[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2649 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
1st Session
S. 2649
To improve community care provided by the Department of Veterans
Affairs, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 27, 2023
Mr. Tester introduced the following bill; which was read twice and
referred to the Committee on Veterans' Affairs
_______________________________________________________________________
A BILL
To improve community care provided by 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 ``Making Community
Care Work for Veterans 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--IMPROVEMENTS TO COMMUNITY CARE
Sec. 101. Requirement that appointments for care or services under
Community Care Program of Department of
Veterans Affairs are timely scheduled.
Sec. 102. Modifications to access standards for care furnished through
Community Care Program of Department of
Veterans Affairs.
Sec. 103. Consideration of telehealth in determining whether an
appointment can be scheduled within the
access standards of the Department of
Veterans Affairs.
Sec. 104. Finality of decision by veteran and veteran's referring
clinician.
Sec. 105. Benefits for persons disabled by treatment under Community
Care Program of Department of Veterans
Affairs.
Sec. 106. Extension of period for submittal of claims by health care
entities and providers.
Sec. 107. Program on self-referral of veterans for certain services
under Veterans Community Care Program.
Sec. 108. Report on referrals for non-Department of Veterans Affairs
health care.
Sec. 109. Requirement that health care providers under Community Care
Program of Department of Veterans Affairs
provide certain data.
Sec. 110. High-compliance rating program for providers under Veterans
Community Care Program of Department of
Veterans Affairs.
Sec. 111. Adoption of national interoperability standards between
Department of Veterans Affairs and
community care providers.
Sec. 112. Analysis of feasibility and advisability of establishing a
community care network for the provision of
care to veterans in the Republic of the
Philippines.
Sec. 113. Pilot program on consolidating the community care dental
treatment plan approval process of
Department of Veterans Affairs.
Sec. 114. Reviews of payment rate waivers under Veterans Community Care
Program.
Sec. 115. Comptroller General report on dentistry under Veterans
Community Care Program.
TITLE II--HEALTH CARE EMPLOYEES
Sec. 201. Establishment of Start and Stay at VA program.
Sec. 202. Expansion of period of payment under Employee Incentive
Scholarship Program.
Sec. 203. Mentorship program for executive leadership teams at medical
centers of the Department of Veterans
Affairs.
TITLE III--OTHER HEALTH CARE MATTERS
Sec. 301. Timing for scheduling of appointments at facilities of
Department of Veterans Affairs.
Sec. 302. Modification of requirements for standards for quality of
care from Department of Veterans Affairs.
Sec. 303. Mental Health Residential Rehabilitation Treatment Program of
the Department of Veterans Affairs.
Sec. 304. Electronic document submission option for the CHAMPVA
program.
Sec. 305. Review of workflows associated with processing referrals
between facilities of the Veterans Health
Administration.
TITLE I--IMPROVEMENTS TO COMMUNITY CARE
SEC. 101. REQUIREMENT THAT APPOINTMENTS FOR CARE OR SERVICES UNDER
COMMUNITY CARE PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS
ARE TIMELY SCHEDULED.
(a) In General.--Section 1703 of title 38, United States Code, is
amended--
(1) by redesignating subsections (m), (n), and (o) as
subsections (n), (o), and (p), respectively; and
(2) by inserting after subsection (l) the following new
subsection (m):
``(m) Scheduling of Appointments.--(1) The Secretary shall ensure
that an appointment for a covered veteran for care or services under
this section--
``(A) in the case of a non-urgent appointment, is scheduled
(but may occur at a later date) not later than seven days after
the earlier of the date on which--
``(i) a clinician of the Department determines that
the veteran requires care; or
``(ii) the veteran presents to the Department
requesting care; and
``(B) in the case of an appointment for urgent care, is
completed not later than 48 hours after the earlier of the date
on which--
``(i) a clinician of the Department determines that
the veteran requires care; or
``(ii) the veteran presents to the Department
requesting care.
``(2) Not less frequently than quarterly, 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
on the average time it takes each medical facility of the Department to
schedule appointments for care or services under this section, broken
out by primary care, mental health care, and each type of specialty
care.
``(3)(A) Each medical facility of the Department for which any
average time reported under paragraph (2) is more than seven days shall
submit to the Under Secretary for Health, not later than 30 days after
the date of the report--
``(i) an explanation for why such average time is more than
seven days, which may include staffing shortages, insufficient
network, surge of appointments, and any other factor increasing
such average time;
``(ii) a remediation plan to bring such average time to not
more than seven days; and
``(iii) an explanation for how each issue specified in
clause (i) is being mitigated.
``(B) With respect to any explanation under subparagraph (A)(i)
that specifies insufficient network, the Under Secretary for Health
shall--
``(i) consult with any third party administrator
responsible for administering such network on how network
insufficiency can be overcome; and
``(ii) examine whether the third party administrator is
meeting contractual obligations.''.
(b) Effective Date.--The Secretary of Veterans Affairs shall comply
with the requirements under section 1703(m)(1) of title 38, United
States Code, as added by subsection (a)(2), by not later than 180 days
after the date of the enactment of this Act.
SEC. 102. MODIFICATIONS TO ACCESS STANDARDS FOR CARE FURNISHED THROUGH
COMMUNITY CARE PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Section 1703B of title 38, United States Code, is
amended--
(1) by striking subsections (a) through (d) and inserting
the following:
``(a) Threshold Eligibility Standards for Access to Community
Care.--A covered veteran shall be eligible to elect to receive,
pursuant to subsection (d)(3) of section 1703 of this title, non-
Department hospital care, medical services, or extended care services
under such section pursuant to subsection (d)(1)(D) of such section
using the following eligibility standards for access to community care:
``(1) With respect to primary care, mental health care, or
non-institutional extended care services, if the Secretary
cannot schedule an appointment for the covered veteran with a
health care provider of the Department--
``(A) not more than 30 minutes average driving time
from the residence of the veteran; and
``(B) not later than 20 days from the date of
request for such an appointment, unless a later date
has been agreed to by the veteran in consultation with
the health care provider, to the first next available
appointment date relevant to the requested medical
service.
``(2) With respect to specialty care or specialty services,
if the Secretary cannot schedule an appointment for the covered
veteran with a health care provider of the Department--
``(A) not more than 60 minutes average driving time
from the residence of the veteran; and
``(B) not later than 28 days from the date of
request for such an appointment, unless a later date
has been agreed to by the veteran in consultation with
the health care provider, to the first next available
appointment date relevant to the requested medical
service.'';
(2) by redesignating subsections (e), (f), (g), (h), and
(i) as subsections (b), (c), (d), (e), and (f), respectively;
(3) in subsection (b), as redesignated by paragraph (2)--
(A) in the matter preceding paragraph (1), by
striking ``Not later than 3 years after the date on
which the Secretary establishes access standards under
subsection (a) and not less frequently than once every
3 years thereafter'' and inserting ``Review and
Report.--Not less frequently than once every three
years'';
(B) in paragraph (1), by striking ``such
standards'' and inserting ``the eligibility standards
for access to community care under subsection (a)'';
and
(C) in paragraph (2), by striking ``and any
modification to the access standards with respect to
the review conducted under paragraph (1)'' and
inserting ``of such review and such recommendations as
the Secretary may have with respect to such eligibility
standards'';
(4) in subsection (c), as so redesignated--
(A) in paragraph (1)--
(i) by striking ``(1) Subject to paragraph
(3)'' and inserting ``Requirement To Meet
Standards.--(1) Subject to paragraphs (3) and
(4)''; and
(ii) by inserting ``and health care
providers specified under section 1703(c) of
this title'' before the period at the end;
(B) in paragraph (2), by striking ``The Secretary''
and inserting ``Subject to paragraphs (3) and (4), the
Secretary''; and
(C) by adding at the end the following new
paragraph:
``(4)(A) A health care provider specified under section 1703(c) of
this title that is furnishing care pursuant to a contract, agreement,
or other arrangement between such provider and the Secretary may
request a waiver to the requirement under this subsection to meet the
access standards established under subsection (a).
``(B) Any waiver requested by a health care provider under
subparagraph (A) must be requested in writing and submitted to the
Secretary for approval.
``(C) In evaluating a waiver request by a health care provider
under subparagraph (A), the Secretary shall consider the factors
specified under paragraph (3)(D) that are relevant to the health care
provider.'';
(5) in subsection (d)(1), as so redesignated, by striking
``(1) The Secretary'' and inserting ``Publication.--(1) The
Secretary'';
(6) in subsection (e)(1), as so redesignated, by striking
``(1) Consistent with'' and inserting ``Determination Regarding
Eligibility.--(1) Consistent with''; and
(7) in subsection (f), as so redesignated, by striking ``In
this section'' and inserting ``Definitions.--In this section''.
(b) Conforming Amendments.--Section 1703(d) of such title is
amended--
(1) in paragraph (1)(D), by striking ``developed by the
Secretary''; and
(2) in paragraph (3), by striking ``developed by the
Secretary''.
SEC. 103. CONSIDERATION OF TELEHEALTH IN DETERMINING WHETHER AN
APPOINTMENT CAN BE SCHEDULED WITHIN THE ACCESS STANDARDS
OF THE DEPARTMENT OF VETERANS AFFAIRS.
Section 1703(d) of title 38, United States Code, is amended by
adding at the end the following new paragraph:
``(4) In determining under paragraph (1)(D) whether the Department
is able to furnish care or services in a manner that complies with the
access standards established under section 1703B(a) of this title, for
purposes of determining the availability of an appointment, a
telehealth appointment will only be considered as an available
appointment if the veteran accepts the use of telehealth by the
Department.''.
SEC. 104. FINALITY OF DECISION BY VETERAN AND VETERAN'S REFERRING
CLINICIAN.
Section 1703(d) of title 38, United States Code, as amended by
section 103, is further amended by adding at the end the following new
paragraph:
``(5)(A) Subject to subparagraph (B), an agreement by a covered
veteran and the covered veteran's referring clinician under paragraph
(1)(E) regarding the best medical interest of the covered veteran is
final and is not subject to review or approval by the Department.
``(B) A covered veteran and the covered veteran's referring
clinician may correct any errors made with respect to an agreement
described in subparagraph (A).''.
SEC. 105. BENEFITS FOR PERSONS DISABLED BY TREATMENT UNDER COMMUNITY
CARE PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Subsection (a) of section 1151 of title 38, United
States Code, is amended--
(1) by redesignating paragraph (2) as paragraph (3);
(2) in paragraph (1)(B), by striking ``or'' at the end; and
(3) by inserting after paragraph (1) the following new
paragraph (2):
``(2) the disability or death was caused by hospital care,
a medical service, or an extended care service furnished the
veteran by a non-Department provider under section 1703 of this
title and the proximate cause of the disability or death was--
``(A) carelessness, negligence, lack of proper
skill, error in judgment, or similar instance of fault
on the part of the provider in furnishing the hospital
care, medical service, or extended care service; or
``(B) an event not reasonably foreseeable; or''.
(b) Offset of Awards.--Such section is amended by adding at the end
the following new subsection:
``(d) The amount of any judgment awarded to an individual in a
civil action brought by the individual against a non-Department
provider in a court of competent jurisdiction for a disability or death
caused by hospital care, a medical service, or an extended care service
furnished by a non-Department provider as described in subsection
(a)(2) shall be offset by the amount of any compensation awarded to the
individual under such subsection for such disability or death.''.
SEC. 106. EXTENSION OF PERIOD FOR SUBMITTAL OF CLAIMS BY HEALTH CARE
ENTITIES AND PROVIDERS.
Section 1703D(b) of title 38, United States Code, is amended by
striking ``180 days'' and inserting ``one year''.
SEC. 107. PROGRAM ON SELF-REFERRAL OF VETERANS FOR CERTAIN SERVICES
UNDER VETERANS COMMUNITY CARE PROGRAM.
(a) In General.--The Secretary of Veterans Affairs shall carry out
a program (in this section referred to as the ``Program'') under which
the Secretary may furnish outpatient services specified in subsection
(b) through a health care provider specified in section 1703(c) of
title 38, United States Code, to a covered veteran who--
(1) is eligible for such services under criteria to be
established by the Secretary; and
(2) chooses to self-refer for such services.
(b) Outpatient Services Specified.--The outpatient services
specified in this subsection are the following:
(1) Vaccinations.
(2) Vision and hearing services.
(c) Conditions Under Which Services Are Provided.--The Secretary
shall provide services under the Program under the same conditions as
such services would be required to be provided under section 1703(d) of
title 38, United States Code.
(d) Report on Program.--
(1) In general.--Not later than two years after the date of
the enactment of this Act, and annually thereafter, the
Secretary shall submit to Congress a report on the Program.
(2) Elements.--Each report required under paragraph (1)
shall include, for the one-year period preceding the date of
the report--
(A) the number of self-referrals made under the
Program, disaggregated by type of services sought;
(B) an assessment of the timeliness of appointments
made under the Program as compared with the timeliness
of other appointments made for the same service;
(C) an assessment of satisfaction of veterans with
the Program;
(D) an assessment of the impact of the Program on
the health of patients receiving services under the
Program; and
(E) such recommendations as the Secretary may have
for services to be added or removed from the Program.
(e) Effective Date.--This section shall take effect on the date
that is one year after the date of the enactment of this Act.
(f) Covered Veteran Defined.--In this section, the term ``covered
veteran'' means a veteran described in section 1703(b) of title 38,
United States Code.
SEC. 108. REPORT ON REFERRALS FOR NON-DEPARTMENT OF VETERANS AFFAIRS
HEALTH CARE.
Not later than 180 days after the date of the enactment of this
Act, and not less frequently than monthly thereafter, the Secretary of
Veterans Affairs 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, with respect to referrals for non-
Department of Veterans Affairs health care originating from medical
facilities of the Department during the one-month period preceding the
date of the report, a measurement of, for each such facility of the
Department--
(1) the period of time between--
(A) the date that a clinician of the Department
determines that a veteran requires care, or a veteran
presents to the Department requesting care, and the
date that the referral for care is sent to a non-
Department health care provider;
(B) the date that the referral for care is sent to
a non-Department health care provider and the date that
a non-Department health care provider accepts the
referral;
(C) the date that a non-Department health care
provider accepts the referral and the date that the
referral to a non-Department health care provider is
completed;
(D) the date that the referral to a non-Department
health care provider is completed and the date that an
appointment with a non-Department health care provider
is made; and
(E) the date that an appointment with a non-
Department health care provider is made and the date
that an appointment with a non-Department health care
provider occurs; and
(2) any other period of time that the Secretary determines
necessary to measure.
SEC. 109. REQUIREMENT THAT HEALTH CARE PROVIDERS UNDER COMMUNITY CARE
PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS PROVIDE CERTAIN
DATA.
(a) In General.--Beginning not later than one year after the date
of the enactment of this Act, the Secretary of Veterans Affairs shall
require that covered providers submit to the Secretary, at such time
and in such manner as the Secretary may require, data required to be
collected and considered by the Secretary under section 1703C(a)(3) of
title 38, United States Code.
(b) Exclusion of Covered Providers.--The Secretary may not permit a
covered provider to participate in the Veterans Community Care Program
under section 1703 of title 38, United States Code, if the provider has
not provided to the Secretary data required under subsection (a).
(c) Other Providers.--The Secretary shall encourage health care
providers specified in section 1703(c) of title 38, United States Code,
that are not covered providers to submit to the Secretary, on a
voluntary basis, data described in subsection (a).
(d) Type of Data Required and Waiver.--
(1) Type of data.--The Secretary shall determine the data
required to be submitted by each type of covered provider under
subsection (a).
(2) Waiver.--The Secretary may waive the requirement to
submit data under subsection (a) for a particular type of
covered provider if the Secretary determines that the submittal
by that type of provider of such data would--
(A) not be appropriate or relevant; or
(B) constitute too heavy of a burden on the
provider.
(e) List of High-Performing Providers.--The Secretary shall publish
and maintain on a website of the Department of Veterans Affairs that is
available to the public an up-to-date list of all health care providers
that--
(1) have provided data described in subsection (a); and
(2) are high-performing providers, as determined by the
Secretary.
(f) Covered Provider Defined.--In this section, the term ``covered
provider'' means a health care provider specified in section 1703(c) of
title 38, United States Code, that the Secretary determines has
sufficient resources to submit the data required under subsection (a)
at the time and in the manner required by the Secretary under such
subsection.
SEC. 110. HIGH-COMPLIANCE RATING PROGRAM FOR PROVIDERS UNDER VETERANS
COMMUNITY CARE PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS.
(a) Program.--The Secretary of Veterans Affairs shall establish a
program under which the Secretary provides a rating of ``High
Compliance'' for community care providers that comply with the
qualifications under subsection (b).
(b) Provider Qualifications.--The Secretary shall provide a
community care provider with a rating of ``High Compliance'' pursuant
to the program established under subsection (a) if the provider--
(1) completes certain continuing medical education courses
provided by the VHA TRAIN program or related to the Opioid
Safety Initiative, as determined by the Secretary;
(2) sends to the specific authorizing office or designated
Community Care Program office of the Veterans Health
Administration the complete medical records and all required
treatment documentation, as identified by the Secretary, of not
less than 95 percent of the veterans treated by the provider
under the Veterans Community Care Program under section 1703 of
title 38, United States Code, not later than 15 days after the
completion of treatment of such veterans; and
(3) complies with such other criteria as the Secretary may
determine appropriate.
(c) Financial Incentive.--The Secretary may provide a financial
incentive for community care providers with a ``High Compliance''
rating.
(d) Program Promotion.--The Secretary shall establish a plan to
promote the program established under subsection (a) and encourage the
participation of community care providers in such program.
(e) Publication of List.--
(1) Initial publication.--The Secretary shall publish on a
publicly available website of the Veterans Health
Administration a list of community care providers that earn a
``High Compliance'' rating pursuant to the program established
under subsection (a).
(2) Update.--The Secretary shall update the list required
under paragraph (1) not less frequently than weekly.
(f) Report.--Not later than one year after the establishment of the
program under subsection (a), and annually 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 on the program, including--
(1) the courses under the VHA TRAIN program or the Opioid
Safety Initiative determined by the Secretary for purposes of
subsection (b)(1); and
(2) the status of the plans of the Secretary for promotion
under subsection (c) of the program established under
subsection (a).
(g) Definitions.--In this section:
(1) Community care provider.--The term ``community care
provider'' means a health care provider specified in subsection
(c) of section 1703 of title 38, United States Code, that is
participating in the Veterans Community Care Program under such
section.
(2) Opioid safety initiative.--The term ``Opioid Safety
Initiative'' means programs, processes, and guidelines of the
Veterans Health Administration related to the management of
opioid therapy and chronic pain.
(3) VHA train program.--The term ``VHA TRAIN program''
means the free program of the Veterans Health Administration
that offers veteran-specific continuing medical education
courses, or successor similar program.
SEC. 111. ADOPTION OF NATIONAL INTEROPERABILITY STANDARDS BETWEEN
DEPARTMENT OF VETERANS AFFAIRS AND COMMUNITY CARE
PROVIDERS.
(a) In General.--The Secretary of Veterans Affairs, in consultation
with the Secretary of Health and Human Services, the Administrator of
the Centers for Medicare & Medicaid Services, and the National
Coordinator for Health Information Technology, shall create and
implement a plan for the Department of Veterans Affairs to adopt
national interoperability standards for the electronic coordination of
care and transfer of health information (including information relating
to dental health) between the Department and community care providers
for the purposes of health care scheduling, provisioning, coordination,
and quality assessment.
(b) Exceptions and Accommodations for Providers With Fewer
Patients.--The plan required to be created and implemented under
subsection (a) shall include appropriate exceptions and accommodations
for community care providers, especially providers in rural areas and
smaller providers, who see fewer patients under the laws administered
by the Secretary of Veterans Affairs and who have not adopted
electronic health records to ensure those providers have the option to
share health information with the Department of Veterans Affairs via
non-electronic methods.
(c) Reports.--
(1) Report on plan.--Not later than one year after the date
of the enactment of this Act, the Secretary of Veterans Affairs
shall submit to Congress a report on the plan required under
subsection (a), which shall include--
(A) a gap analysis between current interoperability
standards in use between the Department of Veterans
Affairs and community care providers and opportunities
and advancements in care delivery and coordination and
related matters using available current standards and
standards under development within the Federal and non-
Federal health care sector, including an analysis of
participation by the Department and community care
providers in the Trusted Exchange Framework and Common
Agreement;
(B) recommendations for further development of
interoperability standards;
(C) a proposed timeline for adopting
interoperability standards under such plan by both the
Department and community care providers; and
(D) an indication of any resources or legislative
authorities the Secretary may request from Congress to
develop and implement adoption of interoperability
standards under such plan.
(2) Report on implementation.--Not later than 18 months
after the date of the enactment of this Act, and every 180 days
thereafter until the date that is four years after the date of
the enactment of this Act, the Secretary shall submit to
Congress a report on the implementation and revision of the
plan required under subsection (a), which shall include--
(A) updates on current gaps in interoperability
standards in use between the Department and community
care providers and recommendations for further
development of such standards; and
(B) updates on implementation of the plan and
adoption of the plan by community care providers and
the Department.
(d) Community Care Provider Defined.--In this section, the term
``community care provider'' means a non-Department health care provider
providing care (including dental care)--
(1) under section 1703 of title 38, United States Code;
(2) pursuant to a Veterans Care Agreement under section
1703A of such title; or
(3) under any other law administered by the Secretary.
SEC. 112. ANALYSIS OF FEASIBILITY AND ADVISABILITY OF ESTABLISHING A
COMMUNITY CARE NETWORK FOR THE PROVISION OF CARE TO
VETERANS IN THE REPUBLIC OF THE PHILIPPINES.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall complete
an analysis of the feasibility and advisability of establishing a
community care network for the provision of care to veterans in the
Republic of the Philippines.
(b) Report.--Not later than 180 days after the completion of the
analysis conducted under subsection (a), 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 that
includes the following:
(1) The results of such analysis.
(2) An assessment of the number of veterans residing in the
Republic of the Philippines who are eligible for the Foreign
Medical Program.
(3) An assessment of the staffing needs and associated
costs of establishing a community care network in the Republic
of the Philippines.
(4) An assessment of the infrastructure needs and
associated costs of establishing a community care network in
the Republic of the Philippines.
(5) An assessment of the challenges of establishing a
community care network in the Republic of the Philippines.
(6) An assessment of how the Secretary would determine
payment rates for providers participating in a community care
network in the Republic of the Philippines to account for
variances in medical costs in the Republic of the Philippines.
(7) An assessment of the impact of a community care network
in the Republic of the Philippines on the timeliness of
reimbursement of providers under the Foreign Medical Program.
(8) Such other elements as the Secretary considers
appropriate.
(c) Foreign Medical Program Defined.--In this section, the term
``Foreign Medical Program'' means the program under which the Secretary
of Veterans Affairs provides hospital care and medical services under
section 1724 of title 38, United States Code.
SEC. 113. PILOT PROGRAM ON CONSOLIDATING THE COMMUNITY CARE DENTAL
TREATMENT PLAN APPROVAL PROCESS OF DEPARTMENT OF VETERANS
AFFAIRS.
(a) In General.--Commencing not later than 180 days after the date
of the enactment of this Act, the Secretary of Veterans Affairs shall
carry out a two-year pilot program (in this section referred to as the
pilot program) to test the efficacy of--
(1) hiring general dentists at the facility level to manage
approval by the Department of Veterans Affairs of treatment
plans requested by dental providers in providing community
care; and
(2) hiring dental specialists at the Veterans Integrated
Service Network level to aid in approving treatment plans for
specialty dental care requested by dental providers in
providing community care.
(b) Locations.--The Secretary shall select not fewer than two
Veterans Integrated Service Networks of the Department at which to
carry out the pilot program.
(c) Reports.--
(1) Initial report.--Not later than one year after the
commencement of the pilot program, 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 on the pilot program, including--
(A) an identification of the Veterans Integrated
Service Networks participating in the pilot program;
(B) a description of the implementation of the
pilot program;
(C) an identification of any barriers or challenges
to implementing the pilot program;
(D) aggregated feedback with respect to the pilot
program from dentists of the Department in Veterans
Integrated Service Networks participating in the pilot
program; and
(E) aggregated feedback from dental providers
providing community care within Veterans Integrated
Service Networks participating in the pilot program
regarding any changes in the timeliness of treatment
plan approvals by the Department.
(2) Final report.--Not later than 90 days before the
completion of the pilot program, 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 on the pilot program that--
(A) includes the matters required under paragraph
(1);
(B) includes recommendations on whether the pilot
program should be continued or adopted throughout the
Department; and
(C) indicates whether the Secretary requests action
by Congress to make the pilot program permanent.
(d) Community Care Defined.--In this section, the term ``community
care'' means dental care provided--
(1) under section 1703 of title 38, United States Code; or
(2) pursuant to a Veterans Care Agreement under section
1703A of such title.
SEC. 114. REVIEWS OF PAYMENT RATE WAIVERS UNDER VETERANS COMMUNITY CARE
PROGRAM.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, and annually thereafter, the Secretary of
Veterans Affairs shall--
(1) conduct a review of payment rate waivers for third
party administrators under the Veterans Community Care Program
under section 1703 of title 38, United States Code, to identify
whether those waivers are helping to alleviate community-
specific challenges, including scarcity of medical services
associated with access to care; and
(2) submit to Congress a report on the results of the
review.
(b) Inclusion in Rate Review.--Each review required under
subsection (a) shall include--
(1) a review of the total number of payment rate waivers
requested for each region, including the number granted,
denied, or withdrawn;
(2) the process for review of payment rate waivers;
(3) the average time to process payment rate waivers in
each region;
(4) the impact of payment rate waivers granted in a region
on access to care in that region; and
(5) trends identified by the Secretary with respect to
payment rate waivers.
SEC. 115. COMPTROLLER GENERAL REPORT ON DENTISTRY UNDER VETERANS
COMMUNITY CARE PROGRAM.
Not later than one year after the date of the enactment of this
Act, the Comptroller General of the United States shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report on dental
care furnished by the Secretary of Veterans Affairs under the Veterans
Community Care Program under section 1703 of title 38, United States
Code, to include a review of--
(1) the impact current reimbursement rates provided by the
Department of Veterans Affairs to dental providers under such
program have on--
(A) the availability of dental care for veterans;
and
(B) the ability of third party administrators of
provider networks under such program to meet their
contractual obligations for network adequacy;
(2) the satisfaction of dental providers providing dental
care under such program with the processes of the Department
for approving dental care under such program; and
(3) the current processes of the Department for approving
emergent dental care under such program.
TITLE II--HEALTH CARE EMPLOYEES
SEC. 201. ESTABLISHMENT OF START AND STAY AT VA PROGRAM.
(a) In General.--Chapter 76 of title 38, United States Code, is
amended by adding at the end the following new subchapter:
``Subchapter X--Start and Stay at VA Program
``Sec. 7699C. Start and Stay at VA Program
``(a) In General.--As part of the Educational Assistance Program,
the Secretary shall carry out a program under this subchapter to
provide--
``(1) scholarships under section 7699C-1 of this title; and
``(2) lump sum education debt reduction under section
7699C-2 of this title.
``(b) Name of Program.--The program under this subchapter shall be
known as the Start and Stay at VA Program (in this subchapter referred
to as the `Program').
``Sec. 7699C-1. Scholarships
``(a) Covered Costs.--A scholarship provided to an individual under
the Program shall consist of payment of reasonable education expenses
of the individual for a course of education or training described in
subsection (b)(3), including tuition, fees, books, and laboratory
expenses.
``(b) Eligibility.--An individual is eligible to receive a
scholarship under the Program if the individual--
``(1) is an employee of the Department serving as a medical
support assistant, advanced medical support assistant, lead
medical support assistant, or supervisory medical support
assistant;
``(2) as of the date on which the individual submits an
application for participation in the Program, has been
continuously employed by the Department in one or more of the
positions specified in paragraph (1) for a period of not less
than two years;
``(3) has been accepted for enrollment or is enrolled as a
student in a course of education or training--
``(A) listed as a requirement for any shortage
occupation position, as determined by the Secretary;
``(B) related to business, health care
administration, or human resources; or
``(C) completion of which results in any other
degree or certification that the Secretary considers
appropriate for purposes of the Program; and
``(4) has a record of employment with the Department that,
in the judgment of the Secretary, demonstrates a high
likelihood that the individual will be successful in completing
such course of education or training and in gaining employment
in a field related to such course of education or training.
``(c) Period of Obligated Service.--
``(1) Agreement.--
``(A) In general.--An agreement between the
Secretary and a participant under the Program who seeks
a scholarship under this section, in addition to the
requirements set forth in section 7604 of this title,
shall include the following:
``(i) The agreement of the Secretary to
provide the participant with a scholarship
under the Program for a specified number of
school years, which may not exceed the credit
equivalent of four full school years, during
which the participant pursues a course of
education or training described in subsection
(b)(3) that meets the requirements set forth in
section 7602(a) of this title.
``(ii) Subject to subparagraph (B), the
agreement of the participant to serve as a
full-time employee in the Department in a
position described in subsection (b)(3)(A) for
a period of time, not less than one year, that
is equal to the period of the course of
education or training for which a scholarship
is provided under this section (in this section
referred to as the `period of obligated
service' of the participant).
``(B) Part-time students.--In the case of a
participant who is a part-time student during a school
year with respect to which a scholarship is provided to
the participant under this section, the period of
obligated service of the participant incurred during
that school year shall be reduced in accordance with
the proportion that the number of credit hours carried
by the participant in that school year bears to the
number of credit hours required to be carried by a
full-time student in the course of education or
training pursued by the participant during that school
year, but in no event may the total period of obligated
service of the participant be reduced to less than one
year.
``(2) Service commencement date.--
``(A) In general.--Except as provided in
subparagraph (F) of (G), not later than 60 days before
the service commencement date of a participant under
this section, the Secretary shall notify the
participant of that service commencement date. That
date is the beginning of the period of obligated
service of the participant.
``(B) Doctors and similar health care
professionals.--In the case of a participant receiving
a degree from a school of medicine, osteopathy,
dentistry, optometry, or podiatry, the service
commencement date of the participant is the date the
participant becomes licensed to practice medicine,
osteopathy, dentistry, optometry, or podiatry, as the
case may be, in a State.
``(C) Nurses.--In the case of a participant
receiving a degree from a school of nursing, the
service commencement date of the participant is the
later of--
``(i) the course completion date of the
participant; or
``(ii) the date the participant becomes
licensed as a registered nurse in a State.
``(D) Other health care professionals.--In the case
of a participant not covered by subparagraph (B) or
(C), the service commencement date of the participant
is the later of--
``(i) the course completion date of the
participant; or
``(ii) the date the participant meets any
applicable licensure or certification
requirements.
``(E) Treatment of part-time students.--The
Secretary shall specify the service commencement date
for participants who were part-time students, which
shall include terms as similar as practicable to the
terms set forth in subparagraphs (B) through (D).
``(F) Service during course of education or
training.--A participant may serve the period of
obligated service of the participant, or any portion of
such period of obligated service, during the period in
which the participant is enrolled as a student in a
course of education or training under subsection (b)(3)
if the participant is employed in a position described
in subparagraph (A) of such subsection.
``(G) Service following licensure or ongoing
training.--With respect to a participant who is
licensed but may enter a residency or similar training
program, the Secretary may adjust the beginning of the
period of obligated service of the participant to begin
following completion of the residency or similar
training program.
``(H) Course completion date defined.--In this
section, the term `course completion date' means the
date on which a participant under this section
completes the course of education or training of the
participant under this section.
``(d) Liability for Breach of Agreement.--
``(1) Liability during course of education or training.--
``(A) In general.--Except as provided in paragraph
(3), a participant under this section shall be liable
to the United States for the amount that has been paid
to or on behalf of the participant under the agreement
under subsection (c)(1) if any of the following occurs:
``(i) The participant fails to maintain an
acceptable level of academic standing in the
educational institution in which the
participant is enrolled (as determined by the
educational institution pursuant to direction
by the Secretary).
``(ii) The participant is dismissed from
such educational institution for disciplinary
reasons.
``(iii) The participant voluntarily
terminates the course of education or training
in such educational institution before the
completion of such course of education or
training.
``(iv) The participant, as applicable,
during a period of time determined by the
Secretary--
``(I) fails to become licensed to
practice medicine, osteopathy,
dentistry, podiatry, or optometry in a
State;
``(II) fails to become licensed as
a registered nurse in a State; or
``(III) in the case of any other
health-care personnel who is not
covered under subclause (I) or (II),
fails to meet any applicable licensure
or certification requirement.
``(B) In lieu of service obligation.--Liability
under this paragraph is in lieu of any period of
obligated service arising under the agreement of the
participant under subsection (c)(1).
``(2) Liability during period of obligated service.--Except
as provided in paragraph (3), if a participant under this
section breaches the agreement under subsection (c)(1) by
failing for any reason to complete the period of obligated
service of the participant, the United States shall be entitled
to recover from the participant an amount equal to--
``(A) the total amount paid under this section to
the participant; multiplied by
``(B) a fraction--
``(i) the numerator of which is--
``(I) the total number of months in
the period of obligated service of the
participant; minus
``(II) the number of months served
by the participant; and
``(ii) the denominator of which is the
total number of months in the period of
obligated service of the participant.
``(3) Limitation on liability for reduction in force.--
Liability shall not arise under paragraph (1) or (2) in the
case of a individual covered by either such paragraph if the
individual does not obtain, or fails to maintain, employment as
an employee of the Department due to staffing changes approved
by the Secretary.
``(e) Payment of Amounts and Limitations.--
``(1) Total amount for a school year.--The total amount of
a scholarship payable to a participant under this section--
``(A) may not exceed $20,000 for the equivalent of
one year of full-time coursework in a course of
education or training; or
``(B) in the case of a participant who is a part-
time student, may not exceed an amount that bears the
same ratio to the amount that would be paid under
subparagraph (A) if the student were a full-time
student in the course of education or training being
pursued by the participant as the coursework carried by
the participant compares to full-time coursework in
that course of education or training.
``(2) Maximum number of school years.--
``(A) Total years.--The number of school years for
which a scholarship may be paid to a participant under
this section may not exceed eight school years.
``(B) Full-time equivalent.--A participant may not
receive a scholarship under this section for more than
the equivalent of four years of full-time coursework.
``(3) Maximum total amount.--The total amount paid to or on
behalf of a participant through a scholarship under this
section may not exceed $80,000.
``(4) Payment of educational expenses by educational
institutions.--The Secretary may arrange with an educational
institution in which a participant under this section is
enrolled for the payment of education expenses under subsection
(a). Such payments may be made without regard to subsections
(a) and (b) of section 3324 of title 31.
``Sec. 7699C-2. Lump sum education debt reduction
``(a) Covered Costs.--Lump sum education debt reduction provided by
the Secretary under this section to an individual shall consist of
payment of principal and interest under a loan, the proceeds of which
were used by or on behalf of that individual to pay costs relating to a
course of education or training, including tuition expenses and other
reasonable educational expenses, including fees, books, laboratory
expenses, and reasonable living expenses.
``(b) Eligibility.--An individual is eligible to receive lump sum
education debt repayment under this section if the individual--
``(1) owes any amount of principal and interest under a
loan, the proceeds of which were used by or on behalf of that
individual to pay costs relating to a course of education or
training;
``(2) commits to a period of obligated service under
subsection (d); and
``(3) has been offered employment in the Department in the
position of a medical support assistant, advanced medical
support assistant, lead medical support assistant, or
supervisory medical support assistant.
``(c) Payments.--
``(1) In general.--A lump sum education debt reduction
payment under this section shall consist of a payment to a
participant under this section of an amount not to exceed the
lesser of--
``(A) the principal and interest on loans described
in subsection (a) that is outstanding for such
participant at the time of the payment; or
``(B) $40,000.
``(2) Proof of use of amounts.--Participants under this
section in receipt of a lump sum education debt reduction
payment under this section must provide proof of payment
verifying the full lump sum payment received was paid to the
lender for the loan held by such participant not later than 45
days after receiving the lump sum payment.
``(d) Period of Obligated Service.--
``(1) In general.--In exchange for a one-time lump sum
education debt payment under this section, a participant under
this section shall agree to be employed for not less than three
years at the Department (in this section referred to as the
`period of obligated service').
``(2) Positions of employment.--
``(A) Medical support.--Not fewer than two of the
years of the period of obligated service of a
participant under this section shall be served in the
position of medical support assistant, advanced medical
support assistant, lead medical support assistant, or
supervisory medical support assistant of the
Department.
``(B) Hard-to-hire or hard-to-recruit.--The
remainder of any period of obligated service not
covered under subparagraph (A) shall be served in a
hard-to-hire or hard-to-recruit position as determined
by the Secretary.
``(e) Liability During Period of Obligated Service.--
``(1) In general.--Except as provided in paragraph (2), if
a participant under this section fails to complete the period
of obligated service of the participant for any reason, the
United States shall be entitled to recover from the participant
an amount equal to--
``(A) the total amount paid under this section to
the participant; multiplied by
``(B) a fraction--
``(i) the numerator of which is--
``(I) the total number of months in
the period of obligated service of the
participant; minus
``(II) the number of months served
by the participant; and
``(ii) the denominator of which is the
total number of months in the period of
obligated service of the participant.
``(2) Exception.--Liability shall not arise under paragraph
(1) in the case of an individual covered by that paragraph if
the individual does not obtain, or fails to maintain,
employment as an employee of the Department due to staffing
changes approved by the Secretary.
``Sec. 7699C-3. Administration
``(a) Outreach.--
``(1) In general.--The Secretary shall develop an outreach
program to Tribal Colleges and Universities, historically Black
colleges and universities, high schools in rural areas,
community colleges, transition assistance programs for members
of the Armed Forces transitioning to civilian life, and spouses
of such members to provide information about the Program.
``(2) Tribal college or university defined.--In this
subsection, the term `Tribal College or University' has the
meaning given that term under section 316 of the Higher
Education Act of 1965 (20 U.S.C. 1059c).
``(b) Mentors.--The Secretary shall ensure that a mentor or mentors
are available for each individual participating in the Program at the
facility at which the individual is employed.
``Sec. 7699C-4. Limitation
``No individual may receive both a scholarship under section 7699C-
1 of this title and a lump sum education debt reduction under section
7699C-2 of this title.
``Sec. 7699C-5. Termination
``The authority to carry out the Program shall terminate on the
date that is 10 years after the date of the enactment of the Making
Community Care Work for Veterans Act of 2023.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by adding at the end the following:
``subchapter x--start and stay at va program
``Sec.
``7699C. Start and Stay at VA Program.
``7699C-1. Scholarships.
``7699C-2. Lump sum education debt reduction.
``7699C-3. Administration.
``7699C-4. Limitation.
``7699C-5. Termination.''.
(c) Conforming Amendments.--
(1) Establishment of program.--Section 7601(a) of such
title is amended--
(A) in paragraph (6), by striking ``and'';
(B) in paragraph (7), by striking the period and
inserting ``; and''; and
(C) by adding at the end the following new
paragraph:
``(8) the program to provide scholarships and lump sum
education debt reduction provided for in subchapter X of this
chapter.''.
(2) Eligibility.--Section 7602 of such title is amended--
(A) in subsection (a)(1)--
(i) by striking ``or IX'' and inserting
``IX, or X'';
(ii) by striking ``or for which a
scholarship'' and inserting ``for which a
scholarship''; and
(iii) by inserting ``or for which a
scholarship or lump sum education debt
reduction may be provided under subchapter X of
this chapter,'' before ``as the case may be'';
and
(B) in subsection (b), by striking ``or IX'' and
inserting ``IX, or X''.
(3) Application.--Section 7603(a)(1) of such title is
amended by striking ``or IX'' and inserting ``IX, or X''.
(4) Terms of agreement.--Section 7604 of such title is
amended by striking ``or IX'' each place it appears and
inserting ``IX, or X''.
(5) Annual report.--Section 7632 of such title is amended--
(A) in paragraph (1), by striking ``and the
Readjustment Counseling Service Scholarship Program''
and inserting ``the Readjustment Counseling Service
Scholarship Program, and the Start and Stay at VA
Program''; and
(B) in paragraph (4), by striking ``and per
participant in the Readjustment Counseling Service
Scholarship Program'' and inserting ``per participant
in the Readjustment Counseling Service Scholarship
Program, and per participant in the Start and Stay at
VA Program''.
SEC. 202. EXPANSION OF PERIOD OF PAYMENT UNDER EMPLOYEE INCENTIVE
SCHOLARSHIP PROGRAM.
Section 7673(c) of title 38, United States Code, is amended--
(1) in paragraph (1) by striking ``six'' and inserting
``eight''; and
(2) in paragraph (2) by striking ``three'' and inserting
``four''.
SEC. 203. MENTORSHIP PROGRAM FOR EXECUTIVE LEADERSHIP TEAMS AT MEDICAL
CENTERS OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--The Secretary of Veterans Affairs may establish a
program to connect covered individuals (in this section referred to as
``mentees'') with peer mentors to facilitate sharing of best practices
and leadership experiences and to foster opportunities to develop
knowledge and skills required to lead successfully at medical
facilities of the Department (in this section referred to as the
``mentorship program'').
(b) Covered Individual Defined.--In this section, the term
``covered individual'' means--
(1) an individual in the position of Facility Director,
Chief of Staff, Associate Director of Patient Care Services,
Associate Director, Assistant Director, or Deputy Director at a
medical center of the Department; or
(2) any other employee of the Department who is determined
by the Secretary to be an executive leader at a medical center
of the Department.
(c) Eligibility.--The following employees of the Department are
eligible for participation as mentees in the mentorship program:
(1) An employee appointed to a position as a covered
individual on or after the date of the enactment of this Act.
(2) A covered individual employed at a medical center of
the Department (regardless of appointment commencement date)
that meets one or more of the following criteria:
(A) Reports poor performance, as defined by the
Secretary, on the Strategic Analytics for Improvement
and Learning Value Model of the Department, or
successor similar model.
(B) Reports data under section 1703C(a)(3) of title
38, United States Code, as published on the Access to
Care website of the Department, or successor similar
website, that--
(i) does not consistently meet the level
reported in the community surrounding such
medical center, as determined by the Secretary;
or
(ii) does not meet a threshold level
determined by the Secretary.
(C) Has one or more recommendations from a report
by the Office of Inspector General of the Department of
Veterans Affairs that is still open more than one year
after the report was published.
(3) A covered individual employed at a medical center of
the Department (regardless of appointment commencement date)
who is recommended by the director of the Veterans Integrated
Service Network overseeing such medical center.
(d) Criteria for Peer Mentors.--Each peer mentor to be paired with
a mentee under subsection (a) shall meet each of the following
criteria:
(1) Previous or current employment in the same position
title as the mentee.
(2) Employment in that position for not less than two
years.
(3) Employment at a medical center of the Department that
reports--
(A) above average performance, as defined by the
Secretary, on the Strategic Analytics for Improvement
and Learning Value Model of the Department, or
successor similar model; and
(B) data under section 1703C(a)(3) of title 38,
United States Code, as published on the Access to Care
website of the Department, or successor similar
website, that exceeds the level reported in the
community surrounding such medical center, as
determined by the Secretary.
(e) Report.--Not later than one year after the date of the
enactment of this Act, and annually thereafter for an additional three
years, 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 on the mentorship program, including--
(1) the number of mentees and peer mentors participating in
the mentorship program, disaggregated by medical center of the
Department;
(2) the number of mentor-mentee pairings initiated under
each of the eligibility criteria outlined in paragraphs (1),
(2), and (3) of subsection (c), including information on any
circumstances in which multiple criteria under such paragraphs
were met;
(3) a description of the actions taken by the Department to
encourage communication between mentees and peer mentors;
(4) aggregated feedback from participants in the mentorship
program; and
(5) the turnover rate for covered individuals.
TITLE III--OTHER HEALTH CARE MATTERS
SEC. 301. TIMING FOR SCHEDULING OF APPOINTMENTS AT FACILITIES 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 1706A the following
new section:
``Sec. 1706B. Requirements for timing of scheduling of appointments at
Department facilities
``The Secretary shall ensure that an appointment for a veteran for
care or services under this chapter from a facility of the Department--
``(1) in the case of a non-urgent appointment, is scheduled
(but may occur at a later date) not later than seven days after
the earlier of the date on which--
``(A) a clinician of the Department determines that
the veteran requires care; or
``(B) the veteran presents to the Department
requesting care; and
``(2) in the case of an appointment for urgent care, is
completed not later than 48 hours after the earlier of the date
on which--
``(A) a clinician of the Department determines that
the veteran requires care; or
``(B) the veteran presents to the Department
requesting care.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such subchapter is amended by inserting after the item relating to
section 1706A the following new item:
``1706B. Requirements for timing of scheduling of appointments at
Department facilities.''.
(c) Effective Date.--The Secretary of Veterans Affairs shall comply
with the requirements under section 1706B of title 38, United States
Code, as added by subsection (a), by not later than 180 days after the
date of the enactment of this Act.
SEC. 302. MODIFICATION OF REQUIREMENTS FOR STANDARDS FOR QUALITY OF
CARE FROM DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Subsection (a) of section 1703C of title 38,
United States Code, is amended--
(1) in paragraph (2)--
(A) by striking ``In establishing'' and inserting
``(A) In establishing''; and
(B) by adding at the end the following new
subparagraph:
``(B) The Secretary shall ensure that the standards for quality
established under paragraph (1) are comparable to industry standards to
ensure there is adequate data transference between care furnished by
the Department and care furnished by a non-Department provider.'';
(2) in paragraph (3)--
(A) in subparagraph (A), by striking ``; and'' and
inserting a semicolon;
(B) in subparagraph (B)--
(i) in the matter preceding clause (i), by
striking ``to the following:'' and inserting
``to--'';
(ii) in clause (i)--
(I) by striking ``Timely'' and
inserting ``timely''; and
(II) by striking the period at the
end and inserting a semicolon;
(iii) in clause (ii)--
(I) by striking ``Effective'' and
inserting ``effective''; and
(II) by striking the period at the
end and inserting a semicolon;
(iv) in clause (iii)--
(I) by striking ``Safety'' and
inserting ``safety''; and
(II) by striking the period at the
end and inserting a semicolon;
(v) in clause (iv)--
(I) by striking ``Efficiency'' and
inserting ``efficiency''; and
(II) by striking the period at the
end and inserting ``; and''; and
(vi) by adding at the end the following new
clause:
``(v) equitable care; and''; and
(C) by adding at the end the following new
subparagraph:
``(C) measurements of standards for quality that include
measurements of--
``(i) the degree to which care is furnished
uniquely to patient needs;
``(ii) workforce safety;
``(iii) employee engagement;
``(iv) safety culture;
``(v) outcomes on patient quality of life; and
``(vi) such other matters as the Secretary
considers appropriate.'';
(3) in paragraph (4), by striking ``and the Centers for
Medicare & Medicaid Services'' and inserting ``the Centers for
Medicare & Medicaid Services, and the Indian Health Service'';
and
(4) by striking paragraph (5) and inserting the following
new paragraphs:
``(5) When collecting, considering, and applying data related to
patient care for purposes of establishing standards for quality under
paragraph (1), the Secretary shall ensure no metric is being over or
under analyzed.
``(6) In establishing standards for quality under paragraph (1),
the Secretary shall--
``(A) utilize the most current practices in extracting and
analyzing relevant data;
``(B) utilize all relevant data available to the Secretary;
``(C) ensure the most efficient use of time and resources
related to the use of data scientists employed by the
Department; and
``(D) collaborate, as appropriate, with entities specified
in paragraph (4).
``(7)(A) Not later than five years after the submittal of the
report required by section 302(d)(2)(B) of the Making Community Care
Work for Veterans Act of 2023, and not less frequently than once every
five years thereafter, the Secretary shall update the standards for
quality established under paragraph (1) pursuant to the requirements
for the establishment of such standards under this subsection.
``(B) Not later than 30 days after any update under subparagraph
(A) of standards for quality established under paragraph (1), the
Secretary shall submit to the appropriate committees of Congress a
report on such updated standards for quality.''.
(b) Publication and Consideration of Public Comments.--Subsection
(b) of such section is amended--
(1) in paragraph (1)--
(A) by striking ``Not later than 1 year after the
date on which the Secretary establishes standards for
quality under subsection (a)'' and inserting ``Not less
frequently than once every three years''; and
(B) by inserting ``pursuant to standards for
quality under subsection (a)'' after ``medical
facilities of the Department''; and
(2) in paragraph (2), by inserting ``or updates'' after
``establishes''.
(c) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit
to the appropriate committees of Congress a report on--
(1) how the Secretary has consulted with entities specified
in paragraph (4) of section 1703C(a) of title 38, United States
Code, before the date of the enactment of this Act in
establishing standards for quality under such section;
(2) how the Secretary has continued to consult with those
entities on and after such date of enactment; and
(3) how the Secretary intends to leverage data sciences to
improve standards for quality care furnished by the Department
of Veterans Affairs.
(d) Initial Update to Quality Care Metrics.--
(1) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
submit to the appropriate committees of Congress a report on
how the Secretary plans to implement the amendments made by
subsections (a) and (b).
(2) Implementation.--Not later than two years after the
date of the enactment of this Act, the Secretary shall--
(A) implement the amendments made by subsections
(a) and (b), including by updating the standards for
quality established under section 1703C(a)(1) of title
38, United States Code; and
(B) submit to the appropriate committees of
Congress a report detailing the standards for quality
updated pursuant to such amendments.
(e) Appropriate Committees of Congress Defined.--In this section,
the term ``appropriate committees of Congress'' means--
(1) the Committee on Veterans' Affairs and the Committee on
Appropriations of the Senate; and
(2) the Committee on Veterans' Affairs and the Committee on
Appropriations of the House of Representatives.
SEC. 303. MENTAL HEALTH RESIDENTIAL REHABILITATION TREATMENT PROGRAM OF
THE DEPARTMENT OF VETERANS AFFAIRS.
(a) General Requirements.--
(1) Deadline.--The Secretary of Veterans Affairs shall
fulfill each requirement under this section by not later than
one year after the date of the enactment of this Act, unless
otherwise specified.
(2) Guidance.--The Secretary shall update the guidance of
the Department of Veterans Affairs on the operation of the
Mental Health Residential Rehabilitation Treatment Program (in
this section referred to as the ``Program'') to reflect each of
the requirements under subsections (b) through (h).
(b) Referral and Admission.--
(1) Referral.--
(A) Standardized process.--The Secretary shall
establish a standardized consultation requirement or
other process for referrals to the Program.
(B) Timeliness standards.--The Secretary shall
specify timeliness standards for responding to
referrals and completing screenings for the Program,
including for when priority admission is requested,
from--
(i) providers of the Department;
(ii) non-Department providers; and
(iii) veteran patients (self-referrals).
(2) Screening of priority veterans.--
(A) In general.--For any veteran who meets priority
admission standards under the Program during a
screening for the Program, the Secretary shall admit
the veteran not later than 72 hours after the time at
which the veteran was screened.
(B) Other admission options.--With respect to a
veteran specified in subparagraph (A), if there are no
available bed spaces for admission under the Program at
the facility of the Department or within the Veterans
Integrated Service Network nearest to the residence of
the veteran within the 72-hour period specified in such
subparagraph, the Secretary shall offer the veteran a
choice of care--
(i) at another facility of the Department
anywhere in the United States that can admit
the veteran within such period; or
(ii) at a non-Department residential care
facility in the community that can admit the
veteran within such period and--
(I) has a contract or agreement
with the Department in place; or
(II) will enter into such a
contract or agreement prior to
furnishing such care.
(3) Admission.--The Secretary shall specify timeliness
standards for the admission of a veteran into the Program, or
the referral of a veteran to a non-Department residential care
facility in the community, upon making an admission decision
with respect to the veteran.
(4) Performance metrics.--
(A) In general.--The Secretary shall develop
metrics to track, and shall subsequently track, the
performance of the Department, and contractors of the
Department that provide residential care to veterans,
in meeting--
(i) the requirements for referral to the
Program under paragraph (1) and any other
provision of law;
(ii) the requirements for screening for the
Program and other admission options under
paragraph (2); and
(iii) the requirements for timely admission
to the Program under paragraph (3).
(B) Elements.--The metrics developed under
subparagraph (A) shall include metrics for tracking
performance with respect to routine and priority access
under the Program.
(c) Placement; Transportation.--
(1) Locations; start dates.--If the Secretary determines
that a veteran is in need of residential care under the
Program, the Secretary shall provide the veteran with a list of
locations that meet--
(A) the care needs of the veteran, including
applicable treatment tracks; and
(B) the clinically indicated best start date for
the veteran to receive care, taking into account the
preferences of the veteran.
(2) Wait times.--The Secretary shall make every effort to
limit the time a veteran waits for placement into the Program,
including by offering the veteran placement at one or more
locations outside of the area of the home facility of the
veteran or the home Veterans Integrated Service Network of the
veteran, or at a non-Department residential care facility, if
there are no other options that meet the care needs of the
veteran and are consistent with the policy of the Department on
wait times for access to care under the Program.
(3) Transportation coverage.--The Secretary shall provide
transportation or pay for or reimburse the costs of
transportation for any veteran who is admitted into the Program
and needs transportation assistance--
(A) from the residence of the veteran or a facility
of the Department or authorized non-Department facility
that does not provide such care to another such
facility that provides residential care covered under
the Program; and
(B) back to the residence of the veteran after the
conclusion of the Program, if applicable.
(d) Considerations.--In making screening, admission, and placement
decisions under the Program, the Secretary shall consider the input and
preferences of the veteran and the treating clinicians of the veteran,
including with respect to wait times, the program specialty, subtype,
or treatment track offered to the veteran, and the geographic placement
of the veteran, including family- or occupation-related preferences or
circumstances.
(e) Appeals.--
(1) In general.--The Secretary shall develop a national
policy and associated procedures under which a veteran, a
representative of a veteran, or a provider who refers a veteran
to the Program, including a provider of the Department or a
non-Department provider, may file an appeal if the veteran is
denied admission into the Program or is accepted into the
Program but is not offered bed placement in a timely manner.
(2) Timeliness standards for review.--
(A) In general.--The national policy and procedures
developed under paragraph (1) for appeals described in
such paragraph shall include timeliness standards for
the Department to review and make a decision on such an
appeal.
(B) Priority admission.--The Secretary shall review
and respond to all appeals related to priority
admission to the Program not later than 72 hours after
receiving the appeal.
(C) Routine admission.--The Secretary shall review
and respond to all appeals related to routine admission
to the Program not later than five business days after
receiving the appeal.
(3) Public guidance.--The Secretary shall develop, and make
available to the public, guidance on how a veteran, a
representative of the veteran, or a referring provider of the
veteran can file an appeal--
(A) if the veteran is denied admission into the
Program;
(B) if the veteran is admitted into the Program and
the first date on which the veteran may enter the
Program does not comply with the wait time standards
established by the Department and under this section
for purposes of priority or routine admission into the
Program; or
(C) with respect to such other factors as the
Secretary may specify.
(f) Tracking of Availability and Wait Times.--
(1) In general.--The Secretary shall create a method for
tracking availability and wait times under the Program across
all facilities and Veterans Integrated Service Networks of the
Department throughout the United States.
(2) Availability of information.--The Secretary shall make
the information tracked under paragraph (1) available in real
time to--
(A) the mental health treatment coordinators at
each facility of the Department;
(B) the leadership of each medical center of the
Department;
(C) the leadership of each Veterans Integrated
Service Network; and
(D) the Office of the Under Secretary for Health of
the Department.
(g) Training and Oversight.--
(1) Training.--
(A) In general.--The Secretary shall update and
implement training for all staff of the Department
involved in the Program regarding referrals, screening,
admission, placement decisions, and appeals for the
Program, including all changes to processes and
guidance under the Program required by this section.
(B) Veterans awaiting admission.--The training
under subparagraph (A) shall include procedures for the
care of veterans awaiting admission into the Program
and communication with such veterans and their
referring providers.
(C) Timing of training.--
(i) In general.--The Secretary shall
require the training under subparagraph (A) to
be completed by staff required to complete such
training--
(I) upon being first employed in a
position that includes work involving
the Program; and
(II) not less frequently than
annually.
(ii) Tracking.--The Secretary shall track
completion of training required under clause
(i) by staff required to complete such training
and ensure its completion as required under
such clause.
(2) Oversight standards.--The Secretary shall review and
revise oversight standards for the leadership of the Veterans
Integrated Service Networks to ensure that facilities and staff
of the Department are adhering to the policy of the Program on
access to care.
(h) Care Coordination and Follow-Up Care.--
(1) Continuity of care.--The Secretary shall ensure each
veteran who is screened for admission to the Program is
offered, and provided if agreed upon, care options during the
period between screening of the veteran and admission of the
veteran to the Program to ensure the veteran does not
experience any lapse in care.
(2) Care coordination for substance use disorder.--For a
veteran being treated for substance use disorder, the Secretary
shall--
(A) ensure there is a care plan in place during the
period between any detoxification services or inpatient
care received by the veteran and admission of the
veteran to the Program; and
(B) communicate that care plan to the veteran, the
primary care provider of the veteran, and the facility
of the Program where the veteran is or will be
residing.
(3) Care planning prior to discharge.--
(A) In general.--The Secretary, in consultation
with the veteran and the treating providers of the
veteran in the Program, shall ensure the completion of
a care plan prior to the veteran being discharged from
the Program.
(B) Matters to be included.--The care plan required
under subparagraph (A) for a veteran shall include
details on the course of treatment for the veteran
following completion of treatment under the Program,
including any needed follow-up care.
(C) Sharing of care plan.--The care plan required
under subparagraph (A) shall be shared with the
veteran, the primary care provider of the veteran, and
any other providers with which the veteran consents to
sharing the plan.
(D) Discharge from non-department facility.--Upon
discharge of a veteran under the Program from a non-
Department facility, the facility shall share with the
Department all care records maintained by the facility
with respect to the veteran and shall work in
consultation with the Department on the care plan of
the veteran required under subparagraph (A).
(i) Reports to Congress.--
(1) Report on changes made to program.--
(A) In general.--Not later than two years 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 a report on changes made to
the guidance, operation, and oversight of the Program
to fulfill the requirements of this section.
(B) Funding.--The report required by subparagraph
(A) shall--
(i) examine how care provided to veterans
under the Program is funded, including care
provided through--
(I) facilities of the Department;
and
(II) non-Department facilities;
(ii) assess whether costs of the Program,
including for residential care provided through
facilities of the Department and non-Department
facilities, serve as a disincentive to
placement in the Program;
(iii) identify the average cost of a stay
under the Program, including total stay average
and daily average, at--
(I) a facility of the Department;
and
(II) a non-Department facility; and
(iv) include such recommendations as the
Secretary may have for legislative or
administrative action to address any funding
constraints or disincentives for use of the
Program.
(C) Actions taken to address recommendations.--
(i) In general.--The Secretary shall
include with the report required by
subparagraph (A) a description of actions taken
by the Department to address the findings and
recommendations by the Secretary contained in
the report under section 503(c) of the STRONG
Veterans Act of 2022 (division V of Public Law
117-328).
(ii) Actions to be included.--Actions to be
included under clause (i) shall include--
(I) any new locations of the
Program added;
(II) any beds added at existing
facilities of the Program; and
(III) any additional treatment
tracks or gender-specific programs
created or added at facilities of the
Department.
(2) Annual report on operation of program.--
(A) In general.--Not later than one year after
submitting the report required by paragraph (1)(A), and
not less frequently than annually 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 on the
operation of the Program.
(B) Elements.--Each report required by subparagraph
(A) shall include the following:
(i) The number of veterans served by the
Program, disaggregated by--
(I) Veterans Integrated Service
Network in which the veteran receives
care;
(II) facility, including facilities
of the Department and non-Department
facilities, at which the veteran
receives care;
(III) type of residential
rehabilitation treatment care received
by the veteran under the Program;
(IV) gender of the veteran; and
(V) race or ethnicity of the
veteran.
(ii) Wait times under the Program for the
most recent year data is available,
disaggregated by--
(I) treatment track or specificity
of residential rehabilitation treatment
care sought by the veteran;
(II) gender of the veteran;
(III) State or territory in which
the veteran is located;
(IV) Veterans Integrated Service
Network in which the veteran is
located; and
(V) facility of the Department at
which the veteran seeks care.
(iii) A list of all locations of the
Program and number of bed spaces at each such
location, disaggregated by residential
rehabilitation treatment care or treatment
track provided under the Program at such
location.
(iv) A list of any new Program locations
added or removed and any bed spaces added or
removed during the one-year period preceding
the date of the report.
(v) Average cost of a stay under the
Program, including total stay average and daily
average, at--
(I) a facility of the Department;
and
(II) a non-Department facility.
(vi) A review of staffing needs and gaps
with respect to the Program.
(vii) Any recommendations for changes to
the operation of the Program, including any
policy changes, guidance changes, training
changes, or other changes.
(j) Government Accountability Office Review on Access to Care Under
the Program.--
(1) In general.--Not later than two years after the date of
the enactment of this Act, the Comptroller General of the
United States shall review access to care under the Program for
veterans in need of residential mental health care and
substance use disorder care.
(2) Elements.--The review required by paragraph (1) shall
include the following:
(A) A review of wait times under the Program,
disaggregated by--
(i) treatment track or specificity of
residential rehabilitation treatment care
needed;
(ii) gender of the veteran;
(iii) home State of the veteran;
(iv) home Veterans Integrated Service
Network of the veteran; and
(v) wait times for--
(I) facilities of the Department;
and
(II) non-Department facilities.
(B) A review of policy and training of the
Department on screening, admission, and placement under
the Program.
(C) A review of the rights of veterans and
referring providers to appeal admission decisions under
the Program and how the Department adjudicates appeals.
(D) A review of how the preferences of a veteran
admitted to the Program are taken into consideration
when determining the facility at which the veteran will
be placed in the Program.
(E) A review of staffing and staffing needs and
gaps of the Program, including with respect to--
(i) mental health providers and
coordinators at the facility level;
(ii) staff of Program facilities; and
(iii) overall administration of the Program
at the national level.
(F) Recommendations for improvement of access by
veterans to care under the Program, including with
respect to--
(i) any new sites or types of programs
needed or in development;
(ii) changes in training or policy;
(iii) changes in communications with
veterans; and
(iv) oversight of the Program by the
Department.
(k) Definitions.--In this section:
(1) Mental health residential rehabilitation treatment
program.--The term ``Mental Health Residential Rehabilitation
Treatment Program''--
(A) means the array of programs and services of the
Department that comprise residential care for mental
health and substance use disorders; and
(B) includes the programs designated as of the date
of the enactment of this Act as domiciliary residential
rehabilitation treatment programs.
(2) Treatment track.--The term ``treatment track'' means a
specialized treatment program that is provided to a subset of
veterans in the Program who receive the same or similar
intensive treatment and rehabilitative services.
(3) United states.--The term ``United States'' means the 50
States, the District of Columbia, the Commonwealth of Puerto
Rico, Guam, the Virgin Islands, American Samoa, and any other
commonwealth, territory, or possession of the United States.
SEC. 304. ELECTRONIC DOCUMENT SUBMISSION OPTION FOR THE CHAMPVA
PROGRAM.
(a) Online Portal.--Not later than 18 months after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall publish
an online portal allowing--
(1) individuals applying for medical care under section
1781 of title 38, United States Code, the ability to--
(A) submit application materials electronically;
(B) view the status of their application online;
and
(C) select their preferred method of communication
regarding their application, which the Department of
Veterans Affairs shall use upon their first attempt to
contact the individual if there are any issues with
their application;
(2) individuals applying for or receiving medical care
under such section the ability to submit electronically--
(A) documentation regarding other health insurance
certification;
(B) documentation regarding school enrollment
certification; and
(C) any other documentation required to apply for
or continue coverage under such section; and
(3) individuals receiving medical care under such section
and providers of medical care under such section the ability
to--
(A) submit medical claims documentation
electronically;
(B) request reprocessing of a denied claim
electronically; and
(C) file a reconsideration or appeal of a claim
electronically.
(b) Contract.--The Secretary may enter into a contract with a non-
Department entity to carry out subsection (a).
(c) Outreach.--Upon the implementation of the online portal
required under subsection (a), the Secretary shall conduct outreach to
ensure individuals eligible for care under section 1781 of title 38,
United States Code, and providers of such care are aware of the portal.
(d) Rule of Construction.--Nothing in this section shall be
construed to limit the ability of the Secretary to collect application
materials relating to medical care under section 1781 of title 38,
United States Code, by mail or by fax.
(e) Reports.--
(1) In general.--Not later than 270 days after the date of
the enactment of this Act, and every 180 days thereafter for
three years, 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 on the
progress of implementation of the online portal required under
subsection (a).
(2) Elements.--Each report required under paragraph (1)
shall include--
(A) whether a contract with a non-Department entity
was procured to carry out subsection (a) and, if so,
information on which entity or entities to which the
contract was awarded;
(B) the number of applications for medical care
under section 1781 of title 38, United States Code,
that are currently pending, disaggregated by whether
they were received--
(i) by mail;
(ii) by fax; or
(iii) electronically;
(C) a description of efforts taken by the
Department to conduct outreach under subsection (c);
and
(D) an assessment of user satisfaction with the new
online portal required under subsection (a).
SEC. 305. REVIEW OF WORKFLOWS ASSOCIATED WITH PROCESSING REFERRALS
BETWEEN FACILITIES OF THE VETERANS HEALTH ADMINISTRATION.
(a) In General.--The Secretary of Veterans Affairs shall conduct a
review of the workflows directly associated with processing referrals
of patients between facilities of the Veterans Health Administration to
identify specific delays or bottlenecks in such referrals.
(b) Inclusion of Consult Management Review.--The review required
under subsection (a) shall include--
(1) a review of the interfacility consult management
guidance of the Veterans Health Administration that assists
facilities in setting up a workflow for consults between
facilities; and
(2) a review of the roles and responsibilities of the
individuals involved in the consult management process in
managing those consults, including the role of the referral
coordination team.
(c) Report.--Not later than 180 days after the date of the
enactment of this Act, the Secretary shall submit to Congress a report
on the results of the review conducted under subsection (a).
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