMUNITY CARE PROGRAM
Sec. 101. Codification of requirements for eligibility standards for
access to community care from Department of
Veterans Affairs.
Sec. 102. Requirement that Secretary notify veterans of eligibility for
care under Veterans Community Care Program.
Sec. 103. Consideration under Veterans Community Care Program of
veteran preference for care and need for
caregiver or attendant.
Sec. 104. Notification of denial of request for care under Veterans
Community Care Program.
Sec. 105. Discussion of telehealth options under Veterans Community
Care Program.
Sec. 106. Finality of decision by veteran and veteran's referring
provider.
Sec. 107. Outreach regarding care and services under Veterans Community
Care Program.
Sec. 108. Plan to improve administration of care under Veterans
Community Care Program.
Sec. 109. Use of value-based reimbursement models under Veterans
Community Care Program.
Sec. 110. Extension of deadline for submittal of claims by health care
entities and providers under prompt payment
standard.
Sec. 111. Inspector General assessment of implementation of Veterans
Community Care Program.
TITLE II--OTHER HEALTH CARE MATTERS
Sec. 201. Strategic plan on transition of Veterans Health
Administration to value-based health care
model.
Sec. 202. Plan on establishment of interactive, online self-service
module for care.
Sec. 203. Publication of wait times for care at medical centers of
Department of Veterans Affairs.
Sec. 204. Documentation of preferences of veterans for scheduling of
appointments for care.
Sec. 205. Staffing model and performance metrics for certain employees
of the Department of Veterans Affairs.
Sec. 206. Modification of requirements for Center for Innovation for
Care and Payment of the Department of
Veterans Affairs and requirement for pilot
program.
Sec. 207. Online health education portal for veterans enrolled in
patient enrollment system of Department of
Veterans Affairs.
Sec. 208. Reports.
TITLE I--IMPROVEMENT OF VETERANS COMMUNITY CARE PROGRAM
SEC. 101. CODIFICATION OF REQUIREMENTS FOR ELIGIBILITY STANDARDS FOR
ACCESS TO COMMUNITY CARE FROM DEPARTMENT OF VETERANS
AFFAIRS.
(a) Eligibility Access Standards.--Section 1703B of title 38,
United States Code, is amended--
(1) by striking subsections (a) through (e) and inserting
the following:
``(a) Eligibility Standards for Access to Community Care.--(1) A
covered veteran shall be eligible to elect to receive non-Department
hospital care, medical services, or extended care services, excluding
nursing home care, through the Veterans Community Care Program under
section 1703 of this title pursuant to subsection (d)(1)(D) of such
section using the following eligibility access standards:
``(A) With respect to primary care, mental health care, or
extended care services, excluding nursing home care, if the
Department cannot schedule an appointment for the covered
veteran with a health care provider of the Department who can
provide the needed service--
``(i) within 30 minutes average driving time (or
such shorter average driving time as the Secretary may
prescribe) from the residence of the veteran unless a
longer average driving time has been agreed to by the
veteran in consultation with a health care provider of
the veteran; and
``(ii) within 20 days (or such shorter period as
the Secretary may prescribe) of the date of request for
such an appointment unless a later date has been agreed
to by the veteran in consultation with a health care
provider of the veteran.
``(B) With respect to specialty care, if the Department
cannot schedule an appointment for the covered veteran with a
health care provider of the Department who can provide the
needed service--
``(i) within 60 minutes average driving time (or
such shorter average driving time as the Secretary may
prescribe) from the residence of the veteran unless a
longer average driving time has been agreed to by the
veteran in consultation with a health care provider of
the veteran; and
``(ii) within 28 days (or such shorter period as
the Secretary may prescribe) of the date of request for
such an appointment unless a later date has been agreed
to by the veteran in consultation with a health care
provider of the veteran.
``(2) For the purposes of determining the eligibility of a covered
veteran for care or services under paragraph (1), the Secretary shall
not take into consideration the availability of telehealth appointments
from the Department when determining whether the Department is able to
furnish such care or services in a manner that complies with the
eligibility access standards under such paragraph.
``(3) In the case of a covered veteran who has had an appointment
with a health care provider of the Department canceled by the
Department for a reason other than the request of the veteran, in
calculating a wait time for a subsequent appointment under paragraph
(1), the Secretary shall calculate such wait time from the date of the
request for the original, canceled appointment.
``(4) If a veteran agrees to a longer average drive time or a later
date under subparagraph (A) or (B) of paragraph (1), the Secretary
shall document the agreement to such longer average drive time or later
date in the electronic health record of the veteran and provide the
veteran a copy of such documentation. Such copy may be provided
electronically.
``(b) Application.--The Secretary shall ensure that the eligibility
access standards established under subsection (a) apply--
``(1) to all care and services within the medical benefits
package of the Department to which a covered veteran is
eligible under section 1703 of this title, excluding nursing
home care; and
``(2) to all covered veterans, regardless of whether a
veteran is a new or established patient.
``(c) Periodic Review of Access Standards.--Not later than three
years after the date of the enactment of the Veterans' Health
Empowerment, Access, Leadership, and Transparency for our Heroes
(HEALTH) Act of 2023, and not less frequently than once every three
years thereafter, the Secretary shall--
``(1) conduct a review of the eligibility access standards
under subsection (a) in consultation with--
``(A) such Federal entities as the Secretary
considers appropriate, including the Department of
Defense, the Department of Health and Human Services,
and the Centers for Medicare & Medicaid Services;
``(B) entities and individuals in the private
sector, including--
``(i) veteran patients;
``(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 with respect to
the review conducted under paragraph (1); and
``(B) such recommendations as the Secretary may
have with respect to the eligibility access standards
under subsection (a).'';
(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 ``eligibility access standards under
subsection (a)''; and
(B) in paragraph (2)(B), by striking ``designated
access standards established under this section'' and
inserting ``eligibility 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.--Section 1703(d) 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 ``eligibility 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 ``eligibility access standards under
section 1703B(a) of this title''.
SEC. 102. REQUIREMENT THAT SECRETARY NOTIFY VETERANS OF ELIGIBILITY FOR
CARE UNDER VETERANS COMMUNITY CARE PROGRAM.
Section 1703(a) of title 38, United States Code, is amended by
adding at the end the following new paragraph:
``(5)(A) The Secretary shall notify each covered veteran in writing
of the eligibility of such veteran for care or services under this
section as soon as possible, but not later than two business days,
after the date on which the Secretary is aware that the veteran is
seeking care or services and is eligible for such care or services
under this section.
``(B) With respect to each covered veteran eligible for care or
services under subsection (d), the Secretary shall provide such veteran
periodic reminders, as the Secretary determines appropriate, of their
ongoing eligibility under such subsection.
``(C) Any notification or reminder under this paragraph may be
provided electronically.''.
SEC. 103. CONSIDERATION UNDER VETERANS COMMUNITY CARE PROGRAM OF
VETERAN PREFERENCE FOR CARE AND NEED FOR CAREGIVER OR
ATTENDANT.
Section 1703(d)(2) of title 38, United States Code, is amended by
adding at the end the following new subparagraphs:
``(F) The preference of the covered veteran for 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. 104. NOTIFICATION OF DENIAL OF REQUEST FOR CARE UNDER VETERANS
COMMUNITY CARE PROGRAM.
Section 1703 of title 38, United States Code, is 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 due to not meeting the
eligibility access standards under section 1703B(a) of this title,
notice under such paragraph shall include an explanation for why the
Secretary does not consider the veteran to have met such standards.
``(3) Any notification under this subsection may be provided
electronically.''.
SEC. 105. DISCUSSION OF TELEHEALTH OPTIONS UNDER VETERANS COMMUNITY
CARE PROGRAM.
Section 1703 of title 38, United States Code, as amended by section
104, is further amended--
(1) by redesignating subsection (p) as subsection (q); and
(2) by inserting after subsection (o) the following new
subsection (p):
``(p) Discussion of Options for Telehealth.--When discussing
options for care or services for a covered veteran under this section,
the Secretary shall ensure that the veteran is informed of the ability
of the veteran to seek care or services via telehealth, either through
a medical facility of the Department or under this section, if
telehealth--
``(1) is available to the veteran;
``(2) is appropriate for the type of care or services the
veteran is seeking, as determined by the Secretary; and
``(3) is acceptable to the veteran.''.
SEC. 106. FINALITY OF DECISION BY VETERAN AND VETERAN'S REFERRING
PROVIDER.
(a) In General.--Section 1703 of title 38, United States Code, as
amended by sections 104 and 105, 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 Decision by Veteran and Referring Provider.--An
agreement by a covered veteran and the covered veteran's referring
provider under this section regarding the best medical interest of the
covered veteran or regarding eligibility for care or services under
this section, including an agreement under subsection (d)(1)(E), is
final and may not be changed by the Department without the knowledge
and consent, documented in writing, of the covered veteran and the
provider unless there is a statutory or regulatory barrier preventing
the Department from providing the care or services in question.''.
(b) Conforming Amendment.--Section 1703(d)(1)(E) of title 38,
United States Code, is amended by striking ``referring clinician'' and
inserting ``referring provider''.
SEC. 107. OUTREACH REGARDING CARE AND SERVICES UNDER VETERANS COMMUNITY
CARE PROGRAM.
(a) In General.--Section 1703 of title 38, United States Code, as
amended by sections 104, 105, and 106, 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--
``(A) conduct public outreach to inform veterans of--
``(i) the conditions for eligibility for care or
services under subsections (d) and (e);
``(ii) how to request such care or services; and
``(iii) how to appeal a denial of a request for
such care or services using the clinical appeals
process of the Veterans Health Administration; and
``(B) ensure that information about eligibility for care or
services under subsections (d) and (e) is prominently displayed
on the website of the Department and included in other outreach
campaigns and activities conducted by the Secretary.
``(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 directly inform the veteran of--
``(A) the conditions for eligibility for care or services
under subsections (d) and (e);
``(B) how to request such care or services; and
``(C) how to appeal a denial of a request for such care or
services using the clinical appeals process of the Veterans
Health Administration.
``(3) The Secretary shall ensure that each medical facility of the
Department publicly displays information regarding--
``(A) the conditions for eligibility of veterans for care
or services under subsections (d) and (e);
``(B) how to request such care or services; and
``(C) how to appeal a denial of a request for such care or
services using the clinical appeals process of the Veterans
Health Administration.''.
(b) Transitional Services Upon Separation From Armed Forces.--
Section 1144(f)(1)(B)(i) of title 10, 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 title 38, the
ability to seek care and services under sections 1703 and 1710 of such
title'' before the semicolon.
(c) 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.
(d) Comptroller General Report on Outreach.--Not later than two
years after the date of the enactment of this Act, the Comptroller
General of the United States shall submit to Congress a report on the
efforts of the Department of Veterans Affairs to ensure that veterans
are informed of the conditions for eligibility for care and services
under section 1703 of title 38, United States Code, including outreach
conducted under subsection (r) of such section, as added by subsection
(a) of this section.
SEC. 108. PLAN TO IMPROVE ADMINISTRATION OF CARE UNDER VETERANS
COMMUNITY CARE PROGRAM.
(a) In General.--The Secretary of Veterans Affairs, working with
Third Party Administrators and acting through the Center for Innovation
for Care and Payment of the Department of Veterans Affairs under
section 1703E of title 38, United States Code, shall develop and
implement a plan--
(1) to provide monetary and non-monetary incentives to
health care providers specified in subsection (c) of section
1703 of title 38, United States Code, furnishing care or
services under the Veterans Community Care Program under such
section pursuant to an agreement with a Third Party
Administrator--
(A) to allow the Secretary and Third Party
Administrators to see the scheduling system of the
provider for purposes of assessing availability and
assisting with scheduling appointments for veterans
under such program, including through synchronous,
asynchronous, and asynchronous assisted digital
scheduling;
(B) to complete training for continuing
professional education credit regarding veteran
cultural competency and other subjects as determined
appropriate by the Secretary and to better account for
equivalent or similar non-Department training;
(C) to improve the rate of the timely return to the
Department 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 such other objectives as 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 incentivize community
providers in those specialties to participate in such program.
(b) Value-Based Reimbursement Models.--In developing the plan under
subsection (a), the Secretary and Third Party Administrators shall
explore value-based reimbursement models authorized to be used under
section 1703(i)(5) of title 38, United States Code, to achieve the
goals under such subsection.
(c) Submittal of Plan.--
(1) Initial plan.--Not later than 180 days after the date
of the enactment of this Act, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives the plan
developed under subsection (a).
(2) Quarterly update.--Not less frequently than quarterly
during the five-year period following the submittal of the plan
under paragraph (1), the Secretary 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 any updates on the implementation of such plan.
(3) Use of value-based reimbursement models.--The Secretary
shall include with the plan submitted under paragraph (1) and
any report submitted under paragraph (2)--
(A) a complete list of the value-based
reimbursement models considered under the plan;
(B) an indication of whether any such model has
been put into practice; and
(C) with respect to any such model that was
considered but not put into practice, a description of
the reasons such model was not put into practice.
(d) No Penalty for Not Meeting Objectives.--Health care providers
specified in section 1703(c) of title 38, United States Code, shall not
be penalized for not meeting an objective under paragraph (1) of
subsection (a) included in the plan required under such subsection.
(e) 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.
(f) 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. 109. USE OF VALUE-BASED REIMBURSEMENT MODELS UNDER VETERANS
COMMUNITY CARE PROGRAM.
(a) In General.--Section 1703(i)(5) of title 38, United States
Code, is amended 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 section 1703 of title 38, United States Code, pursuant to
the amendment made by subsection (a).
(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 section 1703 of title 38, United States Code, 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. 110. EXTENSION OF DEADLINE FOR SUBMITTAL OF CLAIMS BY HEALTH CARE
ENTITIES AND PROVIDERS UNDER PROMPT PAYMENT STANDARD.
Section 1703D(b) of title 38, United States Code, is amended by
striking ``180 days'' and inserting ``one year''.
SEC. 111. 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 considers 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 of the
Department shall commence the initial assessment required by subsection
(a).
TITLE II--OTHER HEALTH CARE MATTERS
SEC. 201. STRATEGIC PLAN ON TRANSITION OF VETERANS HEALTH
ADMINISTRATION TO VALUE-BASED HEALTH CARE MODEL.
(a) Findings.--Congress makes the following findings:
(1) The final report of the Creating Options for Veterans'
Expedited Recovery Commission (commonly referred to as the
``COVER Commission'') established under section 931 of the
Jason Simcakoski Memorial and Promise Act (title IX of Public
Law 114-198; 38 U.S.C. 1701 note) submitted under subsection
(e)(2) of such section made a key recommendation to transform
the current health care delivery model of the Department of
Veterans Affairs into one that is person-centered,
relationship-based, and recovery-focused, and to support that
transformation with a system that is value-based and
incentivized for continuous innovation and quality improvement.
(2) The consensus study report of the Health and Medicine
Division of the National Academies of Sciences, Engineering,
and Medicine dated February 2022 and entitled, ``Achieving
Whole Health: A New Approach for Veterans and the Nation''
recommends the Veterans Health Administration adopt a value-
based model to align with delivering whole health care.
(3) The consensus study report of the National Academy of
Medicine dated October 2020 found that a value-based care model
helps reduce physician burnout.
(4) The National Academy of Medicine has developed a widely
accepted approach that describes high-value health care as
safe, timely, effective, efficient, equitable, and patient-
centered (STEEEP). Further, the Institute for Healthcare
Improvement has translated that approach into a framework for
action known as the ``Quadruple Aim''. The Quadruple Aim is
made up of better patient outcomes, improved patient
satisfaction, lower costs, and physician and health care
professional well-being.
(5) Health care systems that have made the transition to
value-based care have seen a significant decrease in suicides
among their patient population, and the top clinical priority
of the Veterans Health Administration is suicide prevention.
(6) Value-based care programs can encourage providers to
work together to deliver coordinated, person-centered care,
which will improve the overall quality of care.
(7) A critical component of a successful transition to a
value-based care delivery model is an operational electronic
health record system in place as a foundation.
(b) Establishment of Working Group.--
(1) In general.--Not later than 90 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall establish a working group on the shift of the Veterans
Health Administration to a value-based care system.
(2) Membership.--
(A) Required members.--The working group shall
include, at a minimum, the following members:
(i) The Under Secretary of Veterans Affairs
for Health.
(ii) The Director of the Office of Mental
Health and Suicide Prevention of the Department
of Veterans Affairs, or successor office.
(iii) The Director of the Office of
Integrated Veteran Care of the Department, or
successor office.
(iv) The Director of the Office of Rural
Health of the Department, or successor office.
(v) The Director of the Office of Connected
Care of the Department, or successor office.
(vi) The Director of the Office of
Information and Technology of the Department,
or successor office.
(vii) The Chief Officer of the Office of
Healthcare Innovation and Learning of the
Office of Discovery, Education, and Affiliate
Networks of the Veterans Health Administration,
or successor office.
(viii) An individual designated by the
Secretary from the Center for Innovation for
Care and Payment of the Department under
section 1703E of title 38, United States Code.
(ix) An individual designated by the
Administrator of the Centers for Medicare &
Medicaid Services from the Center for Medicare
and Medicaid Innovation.
(x) An individual designated by the
Secretary of Health and Human Services from the
Federal Office of Rural Health Policy of the
Health Resources and Services Administration.
(B) Optional members.--The Secretary of Veterans
Affairs may appoint any of the following individuals as
members of the working group:
(i) An individual representing the Health
and Medicine Division of the National Academies
of Sciences, Engineering, and Medicine.
(ii) An individual designated by the
Chairman of the Veterans' Expedited Recovery
Commission (commonly referred to as the ``COVER
Commission'') established under section 931 of
the Jason Simcakoski Memorial and Promise Act
(title IX of Public Law 114-198; 38 U.S.C. 1701
note).
(iii) Three individuals representing a
private health care system that has made the
transition to value-based care.
(iv) Three individuals representing a
health care provider participating in the
Veterans Community Care Program under section
1703 of title 38, United States Code, that
operates under a value-based care model.
(v) An individual representing an
organization recognized by the Secretary of
Veterans Affairs under section 5902 of title
38, United States Code.
(3) Exemption from application of faca.--Chapter 10 of
title 5, United States Code, shall not apply to the working
group established under paragraph (1).
(c) Development of Strategic Plan.--
(1) In general.--Not later than one year after the
establishment of the working group under subsection (b), the
working group shall develop a strategic plan to shift the
Veterans Health Administration to a value-based care system.
(2) Elements.--The strategic plan required under paragraph
(1) shall contain the following elements:
(A) An identification of the current state of the
Veterans Health Administration, including an assessment
of the current model of health care delivery used by
the Veterans Health Administration in medical
facilities of the Department of Veterans Affairs and
through the Veterans Community Care Program under
section 1703 of title 38, United States Code, in
comparison to a value-based care system.
(B) An analysis of the leadership of the Veterans
Health Administration, including an assessment of
leadership acumen and ability to implement a shift with
a clear, shared vision and effective change management
and care coordination.
(C) An identification of goals for the future of
the Veterans Health Administration.
(D) An identification and classification of the
current capabilities and gaps of the health care system
of the Department of Veterans Affairs.
(E) An analysis of the four main types of value-
based care models, including--
(i) a selection of the model that best fits
a successful transition for the Veterans Health
Administration; and
(ii) a thorough justification of the
selection of such model.
(F) A definition of what quality means with respect
to access to health care and delivery of health care.
(G) A definition of what value means with respect
to care furnished by the Veterans Health
Administration, a system, with metrics, for measuring
value within the Veterans Health Administration that
includes outcomes, safety, service, access, and total
cost of patient care, and an analysis of variable value
with respect to patient outcomes across different
health care types and specialities.
(H) An assessment of the current information
technology infrastructure of the Veterans Health
Administration and any recommendations to make such
infrastructure more robust.
(I) An assessment of the workforce challenges and
needs of the Veterans Health Administration, including
with respect to recruitment and retention and the
effectiveness of the ability of the performance
appraisal system of the Veterans Health Administration
to appropriately incentivize and reward employees and
ensure adherence to relevant statutes, regulations,
policy directives, and treatment guidelines.
(J) An assessment of the current value-driven
framework of the Department for evaluating health care
innovations and how that framework could be used to
propel a shift in the model of care delivery by the
Department.
(K) A focus on value-based care for primary care,
inpatient and outpatient mental health care, and
inpatient and outpatient substance use treatment.
(L) A description of the timeline, costs, and
legislative or administrative action necessary to
transition the Veterans Health Administration to a
value-based care system.
(d) Submittal of Strategic Plan to Congress.--Not later than 30
days after the completion by the working group established under
subsection (b) of the strategic plan required under subsection (c), the
Secretary of Veterans Affairs shall submit the strategic plan to the
Committee on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives.
(e) Pilot Program Implementation of Strategic Plan.--
(1) In general.--Not later than 180 days after the
submittal under subsection (d) of the strategic plan required
under subsection (c), the Secretary of Veterans Affairs shall
commence a five-year pilot program to implement the strategic
plan.
(2) Care included.--The pilot program under paragraph (1)
shall include the implementation of the strategic plan for the
delivery by the Veterans Health Administration of primary care,
inpatient and outpatient mental health treatment, and inpatient
and outpatient substance use treatment.
(3) Locations.--The Secretary shall carry out the pilot
program under paragraph (1) in four Veterans Integrated Service
Networks that are geographically dispersed and shall include
the following:
(A) A Veterans Integrated Service Network that
predominately serves veterans in rural and highly rural
areas.
(B) A Veterans Integrated Service Network that
predominately serves veterans in urban areas.
(C) A Veterans Integrated Service Network that has
a high rate of suicide among veterans.
(D) A Veterans Integrated Service Network that has
a high rate of substance use disorder among veterans.
(E) A Veterans Integrated Service Network with a
documented issue with workforce recruitment and
retention.
(4) Reports to congress.--
(A) Annual report.--Not later than one year after
the commencement of the pilot program, and annually
thereafter during the duration of the pilot program,
the Secretary shall submit to Congress a report on the
pilot program.
(B) Final report.--Not later than 180 days before
the conclusion of the pilot program, the Secretary
shall submit to Congress a final report on the pilot
program that includes a plan and timeline for full
implementation of the strategic plan required under
subsection (c) across the entire Veterans Health
Administration.
SEC. 202. PLAN ON ESTABLISHMENT OF INTERACTIVE, ONLINE SELF-SERVICE
MODULE FOR CARE.
(a) In General.--The Secretary of Veterans Affairs, working with
Third Party Administrators and acting through the Center for Innovation
for Care and Payment of the Department of Veterans Affairs under
section 1703E of title 38, United States Code, shall develop and
implement a plan to establish an interactive, online self-service
module--
(1) to allow veterans to request appointments, track
referrals for health care under the laws administered by the
Secretary, whether at a facility of the Department or through a
non-Department provider, and receive appointment reminders;
(2) to allow veterans to appeal and track decisions
relating to--
(A) denials of requests for care or services under
section 1703 of title 38, United States Code; or
(B) denials of requests for care or services at
facilities of the Department, including under section
1710 of such title; and
(3) to implement such other matters as determined
appropriate by the Secretary in consultation with Third Party
Administrators.
(b) Submittal of Plan.--
(1) Initial plan.--Not later than 180 days after the date
of the enactment of this Act, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives the plan
developed under subsection (a).
(2) Quarterly update.--Not less frequently than quarterly
following the submittal of the plan under paragraph (1) and for
two years thereafter, the Secretary 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 any updates on the implementation of such plan.
(c) 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.
(d) 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. 203. PUBLICATION OF WAIT TIMES FOR CARE AT MEDICAL CENTERS OF
DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Subchapter I of chapter 17 of title 38, United
States Code, is amended by inserting after section 1703F the following
new section:
``Sec. 1703G. Publication of wait times for care at medical centers
``(a) In General.--The Secretary shall publish on a publicly
available internet website of the Department the average wait time for
a veteran to schedule an appointment at each medical center of the
Department for the receipt of primary care, specialty care, and mental
health care measured from the date of request for the appointment to
the date on which the care was provided.
``(b) Update.--The Secretary shall update the wait times published
under subsection (a) not less frequently than monthly.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such subchapter is amended by inserting after the item relating to
section 1703F the following new item:
``1703G. Publication of wait times for care at medical centers.''.
SEC. 204. DOCUMENTATION OF PREFERENCES OF VETERANS FOR SCHEDULING OF
APPOINTMENTS FOR CARE.
(a) In General.--Upon enrollment of a veteran in the system of
annual patient enrollment of the Department of Veterans Affairs
established and operated under section 1705(a) of title 38, United
States Code, and not less frequently than annually thereafter, the
Secretary of Veterans Affairs shall solicit from the veteran the
preference of the veteran for scheduling of appointments for health
care and related services furnished by the Department, including
through non-Department providers.
(b) Documentation of Preference.--Preferences provided by a veteran
pursuant to subsection (a) shall be documented on My HealtheVet or
another system designated by the Secretary that allows the veteran to
change such preferences at any time.
(c) Inclusion in Preference.--Preferences solicited under
subsection (a) shall include the following:
(1) How and when the veteran prefers to be contacted by the
Department about an appointment for health care.
(2) Whether the veteran prefers to schedule their own
appointments, if able.
(3) Whether the veteran prefers to select their own
provider, if able.
(4) Whether the veteran prefers appointments to be
scheduled during certain days or times.
(5) Whether the veteran is willing to consider telehealth
appointments.
(d) Use of Preference.--The Secretary shall make the preferences
provided under subsection (a) easily accessible to medical support
assistants and other staff of the Department assisting in the
appointment scheduling process to use to improve the timeliness of the
scheduling of appointments for health care and related services
furnished by the Department, including through non-Department
providers.
SEC. 205. STAFFING MODEL AND PERFORMANCE METRICS FOR CERTAIN EMPLOYEES
OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Staffing Model.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall--
(A) develop, validate, and implement a staffing
model for the Office of Integrated Veteran Care of the
Department of Veterans Affairs, or successor office,
Veterans Integrated Services Networks, and medical
centers of the Department that includes appropriate
target staffing levels nationally, regionally, and
locally to ensure timely access to care and effectively
oversee the provision of care by the Department,
whether at a facility of the Department or through a
non-Department provider; and
(B) provide to Congress a briefing on such staffing
model, which shall include--
(i) the metrics and measures used by the
Secretary in developing such staffing model;
and
(ii) an analysis of how such staffing model
compares to the staffing models of other
relevant government and private sector health
care systems.
(2) Report on implementation of staffing model.--Not later
than one year after implementing the staffing model required
under paragraph (1), the Secretary shall submit to Congress and
the Comptroller General of the United States a report
containing--
(A) an update on such implementation; and
(B) information on the outcomes yielded by such
staffing model in terms of improved access to care for
veterans and improved compliance with relevant laws,
regulations, policy directives, and guidance governing
access to care.
(b) Performance Metrics.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary shall develop and
implement a plan to incorporate appropriate performance metrics
and accountability measures within the performance appraisal
systems for employees of the Department specified in paragraph
(2).
(2) Employees of the department specified.--Employees of
the Department specified in this paragraph are employees who
are responsible for ensuring timely access to care from the
Department, compliance with relevant statutes and regulations
relating to the provision of care, including section 1703 of
title 38, United States Code, and overseeing the provision of
care, whether at a facility of the Department or through a non-
Department provider, including employees within the Office of
Integrated Veteran Care of the Department, or successor office,
employees of a Veterans Integrated Service Network, and
employees of a medical center of the Department.
(3) Report on implementation of performance metrics.--Not
later than one year after implementing the performance metrics
required under paragraph (1), the Secretary shall submit to
Congress and the Comptroller General of the United States a
report containing--
(A) an update on such implementation; and
(B) information on the outcomes yielded by such
performance metrics in terms of improved access to care
for veterans and improved compliance with relevant
laws, policy directives, and guidance governing access
to care.
(c) Comptroller General Report.--Not later than two years after
receiving the report under subsection (a)(2) or the report under
subsection (b)(3), whichever occurs later, the Comptroller General of
the United States shall submit to Congress a report--
(1) assessing the performance of the Office of Integrated
Veteran Care of the Department, or successor office, in
improving access to care for veterans in facilities of the
Department and pursuant to section 1703 of title 38, United
States Code; and
(2) containing such recommendations as the Comptroller
General considers appropriate relating to improving access to
such care.
SEC. 206. MODIFICATION OF REQUIREMENTS FOR CENTER FOR INNOVATION FOR
CARE AND PAYMENT OF THE DEPARTMENT OF VETERANS AFFAIRS
AND REQUIREMENT FOR PILOT PROGRAM.
(a) In General.--Section 1703E of title 38, United States Code, is
amended--
(1) in subsection (a)--
(A) in paragraph (1), by striking ``within the
Department'' and inserting ``within the Office of the
Secretary'';
(B) in paragraph (2), by striking ``may'' and
inserting ``shall''; and
(C) in paragraph (3)--
(i) in subparagraph (A), by striking ``;
and'' and inserting a semicolon;
(ii) in subparagraph (B), by striking the
period at the end and inserting ``; or''; and
(iii) by adding at the end the following
new subparagraph:
``(C) increase productivity, efficiency, and modernization
throughout the Department.'';
(2) by striking subsection (d) and inserting the following
new subsection (d):
``(d) Budgetary Line Item.--The Secretary shall include in the
budget justification materials submitted to Congress in support of the
budget of the Department of Veterans Affairs for a fiscal year (as
submitted with the budget of the President under section 1105(a) of
title 31) specific identification, as a budgetary line item, of the
amounts required to carry out this section.'';
(3) in subsection (f)--
(A) in paragraph (1), by striking ``in subchapters
I, II, and III of this chapter'' and inserting ``of
this title, of title 38, Code of Federal Regulations,
and of any handbooks, directives, or policy documents
of the Department''; and
(B) in paragraph (2), in the matter preceding
subparagraph (A), by striking ``waiving any authority''
and inserting ``waiving any provision of this title'';
(4) in subsection (g)(1), by inserting ``fewer than three
or'' before ``more than 10'';
(5) in subsection (i)--
(A) in paragraph (1), by striking ``the Under
Secretary for Health and the Special Medical Advisory
Group established pursuant to section 7312 of this
title'' and inserting ``the Under Secretary for Health,
the Special Medical Advisory Group established pursuant
to section 7312 of this title, the Office of Integrated
Veteran Care (or successor office), the Office of
Finance (or successor office), the Veteran Experience
Office (or successor office), the Office of Enterprise
Integration (or successor office), and the Office of
Information and Technology (or successor office)''; and
(B) in paragraph (2), by striking ``representatives
of relevant Federal agencies, and clinical and
analytical experts with expertise in medicine and
health care management'' and inserting
``representatives of relevant Federal agencies,
nonprofit organizations, and other public and private
sector entities, including those with clinical and
analytical experts with expertise in medicine and
health care management''; and
(6) by adding at the end the following new subsection:
``(k) Report on Activities of Center for Innovation for Care and
Payment.--Not less frequently than annually, the Secretary shall submit
to Congress a report that contains, for the one-year period preceding
the date of the report--
``(1) a full accounting of the activities, staff, budget,
and other resources and efforts of the Center; and
``(2) an assessment of the outcomes of the efforts of the
Center.''.
(b) Comptroller General Report.--Not later than 18 months after the
date of the enactment of this Act, the Comptroller General of the
United States shall submit to Congress a report--
(1) on the efforts of the Center for Innovation for Care
and Payment of the Department of Veterans Affairs in fulfilling
the objectives and requirements under section 1703E of title
38, United States Code, as amended by subsection (a); and
(2) containing such recommendations as the Comptroller
General considers appropriate.
(c) Pilot Program.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Center for Innovation for Care
and Payment of the Department of Veterans Affairs under section
1703E of title 38, United States Code, shall establish a three-
year pilot program in not fewer than five locations to allow
veterans enrolled in the system of annual patient enrollment of
the Department established and operated under section 1705(a)
of such title to access outpatient mental health and substance
use services through health care providers specified under
section 1703(c) of such title without referral or pre-
authorization.
(2) Priority.--In selecting sites for the pilot program
under paragraph (1), the Secretary shall prioritize sites in
the following areas:
(A) Areas with varying degrees of urbanization,
including urban, rural, and highly rural areas.
(B) Areas with high rates of suicide among
veterans.
(C) Areas with high rates of overdose deaths among
veterans.
(D) Areas with high rates of calls to the Veterans
Crisis Line.
(E) Areas with long wait times for mental health
and substance use services at facilities of the
Department.
(F) Areas with outpatient mental health and
substance use programs that utilize a value-based care
model, to the extent practicable.
(3) Elements.--The Secretary, in implementing the pilot
program under paragraph (1), shall ensure the Department has a
care coordination system in place that includes--
(A) knowledge sharing, including the timely
exchange of medical documentation;
(B) assistance with transitions of care, including
the potential need for inpatient or residential
psychiatric services, substance use detoxification
services, post-detoxification step-down services, and
residential rehabilitation programs;
(C) continuous assessment of patient needs and
goals; and
(D) creating personalized, proactive care plans.
(4) Oversight and outcomes.--The Secretary shall develop
appropriate metrics and measures--
(A) to track and oversee sites at which the pilot
program under paragraph (1) is carried out;
(B) to monitor patient safety and outcomes under
the pilot program; and
(C) to assess and mitigate any barriers to
extending the pilot program across the entire Veterans
Health Administration.
(5) Annual report.--
(A) In general.--Not later than one year after the
commencement of the pilot program under paragraph (1),
and not less frequently than annually thereafter during
the duration of the pilot program, the Secretary shall
submit to the Committee on Veterans' Affairs of the
Senate and Committee on Veterans' Affairs of the House
of Representatives a report on the pilot program, which
shall include the following:
(i) The number of unique veterans who
participated in the pilot program.
(ii) The number of health care providers
who participated in the pilot program.
(iii) An assessment of the effectiveness of
the pilot program in increasing access to, and
improving outcomes for, mental health and
substance use treatment services.
(iv) The cost of the pilot program.
(v) Such other matters as the Secretary
considers appropriate.
(B) Final report.--The Secretary shall include in
the final report submitted under subparagraph (A), in
addition to the requirements under such subparagraph,
the assessment by the Secretary of the feasibility and
advisability of extending the pilot program across the
entire Veterans Health Administration, including a
plan, timeline, and required resources for such an
extension.
(6) Veterans crisis line defined.--In this subsection, the
term ``Veterans Crisis Line'' means the toll-free hotline for
veterans established under section 1720F(h) of title 38, United
States Code.
SEC. 207. ONLINE HEALTH EDUCATION PORTAL FOR VETERANS ENROLLED IN
PATIENT ENROLLMENT SYSTEM OF DEPARTMENT OF VETERANS
AFFAIRS.
Not later than one year after the date of the enactment of this
Act, the Secretary of Veterans Affairs shall establish an online health
education portal that includes interactive online educational modules
to ensure veterans enrolled in the patient enrollment system of the
Department of Veterans Affairs established and operated under section
1705(a) of title 38, United States Code, understand their basic health
care eligibilities and entitlements under the laws administered by the
Secretary, including under the Veterans Community Care Program under
section 1703 of such title.
SEC. 208. REPORTS.
(a) Report on Improvements to Clinical Appeals Process.--Not later
than one year after the date of the enactment of this Act, and not less
frequently than once every three years thereafter, the Secretary of
Veterans Affairs, in consultation with veterans service organizations,
veterans, caregivers of veterans, employees of the Department of
Veterans Affairs, and other stakeholders as determined by the
Secretary, shall submit to the Committee on Veterans' Affairs of the
Senate and Committee on Veterans' Affairs of the House of
Representatives a report containing recommendations for legislative or
administrative action to improve the clinical appeals process of the
Department with respect to timeliness, transparency, objectivity,
consistency, and fairness.
(b) Report on Required Care and Services Under Community Care
Program.--Not later than one year after the date of the enactment of
this Act, and not less frequently than annually thereafter, the
Secretary shall submit to the Committee on Veterans' Affairs of the
Senate and Committee on Veterans' Affairs of the House of
Representatives a report that contains, for the one-year period
preceding the date of the report, the following:
(1) The number of veterans eligible for care or services
under section 1703 of title 38, United States Code, and the
reasons for such eligibility, including multiple such reasons
for veterans eligible under more than one eligibility criteria.
(2) The number of veterans who opt to seek care or services
under such section.
(3) The number of veterans who do not opt to seek care or
services under such section.
(4) An assessment of the timeliness of referrals for care
or services under such section.
(5) The number of times a veteran did not show for an
appointment for care or services under such section.
(6) The number of requests for an appeal of a denial of
care or services under such section using the clinical appeals
process of the Veterans Health Administration.
(7) The timeliness of each such appeal.
(8) The outcome of each such appeal.
(c) Veterans Service Organization Defined.--In this section, the
term ``veterans service organization'' means any organization
recognized by the Secretary under section 5902 of title 38, United
States Code.
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