Title III — Health Care

116th Congress · Approved Jan 5, 2021 · 134 Stat. 4932

TITLE III Health Care

Subtitle A Health Care Generally

SEC. 3001. Expansion of Modifications to Veteran Directed Care Program.

Section 20006 of the Coronavirus Aid, Relief, and Economic Security Act (Public Law 116–136) is amended—

(1)

by striking “ During a public health emergency” each place it appears and inserting “ During the period specified in subsection (f)”;

(2)

in subsection (a)—

(A)

in the matter preceding paragraph (1), by striking “ during a public health emergency” and inserting “ during the period specified in subsection (f)”; and

(B)

in paragraph (1), by striking “ an area agency on aging” and inserting “ a covered provider”; and

(3)

by striking subsection (e) and inserting the following new subsections:

“(e) Transfer of Certain Veterans to the Program.—During the period specified in subsection (f), the Secretary shall allow a veteran residing in an area covered by the Program to be transferred to the Program for the duration of such period if—

“(1) the veteran had been receiving extended care services paid for by the Department, such as adult day services or homemaker or home health aide services, immediately preceding such period; and

“(2) those services are no longer available due to a public health emergency.

“(f) Period Specified.—The period specified in this subsection is the period beginning on the date on which a public health emergency was first declared and ending on the date that is 60 days after the date on which a public health emergency is no longer in effect.

“(g) Covered Provider Defined.—In this section, the term ‘covered provider’ means a provider participating in the Program, including—

“(1) an Aging and Disability Resource Center, an area agency on aging, or a State agency (as those terms are defined in section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002)); or

“(2) a center for independent living (as defined in section 702 of the Rehabilitation Act of 1973 (29 U.S.C. 796a)).”

SEC. 3002. Prohibition on Collection of a Health Care Copayment by the Secretary of Veterans Affairs from a Veteran Who Is a Member of an Indian Tribe.

(a)

In General.— Section 1730A of title 38, United States Code, is amended—

(1)

in the heading, by striking “ catastrophically disabled” and inserting “ certain”;

(2)

by inserting “ (a) Prohibition.—” before “ Notwithstanding”;

(3)

by striking “ a veteran who is catastrophically disabled, as defined by the Secretary,” and inserting “ a covered veteran”; and

(4)

by adding at the end the following new subsection:

“(b) Covered Veteran Defined.—In this section, the term ‘covered veteran’ means a veteran who—

“(1) is catastrophically disabled, as defined by the Secretary; or

“(2) is an Indian or urban Indian (as those terms are defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)).”

(b)

Technical Amendment.— The table of sections at the beginning of chapter 17 of such title is amended by striking the item relating to section 1730A and inserting the following:

“1730A. Prohibition on collection of copayments from certain veterans.”.

(c)

Effective Date.— The amendments made by this section shall take effect on the day that is one year after the date of the enactment of this Act.

SEC. 3003. Oversight for State Homes Regarding Covid–19 Infections, Response Capacity, and Staffing Levels.

(a)

Reporting.—

(1)

In general.— During a covered public health emergency, each State home shall submit weekly to the Secretary of Veterans Affairs and the National Healthcare Safety Network of the Centers for Disease Control and Prevention, through an electronic medium and in a standardized format specified by the Secretary, a report on the emergency.

(2)

Elements.— Each report required by paragraph (1) for a State home shall include the following:

(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)

Publication of Total Infections and Deaths.—

(1)

In general.— Not later than 30 days after the date of the enactment of this Act, and not less frequently than weekly thereafter, the Secretary shall post on a publicly available website of the Department of Veterans Affairs—

(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)

Information on residents and staff.— The Secretary shall disaggregate information on residents and staff published under paragraph (1) by veteran, staff, and other.

(c)

Definitions.— In this section:

(1)

Covered public health emergency.— The term “covered public health emergency” means an emergency with respect to COVID–19 declared by a Federal, State, or local authority.

(2)

State home.— The term “State home” has the meaning given that term in section 101(19) of title 38, United States Code.

SEC. 3004. Grants for State Homes Located on Tribal Lands.

(a)

State Home Defined.— Section 101(19) of title 38, United States Code, is amended by inserting “ or Indian tribe (as defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304))” after “ (other than a possession)”.

(b)

Payments to State Homes.— Section 1741 of title 38, United States Code, is amended by adding at the end the following new subsection:

“(g) In this subchapter, the term ‘State’ means each of the several States and each Indian tribe (as defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304)).”

(c)

State Home Construction.—

(1)

In general.— Section 8131(2) of title 38, United States Code, is amended by inserting “ includes each Indian tribe (as defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304)) but” before “ does not”.

(2)

Conforming amendment.— Section 8132 of such title is amended by striking “ several”.

(d)

Additional Legislative or Administrative Action.—

(1)

Consultation with indian tribes.— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall consult with Indian tribes to determine if any legislative or administrative action is necessary to modify the State home program to function efficiently in support of State homes operated by Indian tribes pursuant to the amendments made by this section.

(2)

Report to congress.— Not later than 90 days after completing consultations under paragraph (1), the Secretary shall submit to the appropriate committees of Congress a report recommending legislative action that the Secretary considers appropriate to modify the State home program described in such paragraph in light of those consultations.

(3)

Modifications.— Not later than 180 days after completing consultations under paragraph (1), the Secretary shall make any modifications to regulations implementing the State home program, for which legislative action is not necessary, as the Secretary considers appropriate in light of those consultations.

(e)

Technical Support and Assistance.— The Secretary of Veterans Affairs shall provide technical support and assistance to Indian tribes in carrying out the State home program at State homes operated by Indian tribes pursuant to the amendments made by this section.

(f)

Definitions.— In this section:

(1)

Appropriate committees of congress.— The term “appropriate committees of Congress” means—

(A)

the Committee on Veterans’ Affairs and the Committee on Indian Affairs of the Senate; and

(B)

the Committee on Veterans’ Affairs and the Subcommittee for Indigenous Peoples of the United States of the Committee on Natural Resources of the House of Representatives.

(2)

Indian tribe.— The term “Indian tribe” has the meaning given that term in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304).

(3)

State home.— The term “State home” has the meaning given that term in section 101(19) of title 38, United States Code.

(4)

State home program.— The term “State home program” means the program of the Department of Veterans Affairs for which payments are made under subchapter V of chapter 17 of title 38, United States Code, and assistance is provided under subchapter III of chapter 81 of such title.

SEC. 3005. Continuation of Women’s Health Transition Training Program of Department of Veterans Affairs.

(a)

Duration.— The Secretary of Veterans Affairs shall carry out the Women’s Health Transition Training program of the Department of Veterans Affairs (in this section referred to as the “Program”) until at least one year after the date of the enactment of this Act.

(b)

Report.— Not later than one year and ten days after the date of the enactment of this Act, the Secretary of Defense and the Secretary of Veterans Affairs shall jointly submit to the appropriate congressional committees a report on the Program that includes the following:

(1)

The number of women members of the Armed Forces, disaggregated by military department (with respect to the Department of the Navy, disaggregated by the Navy and Marine Corps), who participated in the Program.

(2)

The number of courses held under the Program.

(3)

The locations at which such courses were held, the number of seats available for such courses, and the number of participants at each such location.

(4)

With respect to the number of members of the Armed Forces who participated in the Program as specified under paragraph (1)—

(A)

the number who enrolled in the health care system of the Department of Veterans Affairs under section 1705(a) of title 38, United States Code; and

(B)

the number who attended at least one health care appointment at a medical facility of the Department of Veterans Affairs.

(5)

Data relating to—

(A)

satisfaction with courses held under the Program;

(B)

improved awareness of health care services administered by the Secretary of Veterans Affairs; and

(C)

any other available statistics regarding the Program.

(6)

A discussion of regulatory, legal, or resource barriers to—

(A)

making the Program permanent to enable access to services provided under the Program by a greater number of women members of the Armed Forces at locations throughout the United States;

(B)

offering the Program online for women members of the Armed Forces who are unable to attend courses held under the Program in person; and

(C)

the feasability of automatically enrolling Program participants in the health care system of the Department of Veterans Affairs under section 1705(a) of title 38, United States Code.

(c)

Appropriate Congressional Committees Defined.— In this section, the term “appropriate congressional committees” means—

(1)

the Committee on Armed Services and the Committee on Veterans’ Affairs of the Senate; and

(2)

the Committee on Armed Services and the Committee on Veterans’ Affairs of the House of Representatives.

SEC. 3006. Authority for Secretary of Veterans Affairs to Furnish Medically Necessary Transportation for Newborn Children of Certain Women Veterans.

(a)

In General.— Section 1786 of title 38, United States Code, as amended by section 9102 of the William M. (Mac) Thornberry National Defense Authorization Act for Fiscal Year 2021, is further amended—

(1)

in subsection (a)—

(A)

in the matter before paragraph (1), by inserting “ and transportation necessary to receive such services” after “ described in subsection (b)”;

(B)

in paragraph (1), by striking “ or”;

(C)

in paragraph (2), by striking the period at the end and inserting “ ; or”; and

(D)

by adding at the end the following new paragraph:

“(3) another location, including a health care facility, if the veteran delivers the child before arriving at a facility described in paragraph (1) or (2).”

(2)

in subsection (b), by inserting before the period at the end the following: “ , including necessary health care services provided by a facility other than the facility where the newborn child was delivered (including a specialty pediatric hospital) that accepts transfer of the newborn child and responsibility for treatment of the newborn child”; and

(3)

by adding at the end the following new subsections:

“(d) Transportation.—

(1) Transportation furnished under subsection (a) to, from, or between care settings to meet the needs of a newborn child includes costs for either or both the newborn child and parents.

“(2) Transportation furnished under subsection (a) includes transportation by ambulance, including air ambulance, or other appropriate medically staffed modes of transportation—

“(A) to another health care facility (including a specialty pediatric hospital) that accepts transfer of the newborn child or otherwise provides post-delivery care services when the treating facility is not capable of furnishing the care or services required; or

“(B) to a health care facility in a medical emergency of such nature that a prudent layperson reasonably expects that delay in seeking immediate medical attention would be hazardous to life or health.

“(3) Amounts paid by the Department for transportation under this section shall be derived from the Medical Services appropriations account of the Department.

“(e) Reimbursement or Payment for Health Care Services or Transportation.—

(1) Pursuant to regulations the Secretary shall prescribe to establish rates of reimbursement and any limitations thereto under this section, the Secretary shall directly reimburse a covered entity for health care services or transportation services provided under this section, unless the cost of the services or transportation is covered by an established agreement or contract. If such an agreement or contract exists, its negotiated payment terms shall apply.

“(2)

(A) Reimbursement or payment by the Secretary under this section on behalf of an individual to a covered entity shall, unless rejected and refunded by the covered entity within 30 days of receipt, extinguish any liability on the part of the individual for the health care services or transportation covered by such payment.

“(B) Neither the absence of a contract or agreement between the Secretary and a covered entity nor any provision of a contract, agreement, or assignment to the contrary shall operate to modify, limit, or negate the requirements of subparagraph (A).

“(3) In this subsection, the term ‘covered entity’ means any individual, transportation carrier, organization, or other entity that furnished or paid for health care services or transportation under this section.”

(b)

Treatment of Certain Expenses Already Incurred.—

(1)

In general.— Pursuant to such regulations as the Secretary of Veterans Affairs shall prescribe, with respect to transportation furnished in order for a newborn child of a veteran to receive health care services under section 1786 of title 38, United States Code, during the period specified in paragraph (2), the Secretary may—

(A)

waive a debt owed by the veteran to the Department of Veterans Affairs or reimburse expenses already paid by the veteran to the Department for such transportation;

(B)

reimburse the veteran for expenses already paid by the veteran to a covered entity for such transportation; or

(C)

reimburse a covered entity for the costs of such transportation.

(2)

Period specified.— The period specified in this paragraph is the period beginning on May 5, 2010, and ending on the date of the enactment of this Act.

(3)

Covered entity defined.— In this subsection, the term “covered entity” has the meaning given that term in section 1786(e)(3) of title 38, United States Code, as added by subsection (a).

SEC. 3007. Waiver of Requirements of Department of Veterans Affairs for Receipt of per Diem Payments for Domiciliary Care at State Homes and Modification of Eligibility for Such Payments.

(a)

Waiver of Requirements.— Notwithstanding section 1741 of title 38, United States Code (as amended by subsection (b)), the Secretary of Veterans Affairs shall modify section 51.51(b) of title 38, Code of Federal Regulations (or successor regulations), to provide the Secretary the authority to waive the requirements under such section 51.51(b) for a veteran to be eligible for per diem payments for domiciliary care at a State home if—

(1)

the veteran has met not fewer than four of the requirements set forth in such section; or

(2)

such waiver would be in the best interest of the veteran.

(b)

Modification of Eligibility.— Section 1741(a)(1) of title 38, United States Code, is amended, in the flush text following subparagraph (B), by striking “ in a Department facility” and inserting “ under the laws administered by the Secretary”.

(c)

State Home Defined.— In this section, the term “State home” has the meaning given that term in section 101(19) of title 38, United States Code.

SEC. 3008. Expansion of Quarterly Update of Information on Staffing and Vacancies at Facilities of the Department of Veterans Affairs to Include Information on Duration of Hiring Process.

(a)

Quarterly Update.— Subsection (a)(1) of section 505 of the VA MISSION Act of 2018 (Public Law 115–182; 38 U.S.C. 301 note) is amended by adding at the end the following new subparagraph:

“(E) Beginning with any update under paragraph (3) on or after the date of the enactment of the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020, the following:

“(i) For employees appointed under paragraphs (1) and (3) of section 7401 of title 38, United States Code, the number of employees for which the duration of the process from validation of vacancy to receipt of official offer and notification of actual start date exceeds the metrics laid out in the Time to Hire Model of the Veterans Health Administration, or successor model.

“(ii) The percentage of employees who are described in clause (i) compared to all employees appointed under paragraphs (1) and (3) of section 7401 of such title during the same period.

“(iii) The average number of days potential hires or new hires appointed under paragraphs (1) and (3) of section 7401 of such title spent in each phase of the Time to Hire Model, or successor model.”

(b)

Annual Report.— Subsection (b) of such section is amended, in the first sentence, by adding before the period at the end the following: “ and to improve the onboard timeline for facilities for which the duration of the onboarding process exceeds the metrics laid out in the Time to Hire Model of the Veterans Health Administration, or successor model”.

SEC. 3009. Requirement for Certain Department of Veterans Affairs Medical Facilities to Have Physical Location for the Disposal of Controlled Substances Medications.

(a)

In General.— The Secretary of Veterans Affairs shall ensure that each covered Department medical facility has a physical location where patients may dispose of controlled substances medications.

(b)

Covered Department Medical Facility.— In this section, the term “covered Department medical facility” means a medical facility of the Department of Veterans Affairs with an onsite pharmacy or a physical location dedicated for law enforcement purposes.

(c)

Effective Date.— This section shall take effect on January 1, 2022.

SEC. 3010. Department of Veterans Affairs Pilot Program for Clinical Observation by Undergraduate Students.

(a)

Establishment.— The Secretary of Veterans Affairs shall carry out a pilot program for a one-year period, beginning not later than August 15, 2021, to provide certain students described in subsection (d) a clinical observation experience at medical centers of the Department of Veterans Affairs.

(b)

Medical Center Selection.— The Secretary shall carry out the pilot program under this section at not fewer than five medical centers of the Department. In selecting such medical centers, the Secretary shall ensure regional diversity among such selected medical centers.

(c)

Clinical Observation Sessions.—

(1)

Frequency and duration.— In carrying out the pilot program, the Secretary shall—

(A)

provide at least one and not more than three clinical observation sessions at each medical center selected during each calendar year;

(B)

ensure that each clinical observation session—

(i)

lasts between four and six months; and

(ii)

to the extent practicable, begins and ends concurrently with one or more academic terms of an institution of higher education (as defined in section 101 of the Higher Education Act of 1965 (20 U.S.C. 1001)); and

(C)

ensure that the clinical observation sessions provided at a medical center have minimal overlap.

(2)

Sessions.— The Secretary shall ensure that the pilot program consists of clinical observation sessions as follows:

(A)

Each session shall allow for not fewer than five students nor greater than 15 students to participate in the session.

(B)

Each session shall consist of not fewer than 20 observational hours nor greater than 40 observational hours.

(C)

A majority of the observational hours shall be spent observing a health professional. The other observational hours shall be spent in a manner that ensures a robust, well rounded experience that exposes the students to a variety of aspects of medical care and health care administration.

(D)

Each session shall provide a diverse clinical observation experience.

(d)

Students.—

(1)

Selection.— The Secretary shall select to participate in the pilot program under subsection (a) students who are—

(A)

nationals of the United States;

(B)

enrolled in an accredited program of study at an institution of higher education; and

(C)

referred by their institution of higher education following an internal application process.

(2)

Priority.— In making such selection, the Secretary shall give priority to each of the following five categories of students:

(A)

Students who, at the time of the completion of their secondary education, resided in a health professional shortage area (as defined in section 332 of the Public Health Service Act (42 U.S.C. 254e)).

(B)

First generation college students (as defined in section 402A(h)(3) of the Higher Education Act of 1965 (20 U.S.C. 1067q(a))).

(C)

Students who have been referred by minority-serving institutions (as defined in section 371(a) of the Higher Education Act of 1965 (20 U.S.C. 1067q(a))).

(D)

Veterans (as defined in section 101 of title 38, United States Code).

(E)

Students who indicate an intention to specialize in a health professional occupation identified by the Inspector General of the Department under section 7412 of title 38, United States Code, as having a staffing shortage.

(3)

Assignment to medical centers.— The Secretary shall assign students selected under paragraph (1) to medical centers selected under subsection (b) without regard for whether such medical centers have staffing shortages in any health professional occupation pursuant to section 7412 of title 38, United States Code.

(e)

Other Matters.— In carrying out the pilot program under this section, the Secretary shall—

(1)

establish a formal status to facilitate the access to medical centers of the Department by student observers participating in the pilot program;

(2)

establish standardized legal, privacy, and ethical requirements for the student observers, including with respect to—

(A)

ensuring that no student observer provides any care to patients while participating as an observer; and

(B)

ensuring the suitability of a student to participate in the pilot program to ensure that the student poses no risk to patients;

(3)

develop and implement a partnership strategy with minority-serving institutions to encourage referrals;

(4)

create standardized procedures for student observers;

(5)

create an online information page about the pilot program on the internet website of the Department;

(6)

publish on the online information page created under paragraph (5) the locations of such centers, and other information on the pilot program, not later than 180 days before the date on which applications are required to be submitted by potential student observers;

(7)

identify medical centers and specific health professionals participating in the pilot program; and

(8)

notify the Committees on Veterans’ Affairs of the House of Representatives and the Senate of the medical centers selected under subsection (c) within 30 days of selection, to facilitate program awareness.

(f)

Report.— Not later than 180 days after the completion of the pilot program under subsection (a), the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the results of the pilot program, including—

(1)

the number and demographics of all applicants, those accepted to participate in the pilot program, and those who completed the pilot program; and

(2)

if participating institutions of higher education choose to administer satisfaction surveys that assess the experience of those who completed the pilot program, the results of any such satisfaction surveys, provided at the discretion of the institution of higher education.

(g)

Sense of Congress Regarding Department of Veterans Affairs Pilot Program for Clinical Observation by Undergraduate Students.— It is the sense of Congress that the pilot program described in subsection (a) should be designed to—

(1)

increase the awareness, knowledge, and empathy of future health professionals toward the health conditions common to veterans;

(2)

increase the diversity of the recruitment pool of future physicians of the Department; and

(3)

expand clinical observation opportunities for all students by encouraging students of all backgrounds to consider a career in the health professions.

(h)

No Additional Funds Authorized.— No additional funds are authorized to be appropriated to carry out the requirements of this section. Such requirements shall be carried out using amounts otherwise authorized to be appropriated.

Subtitle B Scheduling and Consult Management

SEC. 3101. Process and Requirements for Scheduling Appointments for Health Care from Department of Veterans Affairs and Non-Department Health Care.

(a)

Process and Requirements.—

(1)

In general.— Not later than 60 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall—

(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 section 1703 of title 38, United States Code, by a non-Department health care provider; and

(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)

Elements of description.— The description of the process and requirements for scheduling appointments for health care required to be submitted under paragraph (1)(B) shall include—

(A)

information on how such process and requirements take into account the access standards established under section 1703B of title 38, United States Code; and

(B)

the maximum number of days allowed to complete each step of such process.

(3)

Periodic revision.—

(A)

In general.— The Secretary may revise the process and requirements required under paragraph (1) as the Secretary considers necessary.

(B)

Submittal to congress.— Not later than 30 days before revising the process and requirements under subparagraph (A), the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a description of such revised process and requirements, including a description of any modifications to the certification and training under subsection (b).

(b)

Certification and Training on Process and Requirements.—

(1)

Certification.— Not later than one year after the date of the enactment of this Act, the Secretary shall require each individual involved in the scheduling of appointments for health care from the Department or health care described in subsection (a)(1)(A)(ii), including schedulers, clinical coordinators, and supervisors, to certify to the Secretary that the individual understands the process and requirements established under subsection (a), including the maximum number of days allowed to complete each step of such process.

(2)

New employees.— The Secretary shall require each employee hired by the Department on or after the date of the enactment of this Act who is to be involved in the scheduling of appointments for health care from the Department or health care described in subsection (a)(1)(A)(ii)—

(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)

Method to Monitor Compliance.—

(1)

In general.— Not later than 180 days after the date of the enactment of this Act, the Secretary shall establish or maintain a method or tool—

(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)

Use throughout department.—

(A)

In general.— The Secretary shall require each medical facility of the Department to use the method or tool described in paragraph (1).

(B)

Report.— Not later than one year after the date of the enactment of this Act, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report indicating whether each medical facility of the Department is using the method or tool described in paragraph (1).

(d)

Comptroller General Report.— Not later than two years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the compliance of the Secretary with the requirements of this section.

SEC. 3102. Audits Regarding Scheduling of Appointments and Management of Consultations for Health Care from Department of Veterans Affairs and Non-Department Health Care.

(a)

In General.— Not later than each of one year and two years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall provide for the conduct of a facility-level audit of the scheduling of appointments and the management of consultations for health care under the laws administered by the Secretary.

(b)

Application.—

(1)

First audit.— The first audit required under subsection (a) shall apply to each medical facility of the Department of Veterans Affairs.

(2)

Second audit.— The second audit required under subsection (a) shall apply to only those medical facilities of the Department that are in need of corrective action based on the first audit, as determined by the Secretary.

(c)

Elements.— Each audit conducted under subsection (a) shall include the following:

(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 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) 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)

Conduct of Audit by Third Party.— Each audit conducted under subsection (a) with respect to a medical facility of the Department shall be conducted by an individual or entity that is not affiliated with the facility.

(e)

Transmittal to VHA.— Each audit conducted under subsection (a) shall be transmitted to the Under Secretary for Health of the Department so that the Under Secretary can—

(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)

Annual Report.—

(1)

In general.— Not later than December 31 of each year in which an audit is conducted under subsection (a), the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the audit conducted during that year.

(2)

Elements.— The Secretary shall include in each report required by paragraph (1)—

(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.

SEC. 3103. Administration of Non-Department of Veterans Affairs Health Care.

(a)

Certification of Proper Administration of Non-Department Care.—

(1)

Review.—

(A)

In general.— The Secretary of Veterans Affairs shall conduct a review of the staffing, training, and other requirements necessary to administer section 1703 of title 38, United States Code.

(B)

Elements.— The review conducted under subparagraph (A) shall include, with respect to each medical facility of the Department of Veterans Affairs—

(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)

Submittal to congress.— Not later than 180 days after the date of the enactment of this Act, and every 180 days 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)

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)

Scheduling of Appointments.—

(1)

Measurement of timeliness for each facility.— Not later than 120 days after the date of the enactment of this Act, the Secretary shall measure, with respect to referrals for non-Department health care originating from medical facilities of the Department, for each such facility—

(A)

the period of time between—

(i)

(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)

Submissions to congress.—

(A)

In general.— Not later than one year after the date of the enactment of this Act, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives the data measured under paragraph (1), disaggregated by medical facility.

(B)

Update.— Not less frequently than biweekly, the Secretary shall update the data submitted under subparagraph (A).

(c)

Comptroller General Report.—

(1)

Review.— Beginning not later than one year after the date of the enactment of this Act, the Comptroller General of the United States shall review compliance by the Secretary with the requirements of this section, including a review of the validity and reliability of data submitted by the Secretary under subsection (b)(2).

(2)

Report.— Not later than three years after the date of the enactment of this Act, the Comptroller General shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives the results of the review conducted under paragraph (1).

SEC. 3104. Examination of Health Care Consultation and Scheduling Positions of Department of Veterans Affairs.

(a)

Proper Grading of Consultation and Scheduling Positions.—

(1)

In general.— The Secretary of Veterans Affairs shall conduct an examination of health care positions of the Department of Veterans Affairs to determine whether health care positions involved in the consultation and scheduling processes are appropriately graded.

(2)

Consultation.— In conducting the examination under paragraph (1), the Secretary shall consult with health care staffing experts in the Federal Government and the private sector.

(3)

Submittal to congress.— Not later than 120 days after the date of the enactment of this Act, the Secretary shall submit to the appropriate committees of Congress the results of the examination conducted under paragraph (1).

(b)

Review of Onboarding Process.— Not later than 180 days after the date of the enactment of this Act, the Secretary shall submit to the appropriate committees of Congress—

(1)

a review of the onboarding process of individuals in health care positions described in subsection (a), including how long it takes to hire those individuals; and

(2)

a description of any changes that the Secretary has made or plans to make to improve that process.

(c)

Appropriate Committees of Congress Defined.— In this section, the term “appropriate committees of Congress” means—

(1)

the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and

(2)

the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.

Title III — Health Care