SUBCHAPTER I—GENERAL
§1701. Definitions
For the purposes of this chapter—
(1) The term "disability" means a disease, injury, or other physical or mental defect.
(2) The term "veteran of any war" includes any veteran awarded the Medal of Honor.
(3) The term "facilities of the Department" means—
(A) facilities over which the Secretary has direct jurisdiction;
(B) Government facilities for which the Secretary contracts; and
(C) public or private facilities at which the Secretary provides recreational activities for patients receiving care under
(4) The term "non-Department facilities" means facilities other than Department facilities.
(5) The term "hospital care" includes—
(A)(i) medical services rendered in the course of the hospitalization of any veteran, and (ii) travel and incidental expenses pursuant to the provisions of
(B) such mental health services, consultation, professional counseling, marriage and family counseling, and training for the members of the immediate family or legal guardian of a veteran, or the individual in whose household such veteran certifies an intention to live, as the Secretary considers appropriate for the effective treatment and rehabilitation of a veteran or dependent or survivor of a veteran receiving care under the last sentence of
(C)(i) medical services rendered in the course of the hospitalization of a dependent or survivor of a veteran receiving care under the last sentence of
(6) The term "medical services" includes, in addition to medical examination, treatment, and rehabilitative services, the following:
(A) Surgical services.
(B) Dental services and appliances as described in
(C) Optometric and podiatric services.
(D) Preventive health services.
(E) Noninstitutional extended care services, including alternatives to institutional extended care that the Secretary may furnish directly, by contract, or through provision of case management by another provider or payer.
(F) In the case of a person otherwise receiving care or services under this chapter—
(i) wheelchairs, artificial limbs, trusses, and similar appliances;
(ii) special clothing made necessary by the wearing of prosthetic appliances; and
(iii) such other supplies or services as the Secretary determines to be reasonable and necessary.
(G) Travel and incidental expenses pursuant to
(H) Chiropractic services.
(I) The provision of medically necessary van lifts, raised doors, raised roofs, air conditioning, and wheelchair tiedowns for passenger use.
(7) The term "domiciliary care" includes necessary medical services and travel and incidental expenses pursuant to the provisions of
(8) The term "rehabilitative services" means such professional, counseling, chiropractic, and guidance services and treatment programs as are necessary to restore, to the maximum extent possible, the physical, mental, and psychological functioning of an ill or disabled person.
(9) The term "preventive health services" means—
(A) periodic medical and dental examinations;
(B) patient health education (including nutrition education);
(C) maintenance of drug use profiles, patient drug monitoring, and drug utilization education;
(D) mental health preventive services;
(E) substance abuse prevention measures;
(F) chiropractic examinations and services;
(G) immunizations against infectious diseases, including each immunization on the recommended adult immunization schedule at the time such immunization is indicated on that schedule;
(H) prevention of musculoskeletal deformity or other gradually developing disabilities of a metabolic or degenerative nature;
(I) genetic counseling concerning inheritance of genetically determined diseases;
(J) routine vision testing and eye care services;
(K) periodic reexamination of members of likely target populations (high-risk groups) for selected diseases and for functional decline of sensory organs, together with attendant appropriate remedial intervention; and
(L) such other health-care services as the Secretary may determine to be necessary to provide effective and economical preventive health care.
(10) The term "recommended adult immunization schedule" means the schedule established (and periodically reviewed and, as appropriate, revised) by the Advisory Committee on Immunization Practices established by the Secretary of Health and Human Services and delegated to the Centers for Disease Control and Prevention.
(
Editorial Notes
Codification
The text of
Prior Provisions
Prior sections 1700 and 1701 were renumbered
Amendments
2023—Par. (6)(I).
2018—Par. (6)(H).
Par. (8).
Par. (9)(F) to (L).
2016—Par. (9)(F).
Par. (10).
2008—Par. (5)(B).
Par. (6)(E) to (G).
Par. (10).
"(10)(A) During the period beginning on November 30, 1999, and ending on December 31, 2008, the term 'medical services' includes noninstitutional extended care services.
"(B) For the purposes of subparagraph (A), the term 'noninstitutional extended care services' means such alternatives to institutional extended care which the Secretary may furnish (i) directly, (ii) by contract, or (iii) (through provision of case management) by another provider or payor."
2003—Par. (8).
Par. (10)(A).
2002—Par. (5).
Par. (6).
Par. (6)(A).
Par. (6)(B) to (F).
Par. (10)(A).
1999—Par. (10).
1996—Par. (6)(A)(i).
Par. (6)(B)(i)(I).
Par. (6)(B)(i)(II).
1994—Par. (3).
1992—Par. (6)(A)(i).
Par. (9).
1991—
Par. (2).
Par. (3).
Par. (4).
Par. (5).
Par. (6).
Par. (9).
1988—Par. (4)(C).
1986—Par. (4).
Par. (6)(A)(i).
Par. (6)(B).
"(i) of the service-connected disability of a veteran pursuant to
"(ii) in the discretion of the Administrator, of the non-service-connected disability of a veteran eligible for treatment under
for the members of the immediate family or legal guardian of a veteran, or the individual in whose household such veteran certifies an intention to live, as may be essential to the effective treatment and rehabilitation of the veteran (including, under the terms and conditions set forth in
Par. (6)(B)(ii).
Par. (9).
1985—Par. (4)(C)(v).
1984—Par. (4)(C)(v).
1983—Par. (4)(C)(v).
Par. (6)(a)(i).
1982—Par. (4)(C)(v).
1981—Par. (4)(C)(v).
1979—Par. (4).
Par. (4)(C)(iii).
Par. (5)(A).
Par. (5)(C).
Par. (6)(A)(i).
Par. (6)(B).
1978—Par. (4)(C)(v).
1976—Par. (4)(A).
Par. (4)(C).
Par. (5)(A)(ii).
Par. (5)(B).
Par. (6).
Par. (7).
Par. (8).
1973—Par. (4)(C).
Par. (5).
Par. (6).
1968—Par. (4)(C)(iii).
1964—Par. (2).
1960—Par. (6).
Statutory Notes and Related Subsidiaries
Effective Date of 1994 Amendment
Effective Date of 1986 Amendment
Amendment by section 19011(d)(2) of
Effective Date of 1979 Amendment
Amendment by
Effective Date of 1976 Amendment
Amendment by
Effective Date of 1973 Amendment
Construction of 2016 Amendment
Department of Veterans Affairs Treatment and Research of Prostate Cancer
"(a)
"(1) Prostate cancer is the number one cancer diagnosed in the Veterans Health Administration.
"(2) A 1996 report published by the National Academy of Sciences, Engineering, and Medicine established a link between prostate cancer and exposure to herbicides, such as Agent Orange.
"(3) It is essential to acknowledge that due to these circumstances, certain veterans are made aware that they are high-risk individuals when it comes to the potential to develop prostate cancer.
"(4) In being designated as 'high risk', it is essential that veterans are proactive in seeking earlier preventative clinical services for the early detection and successful treatment of prostate cancer, whether that be through the Veterans Health Administration or through a community provider.
"(5) Clinical preventative services and initial detection are some of the most important components in the early detection of prostate cancer for veterans at high risk of prostate cancer.
"(6) For veterans with prostate cancer, including prostate cancer that has metastasized, precision oncology, including biomarker-driven clinical trials and innovations underway through the Prostate Cancer Foundation and Department of Veterans Affairs partnership, represents one of the most promising areas of interventions, treatments, and cures for such veterans and their families.
"(b)
"(1)
"(2)
"(A) A diagnosis pathway for prostate cancer that includes early screening and diagnosis protocol, including screening recommendations for veterans with evidence-based risk factors.
"(B) A treatment pathway that details the respective roles of each office of the Department that will interact with veterans receiving prostate cancer care, including treatment protocol recommendations for veterans with evidence-based risk factors.
"(C) Treatment recommendations for all stages of prostate cancer that reflect nationally recognized standards for oncology, including National Comprehensive Cancer Network guidelines.
"(D) A suggested protocol timeframe for each point of care, from early screening to treatment and end-of-life care, based on severity and stage of cancer.
"(E) A plan that includes, as appropriate, both Department medical facilities and community-based partners and providers and research centers specializing in prostate cancer, especially such centers that have entered into partnerships with the Department.
"(3)
"(A) the National Institutes of Health;
"(B) the National Cancer Institute;
"(C) the National Institute on Minority Health and Health Disparities;
"(D) the Centers for Disease Control and Prevention;
"(E) the Centers for Medicare and Medicaid Services;
"(F) the Patient-Centered Outcomes Research Institute;
"(G) the Food and Drug Administration;
"(H) the Department of Defense; and
"(I) other Institutes and Centers as the Secretary determines necessary.
"(4)
"(5)
"(A) publish the clinical pathway established under this subsection on a publicly available Department website; and
"(B) update the clinical pathway as needed by review of the medical literature and available evidence-based guidelines at least annually, in accordance with the criteria under paragraph (2).
"(c)
"(1)
"(2)
"(A) receive direct oversight from the Deputy Undersecretary for Health of the Department of Veterans Affairs;
"(B) include a yearly program implementation evaluation to facilitate replication for other disease states or in other healthcare institutions;
"(C) be metric driven and include the development of biannual reports on the quality of prostate cancer care, which shall be provided to the leadership of the Department, medical centers, and providers and made publicly available in an electronic form; and
"(D) include an education plan for patients and providers.
"(3)
"(4)
"(A) include details regarding the funding of and coordination between the National Precision Oncology Program of the Department and the PCF–VA Precision Oncology Centers of Excellence as related to the requirements of this Act [div. U of
"(B) affirm that no funding included in such funding plan is duplicative in nature.
"(d)
"(e)
"(1)
"(2)
Strategic Plan To Ensure Continuity of Care in the Case of the Realignment of a Medical Facility of the Department
"(a)
"(b)
"(1)
"(2)
"(A) An assessment of the progress of the Department in identifying impending realignments of medical facilities of the Department and the impact of such realignments on access of veterans to care, including any impact on the network of health care providers under the Community Care Program.
"(B) The progress of the Department in establishing operated sites of care and related activities to address the impact of such a realignment.
"(C) An outline of collaborative actions and processes the Department can take to address potential gaps in health care created by such a realignment, including actions and processes to be taken by the Office of Integrated Veteran Care, the Chief Strategy Office, and the Office of Asset Enterprise Management of the Department.
"(D) A description of how the Department can identify to Third Party Administrators changes in the catchment areas of medical facilities to be realigned and develop a process with Third Party Administrators to strengthen provider coverage in advance of such realignments.
"(3)
"(c)
"(1)
"(2)
"(A) any action that changes the number of facilities or relocates services, functions, or personnel positions; and
"(B) strategic collaborations between the Department and non-Federal Government entities, including tribal organizations and Urban Indian Organizations.
"(3)
"(4)
"(5)
Establishment of Strategic Plan Requirement for Office of Connected Care of Department of Veterans Affairs
"(a)
"(1) The COVID–19 pandemic caused the Department of Veterans Affairs to exponentially increase telehealth and virtual care modalities, including VA Video Connect, to deliver health care services to veteran patients.
"(2) Between January 2020 and January 2021, the number of telehealth appointments offered by the Department increased by 1,831 percent.
"(3) The Department maintains strategic partnerships, such as the Digital Divide Consult, with a goal of ensuring veterans who reside in rural, highly rural, or medically underserved areas have access to high-quality telehealth services offered by the Department.
"(4) As of 2019, veterans who reside in rural and highly rural areas make up approximately 1/3 of veteran enrollees in the patient enrollment system, and are on average, older than their veteran peers in urban areas, experience higher degrees of financial instability, and live with a greater number of complex health needs and comorbidities.
"(5) The Federal Communications Commission estimated in 2020 that 15 percent of veteran households do not have an internet connection.
"(6) Under the Coronavirus Aid, Relief, and Economic Security Act (
"(7) The authority described in paragraph (6) was not utilized to the fullest extent by the Department.
"(8) Though the Department has made significant progress in expanding telehealth services offered to veterans who are enrolled in the patient enrollment system, significant gaps still exist to ensure all veterans receive equal and high-quality access to virtual care.
"(9) Questions regarding the efficacy of using telehealth for certain health care services and specialties remain, and should be further studied.
"(10) The Department continues to expand telehealth and virtual care offerings for primary care, mental health care, specialty care, urgent care, and even remote intensive care units.
"(b)
"(c)
"(1)
"(2)
"(A)
"(B)
"(i) The Chief Officer of the Office of Connected Care of the Department.
"(ii) The Executive Director of Telehealth Services of the Office of Connected Care.
"(iii) The Executive Director of Connected Health of the Office of Connected Care.
"(iv) The Executive Director of the Office of Rural Health of the Department.
"(v) The Executive Director of Solution Delivery, IT Operations and Services of the Office of Information and Technology of the Department.
"(3)
"(A) A comprehensive list of all health care specialties the Department is currently delivering by telehealth or virtual care.
"(B) An assessment of the effectiveness and patient outcomes for each type of health care specialty delivered by telehealth or virtual care by the Department.
"(C) An assessment of satisfaction of veterans in receiving care through telehealth or virtual care disaggregated by age group and by Veterans Integrated Service Network.
"(D) An assessment of the percentage of virtual visits delivered by the Department through each modality including standard telephone telehealth, VA Video Connect, and the Accessing Telehealth through Local Area Stations program of the Department.
"(E) An outline of all current partnerships maintained by the Department to bolster telehealth or virtual care services for veterans.
"(F) An assessment of the barriers faced by the Department in delivering telehealth or virtual care services to veterans residing in rural and highly rural areas, and the strategies the Department is deploying beyond purchasing hardware for veterans who are enrolled in the patient enrollment system.
"(G) A detailed plan illustrating how the Department is working with other Federal agencies, including the Department of Health and Human Services, the Department of Agriculture, the Federal Communications Commission, and the National Telecommunications and Information Administration, to enhance connectivity in rural, highly rural, and medically underserved areas to better reach all veterans.
"(H) The feasibility and advisability of partnering with Federally qualified health centers, rural health clinics, and critical access hospitals to fill the gap for health care services that exists for veterans who reside in rural and highly rural areas.
"(I) An evaluation of the number of veterans who are enrolled in the patient enrollment system who have previously received care under the Veterans Community Care Program under
"(d)
"(1) The completed strategic plan or update, as the case may be.
"(2) An identification of areas of improvement by the Department in the delivery of telehealth and virtual care services to veterans who are enrolled in the patient enrollment system, with a timeline for improvements to be implemented.
"(e)
"(1)
"(2)
"(3)
Improved Accessibility and Accuracy of Data Provided by Department of Veterans Affairs
"(b)
"(1)
"(A) The Website is directly accessible from—
"(i) the main homepage of the publicly accessible internet website of the Department; and
"(ii) the main homepage of the publicly accessible internet website of each medical center of the Department.
"(B) Where practicable, the Website is organized and searchable by each medical center of the Department.
"(C) The Website is easily understandable and usable by the general public.
"(2)
"(A) shall consult with—
"(i) veterans service organizations; and
"(ii) veterans and caregivers of veterans from geographically diverse areas and representing different eras of service in the Armed Forces; and
"(B) may enter into a contract to design the Website with a company, non-profit entity, or other entity specializing in website design that has substantial experience in presenting health care data and information in a easily understandable and usable manner to patients and consumers.
"(c)
"(1)
"(2)
"(A) determines the extent that the medical record information, clinical information, data, and documentation provided by each medical facility of the Department that is used to calculate the information on the Website is accurate and complete;
"(B) identifies any deficiencies in the recording of medical record information, clinical information, or data by medical facilities of the Department that affects the accuracy and completeness of the information on the Website; and
"(C) provides recommendations to medical facilities of the Department on how to—
"(i) improve the accuracy and completeness of the medical record information, clinical information, data, and documentation that is used to calculate the information on the Website; and
"(ii) ensure that each medical facility of the Department provides such information in a uniform manner.
"(3)
Improvement of Sleep Disorder Care Furnished by Department of Veterans Affairs
"(a)
"(b)
"(1) assessment and treatment options for such disorders;
"(2) barriers to care for such disorders, such as wait time, travel time, and lack of staffing;
"(3) the efficacy of the clinical practice guidelines of the Department of Veterans Affairs and the Department of Defense for such disorders; and
"(4) the availability of and efficacy of the use by the Department of Veterans Affairs of cognitive behavioral therapy for insomnia.
"(c)
"(1) the findings from the analysis conducted under subsection (b); and
"(2) any actions taken under subsection (a) to improve the assessment and treatment of veterans with sleep disorders.
"(d)
Strengthening and Amplifying Vaccination Efforts to Locally Immunize All Veterans and Every Spouse
"SECTION 1. SHORT TITLE.
"This Act may be cited as the 'Strengthening and Amplifying Vaccination Efforts to Locally Immunize All Veterans and Every Spouse Act' or the 'SAVE LIVES Act'.
"SEC. 2. AUTHORITY OF SECRETARY OF VETERANS AFFAIRS TO FURNISH COVID–19 VACCINE TO CERTAIN INDIVIDUALS NOT ENROLLED IN PATIENT ENROLLMENT SYSTEM OF DEPARTMENT OF VETERANS AFFAIRS.
"(a)
"(b)
"(1) prioritize the vaccination of veterans who are enrolled in the patient enrollment system, veterans who receive hospital care and medical services pursuant to subsection (c)(2) of
"(2) only furnish vaccines for COVID–19 to covered individuals under this section to the extent that such vaccines are available.
"(c)
"(d)
"(e)
"(1)
"(2)
"(A) A veteran who is not eligible to enroll in the patient enrollment system.
"(B) A veteran who is eligible for care under
"(C) A beneficiary under section 1781 of such title.
"(D) A family caregiver of a veteran participating in the program of comprehensive assistance for family caregivers under section 1720G(a) of such title.
"(E) A caregiver of a veteran participating in the program of general caregiver support services under section 1720G(b) of such title.
"(F) A caregiver of a veteran participating in the Medical Foster Home Program, Bowel and Bladder Program, Home Based Primary Care Program, or Veteran Directed Care Program of the Department of Veterans Affairs.
"(G) A spouse of a veteran.
"(3)
"(4)
"(5)
"(6)
Prohibition on Copayments and Cost Sharing for Veterans During Emergency Relating to COVID–19
"(a)
"(1) shall provide for any copayment or other cost sharing with respect to health care under the laws administered by the Secretary received by a veteran during the period specified in subsection (b); and
"(2) shall reimburse any veteran who paid a copayment or other cost sharing for health care under the laws administered by the Secretary received by a veteran during such period the amount paid by the veteran.
"(b)
"(c)
Oversight for State Homes Regarding COVID–19 Infections, Response Capacity, and Staffing Levels
"(a)
"(1)
"(2)
"(A) The number of suspected and confirmed COVID–19 infections among residents and staff, including residents previously treated for COVID–19, disaggregated by—
"(i) veteran, spouse of a veteran, staff, and other;
"(ii) race and ethnicity;
"(iii) gender; and
"(iv) age.
"(B) The number of total deaths and COVID–19 deaths among residents and staff, disaggregated by—
"(i) veteran, spouse of a veteran, staff, and other;
"(ii) race and ethnicity;
"(iii) gender; and
"(iv) age.
"(C) An assessment of the supply of personal protective equipment and hand hygiene supplies.
"(D) An assessment of ventilator capacity and supplies.
"(E) The number of resident beds and the occupancy rate, disaggregated by veteran, spouse of a veteran, and other.
"(F) An assessment of the access of residents to testing for COVID–19.
"(G) An assessment of staffing shortages, if any.
"(H) Such other information as the Secretary may specify.
"(b)
"(1)
"(A) the total number of residents and staff of State homes who are infected with COVID–19; and
"(B) the total number of such residents and staff who have died from COVID–19.
"(2)
"(c)
"(1)
"(2)
Process and Requirements for Scheduling Appointments for Health Care From Department of Veterans Affairs and Non-Department Health Care
"(a)
"(1)
"(A) establish a process and requirements for scheduling appointments for—
"(i) health care from the Department of Veterans Affairs; and
"(ii) health care furnished through the Veterans Community Care Program under
"(B) submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a description of such process and requirements.
"(2)
"(A) information on how such process and requirements take into account the access standards established under
"(B) the maximum number of days allowed to complete each step of such process.
"(3)
"(A)
"(B)
"(b)
"(1)
"(2)
"(A) to undergo training on the process and requirements established under subsection (a) as part of training for the position for which the employee has been hired; and
"(B) to make the certification to the Secretary required under paragraph (1).
"(c)
"(1)
"(A) to enable monitoring of the compliance of the Department with the process and requirements established under subsection (a), including compliance with policies of the Department relating to the maximum number of days allowed to complete each step of such process; and
"(B) to ensure that each medical facility of the Department complies with such process and requirements.
"(2)
"(A)
"(B)
"(d)
Audits Regarding Scheduling of Appointments and Management of Consultations for Health Care From Department of Veterans Affairs and Non-Department Health Care
"(a)
"(b)
"(1)
"(2)
"(c)
"(1) With respect to each medical center of the Department covered by the audit, an assessment of any scheduling or consultation management issues at that medical center, including the following:
"(A) An assessment of noncompliance with policies of the Veterans Health Administration relating to scheduling appointments and managing consultations.
"(B) An assessment of the extent to which appointments or consultations are not timely processed.
"(C) A description of any backlogs in appointments or consultations that are awaiting action.
"(D) An assessment of whether consultations are appropriately processed.
"(E) Data with respect to consultations as follows:
"(i) Consultations that were scheduled within the request window.
"(ii) Duplicate consultation requests.
"(iii) Consultations that were discontinued.
"(iv) Delays in consultations.
"(v) Consultations that were not properly closed or discontinued, including a description of remediation attempts.
"(F) A review for accuracy with respect to consultation management as follows:
"(i) A review of the accuracy of the type of service, either administrative or clinical, that is inputted in the electronic health record.
"(ii) A review of the accuracy of the type of consultation setting, either impatient [sic] or outpatient, that is inputted in the electronic health record.
"(iii) A review of the appropriateness of the level of urgency of the consultation that is inputted in the electronic health record.
"(iv) A review of any delayed or unresolved consultations.
"(2) An identification of such recommendations for corrective action as the Secretary considers necessary, including additional training, increased personnel, and other resources.
"(3) A certification that the director of each medical center of the Department covered by the audit is in compliance with the process and requirements established under section 3101(a) [set out as a note above] and such other requirements relating to the scheduling of appointments and management of consultations as the Secretary considers appropriate.
"(4) With respect to referrals for health care between health care providers or facilities of the Department, a measurement of, for each medical facility of the Department covered by the audit—
"(A) the period of time between—
"(i) the date that a clinician of the Department determines that a veteran requires care from another health care provider or facility and the date that the referral for care is sent to the other health care provider or facility;
"(ii) the date that the referral for care is sent to the other health care provider or facility and the date that the other health care provider or facility accepts the referral;
"(iii) the date that the other health care provider or facility accepts the referral and the date that the appointment with the other health care provider or at the other facility is made; and
"(iv) the date that the appointment with the other health care provider or at the other facility is made and the date of the appointment with the other health care provider or at the other facility; and
"(B) any other period of time that the Secretary determines necessary to measure.
"(5) With respect to referrals for non-Department health care originating from medical facilities of the Department, a measurement of, for each such facility covered by the audit—
"(A) the period of time between—
"(i) 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;
"(ii) 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;
"(iii) 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;
"(iv) 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
"(v) 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
"(B) any other period of time that the Secretary determines necessary to measure.
"(d)
"(e)
"(1) strengthen oversight of the scheduling of appointments and management of consultations throughout the Department;
"(2) monitor national policy on such scheduling and management; and
"(3) develop a remediation plan to address issues uncovered by those audits.
"(f)
"(1)
"(2)
"(A) the nationwide results of the audit conducted under subsection (a);
"(B) the results of such audit with respect to each medical facility of the Department covered by such audit;
"(C) an assessment of how the Department strengthened oversight of the scheduling of appointments and management of consultations at each such facility as a result of the audit;
"(D) an assessment of how the audit informed the national policy of the Department with respect to the scheduling of appointments and management of consultations; and
"(E) a description of any remediation plans to address issues raised by the audit that was completed."
Establishment of Environment of Care Standards and Inspections at Department of Veterans Affairs Medical Centers
"(a)
"(1) an alignment of the requirements for such standards and inspections with the women's health handbook of the Veterans Health Administration;
"(2) a requirement for the frequency of such inspections;
"(3) delineation of the roles and responsibilities of staff at each medical center who are responsible for compliance;
"(4) the requirement that each medical center submit to the Secretary and make publicly available a report on the compliance of the medical center with the standards; and
"(5) a remediation plan.
"(b)
Study on Staffing of Women Veteran Program Manager Program at Medical Centers of Department of Veterans Affairs and Training of Staff
"(a)
"(1) if the program is appropriately staffed at each medical center of the Department;
"(2) whether each medical center of the Department is staffed with a Women Veteran Program Manager; and
"(3) whether it would be feasible and advisable to have a Women Veteran Program Ombudsman at each medical center of the Department.
"(b)
"(c)
Recording of Obligations
Expanded Telehealth From Department of Veterans Affairs
"(a)
"(b)
"(1)
"(2)
"(3)
"(A)
"(i) Purchasing, replacing or upgrading hardware or software necessary for the provision of secure and private telehealth services.
"(ii) Upgrading security protocols for consistency with the security requirements of the Department of Veterans Affairs.
"(iii) Training of site attendants, including payment of those attendants for completing that training, with respect to—
"(I) military and veteran cultural competence, if the entity is not an organization that represents veterans;
"(II) equipment required to provide telehealth services;
"(III) privacy, including the Health Insurance Portability and Accountability Act of 1996 [
"(IV) scheduling for telehealth services for veterans; or
"(V) any other unique training needs for the provision of telehealth services to veterans.
"(iv) Upgrading existing infrastructure owned or leased by the entity to make rooms more conducive to telehealth care, including—
"(I) additions or modifications to windows or walls in an existing room, or other alterations as needed to create a new, private room, including permits or inspections required in association with space modifications;
"(II) soundproofing of an existing room;
"(III) new electrical, telephone, or internet outlets in an existing room; or
"(IV) aesthetic enhancements to establish a more suitable therapeutic environment.
"(v) Upgrading existing infrastructure to comply with the Americans with Disabilities Act of 1990 (
"(vi) Upgrading internet infrastructure and sustainment of internet services.
"(vii) Sustainment of telephone services.
"(B)
"(c)
"(1)
"(2)
"(d)
"(1)
"(2)
"(A) A description of the barriers veterans face in using telehealth while not on property of the Department.
"(B) A description of how the Department plans to address the barriers described in subparagraph (A).
"(C) Such other matters related to access by veterans to telehealth while not on property of the Department as the Secretary considers relevant.
"(3)
Partnerships to Provide Hyperbaric Oxygen Therapy to Veterans
"(1)
"(2)
"(A) Partnerships to conduct research on hyperbaric oxygen therapy.
"(B) Partnerships to review research on hyperbaric oxygen therapy provided to nonveterans.
"(C) Partnerships to create industry working groups to determine standards for research on hyperbaric oxygen therapy.
"(D) Partnerships to provide to veterans hyperbaric oxygen therapy for the purposes of conducting research on the effectiveness of such therapy.
"(3)
Review of Effectiveness of Hyperbaric Oxygen Therapy
Coverage of Testing for COVID–19: Application With Respect to Veterans
Plans To Improve Medical Facilities of the Department of Veterans Affairs
"(a)
"(1)
"(2)
"(b)
"(c)
Prevention of Certain Health Care Providers From Providing Non-Department Health Care Services to Veterans
"(a)
"(1) was removed from employment with the Department of Veterans Affairs due to conduct that violated a policy of the Department relating to the delivery of safe and appropriate health care; or
"(2) violated the requirements of a medical license of the health care provider that resulted in the loss of such medical license.
"(b)
"(c)
"(d)
"(e)
"(1) The aggregate number of health care providers denied or suspended under this section from participation in providing non-Department health care services.
"(2) An evaluation of any impact on access to health care for patients or staffing shortages in programs of the Department providing non-Department health care services.
"(3) An explanation of the coordination of the Department with the medical licensing boards of States in implementing this section, the amount of involvement of such boards in such implementation, and efforts by the Department to address any concerns raised by such boards with respect to such implementation.
"(4) Such recommendations as the Comptroller General considers appropriate regarding harmonizing eligibility criteria between health care providers of the Department and health care providers eligible to provide non-Department health care services.
"(f)
"(1) provided under subchapter I of
"(2) provided under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (
"(3) purchased through the Medical Community Care account of the Department; or
"(4) purchased with amounts deposited in the Veterans Choice Fund under section 802 of the Veterans Access, Choice, and Accountability Act of 2014 [
Veterans' Education and Training Programs
"SEC. 121. EDUCATION PROGRAM ON HEALTH CARE OPTIONS.
"(a)
"(b)
"(1) teach veterans about—
"(A) eligibility criteria for care from the Department set forth under sections 1703, as amended by
"(B) priority groups for enrollment in the system of annual patient enrollment under section 1705(a) of such title [
"(C) the copayments and other financial obligations, if any, required of certain individuals for certain services; and
"(D) how to utilize the access standards and standards for quality established under sections 1703B and 1703C of such title;
"(2) teach veterans about the interaction between health insurance (including private insurance, Medicare, Medicaid, the TRICARE program, the Indian Health Service, tribal health programs, and other forms of insurance) and health care from the Department; and
"(3) provide veterans with information on what to do when they have a complaint about health care received from the Department (whether about the provider, the Department, or any other type of complaint).
"(c)
"(1) to veterans who may not have access to the internet; and
"(2) to veterans in a manner that complies with the Americans with Disabilities Act of 1990 (
"(d)
"(1)
"(2)
"(e)
"(1)
"(2)
"(3)
"SEC. 122. TRAINING PROGRAM FOR ADMINISTRATION OF NON-DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE.
"(a)
"(1) Reimbursement for non-Department emergency room care.
"(2) The Veterans Community Care Program under
"(3) Management of prescriptions pursuant to improvements under section 131.
"(b)
"(1) develop a method to evaluate the effectiveness of the training program developed and implemented under subsection (a);
"(2) evaluate such program not less frequently than once each year; and
"(3) not less frequently than once each year, submit to Congress the findings of the Secretary with respect to the most recent evaluation carried out under paragraph (2).
"SEC. 123. CONTINUING MEDICAL EDUCATION FOR NON-DEPARTMENT MEDICAL PROFESSIONALS.
"(a)
"(1)
"(2)
"(A) Identifying and treating common mental and physical conditions of veterans and family members of veterans.
"(B) The health care system of the Department of Veterans Affairs.
"(C) Such other matters as the Secretary considers appropriate.
"(b)
"(c)
"(1)
"(2)
"(3)
"(4)
"(A) The medical licensing agency of each State in which the program is accredited.
"(B) Such medical credentialing organizations as the Secretary considers appropriate.
"(5)
"(6)
"(d)
Establishment of Processes To Ensure Safe Opioid Prescribing Practices by Non-Department of Veterans Affairs Health Care Providers
"(a)
"(b)
"(c)
"(1)
"(2)
"(A) ensure the Department is responsible for the recording of the prescription in the electronic health record of the veteran; and
"(B) enable other monitoring of the prescription as outlined in the Opioid Safety Initiative of the Department.
"(3)
"(d)
"(1)
"(2)
"(3)
"(A) conflict with or are otherwise inconsistent with the standards of appropriate and safe care;
"(B) violate the requirements of a medical license of the health care provider; or
"(C) may place at risk the veterans receiving health care from the provider.
"(e)
Competency Standards for Non-Department of Veterans Affairs Health Care Providers
"(a)
"(b)
"(2) Each non-Department of Veterans Affairs health care provider who enters into a contract, agreement, or other arrangement after the effective date identified in subsection (c) shall, to the extent practicable, meet the standards and requirements established pursuant to subsection (a) within 6 months of the contract, agreement, or other arrangement taking effect.
"(c)
Program on Establishment of Peer Specialists in Patient Aligned Care Team Settings Within Medical Centers of Department of Veterans Affairs
"(a)
"(b)
"(1) Not later than May 31, 2019, at not fewer than 15 medical centers of the Department.
"(2) Not later than May 31, 2020, at not fewer than 30 medical centers of the Department.
"(c)
"(1)
"(A) Not fewer than five shall be medical centers of the Department that are designated by the Secretary as polytrauma centers.
"(B) Not fewer than 10 shall be medical centers of the Department that are not designated by the Secretary as polytrauma centers.
"(2)
"(A) Rural areas and other areas that are underserved by the Department.
"(B) Areas that are not in close proximity to an active duty military installation.
"(C) Areas representing different geographic locations, such as census tracts established by the Bureau of the Census.
"(d)
"(1)
"(A) As of the date of the enactment of the STRONG Veterans Act of 2022 [Dec. 29, 2022], the Secretary shall make such program permanent at each medical center participating in the program on the day before such date of enactment.
"(B) During the seven-year period following such date of enactment, the Secretary shall expand the program to an additional 25 medical centers per year until the program is carried out at each medical center of the Department.
"(2)
"(A) Rural areas and other areas that are underserved by the Department.
"(B) Areas that are not in close proximity to an active duty military installation.
"(C) Areas representing different geographic locations, such as census tracts established by the Bureau of the Census.
"(e)
"(1) the needs of female veterans are specifically considered and addressed;
"(2) female peer specialists are hired and made available to support female veterans who are treated at each medical center.
"(f)
"(g)
"(1)
"(A)
"(B)
"(i) The findings and conclusions of the Secretary with respect to the program.
"(ii) An assessment of the benefits of the program to veterans and family members of veterans.
"(iii) An assessment of the effectiveness of peer specialists in engaging under subsection (f) with health care providers in the community and veterans served by such providers.
"(iv) The name and location of each medical center where new peer specialists were hired.
"(v) The number of new peer specialists hired at each medical center pursuant to this section and the total number of peer specialists within the Department hired pursuant to this section.
"(vi) An assessment of any barriers confronting the recruitment, training, or retention of peer specialists.
"(2)
Department of Veterans Affairs Medical Scribe Pilot Program.
"(a)
"(b)
"(1) At least four such medical centers located in rural areas.
"(2) At least four such medical centers located in urban areas.
"(3) Two such medical centers located in areas with need for increased access or increased efficiency, as determined by the Secretary.
"(c)
"(1)
"(A) hire 20 new Department of Veterans Affairs term employees as medical scribes; and
"(B) seek to enter into contracts with appropriate entities for the employment of 20 additional medical scribes.
"(2)
"(A) Two scribes shall be assigned to each of two physicians.
"(B) Thirty percent of the scribes shall be employed in the provision of emergency care.
"(C) Seventy percent of the scribes shall be employed in the provision of specialty care in specialties with the longest patient wait times or lowest efficiency ratings, as determined by the Secretary.
"(d)
"(1)
"(A) A separate analysis of each [of] the following with respect to medical scribes employed by the Department of Veterans Affairs and medical scribes performing Department of Veterans Affairs functions under a contract:
"(i) Provider efficiency.
"(ii) Patient satisfaction.
"(iii) Average wait time.
"(iv) The number of patients seen per day by each physician or practitioner.
"(v) The amount of time required to hire and train an employee to perform medical scribe functions under the pilot program.
"(B) Metrics and data for analyzing the effects of the pilot program, including an evaluation of the each of the [sic] elements under clauses (i) through (iv) of subparagraph (A) at medical centers who employed scribes under the pilot program for an appropriate period preceding the hiring of such scribes.
"(2)
"(e)
"(1) The term 'medical scribe' means an unlicensed individual hired to enter information into the electronic health record or chart at the direction of a physician or licensed independent practitioner whose responsibilities include the following:
"(A) Assisting the physician or practitioner in navigating the electronic health record.
"(B) Responding to various messages as directed by the physician or practitioner.
"(C) Entering information into the electronic health record, as directed by the physician or practitioner.
"(2) The terms 'urban' and 'rural' have the meanings given such terms under the rural-urban commuting codes developed by the Secretary of Agriculture and the Secretary of Health and Human Services.
"(f)
Pilot Program for Health and Wellness Centers and Programs
Investigation of Medical Centers of the Department of Veterans Affairs
"(a)
"(b)
"(1)
"(2)
"(c)
"(1) to prevent the Office of the Inspector General of the Department of Veterans Affairs from conducting any review, audit, evaluation, or inspection regarding a topic for which an investigation is conducted under this section; or
"(2) to modify the requirement that employees of the Department assist with any review, audit, evaluation, or inspection conducted by the Office of the Inspector General of the Department."
Faster Care for Veterans
"SECTION 1. SHORT TITLE.
"This Act may be cited as the 'Faster Care for Veterans Act of 2016'.
"SEC. 2. PILOT PROGRAM ESTABLISHING A PATIENT SELF-SCHEDULING APPOINTMENT SYSTEM.
"(a)
"(b)
"(c)
"(1)
"(2)
"(3)
"(d)
"(1)
"(2)
"(e)
"SEC. 3. CAPABILITIES OF PATIENT SELF-SCHEDULING APPOINTMENT SYSTEM.
"(a)
"(1) Capability to schedule, modify, and cancel appointments for primary care, specialty care, and mental health.
"(2) Capability to support appointments for the provision of health care regardless of whether such care is provided in person or through telehealth services.
"(3) Capability to view appointment availability in real time.
"(4) Capability to make available, in real time, appointments that were previously filled but later cancelled by other patients.
"(5) Capability to provide prompts or reminders to veterans to schedule follow-up appointments.
"(6) Capability to be used 24 hours per day, 7 days per week.
"(7) Capability to integrate with the Veterans Health Information Systems and Technology Architecture of the Department, or such successor information technology system.
"(b)
"(1)
"(A) The Secretary shall seek to enter into an agreement with an appropriate non-governmental, not-for-profit entity with expertise in health information technology to independently validate and verify that the patient self-scheduling appointment system used in the pilot program under section 2, and any other patient self-scheduling appointment system developed or used by the Department of Veterans Affairs, includes the capabilities specified in subsection (a).
"(B) Each independent validation and verification conducted under subparagraph (A) shall be completed as follows:
"(i) With respect to the validation and verification of the patient self-scheduling appointment system used in the pilot program under section 2, by not later than 60 days after the date on which such pilot program commences.
"(ii) With respect to any other patient self-scheduling appointment system developed or used by the Department of Veterans Affairs, by not later than 60 days after the date on which such system is deployed, regardless of whether such deployment is on a limited basis, but not including any deployments for testing purposes.
"(2)
"(A) The Comptroller General of the United States shall evaluate each validation and verification conducted under paragraph (1).
"(B) Not later than 30 days after the date on which the Comptroller General completes an evaluation under paragraph (1), the Comptroller General shall submit to the appropriate congressional committees a report on such evaluation.
"(C) In this paragraph, the term 'appropriate congressional committees' means—
"(i) the Committees on Veterans' Affairs of the House of Representatives and the Senate; and
"(ii) the Committees on Appropriations of the House of Representatives and the Senate.
"(c)
"(1)
"(2)
"(3)
"SEC. 4. PROHIBITION ON NEW APPROPRIATIONS.
"No additional funds are authorized to carry out the requirements of this Act. Such requirements shall be carried out using amounts otherwise authorized."
Inspection Program for Kitchens and Food Service Areas at Department of Veterans Affairs Medical Facilities
"(a)
"(b)
"(1)
"(2)
"(A) is not part of the Federal Government;
"(B) operates as a not-for-profit entity; and
"(C) has expertise and objectivity comparable to that of the Joint Commission on Accreditation of Hospital Organizations.
"(c)
"(1)
"(A) implement a remediation plan for that medical facility within 72 hours; and
"(B) Conduct [sic] a second inspection under subsection (a) at that medical facility within 14 days of the failed inspection.
"(2)
"(3)
"(d)
Mold Inspection Program for Department of Veterans Affairs Medical Facilities
"(a)
"(b)
"(1)
"(2)
"(A) is not part of the Federal Government;
"(B) operates as a not-for-profit entity; and
"(C) has expertise and objectivity comparable to that of the Joint Commission on Accreditation of Hospital Organizations.
"(c)
"(1) implement a remediation plan for that medical facility within 7 days; and
"(2) Conduct [sic] a second inspection under subsection (a) at that medical facility within 90 days of the initial inspection.
"(d)
Improvement of Health Care Relating to Use of Opioids, Patient Advocacy, Complementary and Integrative Health, and Fitness of Providers
"SEC. 901. SHORT TITLE.
"This title may be cited as the 'Jason Simcakoski Memorial and Promise Act'.
"SEC. 902. DEFINITIONS.
"In this title:
"(1) The term 'controlled substance' has the meaning given that term in section 102 of the Controlled Substances Act (
"(2) The term 'State' means each of the several States, territories, and possessions of the United States, the District of Columbia, and the Commonwealth of Puerto Rico.
"(3) The term 'complementary and integrative health' has the meaning given that term, or any successor term, by the National Institutes of Health.
"(4) The term 'opioid receptor antagonist' means a drug or device approved or cleared under the Federal Food, Drug, and Cosmetic Act (
"Subtitle A—Opioid Therapy and Pain Management
"SEC. 911. IMPROVEMENT OF OPIOID SAFETY MEASURES BY DEPARTMENT OF VETERANS AFFAIRS.
"(a)
"(1)
"(2)
"(3)
"(A) that such tests occur not less frequently than once each year or as otherwise determined according to treatment protocols; and
"(B) that health care providers appropriately order, interpret and respond to the results from such tests to tailor pain therapy, safeguards, and risk management strategies to each patient.
"(b)
"(1)
"(2)
"(A) The implementation of and full compliance with the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, including any update to such guideline.
"(B) The use of evidence-based pain management therapies and complementary and integrative health services, including cognitive-behavioral therapy, non-opioid alternatives, and non-drug methods and procedures to managing pain and related health conditions including, to the extent practicable, medical devices approved or cleared by the Food and Drug Administration for the treatment of patients with chronic pain and related health conditions.
"(C) Screening and identification of patients with substance use disorder, including drug-seeking behavior, before prescribing opioids, assessment of risk potential for patients developing an addiction, and referral of patients to appropriate addiction treatment professionals if addiction is identified or strongly suspected.
"(D) Communication with patients on the potential harm associated with the use of opioids and other controlled substances, including the need to safely store and dispose of supplies relating to the use of opioids and other controlled substances.
"(E) Such other education and training as the Secretary considers appropriate to ensure that veterans receive safe and high-quality pain management care from the Department.
"(3)
"(c)
"(1)
"(2)
"(A)
"(B)
"(i) consults with a health care provider with pain management expertise or who is on the pain management team of the medical facility; and
"(ii) refers the patient to the pain management team for any subsequent prescriptions and related therapy.
"(3)
"(A)
"(B)
"(i) a certification as to whether all members of the pain management team at the medical facility have completed the education and training required under subsection (b);
"(ii) a plan for the management and referral of patients to such pain management team if health care providers without expertise in prescribing analgesics prescribe opioid medications to treat acute and chronic pain that is non-cancer related; and
"(iii) a certification as to whether the medical facility—
"(I) fully complies with the stepped-care model, or successor models, of pain management and other pain management policies of the Department; or
"(II) does not fully comply with such stepped-care model, or successor models, of pain management and other pain management policies but is carrying out a corrective plan of action to ensure such full compliance.
"(d)
"(1)
"(A) ensure access by health care providers of the Department to information on controlled substances, including opioids and benzodiazepines, prescribed to veterans who receive care outside the Department through the prescription drug monitoring program of each State with such a program, including by seeking to enter into memoranda of understanding with States to allow shared access of such information between States and the Department;
"(B) include such information in the Opioid Therapy Risk Report tool; and
"(C) require health care providers of the Department to submit to the prescription drug monitoring program of each State with such a program information on prescriptions of controlled substances received by veterans in that State under the laws administered by the Secretary.
"(2)
"(A) the key clinical indicators with respect to the totality of opioid use by veterans;
"(B) concurrent prescribing by health care providers of the Department of opioids in different health care settings, including data on concurrent prescribing of opioids to treat mental health disorders other than opioid use disorder; and
"(C) mail-order prescriptions of opioids prescribed to veterans under the laws administered by the Secretary.
"(e)
"(1)
"(A)
"(B)
"(i) equip each pharmacy of the Department with opioid receptor antagonists to be dispensed to outpatients as needed; and
"(ii) expand the Overdose Education and Naloxone Distribution program of the Department to ensure that all veterans in receipt of health care under laws administered by the Secretary who are at risk of opioid overdose may access such opioid receptor antagonists and training on the proper administration of such opioid receptor antagonists.
"(C)
"(i) veterans receiving long-term opioid therapy;
"(ii) veterans receiving opioid therapy who have a history of substance use disorder or prior instances of overdose; and
"(iii) veterans who are at risk as determined by a health care provider who is treating the veteran.
"(2)
"(f)
"(1)
"(A) information on the most recent time the tool was accessed by a health care provider of the Department with respect to each veteran; and
"(B) information on the results of the most recent urine drug test for each veteran.
"(2)
"(g)
"(1) is receiving opioid therapy and has a history of substance use disorder or prior instances of overdose;
"(2) has a history of opioid abuse; or
"(3) is at risk of developing an opioid use disorder, as determined by a health care provider who is treating the veteran.
"SEC. 912. STRENGTHENING OF JOINT WORKING GROUP ON PAIN MANAGEMENT OF THE DEPARTMENT OF VETERANS AFFAIRS AND THE DEPARTMENT OF DEFENSE.
"(a)
"(1) The opioid prescribing practices of health care providers of each Department.
"(2) The ability of each Department to manage acute and chronic pain among individuals receiving health care from the Department, including training health care providers with respect to pain management.
"(3) The use by each Department of complementary and integrative health in treating such individuals.
"(4) The concurrent use and practice by health care providers of each Department of opioids and prescription drugs to treat mental health disorders, including benzodiazepines.
"(5) The use of care transition plans by health care providers of each Department to address case management issues for patients receiving opioid therapy who transition between inpatient and outpatient care.
"(6) The coordination in coverage of and consistent access to medications prescribed for patients transitioning from receiving health care from the Department of Defense to receiving health care from the Department of Veterans Affairs.
"(7) The ability of each Department to properly screen, identify, refer, and treat patients with substance use disorders who are seeking treatment for acute and chronic pain management conditions.
"(b)
"(1) coordinates the activities of the working group with other relevant working groups established under
"(2) consults with other relevant Federal agencies, including the Centers for Disease Control and Prevention, with respect to the activities of the working group; and
"(3) consults with the Department of Veterans Affairs and the Department of Defense with respect to the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, or any successor guideline, and reviews and provides comments before any update to the guideline is released.
"(c)
"(1)
"(2)
"(A) Enhanced guidance with respect to—
"(i) the co-administration of an opioid and other drugs, including benzodiazepines, that may result in life-limiting drug interactions;
"(ii) the treatment of patients with current acute psychiatric instability or substance use disorder or patients at risk of suicide; and
"(iii) the use of opioid therapy to treat mental health disorders other than opioid use disorder.
"(B) Enhanced guidance with respect to the treatment of patients with behaviors or comorbidities, such as post-traumatic stress disorder or other psychiatric disorders, or a history of substance abuse or addiction, that requires a consultation or co-management of opioid therapy with one or more specialists in pain management, mental health, or addictions.
"(C) Enhanced guidance with respect to health care providers—
"(i) conducting an effective assessment for patients beginning or continuing opioid therapy, including understanding and setting realistic goals with respect to achieving and maintaining an expected level of pain relief, improved function, or a clinically appropriate combination of both; and
"(ii) effectively assessing whether opioid therapy is achieving or maintaining the established treatment goals of the patient or whether the patient and health care provider should discuss adjusting, augmenting, or discontinuing the opioid therapy.
"(D) Guidelines to inform the methodologies used by health care providers of the Department of Veterans Affairs and the Department of Defense to safely taper opioid therapy when adjusting or discontinuing the use of opioid therapy, including—
"(i) prescription of the lowest effective dose based on patient need;
"(ii) use of opioids only for a limited time; and
"(iii) augmentation of opioid therapy with other pain management therapies and modalities.
"(E) Guidelines with respect to appropriate case management for patients receiving opioid therapy who transition between inpatient and outpatient health care settings, which may include the use of care transition plans.
"(F) Guidelines with respect to appropriate case management for patients receiving opioid therapy who transition from receiving care during active duty to post-military health care networks.
"(G) Guidelines with respect to providing options, before initiating opioid therapy, for pain management therapies without the use of opioids and options to augment opioid therapy with other clinical and complementary and integrative health services to minimize opioid dependence.
"(H) Guidelines with respect to the provision of evidence-based non-opioid treatments within the Department of Veterans Affairs and the Department of Defense, including medical devices and other therapies approved or cleared by the Food and Drug Administration for the treatment of chronic pain as an alternative to or to augment opioid therapy.
"(I) Guidelines developed by the Centers for Disease Control and Prevention for safely prescribing opioids for the treatment of chronic, non-cancer related pain in outpatient settings.
"(3)
"SEC. 913. REVIEW, INVESTIGATION, AND REPORT ON USE OF OPIOIDS IN TREATMENT BY DEPARTMENT OF VETERANS AFFAIRS.
"(a)
"(1)
"(2)
"(A) An assessment of the implementation and monitoring by the Veterans Health Administration of the Opioid Safety Initiative of the Department, including examining, as appropriate, the following:
"(i) How the Department monitors the key clinical outcomes of such safety initiative (for example, the percentage of unique veterans visiting each medical center of the Department that are prescribed an opioid or an opioid and benzodiazepine concurrently) and how the Department uses that information—
"(I) to improve prescribing practices; and
"(II) to identify high prescribing or otherwise inappropriate prescribing practices by health care providers.
"(ii) How the Department monitors the use of the Opioid Therapy Risk Report tool of the Department (as developed through such safety initiative) and compliance with such tool by medical facilities and health care providers of the Department, including any findings by the Department of prescription rates or prescription practices by medical facilities or health care providers that are inappropriate.
"(iii) The implementation of academic detailing programs within the Veterans Integrated Service Networks of the Department and how such programs are being used to improve opioid prescribing practices.
"(iv) Recommendations on such improvements to the Opioid Safety Initiative of the Department as the Comptroller General considers appropriate.
"(B) Information made available under the Opioid Therapy Risk Report tool with respect to—
"(i) deaths resulting from sentinel events involving veterans prescribed opioids by a health care provider;
"(ii) overall prescription rates and, if applicable, indications used by health care providers for prescribing chronic opioid therapy to treat non-cancer, non-palliative, and non-hospice care patients;
"(iii) the prescription rates and indications used by health care providers for prescribing benzodiazepines and opioids concomitantly;
"(iv) the practice by health care providers of prescribing opioids to treat patients without any pain, including to treat patients with mental health disorders other than opioid use disorder; and
"(v) the effectiveness of opioid therapy for patients receiving such therapy, including the effectiveness of long-term opioid therapy.
"(C) An evaluation of processes of the Department in place to oversee opioid use among veterans, including procedures to identify and remedy potential over-prescribing of opioids by health care providers of the Department.
"(D) An assessment of the implementation by the Secretary of Veterans Affairs of the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, including any figures or approaches used by the Department to assess compliance with such guidelines by medical centers of the Department and identify any medical centers of the Department operating action plans to improve compliance with such guidelines.
"(E) An assessment of the data that the Department has developed to review the opioid prescribing practices of health care providers of the Department, as required by this subtitle, including a review of how the Department identifies the practices of individual health care providers that warrant further review based on prescribing levels, health conditions for which the health care provider is prescribing opioids or opioids and benzodiazepines concurrently, or other practices of the health care provider.
"(b)
"(c)
"(1) The number of patients and the percentage of the patient population of the Department who were prescribed benzodiazepines and opioids concurrently by a health care provider of the Department.
"(2) The number of patients and the percentage of the patient population of the Department without any pain who were prescribed opioids by a health care provider of the Department, including those who were prescribed benzodiazepines and opioids concurrently.
"(3) The number of non-cancer, non-palliative, and non-hospice care patients and the percentage of such patients who were treated with opioids by a health care provider of the Department on an inpatient-basis and who also received prescription opioids by mail from the Department while being treated on an inpatient-basis.
"(4) The number of non-cancer, non-palliative, and non-hospice care patients and the percentage of such patients who were prescribed opioids concurrently by a health care provider of the Department and a health care provider that is not a health care provider of the Department.
"(5) With respect to each medical facility of the Department, the collected and reviewed information on opioids prescribed by health care providers at the facility to treat non-cancer, non-palliative, and non-hospice care patients, including—
"(A) the prescription rate at which each health care provider at the facility prescribed benzodiazepines and opioids concurrently to such patients and the aggregate of such prescription rate for all health care providers at the facility;
"(B) the prescription rate at which each health care provider at the facility prescribed benzodiazepines or opioids to such patients to treat conditions for which benzodiazepines or opioids are not approved treatment and the aggregate of such prescription rate for all health care providers at the facility;
"(C) the prescription rate at which each health care provider at the facility prescribed or dispensed mail-order prescriptions of opioids to such patients while such patients were being treated with opioids on an inpatient-basis and the aggregate of such prescription rate for all health care providers at the facility; and
"(D) the prescription rate at which each health care provider at the facility prescribed opioids to such patients who were also concurrently prescribed opioids by a health care provider that is not a health care provider of the Department and the aggregate of such prescription rates for all health care providers at the facility.
"(6) With respect to each medical facility of the Department, the number of times a pharmacist at the facility overrode a critical drug interaction warning with respect to an interaction between opioids and another medication before dispensing such medication to a veteran.
"(d)
"(1) immediately notify the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives of such determination, including information relating to such determination, prescription rate, and health care provider or medical facility, as the case may be; and
"(2) through the Office of the Medical Inspector of the Veterans Health Administration, conduct a full investigation of the health care provider or medical facility, as the case may be.
"(e)
"(1) The number of patients treated with opioids by the health care provider or at the medical facility, as the case may be, divided by the total number of pharmacy users of that health care provider or medical facility.
"(2) The average number of morphine equivalents per day prescribed by the health care provider or at the medical facility, as the case may be, to patients being treated with opioids.
"(3) Of the patients being treated with opioids by the health care provider or at the medical facility, as the case may be, the average number of prescriptions of opioids per patient.
"SEC. 914. MANDATORY DISCLOSURE OF CERTAIN VETERAN INFORMATION TO STATE CONTROLLED SUBSTANCE MONITORING PROGRAMS.
[Amended
"SEC. 915. ELIMINATION OF COPAYMENT REQUIREMENT FOR VETERANS RECEIVING OPIOID ANTAGONISTS OR EDUCATION ON USE OF OPIOID ANTAGONISTS.
"(a)
"(b)
"Subtitle B—Patient Advocacy
"SEC. 921. COMMUNITY MEETINGS ON IMPROVING CARE FURNISHED BY DEPARTMENT OF VETERANS AFFAIRS.
"(a)
"(1)
"(2)
"(b)
"(1)
"(2)
"(c)
"SEC. 922. IMPROVEMENT OF AWARENESS OF PATIENT ADVOCACY PROGRAM AND PATIENT BILL OF RIGHTS OF DEPARTMENT OF VETERANS AFFAIRS.
"Not later than 90 days after the date of the enactment of this Act [July 22, 2016], the Secretary of Veterans Affairs shall, in as many prominent locations as the Secretary determines appropriate to be seen by the largest percentage of patients and family members of patients at each medical facility of the Department of Veterans Affairs—
"(1) display the purposes of the Patient Advocacy Program of the Department and the contact information for the patient advocate at such medical facility; and
"(2) display the rights and responsibilities of—
"(A) patients and family members of patients at such medical facility; and
"(B) with respect to community living centers and other residential facilities of the Department, residents and family members of residents at such medical facility.
"SEC. 923. COMPTROLLER GENERAL REPORT ON PATIENT ADVOCACY PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS.
"(a)
"(b)
"(1) A description of the Program, including—
"(A) the purpose of the Program;
"(B) the activities carried out under the Program; and
"(C) the sufficiency of the Program in achieving the purpose of the Program.
"(2) An assessment of the sufficiency of staffing of employees of the Department responsible for carrying out the Program.
"(3) An assessment of the sufficiency of the training of such employees.
"(4) An assessment of—
"(A) the awareness of the Program among veterans and family members of veterans; and
"(B) the use of the Program by veterans and family members of veterans.
"(5) Such recommendations and proposals for improving or modifying the Program as the Comptroller General considers appropriate.
"(6) Such other information with respect to the Program as the Comptroller General considers appropriate.
"SEC. 924. ESTABLISHMENT OF OFFICE OF PATIENT ADVOCACY OF THE DEPARTMENT OF VETERANS AFFAIRS.
"(a)
"(b)
"(c)
"Subtitle C—Complementary and Integrative Health
"SEC. 931. EXPANSION OF RESEARCH AND EDUCATION ON AND DELIVERY OF COMPLEMENTARY AND INTEGRATIVE HEALTH TO VETERANS.
"(a)
"(b)
"(1) Examine the efficacy of the evidence-based therapy model used by the Secretary for treating mental health illnesses of veterans and identify areas to improve wellness-based outcomes.
"(2) Conduct a patient-centered survey within each of the Veterans Integrated Service Networks to examine—
"(A) the experience of veterans with the Department of Veterans Affairs when seeking medical assistance for mental health issues through the health care system of the Department;
"(B) the experience of veterans with non-Department facilities and health professionals for treating mental health issues;
"(C) the preference of veterans regarding available treatment for mental health issues and which methods the veterans believe to be most effective;
"(D) the experience, if any, of veterans with respect to the complementary and integrative health treatment therapies described in paragraph (3);
"(E) the prevalence of prescribing prescription medication among veterans seeking treatment through the health care system of the Department as remedies for addressing mental health issues; and
"(F) the outreach efforts of the Secretary regarding the availability of benefits and treatments for veterans for addressing mental health issues, including by identifying ways to reduce barriers to gaps in such benefits and treatments.
"(3) Examine available research on complementary and integrative health treatment therapies for mental health issues and identify what benefits could be made with the inclusion of such treatments for veterans, including with respect to—
"(A) music therapy;
"(B) equine therapy;
"(C) training and caring for service dogs;
"(D) yoga therapy;
"(E) acupuncture therapy;
"(F) meditation therapy;
"(G) outdoor sports therapy;
"(H) hyperbaric oxygen therapy;
"(I) accelerated resolution therapy;
"(J) art therapy;
"(K) magnetic resonance therapy; and
"(L) other therapies the Commission determines appropriate.
"(4) Study the sufficiency of the resources of the Department to ensure the delivery of quality health care for mental health issues among veterans seeking treatment within the Department.
"(5) Study the current treatments and resources available within the Department and assess—
"(A) the effectiveness of such treatments and resources in decreasing the number of suicides per day by veterans;
"(B) the number of veterans who have been diagnosed with mental health issues;
"(C) the percentage of veterans using the resources of the Department who have been diagnosed with mental health issues;
"(D) the percentage of veterans who have completed counseling sessions offered by the Department; and
"(E) the efforts of the Department to expand complementary and integrative health treatments viable to the recovery of veterans with mental health issues as determined by the Secretary to improve the effectiveness of treatments offered by the Department.
"(c)
"(1)
"(A) Two members appointed by the Speaker of the House of Representatives, at least one of whom shall be a veteran.
"(B) Two members appointed by the minority leader of the House of Representatives, at least one of whom shall be a veteran.
"(C) Two members appointed by the majority leader of the Senate, at least one of whom shall be a veteran.
"(D) Two members appointed by the minority leader of the Senate, at least one of whom shall be a veteran.
"(E) Two members appointed by the President, at least one of whom shall be a veteran.
"(2)
"(A) are of recognized standing and distinction within the medical community with a background in treating mental health;
"(B) have experience working with the military and veteran population; and
"(C) do not have a financial interest in any of the complementary and integrative health treatments reviewed by the Commission.
"(3)
"(4)
"(5)
"(6)
"(d)
"(1)
"(A)
"(B)
"(2)
"(3)
"(4)
"(5)
"(6)
"(7)
"(8)
"(9)
"(A)
"(B)
"(10)
"(11)
"(12)
"(13)
"(e)
"(1)
"(A)
"(B)
"(2)
"(A) Recommendations to implement in a feasible, timely, and cost-efficient manner the solutions and remedies identified within the findings of the Commission pursuant to subsection (b).
"(B) An analysis of the evidence-based therapy model used by the Secretary of Veterans Affairs for treating veterans with mental health care issues, and an examination of the prevalence and efficacy of prescription drugs as a means for treatment.
"(C) The findings of the patient-centered survey conducted within each of the Veterans Integrated Service Networks pursuant to subsection (b)(2).
"(D) An examination of complementary and integrative health treatments described in subsection (b)(3) and the potential benefits of incorporating such treatments in the therapy models used by the Secretary for treating veterans with mental health issues.
"(3)
"(A) An action plan for implementing the recommendations established by the Commission on such solutions and remedies for improving wellness-based outcomes for veterans with mental health care issues.
"(B) A feasible timeframe on when the complementary and integrative health treatments described in subsection (b)(3) can be implemented Department-wide.
"(C) With respect to each recommendation established by the Commission, including any complementary and integrative health treatment, that the Secretary determines is not appropriate or feasible to implement, a justification for such determination and an alternative solution to improve the efficacy of the therapy models used by the Secretary for treating veterans with mental health issues.
"(f)
"SEC. 932. EXPANSION OF RESEARCH AND EDUCATION ON AND DELIVERY OF COMPLEMENTARY AND INTEGRATIVE HEALTH TO VETERANS.
"(a)
"(b)
"(1) Research on the following:
"(A) The effectiveness of various complementary and integrative health services, including the effectiveness of such services integrated with clinical services.
"(B) Approaches to integrating complementary and integrative health services into other health care services provided by the Department of Veterans Affairs.
"(2) Education and training for health care professionals of the Department on the following:
"(A) Complementary and integrative health services selected by the Secretary for purposes of the plan.
"(B) Appropriate uses of such services.
"(C) Integration of such services into the delivery of health care to veterans.
"(3) Research, education, and clinical activities on complementary and integrative health at centers of innovation at medical centers of the Department.
"(4) Identification or development of metrics and outcome measures to evaluate the effectiveness of the provision and integration of complementary and integrative health services into the delivery of health care to veterans.
"(5) Integration and delivery of complementary and integrative health services with other health care services provided by the Department.
"(c)
"(1)
"(A) The Director of the National Center for Complementary and Integrative Health of the National Institutes of Health.
"(B) The Commissioner of Food and Drugs.
"(C) Institutions of higher education, private research institutes, and individual researchers with extensive experience in complementary and integrative health and the integration of complementary and integrative health practices into the delivery of health care.
"(D) Nationally recognized providers of complementary and integrative health.
"(E) Such other officials, entities, and individuals with expertise on complementary and integrative health as the Secretary considers appropriate.
"(2)
"(A) To develop the plan.
"(B) To identify specific complementary and integrative health practices that, on the basis of research findings or promising clinical interventions, are appropriate to include as services to veterans.
"(C) To identify barriers to the effective provision and integration of complementary and integrative health services into the delivery of health care to veterans, and to identify mechanisms for overcoming such barriers.
"SEC. 933. PILOT PROGRAM ON INTEGRATION OF COMPLEMENTARY AND INTEGRATIVE HEALTH AND RELATED ISSUES FOR VETERANS AND FAMILY MEMBERS OF VETERANS.
"(a)
"(1)
"(2)
"(A) Means of improving coordination between Federal, State, local, and community providers of health care in the provision of pain management and related health care services to veterans.
"(B) Means of enhancing outreach, and coordination of outreach, by and among providers of health care referred to in subparagraph (A) on the pain management and related health care services available to veterans.
"(C) Means of using complementary and integrative health and wellness-based programs of providers of health care referred to in subparagraph (A) as complements to the provision by the Department of Veterans Affairs of pain management and related health care services to veterans.
"(D) Whether complementary and integrative health and wellness-based programs described in subparagraph (C)—
"(i) are effective in enhancing the quality of life and well-being of veterans;
"(ii) are effective in increasing the adherence of veterans to the primary pain management and related health care services provided such veterans by the Department;
"(iii) have an effect on the sense of well-being of veterans who receive primary pain management and related health care services from the Department; and
"(iv) are effective in encouraging veterans receiving health care from the Department to adopt a more healthy lifestyle.
"(b)
"(c)
"(1)
"(2)
"(d)
"(e)
"(1) has a mental health condition diagnosed by a clinician of the Department;
"(2) experiences chronic pain;
"(3) has a chronic condition being treated by a clinician of the Department; or
"(4) is not described in paragraph (1), (2), or (3) and requests to participate in the pilot program or is referred by a clinician of the Department who is treating the veteran.
"(f)
"(1)
"(2)
"(A) Covered services shall be administered by professionals or other instructors with appropriate training and expertise in complementary and integrative health services who are employees of the Department or with whom the Department enters into an agreement to provide such services.
"(B) Covered services shall be included as part of the Patient Aligned Care Teams initiative of the Office of Patient Care Services, Primary Care Program Office, in coordination with the Office of Patient Centered Care and Cultural Transformation.
"(C) Covered services shall be made available to—
"(i) covered veterans who have received conventional treatments from the Department for the conditions for which the covered veteran seeks complementary and integrative health services under the pilot program; and
"(ii) covered veterans who have not received conventional treatments from the Department for such conditions.
"(g)
"(1)
"(2)
"(A) The findings and conclusions of the Secretary with respect to the pilot program under subsection (a)(1), including with respect to—
"(i) the use and efficacy of the complementary and integrative health services established under the pilot program;
"(ii) the outreach conducted by the Secretary to inform veterans and community organizations about the pilot program; and
"(iii) an assessment of the benefit of the pilot program to covered veterans in mental health diagnoses, pain management, and treatment of chronic illness.
"(B) Identification of any unresolved barriers that impede the ability of the Secretary to incorporate complementary and integrative health services with other health care services provided by the Department.
"(C) Such recommendations for the continuation or expansion of the pilot program as the Secretary considers appropriate.
"Subtitle D—Fitness of Health Care Providers
"SEC. 941. ADDITIONAL REQUIREMENTS FOR HIRING OF HEALTH CARE PROVIDERS BY DEPARTMENT OF VETERANS AFFAIRS.
"As part of the hiring process for each health care provider considered for a position at the Department of Veterans Affairs after the date of the enactment of the [this] Act [July 22, 2016], the Secretary of Veterans Affairs shall require from the medical board of each State in which the health care provider has or had a medical license—
"(1) information on any violation of the requirements of the medical license of the health care provider during the 20-year period preceding the consideration of the health care provider by the Department; and
"(2) information on whether the health care provider has entered into any settlement agreement for a disciplinary charge relating to the practice of medicine by the health care provider.
"SEC. 942. PROVISION OF INFORMATION ON HEALTH CARE PROVIDERS OF DEPARTMENT OF VETERANS AFFAIRS TO STATE MEDICAL BOARDS.
"Notwithstanding
"SEC. 943. REPORT ON COMPLIANCE BY DEPARTMENT OF VETERANS AFFAIRS WITH REVIEWS OF HEALTH CARE PROVIDERS LEAVING THE DEPARTMENT OR TRANSFERRING TO OTHER FACILITIES.
"Not later than 180 days after the date of the enactment of this Act [July 22, 2016], 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 on the compliance by the Department of Veterans Affairs with the policy of the Department—
"(1) to conduct a review of each health care provider of the Department who transfers to another medical facility of the Department, resigns, retires, or is terminated to determine whether there are any concerns, complaints, or allegations of violations relating to the medical practice of the health care provider; and
"(2) to take appropriate action with respect to any such concern, complaint, or allegation.
"Subtitle E—Other Matters
"SEC. 951. MODIFICATION TO LIMITATION ON AWARDS AND BONUSES."
[Amended section 705 of
Funding Account for Non-Department Care
"(1) discretionary medical services funding that is designated for hospital care and medical services furnished at non-Department facilities; and
"(2) any funds transferred for such purpose from the Veterans Choice Fund established by section 802 of the Veterans Access, Choice, and Accountability Act of 2014 (
Limitation on Dialysis Pilot Program
"(a)
"(1) an independent analysis of the dialysis pilot program is conducted for each such initial facility;
"(2) the Secretary submits to the appropriate congressional committees the report under subsection (b); and
"(3) a period of 180 days has elapsed following the date on which the Secretary submits such report.
"(b)
"(1) The independent analysis described in subsection (a)(1).
"(2) A five-year dialysis investment plan explaining all of the options of the Secretary for delivering dialysis care to veterans, including how and where such care will be delivered.
"(c)
"(1) The term 'appropriate congressional committees' means—
"(A) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives; and
"(B) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate.
"(2) The term 'dialysis pilot program' means the pilot demonstration program approved by the Under Secretary of Veterans Affairs for Health in August 2010 and by the Secretary of Veterans Affairs in September 2010 to provide dialysis care to patients at certain outpatient facilities operated by the Department of Veterans Affairs.
"(3) The term 'initial facility' means one of the four outpatient facilities identified by the Secretary to participate in the dialysis pilot program prior to the date of the enactment of this Act [July 31, 2015]."
Veterans Access, Choice and Accountability in Health Care
"SEC. 2. DEFINITIONS.
"In this Act [see Tables for classification]:
"(1) The term 'facility of the Department' has the meaning given the term 'facilities of the Department' in
"(2) The terms 'hospital care' and 'medical services' have the meanings given such terms in
"TITLE I—IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT OF VETERANS AFFAIRS PROVIDERS
"SEC. 101. EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL SERVICES FOR VETERANS THROUGH THE USE OF AGREEMENTS WITH NON-DEPARTMENT OF VETERANS AFFAIRS ENTITIES.
"(a)
"(1)
"(A)
"(B)
"(i) Any health care provider that is participating in the Medicare program under title XVIII of the Social Security Act (
"(ii) Any Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act (
"(iii) The Department of Defense.
"(iv) The Indian Health Service.
"(v) Subject to subsection (d)(5), a health care provider not otherwise covered under any of clauses (i) through (iv).
"(2)
"(3)
"(b)
"(1) the veteran is enrolled in the patient enrollment system of the Department of Veterans Affairs established and operated under
"(2) the veteran—
"(A) attempts, or has attempted, to schedule an appointment for the receipt of hospital care or medical services under
"(i) the wait-time goals of the Veterans Health Administration for the furnishing of such care or services; or
"(ii) with respect to such care or services that are clinically necessary, the period determined necessary for such care or services if such period is shorter than such wait-time goals;
"(B) resides more than 40 miles (as calculated based on distance traveled) from—
"(i) with respect to a veteran who is seeking primary care, a medical facility of the Department, including a community-based outpatient clinic, that is able to provide such primary care by a full-time primary care physician; or
"(ii) with respect to a veteran not covered under clause (i), the medical facility of the Department, including a community-based outpatient clinic, that is closest to the residence of the veteran;
"(C) resides—
"(i) in a State without a medical facility of the Department that provides—
"(I) hospital care;
"(II) emergency medical services; and
"(III) surgical care rated by the Secretary as having a surgical complexity of standard; and
"(ii) more than 20 miles from a medical facility of the Department described in clause (i); or
"(D)(i) resides in a location, other than a location in Guam, American Samoa, or the Republic of the Philippines, that is 40 miles or less from a medical facility of the Department, including a community-based outpatient clinic; and
"(ii)(I) is required to travel by air, boat, or ferry to reach each medical facility described in clause (i) that is 40 miles or less from the residence of the veteran; or
"(II) faces an unusual or excessive burden in traveling to such a medical facility of the Department based on—
"(aa) geographical challenges;
"(bb) environmental factors, such as roads that are not accessible to the general public, traffic, or hazardous weather;
"(cc) a medical condition that impacts the ability to travel; or
"(dd) other factors, as determined by the Secretary.
"(c)
"(1)
"(A) provide the veteran an appointment that exceeds the wait-time goals described in such subsection or place such eligible veteran on an electronic waiting list described in paragraph (2) for an appointment for hospital care or medical services the veteran has elected to receive under this section; or
"(B)(i) authorize that such care or services be furnished to the eligible veteran under this section for a period of time specified by the Secretary; and
"(ii) notify the eligible veteran by the most effective means available, including electronic communication or notification in writing, describing the care or services the eligible veteran is eligible to receive under this section.
"(2)
"(A) To determine the place of such eligible veteran on the waiting list.
"(B) To determine the average length of time an individual spends on the waiting list, disaggregated by medical facility of the Department and type of care or service needed, for purposes of allowing such eligible veteran to make an informed election under paragraph (1).
"(d)
"(1)
"(A)
"(B)
"(2)
"(A)
"(i) negotiate rates for the furnishing of care and services under this section; and
"(ii) reimburse the entity for such care and services at the rates negotiated pursuant to clause (i) as provided in such agreement.
"(B)
"(i)
"(ii)
"(I)
"(II)
"(III)
"(C)
"(3)
"(A)
"(B)
"(i) In the case of the Medicare program, any provider of services that has entered into a provider agreement under section 1866(a) of the Social Security Act (
"(ii) In the case of the Medicaid program, any provider participating under a State plan under title XIX of such Act (
"(4)
"(A) Information on applicable policies and procedures for submitting bills or claims for authorized care or services furnished to eligible veterans under this section.
"(B) Access to a telephone hotline maintained by the Department that such entity may call for information on the following:
"(i) Procedures for furnishing care and services under this section.
"(ii) Procedures for submitting bills or claims for authorized care and services furnished to eligible veterans under this section and being reimbursed for furnishing such care and services.
"(iii) Whether particular care or services under this section are authorized, and the procedures for authorization of such care or services.
"(5)
"(e)
"(1)
"(2)
"(A) is an insurance policy or contract, medical or hospital service agreement, membership or subscription contract, or similar arrangement not administered by the Secretary of Veterans Affairs, under which health services for individuals are provided or the expenses of such services are paid; and
"(B) does not include any such policy, contract, agreement, or similar arrangement pursuant to title XVIII or XIX of the Social Security Act (
"(3)
"(A)
"(B)
"(f)
"(1)
"(2)
"(3)
"(A) The name of the veteran.
"(B) An identification number for the veteran that is not the social security number of the veteran.
"(C) The contact information of an appropriate office of the Department for health care providers to confirm that care or services under this section are authorized for the veteran.
"(D) Contact information and other relevant information for the submittal of claims or bills for the furnishing of care or services under this section.
"(E) The following statement: 'This card is for qualifying medical care outside the Department of Veterans Affairs. Please call the Department of Veterans Affairs phone number specified on this card to ensure that treatment has been authorized.'.
"(4)
"(g)
"(1) When the veteran enrolls in the patient enrollment system of the Department under
"(2) When the veteran attempts to schedule an appointment for the receipt of hospital care or medical services from the Department but is unable to schedule an appointment within the wait-time goals of the Veterans Health Administration for the furnishing of such care or services.
"(3) When the veteran becomes eligible for hospital care or medical services under this section under subparagraph (B), (C), or (D) of subsection (b)(2).
"(h)
"(i)
"(1) maintain at least the same or similar credentials and licenses as those credentials and licenses that are required of health care providers of the Department, as determined by the Secretary for purposes of this section; and
"(2) submit, not less frequently than once each year during the period in which the Secretary is authorized to carry out this section pursuant to subsection (p), verification of such licenses and credentials maintained by such health care provider.
"(j)
"(1)
"(2)
"(3)
"(k)
"(1)
"(2)
"(3)
"(4)
"(A)
"(B)
"(i)
"(ii)
"(I) A description of the goals for accuracy for such system specified by the Secretary under subparagraph (A).
"(II) An assessment of the success of the Department in meeting such goals during the quarter covered by the report.
"(iii)
"(l)
"(1)
"(2)
"(m)
"(n)
"(o)
"(p)
"(q)
"(1)
"(A) The number of eligible veterans who have received care or services under this section.
"(B) A description of the types of care and services furnished to eligible veterans under this section.
"(2)
"(A) The total number of eligible veterans who have received care or services under this section, disaggregated by—
"(i) eligible veterans described in subsection (b)(2)(A);
"(ii) eligible veterans described in subsection (b)(2)(B);
"(iii) eligible veterans described in subsection (b)(2)(C); and
"(iv) eligible veterans described in subsection (b)(2)(D).
"(B) A description of the types of care and services furnished to eligible veterans under this section.
"(C) An accounting of the total cost of furnishing care and services to eligible veterans under this section.
"(D) The results of a survey of eligible veterans who have received care or services under this section on the satisfaction of such eligible veterans with the care or services received by such eligible veterans under this section.
"(E) An assessment of the effect of furnishing care and services under this section on wait times for appointments for the receipt of hospital care and medical services from the Department.
"(F) An assessment of the feasibility and advisability of continuing furnishing care and services under this section after the termination date specified in subsection (p).
"(r)
"(s)
"(1)
"(2)
"(A) for purposes of this section, the wait-time goals of the Veterans Health Administration shall be the wait-time goals submitted by the Secretary under this paragraph; and
"(B) the Secretary shall publish such wait-time goals in the Federal Register and on an Internet website of the Department available to the public.
"(t)
"SEC. 102. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF VETERANS AFFAIRS AND INDIAN HEALTH SERVICE.
"(a)
"(1) eligible for health care at such facilities; and
"(2)(A) enrolled in the patient enrollment system of the Department established and operated under
"(B) eligible for hospital care and medical services pursuant to subsection (c)(2) of such section.
"(b)
"(c)
"(1) Entering into agreements for the reimbursement by the Secretary of the costs of direct care services provided through organizations receiving amounts pursuant to grants made or contracts entered into under section 503 of the Indian Health Care Improvement Act (
"(2) Including the reimbursement of the costs of direct care services provided to veterans who are not Indians in agreements between the Department and the following:
"(A) The Indian Health Service.
"(B) An Indian tribe or tribal organization operating a medical facility through a contract or compact with the Indian Health Service under the Indian Self-Determination and Education Assistance Act (
"(C) A medical facility of the Indian Health Service.
"(3) Entering into an agreement between the Department and the Indian Health Service described in paragraph (2)(A) with respect to the effect of such agreement on the priority access of any Indian to health care services provided through the Indian Health Service, the eligibility of any Indian to receive health services through the Indian Health Service, and the quality of health care services provided to any Indian through the Indian Health Service.
"SEC. 103. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF VETERANS AFFAIRS AND NATIVE HAWAIIAN HEALTH CARE SYSTEMS.
"(a)
"(b)
"SEC. 104. REAUTHORIZATION AND MODIFICATION OF PILOT PROGRAM OF ENHANCED CONTRACT CARE AUTHORITY FOR HEALTH CARE NEEDS OF VETERANS.
[Amended section 403 of Pub. L. 110—387, set out as a note under
"SEC. 105. PROMPT PAYMENT BY DEPARTMENT OF VETERANS AFFAIRS.
"(a)
"(b)
"(1)
"(2)
"(c)
"(d)
"(1) The results of a survey of non-Department health care providers who have submitted claims to the Department for hospital care, medical services, or other health care furnished to veterans for which payment is authorized under the laws administered by the Secretary during the one-year period preceding the submittal of the report, which survey shall include the following:
"(A) The amount of time it took for such health care providers, after submitting such claims, to receive payment from the Department for such care or services.
"(B) A comparison of the amount of time under subparagraph (A) and the amount of time it takes such health care providers to receive payments from the United States for similar care or services provided to the following, if applicable:
"(i) Beneficiaries under the Medicare program under title XVIII of the Social Security Act (
"(ii) Covered beneficiaries under the TRICARE program under
"(2) Such recommendations for legislative or administrative action as the Comptroller General considers appropriate.
"(e)
"(1) are located in different geographic areas;
"(2) furnish a variety of different hospital care, medical services, and other health care; and
"(3) furnish such care and services in a variety of different types of medical facilities.
"SEC. 106. TRANSFER OF AUTHORITY FOR PAYMENTS FOR HOSPITAL CARE, MEDICAL SERVICES, AND OTHER HEALTH CARE FROM NON-DEPARTMENT OF VETERANS AFFAIRS PROVIDERS TO THE CHIEF BUSINESS OFFICE OF THE VETERANS HEALTH ADMINISTRATION.
"(a)
"(1)
"(A) the Veterans Integrated Service Networks and medical centers of the Department of Veterans Affairs, to
"(B) the Chief Business Office of the Veterans Health Administration of the Department of Veterans Affairs.
"(2)
"(3)
"(b)
"TITLE II—HEALTH CARE ADMINISTRATIVE MATTERS
"SEC. 201. INDEPENDENT ASSESSMENT OF THE HEALTH CARE DELIVERY SYSTEMS AND MANAGEMENT PROCESSES OF THE DEPARTMENT OF VETERANS AFFAIRS.
"(a)
"(1)
"(A) Current and projected demographics and unique health care needs of the patient population served by the Department.
"(B) Current and projected health care capabilities and resources of the Department, including hospital care, medical services, and other health care furnished by non-Department facilities under contract with the Department, to provide timely and accessible care to veterans.
"(C) The authorities and mechanisms under which the Secretary may furnish hospital care, medical services, and other health care at non-Department facilities, including whether the Secretary should have the authority to furnish such care and services at such facilities through the completion of episodes of care.
"(D) The appropriate system-wide access standard applicable to hospital care, medical services, and other health care furnished by and through the Department, including an identification of appropriate access standards for each individual specialty and post-care rehabilitation.
"(E) The workflow process at each medical facility of the Department for scheduling appointments for veterans to receive hospital care, medical services, or other health care from the Department.
"(F) The organization, workflow processes, and tools used by the Department to support clinical staffing, access to care, effective length-of-stay management and care transitions, positive patient experience, accurate documentation, and subsequent coding of inpatient services.
"(G) The staffing level at each medical facility of the Department and the productivity of each health care provider at such medical facility, compared with health care industry performance metrics, which may include an assessment of any of the following:
"(i) The case load of, and number of patients treated by, each health care provider at such medical facility during an average week.
"(ii) The time spent by such health care provider on matters other than the case load of such health care provider, including time spent by such health care provider as follows:
"(I) At a medical facility that is affiliated with the Department.
"(II) Conducting research.
"(III) Training or supervising other health care professionals of the Department.
"(H) The information technology strategies of the Department with respect to furnishing and managing health care, including an identification of any weaknesses and opportunities with respect to the technology used by the Department, especially those strategies with respect to clinical documentation of episodes of hospital care, medical services, and other health care, including any clinical images and associated textual reports, furnished by the Department in Department or non-Department facilities.
"(I) Business processes of the Veterans Health Administration, including processes relating to furnishing non-Department health care, insurance identification, third-party revenue collection, and vendor reimbursement, including an identification of mechanisms as follows:
"(i) To avoid the payment of penalties to vendors.
"(ii) To increase the collection of amounts owed to the Department for hospital care, medical services, or other health care provided by the Department for which reimbursement from a third party is authorized and to ensure that such amounts collected are accurate.
"(iii) To increase the collection of any other amounts owed to the Department with respect to hospital care, medical services, and other health care and to ensure that such amounts collected are accurate.
"(iv) To increase the accuracy and timeliness of Department payments to vendors and providers.
"(J) The purchasing, distribution, and use of pharmaceuticals, medical and surgical supplies, medical devices, and health care related services by the Department, including the following:
"(i) The prices paid for, standardization of, and use by the Department of the following:
"(I) Pharmaceuticals.
"(II) Medical and surgical supplies.
"(III) Medical devices.
"(ii) The use by the Department of group purchasing arrangements to purchase pharmaceuticals, medical and surgical supplies, medical devices, and health care related services.
"(iii) The strategy and systems used by the Department to distribute pharmaceuticals, medical and surgical supplies, medical devices, and health care related services to Veterans Integrated Service Networks and medical facilities of the Department.
"(K) The process of the Department for carrying out construction and maintenance projects at medical facilities of the Department and the medical facility leasing program of the Department.
"(L) The competency of leadership with respect to culture, accountability, reform readiness, leadership development, physician alignment, employee engagement, succession planning, and performance management.
"(2)
"(A)
"(i) Review all training materials pertaining to scheduling of appointments at each medical facility of the Department.
"(ii) Assess whether all employees of the Department conducting tasks related to scheduling are properly trained for conducting such tasks.
"(iii) Assess whether changes in the technology or system used in scheduling appointments are necessary to limit access to the system to only those employees that have been properly trained in conducting such tasks.
"(iv) Assess whether health care providers of the Department are making changes to their schedules that hinder the ability of employees conducting such tasks to perform such tasks.
"(v) Assess whether the establishment of a centralized call center throughout the Department for scheduling appointments at medical facilities of the Department would improve the process of scheduling such appointments.
"(vi) Assess whether booking templates for each medical facility or clinic of the Department would improve the process of scheduling such appointments.
"(vii) Assess any interim technology changes or attempts by Department to internally develop a long-term scheduling solutions with respect to the feasibility and cost effectiveness of such internally developed solutions compared to commercially available solutions.
"(viii) Recommend actions, if any, to be taken by the Department to improve the process for scheduling such appointments, including the following:
"(I) Changes in training materials provided to employees of the Department with respect to conducting tasks related to scheduling such appointments.
"(II) Changes in monitoring and assessment conducted by the Department of wait times of veterans for such appointments.
"(III) Changes in the system used to schedule such appointments, including changes to improve how the Department—
"(aa) measures wait times of veterans for such appointments;
"(bb) monitors the availability of health care providers of the Department; and
"(cc) provides veterans the ability to schedule such appointments.
"(IV) Such other actions as the private sector entity or entities considers appropriate.
"(B)
"(i) Review the process of the Department for identifying and designing proposals for construction and maintenance projects at medical facilities of the Department and leases for medical facilities of the Department.
"(ii) Assess the process through which the Department determines the following:
"(I) That a construction or maintenance project or lease is necessary with respect to a medical facility or proposed medical facility of the Department.
"(II) The proper size of such medical facility or proposed medical facility with respect to treating veterans in the catchment area of such medical facility or proposed medical facility.
"(iii) Assess the management processes of the Department with respect to the capital management programs of the Department, including processes relating to the methodology for construction and design of medical facilities of the Department, the management of projects relating to the construction and design of such facilities, and the activation of such facilities.
"(iv) Assess the medical facility leasing program of the Department.
"(3)
"(b)
"(1) has experience and proven outcomes in optimizing the performance of the health care delivery systems of the Veterans Health Administration and the private sector and in health care management; and
"(2) specializes in implementing large-scale organizational and cultural transformations, especially with respect to health care delivery systems.
"(c)
"(1)
"(2)
"(d)
"(1)
"(2)
"(e)
"SEC. 202. COMMISSION ON CARE.
"(a)
"(1)
"(2)
"(A)
"(i) Three members appointed by the Speaker of the House of Representatives, at least one of whom shall be a veteran.
"(ii) Three members appointed by the Minority Leader of the House of Representatives, at least one of whom shall be a veteran.
"(iii) Three members appointed by the Majority Leader of the Senate, at least one of whom shall be a veteran.
"(iv) Three members appointed by the Minority Leader of the Senate, at least one of whom shall be a veteran.
"(v) Three members appointed by the President, at least two of whom shall be veterans.
"(B)
"(i) at least one member shall represent an organization recognized by the Secretary of Veterans Affairs for the representation of veterans under
"(ii) at least one member shall have experience as senior management for a private integrated health care system with an annual gross revenue of more than $50,000,000;
"(iii) at least one member shall be familiar with government health care systems, including those systems of the Department of Defense, the Indian Health Service, and Federally-qualified health centers (as defined in section 1905(l)(2)(B) of the Social Security Act (
"(iv) at least one member shall be familiar with the Veterans Health Administration but shall not be currently employed by the Veterans Health Administration; and
"(v) at least one member shall be familiar with medical facility construction and leasing projects carried out by government entities and have experience in the building trades, including construction, engineering, and architecture.
"(C)
"(3)
"(A) In
"(B)
"(4)
"(5)
"(6)
"(7)
"(b)
"(1)
"(2)
"(3)
"(A) Not later than 90 days after the date of the initial meeting of the Commission, an interim report on—
"(i) the findings of the Commission with respect to the evaluation and assessment required by this subsection; and
"(ii) such recommendations as the Commission may have for legislative or administrative action to improve access to health care through the Veterans Health Administration.
"(B) Not later than June 30, 2016, a final report on—
"(i) the findings of the Commission with respect to the evaluation and assessment required by this subsection; and
"(ii) such recommendations as the Commission may have for legislative or administrative action to improve access to health care through the Veterans Health Administration.
"(c)
"(1)
"(2)
"(d)
"(1)
"(A)
"(B)
"(2)
"(3)
"(A)
"(B)
"(4)
"(5)
"(e)
"(f)
"(g)
"(1)
"(A) considers feasible and advisable; and
"(B) determines can be implemented without further legislative action.
"(2)
"(A) An assessment of the feasibility and advisability of each recommendation contained in the report received by the President.
"(B) For each recommendation assessed as feasible and advisable under subparagraph (A) the following:
"(i) Whether such recommendation requires legislative action.
"(ii) If such recommendation requires legislative action, a recommendation concerning such legislative action.
"(iii) A description of any administrative action already taken to carry out such recommendation.
"(iv) A description of any administrative action the President intends to be taken to carry out such recommendation and by whom.
"SEC. 203. TECHNOLOGY TASK FORCE ON REVIEW OF SCHEDULING SYSTEM AND SOFTWARE OF THE DEPARTMENT OF VETERANS AFFAIRS.
"(a)
"(1)
"(2)
"(A)
"(B)
"(b)
"(1)
"(2)
"(A) Proposals for specific actions to be taken by the Department to improve the scheduling system and scheduling software of the Department described in subsection (a)(1).
"(B) A determination as to whether one or more existing off-the-shelf systems would—
"(i) meet the needs of the Department to schedule appointments for veterans for hospital care, medical services, and other health care from the Department; and
"(ii) improve the access of veterans to such care and services.
"(3)
"(c)
"SEC. 204. IMPROVEMENT OF ACCESS OF VETERANS TO MOBILE VET CENTERS AND MOBILE MEDICAL CENTERS OF THE DEPARTMENT OF VETERANS AFFAIRS.
"(a)
"(1)
"(2)
"(A) The number of days each mobile vet center and mobile medical center of the Department is expected to travel per year.
"(B) The number of locations and events each center is expected to visit per year.
"(C) The number of appointments and outreach contacts each center is expected to conduct per year.
"(D) The method and timing of notifications given by each center to individuals in the area to which the center is traveling, including notifications informing veterans of the availability to schedule appointments at the center.
"(3)
"(b)
"(1)
"(2)
"(A) A description of the use of mobile vet centers and mobile medical centers to provide telemedicine services and readjustment counseling to veterans during the year preceding the submittal of the report, including the following:
"(i) The number of days each mobile vet center and mobile medical center was open to provide such services.
"(ii) The number of days each center traveled to a location other than the headquarters of the center to provide such services.
"(iii) The number of appointments and outreach contacts each center conducted to provide such services on average per month and in total during such year.
"(B) An analysis of the effectiveness of using mobile vet centers and mobile medical centers to provide health care services and readjustment counseling to veterans through the use of telemedicine.
"(C) Any recommendations for an increase in the number of mobile vet centers and mobile medical centers of the Department.
"(D) Any recommendations for an increase in the telemedicine capabilities of each mobile vet center and mobile medical center.
"(E) The feasibility and advisability of using temporary health care providers, including locum tenens, to provide direct health care services to veterans at mobile medical centers.
"(F) Such other recommendations on improvement of the use of mobile vet centers and mobile medical centers by the Department as the Secretary considers appropriate.
"SEC. 205. IMPROVED PERFORMANCE METRICS FOR HEALTH CARE PROVIDED BY DEPARTMENT OF VETERANS AFFAIRS.
"(a)
"(1) Directors, associate directors, assistant directors, deputy directors, chiefs of staff, and clinical leads of medical centers of the Department of Veterans Affairs.
"(2) Directors, assistant directors, and quality management officers of Veterans Integrated Service Networks of the Department of Veterans Affairs.
"(b)
"(1)
"(2)
"(A) Recent reviews by the Joint Commission (formerly known as the 'Joint Commission on Accreditation of Healthcare Organizations') of such facilities.
"(B) The number and nature of recommendations concerning such facilities by the Inspector General of the Department in reviews conducted through the Combined Assessment Program, in the reviews by the Inspector General of community-based outpatient clinics and primary care clinics, and in reviews conducted through the Office of Healthcare Inspections during the two most recently completed fiscal years.
"(C) The number of recommendations described in subparagraph (B) that the Inspector General of the Department determines have not been carried out satisfactorily with respect to such facilities.
"(D) Reviews of such facilities by the Commission on Accreditation of Rehabilitation Facilities.
"(E) The number and outcomes of administrative investigation boards, root cause analyses, and peer reviews conducted at such facilities during the fiscal year for which the assessment is being conducted.
"(F) The effectiveness of any remedial actions or plans resulting from any Inspector General recommendations in the reviews and analyses described in subparagraphs (A) through (E).
"(3)
"(c)
"SEC. 206. IMPROVED TRANSPARENCY CONCERNING HEALTH CARE PROVIDED BY DEPARTMENT OF VETERANS AFFAIRS.
"(a)
"(1) on a publicly accessible Internet website of each medical center of the Department by not later than 30 days after such change; and
"(2) in the Federal Register by not later than 90 days after such change.
"(b)
"(1)
"(2)
"(3)
"(4)
"(c)
"(1)
"(2)
"(A) Measures of timely and effective health care.
"(B) Measures of readmissions, complications of death, including with respect to 30-day mortality rates and 30-day readmission rates, surgical complication measures, and health care related infection measures.
"(C) Survey data of patient experiences, including the Hospital Consumer Assessment of Healthcare Providers and Systems or any similar successor survey developed by the Department of Health and Human Services.
"(D) Any other measures required of or reported with respect to hospitals participating in the Medicare program under title XVIII of the Social Security Act (
"(3)
"(d)
"SEC. 207. INFORMATION FOR VETERANS ON THE CREDENTIALS OF DEPARTMENT OF VETERANS AFFAIRS PHYSICIANS.
"(a)
"(1)
"(2)
"(3)
"(b)
"(1)
"(2)
"(A) The education and training of the surgeon.
"(B) The licensure, registration, and certification of the surgeon by the State or national entity responsible for such licensure, registration, or certification.
"(3)
"(c)
"(1)
"(A) The manner in which contractors under the Patient-Centered Community Care initiative of the Department perform oversight of the credentials of physicians within the networks of such contractors under the initiative.
"(B) The oversight by the Department of the contracts under the Patient-Centered Community Care initiative.
"(C) The verification by the Department of the credentials and licenses of health care providers furnishing hospital care and medical services under section 101.
"(2)
"(A)
"(B)
"SEC. 208. INFORMATION IN ANNUAL BUDGET OF THE PRESIDENT ON HOSPITAL CARE AND MEDICAL SERVICES FURNISHED THROUGH EXPANDED USE OF CONTRACTS FOR SUCH CARE.
"The materials on the Department of Veterans Affairs in the budget of the President for a fiscal year, as submitted to Congress pursuant to
"(1) The number of veterans who received hospital care and medical services under section 101 during the fiscal year preceding the fiscal year in which such budget is submitted.
"(2) The amount expended by the Department on furnishing care and services under such section during the fiscal year preceding the fiscal year in which such budget is submitted.
"(3) The amount requested in such budget for the costs of furnishing care and services under such section during the fiscal year covered by such budget, set forth in aggregate and by amounts for each account for which amounts are so requested.
"(4) The number of veterans that the Department estimates will receive hospital care and medical services under such section during the fiscal years covered by the budget submission.
"(5) The number of employees of the Department on paid administrative leave at any point during the fiscal year preceding the fiscal year in which such budget is submitted.
"SEC. 209. PROHIBITION ON FALSIFICATION OF DATA CONCERNING WAIT TIMES AND QUALITY MEASURES AT DEPARTMENT OF VETERANS AFFAIRS.
"Not later than 60 days after the date of the enactment of this Act [Aug. 7, 2014], and in accordance with
"TITLE VIII—OTHER MATTERS
"SEC. 801. APPROPRIATION OF AMOUNTS.
"(a)
"(b)
"(1) To increase the access of veterans to care as follows:
"(A) To hire primary care and specialty care physicians for employment in the Department of Veterans Affairs.
"(B) To hire other medical staff, including the following:
"(i) Physicians.
"(ii) Nurses.
"(iii) Social workers.
"(iv) Mental health professionals.
"(v) Other health care professionals as the Secretary considers appropriate.
"(C) To carry out sections 301 [enacting
"(D) To pay for expenses, equipment, and other costs associated with the hiring of primary care, specialty care physicians, and other medical staff under subparagraphs (A), (B), and (C).
"(2) To improve the physical infrastructure of the Department as follows:
"(A) To maintain and operate hospitals, nursing homes, domiciliary facilities, and other facilities of the Veterans Health Administration.
"(B) To enter into contracts or hire temporary employees to repair, alter, or improve facilities under the jurisdiction of the Department that are not otherwise provided for under this paragraph.
"(C) To carry out leases for facilities of the Department.
"(D) To carry out minor construction projects of the Department.
"(c)
"(d)
"(1)
"(2)
"(A) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate; and
"(B) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives.
"(e)
"SEC. 802. VETERANS CHOICE FUND.
"(a)
"(b)
"(c)
"(1)
"(2)
"(A)
"(B)
"(i) the Secretary determines that the amount of such increase is necessary to carry out section 101;
"(ii) the Secretary submits to the Committees on Veterans' Affairs and Appropriations of the House of Representatives and the Committees on Veterans' Affairs and Appropriations of the Senate a report described in subparagraph (C); and
"(iii) a period of 60 days has elapsed following the date on which the Secretary submits the report under clause (ii).
"(C)
"(i) A notification of the amount of the increase that the Secretary determines necessary under subparagraph (B)(i).
"(ii) The justifications for such increased amount.
"(iii) The administrative requirements that the Secretary will carry out using such increased amount.
"(3)
"(A)
"(B)
"(C)
"(D)
"(i) the amounts used by the Secretary pursuant to subparagraphs (A) and (B); and
"(ii) an identification of such amounts listed by the non-Department provider program for which the amounts were used.
"(E)
"(i) The term 'appropriate congressional committees' means—
"(I) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives; and
"(II) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate.
"(ii) The term 'non-Department facilities' has the meaning given that term in
"(iii) The term 'non-Department provider program' has the meaning given that term in section 4002(d) of the VA Budget and Choice Improvement Act [
"(4)
"(d)
"(1)
"(2)
"(e)
"SEC. 803. EMERGENCY DESIGNATIONS.
"(a)
"(b)
[
Location of Services
Guidelines Relating to Furnishing of Sensori-Neural Aids
Study of Feasibility and Advisability of Alternative Organizational Structures for Effective Provision of Health Care Services to Veterans
Contract Health Care; Ratification of Action of Administrator of Veterans' Affairs
Administration Capability To Provide Appropriate Care for Gender-Specific Disabilities of Women Veterans
Annual Report to Congress Covering Contract-Care Programs
Hospital Care and Medical Services Furnished by Veterans' Administration in Puerto Rico and Virgin Islands; Report to President and Congress
§1702. Presumptions: psychosis after service in World War II and following periods of war; mental illness after service in the Persian Gulf War
(a)
(b)
(1) within two years after discharge or release from the active military, naval, or air service; and
(2) before the end of the two-year period beginning on the last day of the Persian Gulf War.
(
Editorial Notes
Amendments
2008—
Subsecs. (a), (b).
1991—
1986—
1982—
1967—
Statutory Notes and Related Subsidiaries
Effective Date of 1967 Amendment
Amendment by
§1703. Veterans Community Care Program
(a)
(2) The Secretary shall coordinate the furnishing of hospital care, medical services, and extended care services under this section to covered veterans, including coordination of, at a minimum, the following:
(A) Ensuring the scheduling of medical appointments in a timely manner and the establishment of a mechanism to receive medical records from non-Department providers.
(B) Ensuring continuity of care and services.
(C) Ensuring coordination among regional networks if the covered veteran accesses care and services in a different network than the regional network in which the covered veteran resides.
(D) Ensuring that covered veterans do not experience a lapse in care resulting from errors or delays by the Department or its contractors or an unusual or excessive burden in accessing hospital care, medical services, or extended care services.
(3) A covered veteran may only receive care or services under this section upon the authorization of such care or services by the Secretary.
(4) Nothing in this section shall be construed to authorize the Secretary to suspend the program established under paragraph (1).
(b)
(1) is enrolled in the system of annual patient enrollment established and operated under
(2) is not enrolled in such system but is otherwise entitled to hospital care, medical services, or extended care services under subsection (c)(2) of such section.
(c)
(1) Any health care provider that is participating in the Medicare program under title XVIII of the Social Security Act (
(2) The Department of Defense.
(3) The Indian Health Service.
(4) Any Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act (
(5) Any health care provider not otherwise covered under any of paragraphs (1) through (4) that meets criteria established by the Secretary for purposes of this section.
(d)
(A) the Department does not offer the care or services the veteran requires;
(B) the Department does not operate a full-service medical facility in the State in which the covered veteran resides;
(C)(i) the covered veteran was an eligible veteran under section 101(b)(2)(B) of the Veterans Access, Choice, and Accountability Act of 2014 (
(ii) continues to reside in a location that would qualify the veteran for eligibility under such section; and
(iii) either—
(I) resides in one of the five States with the lowest population density as determined by data from the 2010 decennial census; or
(II) resides in a State not described in subclause (I) and—
(aa) received care or services under this title in the year preceding the enactment of the Caring for Our Veterans Act of 2018; and
(bb) is seeking care or services within 2 years of the date of the enactment of the Caring for Our Veterans Act of 2018;
(D) the covered veteran has contacted the Department to request care or services and the Department is not able to furnish such care or services in a manner that complies with designated access standards developed by the Secretary under
(E) the covered veteran and the covered veteran's referring clinician agree that furnishing care and services through a non-Department entity or provider would be in the best medical interest of the covered veteran based upon criteria developed by the Secretary.
(2) The Secretary shall ensure that the criteria developed under paragraph (1)(E) include consideration of the following:
(A) The distance between the covered veteran and the facility that provides the hospital care, medical services, or extended care services the veteran needs.
(B) The nature of the hospital care, medical services, or extended care services required.
(C) The frequency that the hospital care, medical services, or extended care services needs to be furnished.
(D) The timeliness of available appointments for the hospital care, medical services, or extended care services the veteran needs.
(E) Whether the covered veteran faces an unusual or excessive burden to access hospital care, medical services, or extended care services from the Department medical facility where a covered veteran seeks hospital care, medical services, or extended care services, which shall include consideration of the following:
(i) Whether the covered veteran faces an excessive driving distance, geographical challenge, or environmental factor that impedes the access of the covered veteran.
(ii) Whether the hospital care, medical services, or extended care services sought by the veteran is provided by a medical facility of the Department that is reasonably accessible to a covered veteran.
(iii) Whether a medical condition of the covered veteran affects the ability of the covered veteran to travel.
(iv) Whether there is compelling reason, as determined by the Secretary, that the veteran needs to receive hospital care, medical services, or extended care services from a medical facility other than a medical facility of the Department.
(v) Such other considerations as the Secretary considers appropriate.
(3) If the Secretary has determined that the Department does not offer the care or services the covered veteran requires under subparagraph (A) of paragraph (1), that the Department does not operate a full-service medical facility in the State in which the covered veteran resides under subparagraph (B) of such paragraph, that the covered veteran is described under subparagraph (C) of such paragraph, or that the Department is not able to furnish care or services in a manner that complies with designated access standards developed by the Secretary under
(4) In determining under paragraph (1)(D) whether the Department is able to furnish care or services in a manner that complies with designated access standards developed by the Secretary under
(e)
(B) In carrying out subparagraph (A), the Secretary shall—
(i) measure timeliness of the medical service line at a facility of the Department when compared with the same medical service line at different Department facilities; and
(ii) measure quality at a medical service line of a facility of the Department by comparing it with two or more distinct and appropriate quality measures at non-Department medical service lines.
(C)(i) The Secretary may not concurrently furnish hospital care, medical services, or extended care services under subparagraph (A) with respect to more than three medical service lines described in such subparagraph at any one health care facility of the Department.
(ii) The Secretary may not concurrently furnish hospital care, medical services, or extended care services under subparagraph (A) with respect to more than 36 medical service lines nationally described in such subparagraph.
(2) The Secretary may limit the types of hospital care, medical services, or extended care services covered veterans may receive under paragraph (1) in terms of the length of time such care and services will be available, the location at which such care and services will be available, and the clinical care and services that will be available.
(3)(A) Except as provided for in subparagraph (B), the hospital care, medical services, and extended care services authorized under paragraph (1) with respect to a medical service line shall cease when the remediation described in section 1706A with respect to such medical service line is complete.
(B) The Secretary shall ensure continuity and coordination of care for any veteran who elects to receive care or services under paragraph (1) from a health care provider specified in subsection (c) through the completion of an episode of care.
(4) The Secretary shall publish in the Federal Register, and shall take all reasonable steps to provide direct notice to covered veterans affected under this subsection, at least once each year stating the time period during which such care and services will be available, the location or locations where such care and services will be available, and the clinical services available at each location under this subsection in accordance with regulations the Secretary shall prescribe.
(5) When the Secretary exercises the authority under paragraph (1), the decision to receive care or services under such paragraph from a health care provider specified in subsection (c) shall be at the election of the covered veteran.
(f)
(g)
(2) In developing a tiered provider network of eligible providers under paragraph (1), the Secretary shall not prioritize providers in a tier over providers in any other tier in a manner that limits the choice of a covered veteran in selecting a health care provider specified in subsection (c) for receipt of hospital care, medical services, or extended care services under this section.
(h)
(B) For purposes of subparagraph (A), the requirement to enter into consolidated, competitively bid contracts shall not restrict the authority of the Secretary under other provisions of law when modifying such a contract after entering into the contract.
(2)(A) The Secretary shall, to the extent practicable, ensure that covered veterans are able to make their own appointments using advanced technology.
(B) To the extent practicable, the Secretary shall be responsible for the scheduling of appointments for hospital care, medical services, and extended care services under this section.
(3)(A) The Secretary may terminate a contract with an entity entered into under paragraph (1) at such time and upon such notice to the entity as the Secretary may specify for purposes of this section, if the Secretary notifies the appropriate committees of Congress that, at a minimum—
(i) the entity—
(I) failed to comply substantially with the provisions of the contract or with the provisions of this section and the regulations prescribed under this section;
(II) failed to comply with the access standards or the standards for quality established by the Secretary;
(III) is excluded from participation in a Federal health care program (as defined in section 1128B(f) of the Social Security Act (
(IV) is identified as an excluded source on the list maintained in the System for Award Management, or any successor system; or
(V) has been convicted of a felony or other serious offense under Federal or State law and the continued participation of the entity would be detrimental to the best interests of veterans or the Department;
(ii) it is reasonable to terminate the contract based on the health care needs of veterans; or
(iii) it is reasonable to terminate the contract based on coverage provided by contracts or sharing agreements entered into under authorities other than this section.
(B) Nothing in subparagraph (A) may be construed to restrict the authority of the Secretary to terminate a contract entered into under paragraph (1) under any other provision of law.
(4) Whenever the Secretary provides notice to an entity that the entity is failing to meet contractual obligations entered into under paragraph (1), the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on such failure. Such report shall include the following:
(A) An explanation of the reasons for providing such notice.
(B) A description of the effect of such failure, including with respect to cost, schedule, and requirements.
(C) A description of the actions taken by the Secretary to mitigate such failure.
(D) A description of the actions taken by the contractor to address such failure.
(E) A description of any effect on the community provider market for veterans in the affected area.
(5)(A) The Secretary shall instruct each entity awarded a contract under paragraph (1) to recognize and accept, on an interim basis, the credentials and qualifications of health care providers who are authorized to furnish hospital care and medical services to veterans under a community care program of the Department in effect as of the day before the effective date specified in section 101(b) of the Caring for Our Veterans Act of 2018, including under the Patient-Centered Community Care Program and the Veterans Choice Program under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (
(B) The interim acceptance period under subparagraph (A) shall be determined by the Secretary based on the following criteria:
(i) With respect to a health care provider, when the current certification agreement for the health care provider expires.
(ii) Whether the Department has enacted certification and eligibility criteria and regulatory procedures by which non-Department providers will be authorized under this section.
(6) The Secretary shall establish a system or systems for monitoring the quality of care provided to covered veterans through a network under this subsection and for assessing the quality of hospital care, medical services, and extended care services furnished through such network before the renewal of the contract for such network.
(i)
(2)(A) A higher rate than the rate paid by the United States as described in paragraph (1) may be negotiated with respect to the furnishing of care or services to a covered veteran who resides in a highly rural area.
(B) In this paragraph, the term "highly rural area" means an area located in a county that has fewer than seven individuals residing in that county per square mile.
(3) With respect to furnishing care or services under this section in Alaska, the Alaska Fee Schedule of the Department of Veterans Affairs shall be followed, except for when another payment agreement, including a contract or provider agreement, is in effect.
(4) With respect to furnishing hospital care, medical services, or extended care services under this section in a State with an All-Payer Model Agreement under section 1814(b)(3) of the Social Security Act (
(5) Notwithstanding paragraph (1), the Secretary may incorporate, to the extent practicable, the use of value-based reimbursement models to promote the provision of high-quality care.
(6) With respect to hospital care, medical services, or extended care services for which there is not a rate paid under the Medicare program as described in paragraph (1), the rate paid for such care or services shall be determined by the Secretary.
(j)
(k)
(l)
(2) A covered veteran described in this paragraph—
(A) requires an organ or bone marrow transplant; and
(B) has, in the opinion of the primary care provider of the veteran, a medically compelling reason to travel outside the region of the Organ Procurement and Transplantation Network, established under section 372 of the National Organ Transplantation Act 1 (
(m)
(B) The review submitted under subparagraph (A) shall include an assessment of the following:
(i) The top 25 percent of types of care and services most frequently provided under subsection (d) due to the Department not offering such care and services.
(ii) The frequency such care and services were sought by covered veterans under this section.
(iii) An analysis of the reasons the Department was unable to provide such care and services.
(iv) Any steps the Department took to provide such care and services at a medical facility of the Department.
(v) The cost of such care and services.
(2) In monitoring the hospital care, medical services, and extended care services furnished under this section, the Secretary shall do the following:
(A) With respect to hospital care, medical services, and extended care services furnished through provider networks established under subsection (i)—
(i) compile data on the types of hospital care, medical services, and extended care services furnished through such networks and how many patients used each type of care and service;
(ii) identify gaps in hospital care, medical services, or extended care services furnished through such networks;
(iii) identify how such gaps may be fixed through new contracts within such networks or changes in the manner in which hospital care, medical services, or extended care services are furnished through such networks;
(iv) assess the total amounts spent by the Department on hospital care, medical services, and extended care services furnished through such networks;
(v) assess the timeliness of the Department in referring hospital care, medical services, and extended care services to such networks; and
(vi) assess the timeliness of such networks in—
(I) accepting referrals; and
(II) scheduling and completing appointments.
(B) Report the number of medical service lines the Secretary has determined under subsection (e)(1) not to be providing hospital care, medical services, or extended care services that comply with the standards for quality established by the Secretary.
(C) Assess the use of academic affiliates and centers of excellence of the Department to furnish hospital care, medical services, and extended care services to covered veterans under this section.
(D) Assess the hospital care, medical services, and extended care services furnished to covered veterans under this section by medical facilities operated by Federal agencies other than the Department.
(3) Not later than 540 days after the date of the enactment of the Caring for Our Veterans Act of 2018 and not less frequently than once each year 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 information gathered under paragraph (2).
(n)
(2) No provision in this section may be construed to alter or modify any other provision of law establishing specific eligibility criteria for certain hospital care, medical services, or extended care services.
(o)
(1) The term "appropriate committees of Congress" means—
(A) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives.
(2) The term "medical service line" means a clinic within a Department medical center.
(Added
Editorial Notes
References in Text
The Social Security Act, referred to in subsecs. (c)(1) and (i)(1), is act Aug. 14, 1935, ch. 531,
The date of the enactment of the Caring for Our Veterans Act of 2018, referred to in subsecs. (d)(1)(C) and (m)(1), (3), is the date of enactment of
For the effective date specified in section 101(b) of the Caring for Our Veterans Act of 2018, referred to in subsec. (h)(5)(A), see section 101(b) of
Section 372 of the National Organ Transplantation Act, referred to in subsec. (l)(2)(B), probably means section 372 of the Public Health Service Act, act July 1, 1944, ch. 373, which was enacted by section 201 of the National Organ Transplant Act,
Amendments
2022—Subsec. (a)(4).
Subsec. (d)(4).
2018—
Subsec. (h)(1).
Subsec. (h)(5)(A).
2011—Subsec. (d)(4).
2008—Subsec. (d)(4).
2005—Subsec. (d)(2).
2004—Subsec. (d).
1996—Subsec. (a).
Subsec. (a)(2)(A).
Subsec. (a)(2)(B).
Subsec. (a)(2)(C).
Subsec. (a)(7).
1992—Subsec. (a)(1)(C).
1991—
Subsec. (a).
Subsec. (a)(2)(B).
Subsec. (a)(7).
Subsec. (a)(8).
Subsec. (b).
Subsec. (c).
1988—Subsec. (a).
Subsec. (a)(1).
Subsec. (a)(2).
Subsec. (a)(2)(B).
Subsec. (a)(2)(C).
Subsec. (a)(3).
Subsec. (a)(4), (5).
Subsec. (a)(6).
Subsec. (a)(7).
Subsec. (a)(8).
Subsec. (c).
1986—Subsec. (a)(5).
1985—Subsec. (a)(5).
Statutory Notes and Related Subsidiaries
Effective Date of 2018 Amendment
"(1) the date that is 30 days after the date on which the Secretary of Veterans Affairs submits the report required under section 101(q)(2) of the Veterans Access, Choice, and Accountability Act of 2014 (
"(2) the date on which the Secretary promulgates regulations pursuant to subsection (c) [set out as a Regulations note below] [regulations effective June 6, 2019, see 84 F.R. 26278]."
Effective Date of 1988 Amendment
Effective Date of 1985 Amendment
Regulations
"(1)
"(2)
"(A)
"(B)
"(C)
"(i) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate; and
"(ii) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives."
Plan Regarding Informing Veterans of Expected Wait Times for Appointments for Care
"(a)
"(1) the date on which the veteran will be able to receive care through a non-Department of Veterans Affairs provider under such section;
"(2) the date on which the veteran will be able to receive care through a provider of the Department;
"(3) the date on which—
"(A) the Department will schedule an appointment for care through a non-Department provider under such section; or
"(B) for veterans making their own appointments using advanced technology, the veteran would be able to schedule an appointment for care through a provider of the Department or through a non-Department provider under such section;
"(4) the date on which the Department will schedule an appointment for care through a provider of the Department.
"(b)
"(c)
"(d)
Community Care Self-Scheduling Pilot Program
"SEC. 131. DEFINITIONS.
"In this chapter [
"(1)
"(A) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate; and
"(B) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives.
"(2)
"(3)
"(4)
"SEC. 132. PILOT PROGRAM ESTABLISHING COMMUNITY CARE APPOINTMENT SELF-SCHEDULING TECHNOLOGY.
"(a)
"(b)
"(c)
"(d)
"(e)
"(1)
"(2)
"(f)
"SEC. 133. APPOINTMENT SELF-SCHEDULING CAPABILITIES.
"(a)
"(1) Capability to self-schedule, modify, and cancel appointments directly online for primary care, specialty care, and mental health care under the Veterans Community Care Program with regard to each category of eligibility under
"(2) Capability to support appointments for the provision of health care under the Veterans Community Care Program regardless of whether such care is provided in person or through telehealth services.
"(3) Not fewer than two of the following capabilities:
"(A) Capability to view appointment availability in real time to the extent practicable.
"(B) Capability to load relevant patient information from the Decision Support Tool of the Department or any other information technology system of the Department used to determine the eligibility of veterans for health care under
"(C) Capability to search for providers and facilities participating in the Veterans Community Care Program based on distance from the residential address of a veteran.
"(D) Capability to filter provider results by clinical expertise, ratings, reviews, sex, languages spoken, and other criteria as determined by the Secretary.
"(E) Capability to provide telephonic and electronic contact information for all such providers that do not offer online scheduling at the time.
"(F) Capability to store and print authorization letters for veterans for health care under the Veterans Community Care Program.
"(G) Capability to provide prompts or reminders to veterans to schedule initial appointments or follow-up appointments.
"(H) Capability to be used 24 hours per day, seven days per week.
"(I) Capability to ensure veterans who self-schedule appointments through the appointment self-scheduling technology have scheduled such appointment with a provider possessing the required specialty and clinical expertise.
"(J) Capability to integrate with the Veterans Health Information Systems and Technology Architecture of the Department and the health record deployed by the Electronic Health Record Modernization program, or any successor information technology system or health record of the Department.
"(K) Capability to integrate with information technology systems of Third Party Administrators.
"(b)
"(1)
"(2)
"(c)
"(d)
"SEC. 134. REPORT.
"Not later than 180 days after the date of the enactment of this Act, and every 180 days thereafter, the Secretary of Veterans Affairs shall submit to the appropriate congressional committees a report that includes—
"(1) an assessment by the Secretary of the pilot program during the 180-day period preceding the date of the report, including—
"(A) the cost of the pilot program;
"(B) the volume of usage of the appointment self-scheduling technology under the pilot program;
"(C) the quality of the pilot program;
"(D) patient satisfaction with the pilot program;
"(E) benefits to veterans of using the pilot program;
"(F) the feasibility of allowing self-scheduling for different specialties under the pilot program;
"(G) participation in the pilot program by health care providers under the Veterans Community Care Program; and
"(H) such other findings and conclusions with respect to the pilot program as the Secretary considers appropriate; and
"(2) such recommendations as the Secretary considers appropriate regarding—
"(A) extension of the pilot program to other or all Veterans Integrated Service Networks of the Department of Veterans Affairs; and
"(B) making the pilot program permanent."
Support by Department of Veterans Affairs of Maternity Care Coordination
"SEC. 2. DEFINITIONS.
"In this Act [enacting this note, provisions set out as a note under
"(1)
"(2)
"(3)
"(4)
"(5)
"(6)
"SEC. 3. SUPPORT BY DEPARTMENT OF VETERANS AFFAIRS OF MATERNITY CARE COORDINATION.
"(a)
"(1)
"(2)
"(b)
"(1)
"(2)
"(c)
"(1)
"(2)
Administration of Non-Department of Veterans Affairs Health Care
"(a)
"(1)
"(A)
"(B)
"(i) an assessment of the type of positions required to be staffed at the medical facility;
"(ii) the number of such positions authorized;
"(iii) the number of such positions funded;
"(iv) the number of such positions filled; and
"(v) the number of additional such positions required to be authorized.
"(2)
"(A) the results of the review conducted under paragraph (1); and
"(B) a certification that the Secretary has established all staffing, training, and other requirements required to be reviewed under such paragraph.
"(b)
"(1)
"(A) the period of time between—
"(i) 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;
"(ii) 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;
"(iii) 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;
"(iv) 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
"(v) 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
"(B) any other period of time that the Secretary determines necessary to measure.
"(2)
"(A)
"(B)
"(c)
"(1)
"(2)
Establishment of Women Veteran Training Module for Non-Department of Veterans Affairs Health Care Providers
"(a)
"(b)
"(c)
"(d)
"(1) the utilization by community providers of the training module; and
"(2) the effectiveness of the training module.
"(e)
"(1)
"(2)
Continuity of Existing Agreements
"(1)
"(2)
Demonstration Projects on Alternatives for Expanding Care for Veterans in Rural Areas
"(a)
"(1) Establishing a partnership between the Department of Veterans Affairs and the Centers for Medicare and Medicaid Services of the Department of Health and Human Services to coordinate care for veterans in rural areas at critical access hospitals (as designated or certified under section 1820 of the Social Security Act (
"(2) Establishing a partnership between the Department of Veterans Affairs and the Department of Health and Human Services to coordinate care for veterans in rural areas at community health centers.
"(3) Expanding coordination between the Department of Veterans Affairs and the Indian Health Service to expand care for Indian veterans.
"(b)
"(c)
"(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.
"(d)
Pilot Program of Enhanced Contract Care Authority for Health Care Needs of Veterans in Highly Rural Areas
"(a)
"(1)
"(2)
"(3)
"(4)
"(A) Veterans Integrated Service Network 1.
"(B) Veterans Integrated Service Network 6.
"(C) Veterans Integrated Service Network 15.
"(D) Veterans Integrated Service Network 18.
"(E) Veterans Integrated Service Network 19.
"(b)
"(1) is—
"(A) enrolled in the system of patient enrollment established under
"(B) eligible for health care under section 1710(e)(3) of such title; and
"(2) resides in a location that is—
"(A) more than 60 minutes driving distance from the nearest Department health care facility providing primary care services, if the veteran is seeking such services;
"(B) more than 120 minutes driving distance from the nearest Department health care facility providing acute hospital care, if the veteran is seeking such care; or
"(C) more than 240 minutes driving distance from the nearest Department health care facility providing tertiary care, if the veteran is seeking such care.
"(c)
"(d)
"(e)
"(f)
"(g)
"(h)
"(1) are scheduled not later than 5 days after the date on which the appointment is requested; and
"(2) occur not later than 30 days after such date.
"(i)
"(j)
"(k)
"(1) the assessment of the Secretary of the pilot program during the preceding year, including its cost, volume, quality, patient satisfaction, benefit to veterans, and such other findings and conclusions with respect to pilot program as the Secretary considers appropriate; and
"(2) such recommendations as the Secretary considers appropriate regarding—
"(A) the continuation of the pilot program;
"(B) extension of the pilot program to other or all Veterans Integrated Service Networks of the Department; and
"(C) making the pilot program permanent."
Ratification of Medical Services Contracts
Section 1503(c) of
Puerto Rico Contract Care; Limitation on Incurring of Obligations
1 See References in Text note below.
§1703A. Agreements with eligible entities or providers; certification processes
(a)
(B) An agreement entered into under this section to provide hospital care, a medical service, or an extended care service shall be known as a "Veterans Care Agreement".
(C) For purposes of subparagraph (A), hospital care, a medical service, or an extended care service may be considered not feasibly available to a covered individual from a facility of the Department or through a contract or sharing agreement described in such subparagraph when the Secretary determines the covered individual's medical condition, the travel involved, the nature of the care or services required, or a combination of these factors make the use of a facility of the Department or a contract or sharing agreement described in such subparagraph impracticable or inadvisable.
(D) A Veterans Care Agreement may be entered into by the Secretary or any Department official authorized by the Secretary.
(2)(A) Subject to subparagraph (B), the Secretary shall review each Veterans Care Agreement of material size, as determined by the Secretary or set forth in paragraph (3), for hospital care, a medical service, or an extended care service to determine whether it is feasible and advisable to provide such care or service within a facility of the Department or by contract or sharing agreement entered into pursuant to another provision of law and, if so, take action to do so.
(B)(i) The Secretary shall review each Veterans Care Agreement of material size that has been in effect for at least 6 months within the first 2 years of its taking effect, and not less frequently than once every 4 years thereafter.
(ii) If a Veterans Care Agreement has not been in effect for at least 6 months by the date of the review required by subparagraph (A), the agreement shall be reviewed during the next cycle required by subparagraph (A), and such review shall serve as its review within the first 2 years of its taking effect for purposes of clause (i).
(3)(A) In fiscal year 2019 and in each fiscal year thereafter, in addition to such other Veterans Care Agreements as the Secretary may determine are of material size, a Veterans Care Agreement for the purchase of extended care services that exceeds $5,000,000 annually shall be considered of material size.
(B) From time to time, the Secretary may publish a notice in the Federal Register to adjust the dollar amount specified in subparagraph (A) to account for changes in the cost of health care based upon recognized health care market surveys and other available data.
(b)
(1) any provider of services that has enrolled and entered into a provider agreement under section 1866(a) of the Social Security Act (
(2) any provider participating under a State plan under title XIX of such Act (
(3) an Aging and Disability Resource Center, an area agency on aging, or a State agency (as defined in section 102 of the Older Americans Act of 1965 (
(4) a center for independent living (as defined in section 702 of the Rehabilitation Act of 1973 (
(5) any entity or provider not described in paragraph (1) or (2) of this subsection that the Secretary determines to be eligible pursuant to the certification process described in subsection (c).
(c)
(1) establish deadlines for actions on applications for certification;
(2) set forth standards for an approval or denial of certification, duration of certification, revocation of an eligible entity or provider's certification, and recertification of eligible entities or providers;
(3) require the denial of certification if the Secretary determines the eligible entity or provider is excluded from participation in a Federal health care program under section 1128 or section 1128A of the Social Security Act (
(4) establish procedures for screening eligible entities or providers according to the risk of fraud, waste, and abuse that are similar to the standards under section 1866(j)(2)(B) of the Social Security Act (
(5) incorporate and apply the restrictions and penalties set forth in
(d)
(e)
(2) To furnish hospital care, medical services, or extended care services under this section, an eligible entity or provider shall agree—
(A) to accept payment at the rates established in regulations prescribed under this section;
(B) that payment by the Secretary under this section on behalf of a covered individual to a provider of services or care shall, unless rejected and refunded by the provider within 30 days of receipt, constitute payment in full and extinguish any liability on the part of the covered individual for the treatment or care provided, and no provision of a contract, agreement, or assignment to the contrary shall operate to modify, limit, or negate this requirement;
(C) to provide only the care and services authorized by the Department under this section and to obtain the prior written consent of the Department to furnish care or services outside the scope of such authorization;
(D) to bill the Department in accordance with the methodology outlined in regulations prescribed under this section;
(E) to not seek to recover or collect from a health plan contract or third party, as those terms are defined in
(F) to provide medical records to the Department in the time frame and format specified by the Department; and
(G) to meet such other terms and conditions, including quality of care assurance standards, as the Secretary may specify in regulation.
(f)
(2) The Secretary may discontinue a Veterans Care Agreement with an eligible entity or provider at such time and upon such reasonable notice to the eligible entity or provider as may be specified in regulations prescribed under this section, if an official designated by the Secretary—
(A) has determined that the eligible entity or provider failed to comply substantially with the provisions of the Veterans Care Agreement, or with the provisions of this section or regulations prescribed under this section;
(B) has determined the eligible entity or provider is excluded from participation in a Federal health care program under section 1128 or section 1128A of the Social Security Act (
(C) has ascertained that the eligible entity or provider has been convicted of a felony or other serious offense under Federal or State law and determines the eligible entity or provider's continued participation would be detrimental to the best interests of covered individuals or the Department; or
(D) has determined that it is reasonable to terminate the agreement based on the health care needs of a covered individual.
(g)
(h)
(2) Such procedures constitute the eligible entities' and providers' exhaustive and exclusive administrative remedies.
(3) Eligible entities or providers must first exhaust such administrative procedures before seeking any judicial review under
(4) Disputes under this section must pertain to either the scope of authorization under the Veterans Care Agreement or claims for payment subject to the Veterans Care Agreement and are not claims for the purposes of such laws that would otherwise require application of
(i)
(A) an award for the purposes of such laws that would otherwise require the use of competitive procedures for the furnishing of care and services; or
(B) a Federal contract for the acquisition of goods or services for purposes of any provision of Federal law governing Federal contracts for the acquisition of goods or services except
(2)(A) Except as provided in the agreement itself, in subparagraph (B), and unless otherwise provided in this section or regulations prescribed pursuant to this section, an eligible entity or provider that enters into an agreement under this section is not subject to, in the carrying out of the agreement, any law to which providers of services and suppliers under the Medicare program under title XVIII of the Social Security Act (
(B) An eligible entity or provider that enters into an agreement under this section is subject to—
(i) all laws regarding integrity, ethics, or fraud, or that subject a person to civil or criminal penalties; and
(ii) all laws that protect against employment discrimination or that otherwise ensure equal employment opportunities.
(3) Notwithstanding paragraph (2)(B)(i), an eligible entity or provider that enters into an agreement under this section shall not be treated as a Federal contractor or subcontractor for purposes of
(j)
(k)
(l)
(Added
Editorial Notes
References in Text
The Social Security Act, referred to in subsecs. (b)(2) and (i)(2)(A), is act Aug. 14, 1935, ch. 531,
Amendments
2018—Subsec. (a)(1)(A).
Subsec. (a)(1)(C).
Subsec. (e)(2)(B).
Subsec. (f)(2)(C).
Subsec. (f)(2)(D).
Subsec. (g).
Subsec. (h)(4).
Subsec. (j).
Subsec. (l).
Statutory Notes and Related Subsidiaries
Applicability of Directive of Office of Federal Contract Compliance Programs
"(a)
"(b)
"(c)
§1703B. Access standards
(a)(1) The Secretary shall establish access standards for furnishing hospital care, medical services, or extended care services to covered veterans for the purposes of section 1703(d).
(2) The Secretary shall ensure that the access standards established under paragraph (1) define such categories of care to cover all care and services within the medical benefits package of the Department of Veterans Affairs.
(b) The Secretary shall ensure that the access standards provide covered veterans, employees of the Department, and health care providers in the network established under section 1703(h) with relevant comparative information that is clear, useful, and timely, so that covered veterans can make informed decisions regarding their health care.
(c) The Secretary shall consult with all pertinent Federal entities (including the Department of Defense, the Department of Health and Human Services, and the Centers for Medicare & Medicaid Services), entities in the private sector, and other nongovernmental entities in establishing access standards.
(d)(1) Not later than 270 days after the date of the enactment of the Caring for Our Veterans Act of 2018, the Secretary shall submit to the appropriate committees of Congress a report detailing the access standards.
(2)(A) Before submitting the report required under paragraph (1), the Secretary shall provide periodic updates to the appropriate committees of Congress to confirm the Department's progress towards developing the access standards required by this section.
(B) The first update under subparagraph (A) shall occur no later than 120 days from the date of the enactment of the Caring for Our Veterans Act of 2018.
(3) Not later than 540 days after the date on which the Secretary implements the access standards established under subsection (a), the Secretary shall submit to the appropriate committees of Congress a report detailing the implementation of and compliance with such access standards by Department and non-Department entities or providers.
(e) 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, the Secretary shall—
(1) conduct a review of such standards; and
(2) submit to the appropriate committees of Congress a report on the findings and any modification to the access standards with respect to the review conducted under paragraph (1).
(f)(1) Subject to paragraph (3), the Secretary shall meet the access standards established under subsection (a) when furnishing hospital care, medical services, or extended care services to a covered veteran under
(2) The Secretary shall ensure that health care providers specified under
(3)(A) A Third Party Administrator may request a waiver to the requirement under this subsection to meet the access standards established under subsection (a) if—
(i)(I) the scarcity of available providers or facilities in the region precludes the Third Party Administrator from meeting those access standards; or
(II) the landscape of providers or facilities has changed, and certain providers or facilities are not available such that the Third Party Administrator is not able to meet those access standards; and
(ii) to address the scarcity of available providers or the change in the provider or facility landscape, as the case may be, the Third Party Administrator has contracted with other providers or facilities that may not meet those access standards but are the currently available providers or facilities most accessible to veterans within the region of responsibility of the Third Party Administrator.
(B) Any waiver requested by a Third Party Administrator under subparagraph (A) must be requested in writing and submitted to the Office of Integrated Veteran Care of the Department for approval by that office.
(C) As part of any waiver request under subparagraph (A), a Third Party Administrator must include conclusive evidence and documentation that the access standards established under subsection (a) cannot be met because of scarcity of available providers or changes to the landscape of providers or facilities.
(D) In evaluating a waiver request under subparagraph (A), the Secretary shall consider the following:
(i) The number and geographic distribution of eligible health care providers available within the geographic area and specialty referenced in the waiver request.
(ii) The prevailing market conditions within the geographic area and specialty referenced in the waiver request, which shall include the number and distribution of health care providers contracting with other health care plans (including commercial plans and the Medicare program under title XVIII of the Social Security Act (
(iii) Whether the service area is comprised of highly rural, rural, or urban areas or some combination of such areas.
(iv) How significantly the waiver request differs from the access standards established under subsection (a).
(v) The rates offered to providers in the geographic area covered by the waiver.
(E) The Secretary shall not consider inability to contract as a valid sole rationale for granting a waiver under subparagraph (A).
(g)(1) The Secretary shall publish in the Federal Register and on a publicly available internet website of the Department the designated access standards established under this section for purposes of
(2) The Secretary shall publish on a publicly available internet website of the Department the access standards established under subsection (a).
(h)(1) Consistent with paragraphs (1)(D) and (3) of section 1703(d), covered veterans may contact the Department at any time to request a determination regarding whether they are eligible to receive care and services from a non-Department entity or provider based on the Department being unable to furnish such care and services in a manner that complies with the designated access standards established under this section.
(2) The Secretary shall establish a process to review such requests from covered veterans to determine whether—
(A) the requested care is clinically necessary; and
(B) the Department is able to provide such care in a manner that complies with designated access standards established under this section.
(3) The Secretary shall promptly respond to any such request by a covered veteran.
(i) In this section:
(1) The term "appropriate committees of Congress" means—
(A) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives.
(2) The term "covered veterans" means veterans described in
(3) The term "inability to contract", with respect to a Third Party Administrator, means the inability of the Third Party Administrator to successfully negotiate and establish a community care network contract with a provider or facility.
(4) The term "Third Party Administrator" means an entity that manages a provider network and performs administrative services related to such network within the Veterans Community Care Program under
(Added
Editorial Notes
References in Text
The date of the enactment of the Caring for Our Veterans Act of 2018, referred to in subsec. (d)(1), (2)(B), is the date of enactment of
The Social Security Act, referred to in subsec. (f)(3)(D)(ii), is act Aug. 14, 1935, ch. 531,
Amendments
2022—Subsecs. (f), (g).
"(f) The Secretary shall ensure health care providers specified under section 1703(c) are able to comply with the applicable access standards established by the Secretary.
"(g) The Secretary shall publish in the Federal Register and on an internet website of the Department the designated access standards established under this section for purposes of section 1703(d)(1)(D)."
Subsec. (i)(3), (4).
2018—Subsec. (i).
Statutory Notes and Related Subsidiaries
Publication of Clarifying Information for Non-Department of Veterans Affairs Providers
"(a)
"(1) A summary table or similar resource that provides a list of all authorities of the Department to authorize emergency care from non-Department providers and, for each such authority, the corresponding deadline for submission of claims.
"(2) An illustrated summary of steps, such as a process map, with a checklist for the submission of clean claims that non-Department providers can follow to assure compliance with the claims-filing process of the Department.
"(3) Contact information for the appropriate office or service line of the Department to address process questions from non-Department providers.
"(b)
"(c)
§1703C. Standards for quality
(a)
(2) In establishing standards for quality under paragraph (1), the Secretary shall consider existing health quality measures that are applied to public and privately sponsored health care systems with the purpose of providing covered veterans relevant comparative information to make informed decisions regarding their health care.
(3) The Secretary shall collect and consider data for purposes of establishing the standards under paragraph (1). Such data collection shall include—
(A) after consultation with veterans service organizations and other key stakeholders on survey development or modification of an existing survey, a survey of veterans who have used hospital care, medical services, or extended care services furnished by the Veterans Health Administration during the most recent 2-year period to assess the satisfaction of the veterans with service and quality of care; and
(B) datasets that include, at a minimum, elements relating to the following:
(i) Timely care.
(ii) Effective care.
(iii) Safety, including, at a minimum, complications, readmissions, and deaths.
(iv) Efficiency.
(4) The Secretary shall consult with all pertinent Federal entities (including the Department of Defense, the Department of Health and Human Services, and the Centers for Medicare & Medicaid Services), entities in the private sector, and other nongovernmental entities in establishing standards for quality.
(5)(A) Not later than 270 days after the date of the enactment of the Caring for Our Veterans Act of 2018, the Secretary shall submit to the appropriate committees of Congress a report detailing the standards for quality.
(B)(i) Before submitting the report required under subparagraph (A), the Secretary shall provide periodic updates to the appropriate committees of Congress to confirm the Department's progress towards developing the standards for quality required by this section.
(ii) The first update under clause (i) shall occur no later than 120 days from the date of the enactment of the Caring for Our Veterans Act of 2018.
(b)
(2) Not later than 2 years after the date on which the Secretary establishes standards for quality under subsection (a), the Secretary shall consider and solicit public comment on potential changes to the measures used in such standards to ensure that they include the most up-to-date and applicable industry measures for veterans.
(c)
(1) The term "appropriate committees of Congress" means—
(A) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives.
(2) The term "covered veterans" means veterans described in
(Added
Editorial Notes
References in Text
The date of the enactment of the Caring for Our Veterans Act of 2018, referred to in subsec. (a)(5), is the date of enactment of
Amendments
2018—Subsec. (c).
§1703D. Prompt payment standard
(a)
(2) If a claim is denied, the Secretary shall, within 45 calendar days of denial for a paper claim and 30 calendar days of denial for an electronic claim, notify the health care entity or provider of the reason for denying the claim and what, if any, additional information is required to process the claim.
(3) Upon the receipt of the additional information, the Secretary shall ensure that the claim is paid, denied, or otherwise adjudicated within 30 calendar days from the receipt of the requested information.
(4) This section shall only apply to payments made on an invoice basis and shall not apply to capitation or other forms of periodic payment to entities or providers.
(b)
(c)
(2) Pursuant to regulations prescribed by the Secretary, the Secretary shall bar a health care entity or provider from furnishing hospital care, medical services, and extended care services under this chapter when the Secretary determines the entity or provider has submitted to the Secretary fraudulent health care claims for payment by the Secretary.
(d)
(2)(A) If a claim is overdue under this subsection, the Secretary may, under the requirements established by subsection (a) and consistent with the provisions of
(B) Interest paid under subparagraph (A) shall be computed at the rate of interest established by the Secretary of the Treasury under
(3) Not less frequently than annually, the Secretary shall submit to Congress a report on payment of overdue claims under this subsection, disaggregated by paper and electronic claims, that includes the following:
(A) The amount paid in overdue claims described in this subsection, disaggregated by the amount of the overdue claim and the amount of interest paid on such overdue claim.
(B) The number of such overdue claims and the average number of days late each claim was paid, disaggregated by facility of the Department and Veterans Integrated Service Network region.
(e)
(2) Deductions may not be made under this subsection unless the Secretary has made reasonable efforts to notify a health care entity or provider of the right to dispute the existence or amount of such indebtedness and the right to request a compromise of such indebtedness.
(3) The Secretary shall make a determination with respect to any such dispute or request prior to deducting any overpayment unless the time required to make such a determination before making any deductions would jeopardize the Secretary's ability to recover the full amount of such indebtedness.
(f)
(2) The Secretary shall consult with entities in the health care industry, in the public and private sector, to determine the information and documentation to include in the list under paragraph (1).
(3) If the Secretary modifies the information and documentation included in the list under paragraph (1), the Secretary shall notify all health care entities and providers described in paragraph (1) not later than 30 days before such modifications take effect.
(g)
(A) a non-Department entity that is under contract or agreement for the program established under
(B) a non-Department entity that specializes in such processing for other Federal agency health care systems.
(2) The Secretary shall seek to contract with a third party to conduct a review of claims described in paragraph (3) that includes—
(A) a feasibility assessment to determine the capacity of the Department to process such claims in a timely manner; and
(B) a cost benefit analysis comparing the capacity of the Department to a third party entity capable of processing such claims.
(3) The review required under paragraph (2) shall apply to claims for hospital care, medical services, or extended care services furnished under
(h)
(2) The Secretary may coordinate with the Department of Defense, the Department of Health and Human Services, and the Department of the Treasury in developing the report required by paragraph (1).
(i)
(1) The term "appropriate committees of Congress" means—
(A) the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives.
(2) The term "clean electronic claim" means the transmission of data for purposes of payment of covered health care expenses that is submitted to the Secretary which contains substantially all of the required data elements necessary for accurate adjudication, without obtaining additional information from the entity or provider that furnished the care or service, submitted in such format as prescribed by the Secretary in regulations for the purpose of paying claims for care or services.
(3) The term "clean paper claim" means a paper claim for payment of covered health care expenses that is submitted to the Secretary which contains substantially all of the required data elements necessary for accurate adjudication, without obtaining additional information from the entity or provider that furnished the care or service, submitted in such format as prescribed by the Secretary in regulations for the purpose of paying claims for care or services.
(4) The term "fraudulent claims" means the knowing misrepresentation of a material fact or facts by a health care entity or provider made to induce the Secretary to pay a claim that was not legally payable to that provider.
(5) The term "health care entity or provider" includes any non-Department health care entity or provider, but does not include any Federal health care entity or provider.
(Added
Editorial Notes
References in Text
The date of the enactment of the Caring for Our Veterans Act of 2018, referred to in subsec. (h), is the date of enactment of
Amendments
2018—Subsec. (e)(1).
Subsec. (g)(3).
Statutory Notes and Related Subsidiaries
Processing of Claims for Reimbursement Through Electronic Interface
§1703E. Center for Innovation for Care and Payment
(a)
(2) The Secretary, acting through the Center, may carry out such pilot programs the Secretary determines to be appropriate to develop innovative approaches to testing payment and service delivery models in order to reduce expenditures while preserving or enhancing the quality of care furnished by the Department.
(3) The Secretary, acting through the Center, shall test payment and service delivery models to determine whether such models—
(A) improve access to, and quality, timeliness, and patient satisfaction of care and services; and
(B) create cost savings for the Department.
(4)(A) The Secretary shall test a model in a location where the Secretary determines that the model will addresses 1 deficits in care (including poor clinical outcomes or potentially avoidable expenditures) for a defined population.
(B) The Secretary shall focus on models the Secretary expects to reduce program costs while preserving or enhancing the quality of care received by individuals receiving benefits under this chapter.
(C) The models selected may include those described in section 1115A(b)(2)(B) of the Social Security Act (
(5) In selecting a model for testing, the Secretary may consider, in addition to other factors identified in this subsection, the following factors:
(A) Whether the model includes a regular process for monitoring and updating patient care plans in a manner that is consistent with the needs and preferences of individuals receiving benefits under this chapter.
(B) Whether the model places the individual receiving benefits under this chapter (including family members and other caregivers of such individual) at the center of the care team of such individual.
(C) Whether the model uses technology or new systems to coordinate care over time and across settings.
(D) Whether the model demonstrates effective linkage with other public sector payers, private sector payers, or statewide payment models.
(6)(A) Models tested under this section may not be designed in such a way that would allow the United States to recover or collect reasonable charges from a Federal health care program for care or services furnished by the Secretary to a veteran under pilot programs carried out under this section.
(B) In this paragraph, the term "Federal health care program" means—
(i) an insurance program described in section 1811 of the Social Security Act (
(ii) a State plan for medical assistance approved under title XIX of such Act (
(iii) a TRICARE program operated under
(b)
(c)
(d)
(1) provided in advance in appropriations acts for the Veterans Health Administration; and
(2) provided for information technology systems.
(e)
(1) publish information about each pilot program under this section in the Federal Register; and
(2) take reasonable actions to provide direct notice to veterans eligible to participate in such pilot programs.
(f)
(2) Before waiving any authority under paragraph (1), the Secretary shall submit to the Speaker of the House of Representatives, the minority leader of the House of Representatives, the majority leader of the Senate, the minority leader of the Senate, and each standing committee with jurisdiction under the rules of the Senate and of the House of Representatives to report a bill to amend the provision or provisions of law that would be waived by the Department, a report on a request for waiver that describes in detail the following:
(A) The specific authorities to be waived under the pilot program.
(B) The standard or standards to be used in the pilot program in lieu of the waived authorities.
(C) The reasons for such waiver or waivers.
(D) A description of the metric or metrics the Secretary will use to determine the effect of the waiver or waivers upon the access to and quality, timeliness, or patient satisfaction of care and services furnished through the pilot program.
(E) The anticipated cost savings, if any, of the pilot program.
(F) The schedule for interim reports on the pilot program describing the results of the pilot program so far and the feasibility and advisability of continuing the pilot program.
(G) The schedule for the termination of the pilot program and the submission of a final report on the pilot program describing the result of the pilot program and the feasibility and advisability of making the pilot program permanent.
(H) The estimated budget of the pilot program.
(3)(A) Upon receipt of a report submitted under paragraph (2), each House of Congress shall provide copies of the report to the chairman and ranking member of each standing committee with jurisdiction under the rules of the House of Representatives or the Senate to report a bill to amend the provision or provisions of law that would be waived by the Department under this subsection.
(B) The waiver requested by the Secretary under paragraph (2) shall be considered approved under this paragraph if there is enacted into law a joint resolution approving such request in its entirety.
(C) For purposes of this paragraph, the term "joint resolution" means only a joint resolution which is introduced within the period of five legislative days beginning on the date on which the Secretary transmits the report to the Congress under such paragraph (2), and—
(i) which does not have a preamble; and
(ii) the matter after the resolving clause of which is as follows: "that Congress approves the request for a waiver under
(D)(i) Any committee of the House of Representatives to which a joint resolution is referred shall report it to the House without amendment not later than 15 legislative days after the date of introduction thereof. If a committee fails to report the joint resolution within that period, the committee shall be discharged from further consideration of the joint resolution.
(ii) It shall be in order at any time after the third legislative day after each committee authorized to consider a joint resolution has reported or has been discharged from consideration of a joint resolution, to move to proceed to consider the joint resolution in the House. All points of order against the motion are waived. Such a motion shall not be in order after the House has disposed of a motion to proceed on a joint resolution addressing a particular submission. The previous question shall be considered as ordered on the motion to its adoption without intervening motion. The motion shall not be debatable. A motion to reconsider the vote by which the motion is disposed of shall not be in order.
(iii) The joint resolution shall be considered as read. All points of order against the joint resolution and against its consideration are waived. The previous question shall be considered as ordered on the joint resolution to its passage without intervening motion except two hours of debate equally divided and controlled by the proponent and an opponent. A motion to reconsider the vote on passage of the joint resolution shall not be in order.
(E)(i) A joint resolution introduced in the Senate shall be referred to the Committee on Veterans' Affairs.
(ii) Any committee of the Senate to which a joint resolution is referred shall report it to the Senate without amendment not later than 15 session days after the date of introduction of a joint resolution described in paragraph (C). If a committee fails to report the joint resolution within that period, the committee shall be discharged from further consideration of the joint resolution and the joint resolution shall be placed on the calendar.
(iii)(I) Notwithstanding Rule XXII of the Standing Rules of the Senate, it is in order at any time after the third session day on which the Committee on Veterans' Affairs has reported or has been discharged from consideration of a joint resolution described in paragraph (C) (even though a previous motion to the same effect has been disagreed to) to move to proceed to the consideration of the joint resolution, and all points of order against the joint resolution (and against consideration of the joint resolution) are waived. The motion to proceed is not debatable. The motion is not subject to a motion to postpone. A motion to reconsider the vote by which the motion is agreed to or disagreed to shall not be in order. If a motion to proceed to the consideration of the resolution is agreed to, the joint resolution shall remain the unfinished business until disposed of.
(II) Consideration of the joint resolution, and on all debatable motions and appeals in connection therewith, shall be limited to not more than two hours, which shall be divided equally between the majority and minority leaders or their designees. A motion further to limit debate is in order and not debatable. An amendment to, or a motion to postpone, or a motion to proceed to the consideration of other business, or a motion to recommit the joint resolution is not in order.
(III) If the Senate has voted to proceed to a joint resolution, the vote on passage of the joint resolution shall occur immediately following the conclusion of consideration of the joint resolution, and a single quorum call at the conclusion of the debate if requested in accordance with the rules of the Senate.
(IV) Appeals from the decisions of the Chair relating to the application of the rules of the Senate, as the case may be, to the procedure relating to a joint resolution shall be decided without debate.
(F) A joint resolution considered pursuant to this paragraph shall not be subject to amendment in either the House of Representatives or the Senate.
(G)(i) If, before the passage by one House of the joint resolution of that House, that House receives the joint resolution from the other House, then the following procedures shall apply:
(I) The joint resolution of the other House shall not be referred to a committee.
(II) With respect to the joint resolution of the House receiving the joint resolution—
(aa) the procedure in that House shall be the same as if no joint resolution had been received from the other House; but
(bb) the vote on passage shall be on the joint resolution of the other House.
(ii) If the Senate fails to introduce or consider a joint resolution under this paragraph, the joint resolution of the House shall be entitled to expedited floor procedures under this subparagraph.
(iii) If, following passage of the joint resolution in the Senate, the Senate then receives the companion measure from the House of Representatives, the companion measure shall not be debatable.
(H) This subparagraph is enacted by Congress—
(i) as an exercise of the rulemaking power of the Senate and House of Representatives, respectively, and as such it is deemed a part of the rules of each House, respectively, but applicable only with respect to the procedure to be followed in that House in the case of a joint resolution, and it supersedes other rules only to the extent that it is inconsistent with such rules; and
(ii) with full recognition of the constitutional right of either House to change the rules (so far as relating to the procedure of that House) at any time, in the same manner, and to the same extent as in the case of any other rule of that House.
(g)
(2)(A) Subject to subparagraph (B), the Secretary may not expend more than $50,000,000 in any fiscal year from amounts under subsection (d).
(B) The Secretary may expend more than the amount in subparagraph (A) if—
(i) the Secretary determines that the additional expenditure is necessary to carry out pilot programs under this section;
(ii) the Secretary submits to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report setting forth the amount of the additional expenditure and a justification for the additional expenditure; and
(iii) the Chairmen of the Committees on Veterans' Affairs of the Senate and the House of Representatives transmit to the Secretary a letter approving of the additional expenditure.
(3) The waiver provisions in subsection (f) shall not apply unless the Secretary, in accordance with the requirements in subsection (f), submits the first proposal for a pilot program not later than 18 months after the date of the enactment of the Caring for Our Veterans Act of 2018.
(4) Notwithstanding
(5)(A) If the Secretary determines that a pilot program is not improving the quality of care or producing cost savings, the Secretary shall—
(i) propose a modification to the pilot program in the interim report that shall also be considered a report under subsection (f)(2) and shall be subject to the terms and conditions of subsection (f)(2); or
(ii) terminate such pilot program not later than 30 days after submitting the interim report to Congress.
(B) If the Secretary terminates a pilot program under subparagraph (A)(ii), for purposes of subparagraphs (F) and (G) of subsection (f)(2), such interim report will also serve as the final report for that pilot program.
(h)
(A) the quality of care furnished under the model, including the measurement of patient-level outcomes and patient-centeredness criteria determined appropriate by the Secretary; and
(B) the changes in spending by reason of that model.
(2) The Secretary shall make the results of each evaluation under this subsection available to the public in a timely fashion and may establish requirements for other entities participating in the testing of models under this section to collect and report information that the Secretary determines is necessary to monitor and evaluate such models.
(i)
(2) In carrying out the duties under this section, the Secretary shall consult representatives of relevant Federal agencies, and clinical and analytical experts with expertise in medicine and health care management. The Secretary shall use appropriate mechanisms to seek input from interested parties.
(j)
(1) the Secretary determines that such expansion is expected to—
(A) reduce spending without reducing the quality of care; or
(B) improve the quality of patient care without increasing spending; and
(2) the Secretary determines that such expansion would not deny or limit the coverage or provision of benefits for individuals receiving benefits under this chapter.
(Added
Editorial Notes
References in Text
The Social Security Act, referred to in subsec. (a)(6)(B)(ii), is act Aug. 14, 1935, ch. 531,
The date of the enactment of the Caring for Our Veterans Act of 2018, referred to in subsec. (g)(3), is the date of enactment of
§1703F. Credentialing verification requirements for providers of non-Department health care services
(a)
(b)
(1) Hold and maintain an active credential verification accreditation from a national health care accreditation body.
(2) Conduct initial verification of provider history and license sanctions for all States and United States territories for a period of time—
(A) that includes the period before the provider began providing non-Department health care services; and
(B) dating back not less than 10 years.
(3) Not less frequently than every three years, perform recredentialing, including verifying provider history and license sanctions for all States and United States territories.
(4) Implement continuous monitoring of each provider through the National Practitioner Data Bank established pursuant to the Health Care Quality Improvement Act of 1986 (
(5) Perform other forms of credentialing verification as the Secretary considers appropriate.
(c)
(1) The term "credentials verification organization" means an entity that manages the provider credentialing process and performs credentialing verification for non-Department providers that participate in the Veterans Community Care Program under
(2) The term "Third Party Administrator" means an entity that manages a provider network and performs administrative services related to such network within the Veterans Community Care Program under
(3) The term "Veterans Care Agreement" means an agreement for non-Department health care services entered into under
(4) The term "non-Department health care services" means services—
(A) provided under this subchapter at non-Department facilities (as defined in
(B) provided under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (
(C) purchased through the Medical Community Care account of the Department; or
(D) purchased with amounts deposited in the Veterans Choice Fund under section 802 of the Veterans Access, Choice, and Accountability Act of 2014 (
(Added
Editorial Notes
References in Text
The Health Care Quality Improvement Act of 1986, referred to in subsec. (b)(4), is title IV of
Statutory Notes and Related Subsidiaries
Deadline for Implementation
§1704. Preventive health services: annual report
Not later than October 31 each year, the Secretary shall submit to the Committees on Veterans' Affairs of the Senate and House of Representatives a report on preventive health services. Each such report shall include the following:
(1) A description of the programs and activities of the Department with respect to preventive health services during the preceding fiscal year, including a description of the following:
(A) The programs conducted by the Department—
(i) to educate veterans with respect to health promotion and disease prevention;
(ii) to provide veterans with preventive health screenings and other clinical services, with such description setting forth the types of resources used by the Department to conduct such screenings and services and the number of veterans reached by such screenings and services; and
(iii) to provide veterans each immunization on the recommended adult immunization schedule at the time such immunization is indicated on that schedule.
(B) The means by which the Secretary addressed the specific preventive health services needs of particular groups of veterans (including veterans with service-connected disabilities, elderly veterans, low-income veterans, women veterans, institutionalized veterans, and veterans who are at risk for mental illness).
(C) The manner in which the provision of such services was coordinated with the activities of the Medical and Prosthetic Research Service of the Department and the National Center for Preventive Health.
(D) The manner in which the provision of such services was integrated into training programs of the Department, including initial and continuing medical training of medical students, residents, and Department staff.
(E) The manner in which the Department participated in cooperative preventive health efforts with other governmental and private entities (including State and local health promotion offices and not-for-profit organizations).
(F) The specific research carried out by the Department with respect to the long-term relationships among screening activities, treatment, and morbidity and mortality outcomes.
(G) The cost effectiveness of such programs and activities, including an explanation of the means by which the costs and benefits (including the quality of life of veterans who participate in such programs and activities) of such programs and activities are measured.
(2) A specific description of research activities on preventive health services carried out during that period using employees, funds, equipment, office space, or other support services of the Department, with such description setting forth—
(A) the source of funds for those activities;
(B) the articles or publications (including the authors of the articles and publications) in which those activities are described;
(C) the Federal, State, or local governmental entity or private entity, if any, with which such activities were carried out; and
(D) the clinical, research, or staff education projects for which funding applications were submitted (including the source of the funds applied for) and upon which a decision is pending or was denied.
(3) An accounting of the expenditure of funds during that period by the National Center for Preventive Health under
(Added
Editorial Notes
Amendments
2016—Par. (1)(A)(iii).
Statutory Notes and Related Subsidiaries
Construction of 2016 Amendment
Nothing in amendment by
§1704A. Independent assessments of health care delivery systems and management processes
(a)
(2) Each assessment required under paragraph (1) shall address each of the following:
(A) Current and projected demographics and unique health care needs of the patient population served by the Department.
(B) The accuracy of models and forecasting methods used by the Department to project health care demand, including with respect to veteran demographics, rates of use of health care furnished by the Department, the inflation of health care costs, and such other factors as may be determined relevant by the Secretary.
(C) The reliability and accuracy of models and forecasting methods used by the Department to project the budgetary needs of the Veterans Health Administration and how such models and forecasting methods inform budgetary trends.
(D) The authorities and mechanisms under which the Secretary may furnish hospital care, medical services, and other health care at facilities of the Department and non-Department facilities, including through Federal and private sector partners and at joint medical facilities, and the effect of such authorities and mechanisms on eligibility and access to care.
(E) The organization, workflow processes, and tools used by the Department to support clinical staffing, access to care, effective length-of-stay management and care transitions, positive patient experience, accurate documentation, and subsequent coding of inpatient services.
(F) The efforts of the Department to recruit and retain staff at levels necessary to carry out the functions of the Veterans Health Administration and the process used by the Department to determine staffing levels necessary for such functions.
(G) The staffing level at each medical facility of the Department and the productivity of each health care provider at the medical facility, compared with health care industry performance metrics, which may include the following:
(i) An assessment of the case load of, and number of patients treated by, each health care provider at such medical facility during an average week.
(ii) An assessment of the time spent by each such health care provider on matters other than the case load of the health care provider, including time spent by the health care provider as follows:
(I) At a medical facility that is affiliated with the Department.
(II) Conducting research.
(III) Training or supervising other health care professionals of the Department.
(iii) An assessment of the complexity of health care conditions per patient treated by each health care provider at such medical facility during an average week.
(H) The information technology strategies of the Department with respect to furnishing and managing health care, including an identification of any weaknesses or opportunities with respect to the technology used by the Department, especially those strategies with respect to clinical documentation of hospital care, medical services, and other health care, including any clinical images and associated textual reports, furnished by the Department in facilities of the Department or non-Department facilities.
(I) Business processes of the Veterans Health Administration, including processes relating to furnishing non-Department health care, insurance identification, third-party revenue collection, and vendor reimbursement, including an identification of mechanisms as follows:
(i) To avoid the payment of penalties to vendors.
(ii) To increase the collection of amounts owed to the Department for hospital care, medical services, or other health care provided by the Department for which reimbursement from a third party is authorized and to ensure that such amounts collected are accurate.
(iii) To increase the collection of any other amounts owed to the Department with respect to hospital care, medical services, or other health care and to ensure that such amounts collected are accurate.
(iv) To increase the accuracy and timeliness of payments by the Department to vendors and providers.
(v) To reduce expenditures while improving the quality of care furnished.
(J) The purchase, distribution, and use of pharmaceuticals, medical and surgical supplies, medical devices, and health care-related services by the Department, including the following:
(i) The prices paid for, standardization of, and use by, the Department with respect to the following:
(I) Pharmaceuticals.
(II) Medical and surgical supplies.
(III) Medical devices.
(ii) The use by the Department of group purchasing arrangements to purchase pharmaceuticals, medical and surgical supplies, medical devices, and health care-related services.
(iii) The strategy and systems used by the Department to distribute pharmaceuticals, medical and surgical supplies, medical devices, and health care-related services to Veterans Integrated Service Networks and medical facilities of the Department.
(K) The competency of Department leadership with respect to culture, accountability, reform readiness, leadership development, physician alignment, employee engagement, succession planning, and performance management.
(L) The effectiveness of the authorities and programs of the Department to educate and train health personnel pursuant to
(M) The conduct of medical and prosthetic research of the Department.
(N) The provision of assistance by the Department to Federal agencies and personnel involved in responding to a disaster or emergency.
(O) Such additional matters as may be determined relevant by the Secretary.
(b)
(c)
(1) make maximum use of existing data that has been compiled by the Department, compiled for the Department, or purchased by the Department, including data that has been collected for—
(A) the performance of quadrennial market assessments under
(B) the quarterly publication of information on staffing and vacancies with respect to the Veterans Health Administration pursuant to section 505 of the VA MISSION Act of 2018 (
(C) the conduct of annual audits pursuant to section 3102 of the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020 (
(2) maximize the use of existing contracts and other agreements of the Department for studies, analysis, data collection, or research in order to efficiently fulfill the requirements of this section.
(d)
(1) has experience and proven outcomes in optimizing the performance of national health care delivery systems, including the Veterans Health Administration, other federal health care systems, and systems in the private, non-profit, or public health care sector;
(2) specializes in implementing large-scale organizational and cultural transformations, especially with respect to health care delivery systems; and
(3) is not currently under contract with the Department to provide direct or indirect patient care or related clinical care services or supplies under the laws administered by the Secretary.
(e)
(2) The program integrator designated pursuant to paragraph (1) shall be responsible for coordinating the outcomes of the assessments conducted by the private sector entities pursuant to such contracts.
(f)
(B) Each report under subparagraph (A) with respect to an assessment shall include an identification of the following:
(i) Any changes with respect to the matters included in such assessment since the date that is the later of the following:
(I) The date on which the independent assessment under section 201 of the Veterans Access, Choice, and Accountability Act of 2014 (
(II) The date on which the last assessment under subsection (a) was completed.
(ii) Any recommendations regarding matters to be covered by subsequent assessments under subsection (a), including any additional matters to include for assessment or previously assessed matters to exclude.
(2) Not later than 30 days after receiving a report under paragraph (1), the Secretary shall publish such report in the Federal Register and on a publicly accessible internet website of the Department.
(3) Not later than 90 days after receiving a report under paragraph (1), the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report outlining the feasibility and advisability of implementing the recommendations made by the private sector entity or entities in such report received, including an identification of the timeline, cost, and any legislative authorities necessary for such implementation.
(g)
(Added
Statutory Notes and Related Subsidiaries
Deadline for Initial Assessment
§1705. Management of health care: patient enrollment system
(a) In managing the provision of hospital care and medical services under
(1) Veterans with service-connected disabilities rated 50 percent or greater and veterans who were awarded the medal of honor under
(2) Veterans with service-connected disabilities rated 30 percent or 40 percent.
(3) Veterans who are former prisoners of war or who were awarded the Purple Heart, veterans with service-connected disabilities rated 10 percent or 20 percent, and veterans described in subparagraphs (B) and (C) of
(4) Veterans who are in receipt of increased pension based on a need of regular aid and attendance or by reason of being permanently housebound and other veterans who are catastrophically disabled.
(5) Veterans not covered by paragraphs (1) through (4) who are unable to defray the expenses of necessary care as determined under
(6) All other veterans eligible for hospital care, medical services, and nursing home care under
(7) Veterans described in
(8) Veterans described in
(b) In the design of an enrollment system under subsection (a), the Secretary—
(1) shall ensure that the system will be managed in a manner to ensure that the provision of care to enrollees is timely and acceptable in quality;
(2) may establish additional priorities within each priority group specified in subsection (a), as the Secretary determines necessary; and
(3) may provide for exceptions to the specified priorities where dictated by compelling medical reasons.
(c)(1) The Secretary may not provide hospital care or medical services to a veteran under paragraph (2) or (3) of
(2) The Secretary shall provide hospital care and medical services under
(Added
Editorial Notes
References in Text
Amendments
2018—Subsec. (a)(1).
2016—Subsec. (a)(1).
Subsec. (a)(3).
2010—Subsec. (a)(3).
2002—Subsec. (a)(7), (8).
Subsec. (c)(1).
1999—Subsec. (a)(3).
Statutory Notes and Related Subsidiaries
Effective Date of 2018 Amendment
Amendment by
Effective Date of 2002 Amendment
Application
Assessment of Implementation and Operation of Amendments by Pub. L. 104–262
"(a)
"(b)
"(1) the effect of implementation of, and provision and management of care under, sections 101, 103, and 104 (including the amendments made by those sections) on demand for health care services from the Department of Veterans Affairs by veterans described in paragraphs (1), (2), and (3) of
"(2) any differing patterns of demand on the part of such veterans relating to such factors as relative distance from Department facilities and prior experience, or lack of experience, as recipients of care from the Department;
"(3) the extent to which the Department has met such demand for care; and
"(4) changes in health-care delivery patterns in Department facilities and the fiscal impact of such changes.
"(c)
"(1) The number of veterans enrolled for care at each Department medical facility and, of such veterans, the number enrolled at each such facility who had not received care from the Department during the preceding three fiscal years.
"(2) With respect to the veterans who had not received care from the Department during the three preceding fiscal years, the total cost of providing care to such veterans, shown in total and separately (A) by level of care, and (B) by reference to whether care was furnished in Department facilities or under contract arrangements.
"(3) With respect to the number of veterans described in paragraphs (1), (2), and (3) of
"(A) the number who applied for care (shown in total and separately by facility);
"(B) the number who were denied enrollment (shown in total and separately by facility); and
"(C) the number who were denied care which was considered to be medically necessary but not of an emergency nature (shown in total and separately by facility).
"(4) The numbers and characteristics of, and the type and extent of health care furnished to, veterans enrolled for care (shown in total and separately by facility).
"(5) The numbers and characteristics of, and the type and extent of health care furnished to, veterans not enrolled for care (shown separately by reference to each class of eligibility, both in total and separately by facility).
"(6) The specific fiscal impact (shown in total and by geographic health-care delivery areas) of changes in delivery patterns instituted under the amendments made by this title [enacting this section and
1 See References in Text note below.
§1705A. Management of health care: information regarding health-plan contracts
(a)
(2) The information required to be provided to the Secretary under paragraph (1) with respect to a health-plan contract shall include, as applicable, the following:
(A) The name of the entity providing coverage under the health-plan contract.
(B) If coverage under the health-plan contract is in the name of an individual other than the individual required to provide information under this section, the name of the policy holder of the health-plan contract.
(C) The identification number for the health-plan contract.
(D) The group code for the health-plan contract.
(b)
(c)
(d)
(Added
Editorial Notes
Amendments
2022—Subsec. (d).
§1706. Management of health care: other requirements
(a) In managing the provision of hospital care and medical services under
(b)(1) In managing the provision of hospital care and medical services under such section, the Secretary shall ensure that the Department (and each geographic service area of the Veterans Health Administration) maintains its capacity to provide for the specialized treatment and rehabilitative needs of disabled veterans (including veterans with spinal cord dysfunction, blindness, amputations, and mental illness) within distinct programs or facilities of the Department that are dedicated to the specialized needs of those veterans in a manner that (A) affords those veterans reasonable access to care and services for those specialized needs, and (B) ensures that overall capacity of the Department (and each geographic service area of the Veterans Health Administration) to provide such services is not reduced below the capacity of the Department, nationwide, to provide those services, as of October 9, 1996. The Secretary shall carry out this paragraph in consultation with the Advisory Committee on Prosthetics and Special Disabilities Programs and the Committee on Care of Severely Chronically Mentally Ill Veterans.
(2) For purposes of paragraph (1), the capacity of the Department (and each geographic service area of the Veterans Health Administration) to provide for the specialized treatment and rehabilitative needs of disabled veterans (including veterans with spinal cord dysfunction, traumatic brain injury, blindness, prosthetics and sensory aids, and mental illness) within distinct programs or facilities shall be measured for seriously mentally ill veterans as follows (with all such data to be provided by geographic service area and totaled nationally):
(A) For mental health intensive community-based care, the number of discrete intensive care teams constituted to provide such intensive services to seriously mentally ill veterans and the number of veterans provided such care.
(B) For opioid substitution programs, the number of patients treated annually and the amounts expended.
(C) For dual-diagnosis patients, the number treated annually and the amounts expended.
(D) For substance-use disorder programs—
(i) the number of beds (whether hospital, nursing home, or other designated beds) employed and the average bed occupancy of such beds;
(ii) the percentage of unique patients admitted directly to outpatient care during the fiscal year who had two or more additional visits to specialized outpatient care within 30 days of their first visit, with a comparison from 1996 until the date of the report;
(iii) the percentage of unique inpatients with substance-use disorder diagnoses treated during the fiscal year who had one or more specialized clinic visits within three days of their index discharge, with a comparison from 1996 until the date of the report;
(iv) the percentage of unique outpatients seen in a facility or geographic service area during the fiscal year who had one or more specialized clinic visits, with a comparison from 1996 until the date of the report; and
(v) the rate of recidivism of patients at each specialized clinic in each geographic service area of the Veterans Health Administration.
(E) For mental health programs, the number and type of staff that are available at each facility to provide specialized mental health treatment, including satellite clinics, outpatient programs, and community-based outpatient clinics, with a comparison from 1996 to the date of the report.
(F) The number of such clinics providing mental health care, the number and type of mental health staff at each such clinic, and the type of mental health programs at each such clinic.
(G) The total amounts expended for mental health during the fiscal year.
(3) For purposes of paragraph (1), the capacity of the Department (and each geographic service area of the Veterans Health Administration) to provide for the specialized treatment and rehabilitative needs of disabled veterans within distinct programs or facilities shall be measured for veterans with spinal cord dysfunction, traumatic brain injury, blindness, or prosthetics and sensory aids as follows (with all such data to be provided by geographic service area and totaled nationally):
(A) For spinal cord injury and dysfunction specialized centers and for blind rehabilitation specialized centers, the number of staffed beds and the number of full-time equivalent employees assigned to provide care at such centers.
(B) For prosthetics and sensory aids, the annual amount expended.
(C) For traumatic brain injury, the number of patients treated annually and the amounts expended.
(4) In carrying out paragraph (1), the Secretary may not use patient outcome data as a substitute for, or the equivalent of, compliance with the requirement under that paragraph for maintenance of capacity.
(5)(A) Not later than April 1 of each year, the Secretary shall submit to the Committees on Veterans' Affairs of the Senate and House of Representatives a report on the Secretary's compliance, by facility and by service-network, with the requirements of this subsection. Each such report shall include information on recidivism rates associated with substance-use disorder treatment.
(B) In preparing each report under subparagraph (A), the Secretary shall use standardized data and data definitions.
(C) Each report under subparagraph (A) shall be audited by the Inspector General of the Department, who shall submit to Congress a certification as to the accuracy of each such report.
(6)(A) To ensure compliance with paragraph (1), the Under Secretary for Health shall prescribe objective standards of job performance for employees in positions described in subparagraph (B) with respect to the job performance of those employees in carrying out the requirements of paragraph (1). Those job performance standards shall include measures of workload, allocation of resources, and quality-of-care indicators.
(B) Positions described in this subparagraph are positions in the Veterans Health Administration that have responsibility for allocating and managing resources applicable to the requirements of paragraph (1).
(C) The Under Secretary shall develop the job performance standards under subparagraph (A) in consultation with the Advisory Committee on Prosthetics and Special Disabilities Programs and the Committee on Care of Severely Chronically Mentally Ill Veterans.
(c) The Secretary shall ensure that each primary care health care facility of the Department develops and carries out a plan to provide mental health services, either through referral or direct provision of services, to veterans who require such services.
(Added
Editorial Notes
Amendments
2016—Subsec. (b)(5)(A).
2006—Subsec. (b)(5)(A).
2002—Subsec. (b)(1).
Subsec. (b)(2) to (4).
Subsec. (b)(5).
Subsec. (b)(6).
2001—Subsec. (c).
1998—Subsec. (b)(1).
Subsec. (b)(2).
Subsec. (b)(3).
Statutory Notes and Related Subsidiaries
Deadline for Prescribing Standards
§1706A. Remediation of medical service lines
(a)
(1) Increasing personnel or temporary personnel assistance, including mobile deployment teams.
(2) Special hiring incentives, including the Education Debt Reduction Program under subchapter VII of
(3) Utilizing direct hiring authority.
(4) Providing improved training opportunities for staff.
(5) Acquiring improved equipment.
(6) Making structural modifications to the facility used by the medical service line.
(7) Such other actions as the Secretary considers appropriate.
(b)
(c)
(d)
(1) submit to Congress an analysis of the remediation actions and costs of such actions taken with respect to each medical service line with respect to which the Secretary submitted an assessment and plan under subsection (a) in the preceding year, including an update on the progress of each such medical service line in complying with the standards for quality and timeliness established by the Secretary and any other actions the Secretary is undertaking to assist the medical service line in complying with standards for quality as established by the Secretary; and
(2) publish such analysis on the internet website of the Department.
(Added
Editorial Notes
Amendments
2018—Subsec. (a).
Subsec. (d)(1).
§1707. Limitations
(a) Funds appropriated to carry out this chapter may not be used for purposes that are inconsistent with the Assisted Suicide Funding Restriction Act of 1997 (
(b) The Secretary may furnish sensori-neural aids only in accordance with guidelines prescribed by the Secretary.
(Added
Editorial Notes
References in Text
The Assisted Suicide Funding Restriction Act of 1997, referred to in subsec. (a), is
Amendments
2002—
Subsec. (a).
Statutory Notes and Related Subsidiaries
Effective Date
Section effective Apr. 30, 1997, and applicable to Federal payments made pursuant to obligations incurred after Apr. 30, 1997, for items and services provided on or after such date, subject to also being applicable with respect to contracts entered into, renewed, or extended after Apr. 30, 1997, as well as contracts entered into before Apr. 30, 1997, to the extent permitted under such contracts, see section 11 of
§1708. Temporary lodging
(a) The Secretary may furnish persons described in subsection (b) with temporary lodging in a Fisher house or other appropriate facility in connection with the examination, treatment, or care of a veteran under this chapter or, as provided for under subsection (e)(5), in connection with benefits administered under this title.
(b) Persons to whom the Secretary may provide lodging under subsection (a) are the following:
(1) A veteran who must travel a significant distance to receive care or services under this title.
(2) A member of the family of a veteran and others who accompany a veteran and provide the equivalent of familial support for such veteran.
(c) In this section, the term "Fisher house" means a housing facility that—
(1) is located at, or in proximity to, a Department medical facility;
(2) is available for residential use on a temporary basis by patients of that facility and others described in subsection (b)(2); and
(3) is constructed by, and donated to the Secretary by, the Zachary and Elizabeth M. Fisher Armed Services Foundation.
(d) The Secretary may establish charges for providing lodging under this section. The proceeds from such charges shall be credited to the medical services account and shall be available until expended for the purposes of providing such lodging.
(e) The Secretary shall prescribe regulations to carry out this section. Such regulations shall include provisions—
(1) limiting the duration of lodging provided under this section;
(2) establishing standards and criteria under which charges are established for such lodging under subsection (d);
(3) establishing criteria for persons considered to be accompanying a veteran under subsection (b)(2);
(4) establishing criteria for the use of the premises of temporary lodging facilities under this section; and
(5) establishing any other limitations, conditions, and priorities that the Secretary considers appropriate with respect to lodging under this section.
(Added
Editorial Notes
Amendments
2008—Subsec. (d).
§1709. Comprehensive policy on reporting and tracking sexual assault incidents and other safety incidents
(a)
(A) suspected, alleged, attempted, or confirmed cases of sexual assault, regardless of whether such assaults lead to prosecution or conviction;
(B) criminal and purposefully unsafe acts;
(C) alcohol or substance abuse related acts (including by employees of the Department); and
(D) any kind of event involving alleged or suspected abuse of a patient.
(2) In developing and implementing a policy under paragraph (1), the Secretary shall consider the effects of such policy on—
(A) the use by veterans of mental health care and substance abuse treatments; and
(B) the ability of the Department to refer veterans to such care or treatment.
(b)
(1) For purposes of reporting and tracking sexual assault incidents and other safety incidents, definitions of the terms—
(A) "safety incident";
(B) "sexual assault"; and
(C) "sexual assault incident".
(2)(A) The development and use of specific risk-assessment tools to examine any risks related to sexual assault that a veteran may pose while being treated at a medical facility of the Department, including clear and consistent guidance on the collection of information related to—
(i) the legal history of the veteran; and
(ii) the medical record of the veteran.
(B) In developing and using tools under subparagraph (A), the Secretary shall consider the effects of using such tools on the use by veterans of health care furnished by the Department.
(3) The mandatory training of employees of the Department on security issues, including awareness, preparedness, precautions, and police assistance.
(4) The mandatory implementation, use, and regular testing of appropriate physical security precautions and equipment, including surveillance camera systems, computer-based panic alarm systems, stationary panic alarms, and electronic portable personal panic alarms.
(5) Clear, consistent, and comprehensive criteria and guidance with respect to an employee of the Department communicating and reporting sexual assault incidents and other safety incidents to—
(A) supervisory personnel of the employee at—
(i) a medical facility of the Department;
(ii) an office of a Veterans Integrated Service Network; and
(iii) the central office of the Veterans Health Administration; and
(B) a law enforcement official of the Department.
(6) Clear and consistent criteria and guidelines with respect to an employee of the Department referring and reporting to the Office of Inspector General of the Department sexual assault incidents and other safety incidents that meet the regulatory criminal threshold prescribed under
(7) An accountable oversight system within the Veterans Health Administration that includes—
(A) systematic information sharing of reported sexual assault incidents and other safety incidents among officials of the Administration who have programmatic responsibility; and
(B) a centralized reporting, tracking, and monitoring system for such incidents.
(8) Consistent procedures and systems for law enforcement officials of the Department with respect to investigating, tracking, and closing reported sexual assault incidents and other safety incidents.
(9) Clear and consistent guidance for the clinical management of the treatment of sexual assaults that are reported more than 72 hours after the assault.
(c)
(d)
(2) The report required by paragraph (1) shall include—
(A) the number and type of sexual assault incidents and other safety incidents reported by each medical facility of the Department;
(B) a detailed description of the implementation of the policy required by subsection (a), including any revisions made to such policy from the previous year; and
(C) the effectiveness of such policy on improving the safety and security of the medical facilities of the Department, including the performance measures used to evaluate such effectiveness.
(Added
§1709A. Teleconsultation
(a)
(2) The Secretary shall, in consultation with appropriate professional societies, promulgate technical and clinical care standards for the use of teleconsultation services within facilities of the Department.
(3) In carrying out an initiative under paragraph (1), the Secretary shall ensure that facilities of the Department are able to provide a mental health or traumatic brain injury assessment to a veteran through contracting with a third-party provider or reimbursing a provider through a fee basis system when—
(A) such facilities are not able to provide such assessment to the veteran without—
(i) such contracting or reimbursement; or
(ii) teleconsultation; and
(B) providing such assessment with such contracting or reimbursement is more clinically appropriate for the veteran than providing such assessment with teleconsultation.
(b)
(Added
§1709B. Evaluations of mental health care and suicide prevention programs
(a)
(2) Each evaluation conducted under paragraph (1) shall—
(A) use metrics that are common among and useful for practitioners in the field of mental health care and suicide prevention, including metrics applicable specifically to women;
(B) identify the most effective mental health care and suicide prevention programs conducted by the Secretary, including such programs conducted at a Center of Excellence;
(C) identify the cost-effectiveness of each program identified under subparagraph (B);
(D) measure the satisfaction of patients with respect to the care provided under each such program;
(E) propose best practices for caring for individuals who suffer from mental health disorders or are at risk of suicide, including such practices conducted or suggested by other departments or agencies of the Federal Government, including the Substance Abuse and Mental Health Services Administration of the Department of Health and Human Services; and
(F) identify the mental health care and suicide prevention programs conducted by the Secretary that are most effective for women veterans and such programs with the highest satisfaction rates among women veterans.
(3) The periods specified in this paragraph are the following:
(A) The period beginning on the date on which the Secretary awards the contract under paragraph (4) and ending on September 30, 2018.
(B) Each fiscal year beginning on or after October 1, 2018.
(4) Not later than 180 days after the date of the enactment of this section, the Secretary shall seek to enter into a contract with an independent third party unaffiliated with the Department of Veterans Affairs to conduct evaluations under paragraph (1).
(5) The independent third party that is awarded the contract under paragraph (4) shall submit to the Secretary each evaluation conducted under paragraph (1).
(b)
(1) The most recent evaluations submitted to the Secretary under subsection (a)(5) that the Secretary has not previously submitted to such Committees.
(2) Any recommendations the Secretary considers appropriate.
(Added
Editorial Notes
References in Text
The date of the enactment of this section, referred to in subsec. (a)(4), is the date of enactment of
Amendments
2016—Subsec. (a)(2)(A).
Subsec. (a)(2)(F).
§1709C. Assistance for child care for certain veterans receiving health care
(a)
(b)
(1) receives the types of health care services described in subsection (c)(2) at a facility of the Department; and
(2) requires travel to and return from such facility for the receipt of such health care services.
(c)
(1) is the primary caretaker of a child or children; and
(2)(A) receives from the Department—
(i) regular mental health care services;
(ii) intensive mental health care services; or
(iii) such other intensive health care services that the Secretary determines that provision of assistance to the veteran to obtain child care would improve access to such health care services by the veteran; or
(B) is in need of regular or intensive mental health care services from the Department, and but for lack of child care services, would receive such health care services from the Department.
(d)
(e)
(A) Stipends for the payment of child care offered by a licensed child care center (either directly or through a voucher program) that shall be, to the extent practicable, modeled after the Department of Veterans Affairs Child Care Subsidy Program established pursuant to section 630 of the Treasury and General Government Appropriations Act, 2002 (
(B) Direct provision of child care at an on-site facility of the Department.
(C) Payments to private child care agencies.
(D) Collaboration with facilities or programs of other Federal agencies.
(E) Such other forms of assistance as the Secretary considers appropriate.
(2) In providing child care assistance under this section, the child care needs of the local area shall be considered and the head of each medical center may select the type of care that is most appropriate or feasible for such medical center.
(3) In the case that child care assistance under this section is provided as a stipend under paragraph (1)(A), such stipend shall cover the full cost of such child care.
(Added
Editorial Notes
References in Text
The date of the enactment of the Deborah Sampson Act of 2020, referred to in subsec. (d), is the date of enactment of title V of
Section 630 of the Treasury and General Government Appropriations Act, 2002, referred to in subsec. (e)(1)(A), is section 630 of