[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 275 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
1st Session
S. 275
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
January 28, 2025
Mr. Moran 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' Assuring
Critical Care Expansions to Support Servicemembers (ACCESS) Act of
2025''.
(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, continuity of
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. Extension of deadline for submittal of claims by health care
entities and providers under prompt payment
standard.
TITLE II--MENTAL HEALTH TREATMENT PROGRAMS
Sec. 201. Definitions.
Sec. 202. Standardized process to determine eligibility of covered
veterans for participation in certain
mental health treatment programs.
Sec. 203. Improvements to Department of Veterans Affairs Mental Health
Residential Rehabilitation Treatment
Program.
TITLE III--OTHER HEALTH CARE MATTERS
Sec. 301. Plan on establishment of interactive, online self-service
module for care.
Sec. 302. Modification of requirements for Center for Innovation for
Care and Payment of the Department of
Veterans Affairs and requirement for pilot
program.
Sec. 303. 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' Assuring
Critical Care Expansions to Support Servicemembers (ACCESS) Act of
2025, 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, CONTINUITY OF 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) Continuity of care.
``(H) 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. 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''.
TITLE II--MENTAL HEALTH TREATMENT PROGRAMS
SEC. 201. DEFINITIONS.
In this title:
(1) Covered treatment program.--The term ``covered
treatment program''--
(A) means--
(i) a mental health residential
rehabilitation treatment program of the
Department of Veterans Affairs; or
(ii) a program of the Department for
residential care for mental health and
substance abuse disorders;
(B) includes--
(i) the programs designated as of the date
of the enactment of this Act as domiciliary
residential rehabilitation treatment programs;
and
(ii) any programs designated as domiciliary
residential rehabilitation treatment programs
on or after such date of enactment; and
(C) does not include Compensated Work Therapy
Transition Residence programs of the Department.
(2) Covered veteran.--The term ``covered veteran'' means a
veteran described in section 1703(b) of title 38, United States
Code.
(3) Social support systems.--The term ``social support
systems'', with respect to a covered veteran--
(A) means--
(i) a member of the family of the covered
veteran, including a parent, spouse, child,
step-family member, or extended family member;
or
(ii) an individual who lives with the
veteran but is not a member of the family of
the veteran; and
(B) does not include a facility-organized peer
support program.
(4) Treatment track.--The term ``treatment track'' means a
specialized treatment program that is provided to a subset of
covered veterans in a covered treatment program who receive the
same or similar intensive treatment and rehabilitative
services.
SEC. 202. STANDARDIZED PROCESS TO DETERMINE ELIGIBILITY OF COVERED
VETERANS FOR PARTICIPATION IN CERTAIN MENTAL HEALTH
TREATMENT PROGRAMS.
(a) Standardized Screening Process.--Not later than one year after
the date of the enactment of this Act, the Secretary of Veterans
Affairs shall establish a standardized screening process to determine,
based on clinical need, whether a covered veteran satisfies criteria
for priority or routine admission to a covered treatment program.
(b) Eligibility Criteria for Priority Admission.--
(1) In general.--Under the standardized screening process
required by subsection (a), a covered veteran shall be eligible
for priority admission to a covered treatment program if the
covered veteran meets criteria established by the Secretary
that include any of the following:
(A) Symptoms that--
(i) significantly affect activities of
daily life; and
(ii) increase the risk of such veteran for
adverse outcomes.
(B) An unsafe living situation.
(C) A high-risk flag for suicide.
(D) A determination of being a high risk for
suicide.
(E) Risk factors for overdose.
(F) Non-responsive, relapsed, or unable to find
recovery from one other course of treatment, such as
outpatient or intensive outpatient treatment.
(G) Such other criteria as the Secretary determines
appropriate.
(2) Consideration.--In making a determination that a
covered veteran meets criteria established by the Secretary
under paragraph (1) for priority admission to a covered
treatment program, the Secretary shall consider any referral of
a health care provider of a covered veteran.
(c) Time for Screening and Admission.--Under the standardized
screening process required by subsection (a), the Secretary shall
ensure a covered veteran--
(1) is screened not later than 48 hours after the date on
which the covered veteran, or a relevant health care provider,
makes a request for the covered veteran to be admitted to a
covered treatment program;
(2) if determined eligible for priority admission to a
covered treatment program, is admitted to such covered
treatment program not later than 48 hours after the date of
such determination; and
(3) is screened at an appropriate time for potential mild,
moderate, or severe traumatic brain injury.
(d) Considerations.--In making placement decisions in a covered
treatment program for veterans who meet criteria for priority
admission, the Secretary shall--
(1) consider the input of the covered veteran with respect
to the--
(A) program specialty, subtype, and treatment track
offered to the covered veteran; and
(B) geographic placement of the covered veteran;
and
(2) maximize the proximity of the covered veteran to social
support systems.
(e) Conditions Under Which Care Shall Be Furnished Through Non-
Department Providers.--
(1) Priority admission.--If the Secretary determines a
covered veteran is eligible for priority admission to a covered
treatment program pursuant to the standardized screening
process required by subsection (a) and the Secretary is unable
to admit such covered veteran to a covered treatment program at
a facility of the Department of Veterans Affairs in a manner
that complies with the requirements under subsections (c) and
(d), the Secretary shall offer the covered veteran the option
to receive care at a non-Department facility that--
(A) can admit the covered veteran within the period
required by subsection (c);
(B) is party to a contract or agreement with the
Department or enters into such a contract or agreement
under which the Department furnishes a program that is
equivalent to a covered treatment program to a veteran
through such non-Department facility;
(C) is licensed by a State; and
(D) is accredited by the Commission on
Accreditation of Rehabilitation Facilities or the Joint
Commission.
(2) Routine admission.--If the Secretary determines a
covered veteran is eligible for routine admission to a covered
treatment program pursuant to the standardized screening
process required by subsection (a) and the Secretary is unable
to admit such covered veteran to a covered treatment program at
a facility of the Department of Veterans Affairs in a manner
that complies with the access standards for mental health care
established pursuant to section 1703B of title 38, United
States Code, the Secretary shall offer the covered veteran the
option to receive care at a non-Department facility that--
(A) is party to a contract or agreement with the
Department or enters into such a contract or agreement
under which the Department furnishes a program that is
equivalent to a covered treatment program to a veteran
through such non-Department facility;
(B) is licensed by a State; and
(C) is accredited by the Commission on
Accreditation of Rehabilitation Facilities or the Joint
Commission.
(3) Rule of construction.--This subsection shall not be
construed to affect a covered veteran in a covered treatment
program pursuant to a determination made on or before the date
of the enactment of this Act.
SEC. 203. IMPROVEMENTS TO DEPARTMENT OF VETERANS AFFAIRS MENTAL HEALTH
RESIDENTIAL REHABILITATION TREATMENT PROGRAM.
(a) Performance Metrics.--
(1) In general.--The Secretary of Veterans Affairs shall
develop metrics to track, and shall subsequently track, the
performance of medical facilities and Veterans Integrated
Service Networks of the Department of Veterans Affairs in
meeting the requirements for--
(A) screening, under section 202, for a covered
treatment program; and
(B) timely admission to a covered treatment program
under such screening.
(2) Elements.--The metrics developed under paragraph (1)
shall include metrics for tracking the performance of medical
facilities and Veterans Integrated Service Networks with
respect to routine and priority admission under a covered
treatment program.
(b) Oversight.--
(1) In general.--The Secretary shall develop a process for
systematically assessing the quality of care delivered by
Department and non-Department providers treating covered
veterans under this section, which shall include assessments
of--
(A) the extent to which the provider is delivering
evidence-based treatments to covered veterans;
(B) clinical outcomes for covered veterans;
(C) the ratio of licensed independent practitioners
per resident;
(D) the rate of completion of training on military
cultural competence by licensed independent
practitioners; and
(E) potentially wasteful, fraudulent, or
inappropriate referral or billing practices.
(c) Placement; Transportation.--
(1) Locations.--If the Secretary determines that a covered
veteran is in need of residential care under a covered
treatment program, the Secretary shall provide to the covered
veteran a list of locations at which such covered veteran can
receive such residential care that meets--
(A) the standards for screening under section 202;
and
(B) the care needs of the covered veteran,
including applicable treatment tracks.
(2) Transportation coverage.--The Secretary shall provide
transportation or pay for or reimburse the costs of
transportation for any covered veteran who is admitted into a
covered treatment program and needs transportation assistance--
(A) from the residence of the covered 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 a covered treatment program; and
(B) back to the residence of the covered veteran
after the conclusion of a covered treatment program, if
applicable.
(d) Appeals.--
(1) In general.--The Secretary shall develop a national
policy and associated procedures under which a covered veteran,
a representative of a covered veteran, or a provider who
requests a covered veteran be admitted to a covered treatment
program, including a provider of the Department or a non-
Department provider, may file a clinical appeal pursuant to
this subsection if the covered veteran is--
(A) denied admission into a covered treatment
program; or
(B) accepted into a covered treatment 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) Decision.--The Secretary shall review and
respond to any appeal under paragraph (1) not later
than 72 hours after the Secretary receives such appeal.
(3) Public guidance.--The Secretary shall develop, and make
available to the public, guidance on how a covered veteran, a
representative of the covered veteran, or a provider of the
covered veteran can file a clinical appeal pursuant to this
subsection--
(A) if the covered veteran is denied admission into
a covered treatment program;
(B) if the first date on which the covered veteran
may enter a covered treatment program does not comply
with the standards established by the Department under
section 1703B of title 38, United States Code, for
purposes of determining eligibility for mental health
care under subsections (d) and (e) of section 1703 of
such title; or
(C) with respect to such other factors as the
Secretary may specify.
(4) Rule of construction.--Nothing in this subsection may
be construed as granting a covered veteran the right to appeal
a decision of the Secretary with respect to admission to a
covered treatment program to the Board of Veterans' Appeals
under chapter 71 of title 38, United States Code.
(e) Tracking of Availability and Wait Times.--
(1) In general.--The Secretary shall, to the extent
practicable, create a method for tracking availability and wait
times under a covered treatment program across all facilities
of the Department, Veterans Integrated Service Networks of the
Department, and non-Department providers throughout the United
States.
(2) Availability of information.--The Secretary shall, to
the extent practicable, 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.
(f) Training and Oversight.--
(1) Training.--
(A) In general.--The Secretary shall update and
implement training for staff of the Department directly
involved in a covered treatment program regarding
referrals, screening, admission, placement decisions,
and appeals for such program, including all changes to
processes and guidance under such program required by
this section and section 202.
(B) Covered veterans awaiting admission.--The
training under subparagraph (A) shall include
procedures for the care of covered veterans awaiting
admission into a covered treatment program and
communication with such covered veterans and the
providers of such covered veterans.
(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) not later than 60 days after
beginning employment at the Department
in a position that includes work
directly involving a covered treatment
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.
(2) Oversight standards.--The Secretary shall review and
revise oversight standards for the leadership of the Veterans
Integrated Service Networks and the Veterans Health
Administration to ensure that facilities and staff of the
Department are adhering to the policy on access to care of each
covered treatment program.
(g) Care Coordination and Follow-Up Care.--
(1) Continuity of care.--The Secretary shall ensure each
covered veteran who is screened for admission to a covered
treatment program is offered, and provided if agreed upon, care
options during the period between screening of the covered
veteran and admission of the covered veteran to such program to
ensure the covered veteran does not experience any lapse in
care.
(2) Care coordination for substance use disorder.--For a
covered 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 covered veteran and admission of
the covered veteran to a covered treatment program; and
(B) communicate that care plan to the covered
veteran, the primary care provider of the covered
veteran, and the facility where the covered veteran is
or will be residing under such program.
(3) Care planning prior to discharge.--
(A) In general.--The Secretary, in consultation
with the covered veteran and the treating providers of
the covered veteran in a covered treatment program,
shall ensure the completion of a care plan prior to the
covered veteran being discharged from such program.
(B) Matters to be included.--The care plan required
under subparagraph (A) for a covered veteran shall
include details on the course of treatment for the
covered veteran following completion of treatment under
the covered treatment program, including any necessary
follow-up care.
(C) Sharing of care plan.--The care plan required
under subparagraph (A) shall be shared with the covered
veteran, the primary care provider of the covered
veteran, and any other providers with which the covered
veteran consents to sharing the plan.
(D) Discharge from non-department facility.--Upon
discharge of a covered veteran under a covered
treatment program from a non-Department facility, the
facility shall share with the Department all care
records maintained by the facility with respect to the
covered veteran and shall work in consultation with the
Department on the care plan of the covered veteran
required under subparagraph (A).
(h) Reports to Congress.--
(1) Report on modifications to programs.--
(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 modifications made
to the guidance, operation, and oversight of covered
treatment programs to fulfill the requirements of this
section.
(B) Elements.--The report required by subparagraph
(A) shall include--
(i) an assessment of whether costs of
covered treatment programs, including for
residential care provided through facilities of
the Department and non-Department facilities,
serve as a disincentive to placement in the
such a program;
(ii) 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; 136 Stat. 5515), including--
(I) such actions with respect to--
(aa) any new locations
added for covered treatment
programs;
(bb) any beds added at
existing facilities of such
programs; and
(cc) any additional
treatment tracks or sex-
specific programs created or
added at facilities of the
Department; and
(II) a breakdown of the number and
percentage of covered veterans who are
determined eligible for priority
placement into a covered treatment
program and the number and percentage
of covered veterans who are determined
eligible for routine placement into a
covered treatment program; and
(iii) such recommendations as the Secretary
may have for legislative or administrative
action to address any funding constraints or
disincentives for use of a covered treatment
program.
(2) Annual report on operation of programs.--
(A) In general.--Not later than one year after the
submission of the report under paragraph (1), and not
less frequently than annually thereafter during the
period in which a covered treatment program is carried
out, 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 such programs.
(B) Elements.--Subject to subparagraph (C), each
report required by subparagraph (A) shall include the
following:
(i) The number of covered veterans served
by a covered treatment program, disaggregated
by--
(I) Veterans Integrated Service
Network in which the covered veteran
receives care;
(II) facility, including facilities
of the Department and non-Department
facilities, at which the covered
veteran receives care;
(III) type of residential
rehabilitation treatment care received
by the covered veteran under such
program;
(IV) sex of the covered veteran;
and
(V) race or ethnicity of the
covered veteran.
(ii) Wait times under a covered treatment
program for the most recent year data is
available, disaggregated by--
(I) treatment track or specificity
of residential rehabilitation treatment
care sought by the covered veteran;
(II) sex of the covered veteran;
(III) State or territory in which
the covered veteran is located;
(IV) Veterans Integrated Service
Network in which the covered veteran is
located; and
(V) facility of the Department at
which the covered veteran seeks care.
(iii) A list of all locations of a covered
treatment program and number of bed spaces at
each such location, disaggregated by
residential rehabilitation treatment care or
treatment track provided under such program at
such location.
(iv) A list of any new locations of covered
treatment programs 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 a covered
treatment program, including total stay average
and daily average, at facilities of the
Department compared to non-Department
facilities.
(vi) A review of staffing needs and gaps
with respect to covered treatment programs.
(vii) Any recommendations for changes to
the operation of covered treatment programs,
including any policy changes, guidance changes,
training changes, or other changes.
(C) Anonymity.--To ensure that the data provided
under this paragraph, or some portion of that data,
will not undermine the anonymity of a veteran, the
Secretary shall provide such data pursuant to
applicable Federal law and in a manner that is wholly
consistent with applicable Federal privacy and
confidentiality laws, including--
(i) section 552a of title 5, United States
Code (commonly known as the ``Privacy Act of
1974'');
(ii) the Health Insurance Portability and
Accountability Act of 1996 (Public Law 104-
191);
(iii) parts 160 and 164 of title 45, Code
of Federal Regulations, or successor
regulations; and
(iv) sections 5701, 5705, and 7332 of title
38, United States Code.
(i) Revision of Guidance.--The Secretary shall update the guidance
of the Department on the operation of covered treatment programs to
reflect each of the requirements under subsections (b) through (h).
(j) Deadline.--The Secretary shall carry out each requirement under
this section by not later than one year after the date of the enactment
of this Act, unless otherwise specified.
(k) Comptroller General Review.--
(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 a covered
treatment program for covered 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 a covered
treatment program, disaggregated by--
(i) treatment track or specificity of
residential rehabilitation treatment care
needed;
(ii) sex of the covered veteran;
(iii) home State of the covered veteran;
(iv) home Veterans Integrated Service
Network of the covered 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
a covered treatment program.
(C) A review of the rights of covered veterans and
providers to appeal admission decisions under a covered
treatment program and how the Department adjudicates
appeals.
(D) When determining the facility at which a
covered veteran admitted to a covered treatment program
will be placed in such program, a review of how the
input of the covered veteran is taken into
consideration with respect to--
(i) program specialty, subtype, or
treatment track offered to the covered veteran;
and
(ii) the geographic placement of the
covered veteran, including family- or
occupation-related preferences or
circumstances.
(E) A review of staffing and staffing needs and
gaps of covered treatment programs, including with
respect to--
(i) mental health providers and
coordinators at the facility level;
(ii) staff of facilities of such programs;
(iii) staff of Veterans Integrated Service
Networks; and
(iv) overall administration of such
programs at the national level.
(F) Recommendations for improvement of access by
covered veterans to care under a covered treatment
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
covered veterans; and
(iv) oversight of covered treatment
programs by the Department.
TITLE III--OTHER HEALTH CARE MATTERS
SEC. 301. 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. 302. 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. 303. 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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