Title I — Health Care Matters

118th Congress · Approved Jan 2, 2025 · 138 Stat. 2706

TITLE I Health Care Matters

Subtitle A Veterans Community Care Program Matters

SEC. 101. Implementation of Provision of Care under Veterans Community Care Program Upon Determination of Eligibility by Veteran and Veteran’s Referring Clinician.

(a)

In General.— During the period specified in subsection (c), the Secretary of Veterans Affairs shall implement section 1703(d)(1)(E) of title 38, United States Code, in compliance with the implementing regulations for such section under section 17.4010(a)(5) of title 38, Code of Federal Regulations, such that the determination of eligibility for care is final and shall be made by the veteran and the veteran’s referring clinician.

(b)

Correction of Errors.— A covered veteran and the referring clinician of such veteran may correct any errors made with respect to a determination described in subsection (a).

(c)

Period Specified.— The period specified in this subsection is the two-year period beginning on the date that is 90 days after the date of the enactment of this Act.

(d)

Report.— Not later than one year and not later than two years after the commencement of the period specified by subsection (c), the Secretary of Veterans Affairs shall submit to Congress a report on the care provided under section 1703(d)(1)(E) of title 38, United States Code, during the one-year period preceding the date of the report, including—

(1)

the number of instances of care provided;

(2)

the type of care provided; and

(3)

the cost of such care.

(e)

Rule of Construction.— Nothing in this section shall be construed to limit the Secretary’s authority to prescribe, amend, or rescind regulations under section 1703 of title 38, United States Code.

(f)

Covered Veteran Defined.— In this section, the term “covered veteran” has the meaning given that term in section 1703(b) of title 38, United States Code.

SEC. 102. Outreach Regarding Care and Services under Veterans Community Care Program.

(a)

Requirement.— Section 1703 of title 38, United States Code, is amended—

(1)

by redesignating subsection (o) as subsection (p); and

(2)

by inserting after subsection (n) the following new subsection (o):

“(o) Outreach Regarding Availability of Care and Services.—

(1) The Secretary shall conduct outreach to inform veterans of the following:

“(A) The conditions for care or services under subsections (d) and (e).

“(B) How to request such care or services.

“(C) How to appeal a denial of a request for such care or services using the clinical appeals process of the Veterans Health Administration.

“(2) Upon enrollment of a veteran in the system of annual patient enrollment established and operated under section 1705 of this title, and not less frequently than every two years thereafter, the Secretary shall inform the veteran of information described in paragraph (1).

“(3) The Secretary shall ensure that information described in paragraph (1) is—

“(A) publicly displayed in each medical facility of the Department;

“(B) prominently displayed on a website of the Department; and

“(C) included in other outreach campaigns and activities conducted by the Secretary.”

(b)

Solid Start Program.— Section 6320(a)(2)(A) of title 38, United States Code, is amended by inserting “ , including how to enroll in the system of annual patient enrollment established and operated under section 1705 of this title and the ability to seek care and services under sections 1703 and 1710 of this title” before the semicolon.

(c)

Comptroller General Report on Outreach.— Not later than two years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the efforts of the Secretary of Veterans Affairs to ensure that veterans are informed of the conditions for eligibility for care and services under section 1703 of title 38, United States Code, including such efforts to conduct outreach pursuant to subsection (o) of such section (as added by subsection (a)).

SEC. 103. Annual Review and Report on Waivers of Certain Payment Rates under Veterans Community Care Program.

(a)

In General.— Section 1703 of title 38, United States Code, is further amended—

(1)

by redesignating subsection (p) as subsection (q); and

(2)

by inserting after subsection (o) the following new subsection (p):

“(p) Annual Review and Report on Waivers of Payment Rates.—

(1) On an annual basis, the Secretary shall—

“(A) conduct a review of waivers of payment rates under subsection (i) for Third Party Administrators to identify whether such waivers help to alleviate community-specific challenges, including scarcity of medical services associated with access to health care; and

“(B) submit to Congress a report on the results of such review.

“(2) Each report under paragraph (1)(B) shall include, with respect to the period covered by the report—

“(A) a statement, disaggregated by region, of the total number of waivers described in subparagraph (A) of such paragraph requested by Third Party Administrators;

“(B) a statement of the total number of such waivers that were—

“(i) granted by the Secretary;

“(ii) denied by the Secretary; or

“(iii) withdrawn by a Third Party Administrator;

“(C) a description of the process for the review required under paragraph (1);

“(D) a statement, disaggregated by region, of the average time to process such waivers;

“(E) an assessment, disaggregated by region, of the extent to which such waivers that were granted by the Secretary improved access to health care for covered veterans; and

“(F) a description of trends, if any, identified by the Secretary with respect to such waivers.

“(3) In this subsection, the term ‘Third Party Administrator’ has the meaning given such term in section 1703B of this title.”

(b)

Deadline.— The Secretary shall submit the first report required under subsection (p) of section 1703 of such title (as added by subsection (a)) not later than 180 days after the date of the enactment of this Act.

SEC. 104. Modification of Requirements for Standards for Quality of Care from Department of Veterans Affairs.

(a)

In General.— Section 1703C of title 38, United States Code, is amended—

(1)

in subsection (a)—

(A)

in paragraph (2)—

(i)

by striking “ In establishing” and inserting “ (A) In establishing”; and

(ii)

by adding at the end the following new subparagraph:

“(B) The Secretary shall ensure that the standards for quality established under paragraph (1) are comparable to industry standards to ensure there is adequate data transference between care furnished by the Department and care furnished by a non-Department provider.”

(B)

in paragraph (3)(B), by adding at the end the following new clause:

“(v) Outcomes relating to patient quality of life.”

(C)

in paragraph (4)—

(i)

by striking “ and the Centers for Medicare & Medicaid Services” and inserting “ the Centers for Medicare & Medicaid Services, and the Indian Health Service”; and

(ii)

by striking “ and other nongovernmental entities” and inserting “ and other non-governmental entities including Third Party Administrators”; and

(D)

by striking paragraph (5) and inserting the following new paragraphs:

“(5) When collecting, considering, and applying data related to patient care for purposes of establishing standards for quality under paragraph (1), the Secretary shall ensure no metric is being over or under analyzed.

“(6) In establishing standards for quality under paragraph (1), the Secretary shall—

“(A) utilize the most up-to-date practices for extracting and analyzing relevant data;

“(B) utilize all relevant data available to the Secretary;

“(C) ensure the most efficient use of time and resources related to the use of data scientists employed by the Department; and

“(D) collaborate, as appropriate, with entities specified in paragraph (4).

“(7)

(A) Not less frequently than once every five years, the Secretary shall update the standards for quality established under paragraph (1) pursuant to the requirements for the establishment of such standards under this subsection.

“(B) Not later than 30 days after any date on which the Secretary updates, pursuant to subparagraph (A), the standards for quality under paragraph (1), the Secretary shall submit to the appropriate committees of Congress a report on such updated standards for quality.”

; and

(2)

in subsection (b)—

(A)

in paragraph (1)—

(i)

by striking “ Not later than 1 year after the date on which the Secretary establishes standards for quality under subsection (a)” and inserting “ Not less frequently than once every three years”; and

(ii)

by inserting “ pursuant to standards for quality under subsection (a)” after “ medical facilities of the Department”; and

(B)

in paragraph (2), by inserting “ or updates” after “ establishes”.

(b)

Deadline for Update.— The Secretary, pursuant to paragraph (7) of section 1703C(a) of title 38, United States Code (as added by subsection (a)), shall make the first update to the standards for quality established under paragraph (1) of such section not later than the date that is five years after the date on which the Secretary submits the report under paragraph (2) of subsection (d).

(c)

Report.— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the appropriate committees of Congress a report on how the Secretary—

(1)

has consulted with entities specified in paragraph (4) of section 1703C(a) of title 38, United States Code, before the date of the enactment of this Act in establishing standards for quality under such section;

(2)

has continued to consult with those entities on and after such date of enactment; and

(3)

intends to leverage data sciences to improve standards for quality care furnished by the Department of Veterans Affairs.

(d)

Updates to Quality Care Metrics.—

(1)

Initial report.— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the appropriate committees of Congress a report on how the Secretary plans to implement the amendments made by subsections (a).

(2)

Deadline; summary report.— Not later than two years after the date of the enactment of this Act, the Secretary shall—

(A)

implement the amendments made by subsection (a), including by updating the standards for quality established under section 1703C of title 38, United States Code; and

(B)

submit to the appropriate committees of Congress a report detailing the standards for quality updated pursuant to such amendments.

(e)

Audit of Quality Care Metrics.—

(1)

In general.— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall enter into one or more contracts with a non-Department entity described in paragraph (2) to conduct an audit on the quality of care from the Department of Veterans Affairs, including through non-Department health care providers pursuant to section 1703 of title 38 United States Code.

(2)

Non-department entity described.— A non-Department entity described in this paragraph is an entity that—

(A)

specializes in analyzing large-scale organizational data collection and analysis efforts, especially with respect to the health care sector; and

(B)

has experience and proven outcomes in optimizing the accuracy and comprehensiveness of data collection and analysis related to the quality of health care services.

(3)

Elements.— The audit required under paragraph (1) shall include the following:

(A)

An assessment of the methodology used by the Department to collect and assess data on the quality of care furnished by the Department, including any vulnerabilities in such methodology.

(B)

An assessment of the accuracy and reliability of the data sources used by the Department to compile data on the quality of care furnished by the Department.

(C)

The extent to which the standards the Department uses to assess the quality of care furnished by the Department are—

(i)

comparable with industry standards;

(ii)

easily accessible to, and understood by—

(I)

veterans;

(II)

employees of the Department; and

(III)

other individuals, as the private sector entity considers appropriate.

(D)

Any recommendations of such private sector entity with respect to improvements that the Secretary could administer to more accurately capture the quality of care furnished by the Department.

(4)

Reports on audit.—

(A)

Report on findings and recommendations.— Not later than 60 days after any date on which a private sector entity described in paragraph (2) completes an audit under paragraph (1), such private sector entity shall submit to the Secretary, the Committee on Veterans’ Affairs of the Senate, and the Committee on Veterans’ Affairs of the House of Representatives a report that includes—

(i)

the findings of such audit; and

(ii)

recommendations of such private sector entity with respect to such audit.

(B)

Report on planned improvements.— Not later than 60 days after any date on which the Secretary receives a report 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 report on how the Secretary plans to improve the standards for quality of care of the Department.

(f)

Appropriate Committees of Congress Defined.— In this section, the term “appropriate committees of Congress” has the meaning given such term in section 1703C of title 38, United States Code.

SEC. 105. Pilot Program to Improve Administration of Care under Veterans Community Care Program.

(a)

Establishment.— Pursuant to section 1703E of title 38, United States Code, the Secretary of Veterans Affairs, acting through the Center for Innovation for Care and Payment established under such section, shall carry out a pilot program to seek to develop and implement a plan—

(1)

to provide monetary and non-monetary incentives to a covered health care provider—

(A)

to allow the Secretary to see the scheduling system of the provider, to assess the availability of, and to assist in scheduling appointments for, veterans under the Veterans Community Care Program under section 1703 of such title, including through synchronous, asynchronous, and asynchronous assisted digital scheduling;

(B)

to complete continuing professional educational training available through the VHA TRAIN program (or any successor program or initiative) regarding veteran cultural competency, the opioid safety initiative (or any successor program or initiative), and other subjects determined appropriate by the Secretary;

(C)

to improve methods of accounting for non-Department training that is equivalent or substantially similar to the continuing professional educational training described in subparagraph (B);

(D)

to improve the rate of the timely return to the Secretary of medical record documentation for care or services provided under the Veterans Community Care Program;

(E)

to improve the timeliness and quality of the delivery of care and services to veterans under such program; and

(F)

to achieve other objectives determined appropriate by the Secretary; and

(2)

to decrease the rate of no-show appointments under such program.

(b)

Report.— Not later than one year after the date of the establishment of the pilot program under this section, and annually thereafter during the term of the pilot program, the Secretary of Veterans Affairs shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the pilot program that includes, with respect to the period covered by the report—

(1)

an assessment of the extent to which—

(A)

the system of the Department of Veterans Affairs for scheduling appointments for veterans under the Veterans Community Care Program has improved;

(B)

the rate of timely return to the Secretary of medical record documentation described in subparagraph (D) of subsection (a)(1) has improved;

(C)

the timeliness and quality of the delivery of care and services described in subparagraph (E) of such subsection has improved; and

(D)

the frequency of no-show appointments described in paragraph (2) of such subsection decreased;

(2)

a list of the continuing professional educational training courses under subparagraph (B) of such subsection available to covered health care providers;

(3)

the rate of participation in such continuing professional education training courses; and

(4)

any other matter the Secretary determines appropriate.

(c)

Definitions.— In this section:

(1)

The term “covered health care provider” means a health care provider—

(A)

described in subsection (c) of section 1703 of title 38, United States Code, that furnishes care or services under the Veterans Community Care Program pursuant to a contract or agreement with a Third Party Administrator; or

(B)

that otherwise furnishes care or services outside of Department facilities pursuant to a contract or agreement with the Secretary of Veterans Affairs.

(2)

The term “opioid safety initiative” means the programs, processes, and guidelines of the Veterans Health Administration of the Department of Veterans Affairs relating to the management of opioid therapy and chronic pain.

(3)

The term “Third Party Administrator” means an entity that manages a network of health care providers and performs administrative services related to such network under section 1703 of such title.

(4)

The term “VHA TRAIN program” means the free program of the Veterans Health Administration that offers veteran-specific continuing medical education courses.

SEC. 106. Pilot Program on Consolidating Approval Process of Department of Veterans Affairs for Covered Dental Care.

(a)

In General.— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs, acting through the Center for Innovation for Care and Payment established under section 1703E of title 38, United States Code, shall carry out a pilot program under which the Secretary shall hire—

(1)

general dentists at medical facilities of the Department of Veterans Affairs to manage approval by the Department of treatment plans requested by dental providers in providing covered dental care; and

(2)

dental specialists at Veterans Integrated Service Networks of the Department to manage approval by the Department of treatment plans for specialty dental care requested by dental providers in providing covered dental care.

(b)

Locations.— The Secretary shall carry out the pilot program in not fewer than two Veterans Integrated Service Networks of the Department.

(c)

Reports.—

(1)

Initial report.— Not later than one year after the date of the commencement of such pilot program, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report on the pilot program, that includes—

(A)

an identification of the Veterans Integrated Service Networks participating in such pilot program;

(B)

a description of the implementation of such pilot program;

(C)

an identification of any barriers or challenges to implementing such pilot program;

(D)

an assessment of the efficacy of hiring general dentists and dental specialists pursuant to such pilot program;

(E)

aggregated feedback with respect to such pilot program from dentists of the Department in Veterans Integrated Service Networks participating in such pilot program; and

(F)

aggregated feedback from dental providers providing covered dental care within such Veterans Integrated Service Networks regarding any changes in the timeliness of treatment plan approvals by the Department.

(2)

Final report.— Not later than 90 days before the date of the completion of such pilot program, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report on the pilot program that—

(A)

includes, with respect to the period covered by the report, each element of the report required under paragraph (1) described in subparagraphs (A) through (F) of such paragraph;

(B)

includes recommendations of the Secretary on whether the pilot program should be—

(i)

extended;

(ii)

expanded; or

(iii)

adopted throughout the Department; and

(C)

indicates whether the Secretary requests action by Congress to make the pilot program permanent.

(d)

Sunset.— The authority to carry out the pilot program under this section shall terminate on the date that is two years after the date of the enactment of this Act.

(e)

Covered Dental Care Defined.— In this section, the term “covered dental care” means dental care provided—

(1)

under section 1703 of title 38, United States Code; or

(2)

pursuant to a Veterans Care Agreement under section 1703A of such title.

SEC. 107. Strategic Plan on Value-Based Health Care System for Veterans Health Administration; Pilot Program.

(a)

Establishment of Working Group.—

(1)

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

(A)

establish a working group on value-based care; and

(B)

submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate the strategic plan developed by the working group pursuant to subsection (b).

(2)

Membership.—

(A)

Required members.— The working group shall include, at a minimum, the following members:

(i)

The Under Secretary for Health of the Department of Veterans Affairs.

(ii)

The Director of the Office of Mental Health and Suicide Prevention of the Department of Veterans Affairs (or any successor office).

(iii)

The Director of the Office of Integrated Veteran Care of the Department (or any successor office).

(iv)

The Director of the Office of Rural Health of the Department (or any successor office).

(v)

The Director of the Office of Connected Care of the Department (or any successor office).

(vi)

The Assistant Secretary for the Office of Information Technology (or any successor office).

(vii)

The Chief Officer of the Office of Healthcare Innovation and Learning of the Office of Discovery, Education, and Affiliate Networks of the Veterans Health Administration (or any successor office).

(viii)

An individual designated by the Secretary from the Center for Innovation for Care and Payment of the Department under section 1703E of title 38, United States Code.

(ix)

An individual designated by the Administrator of the Centers for Medicare & Medicaid Services from the Center for Medicare and Medicaid Innovation.

(x)

An individual designated by the Secretary of Health and Human Services from the Federal Office of Rural Health Policy of the Health Resources and Services Administration.

(xi)

The Chief of Human Capital Management for the Veterans Health Administration.

(xii)

An individual designated by the Secretary of Defense that is a representative of the Defense Health Agency.

(xiii)

An individual selected by the Secretary of Veterans Affairs from the special medical advisory group established under section 7312 of title 38, United States Code.

(B)

Optional members.— The Secretary of Veterans Affairs may appoint any of the following individuals as members of the working group:

(i)

An individual representing the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine.

(ii)

Three individuals representing a private health care system that has made the transition to value-based care.

(iii)

Three individuals representing an organization recognized by the Secretary of Veterans Affairs under section 5902 of title 38, United States Code.

(3)

Public availability.— All meetings deliberations, and products of the working group shall be made publicly available throughout the duration of the working group, including to individuals representing organizations recognized by the Secretary of Veterans Affairs under section 5902 of title 38, United States Code.

(4)

Exemption from faca.— Chapter 10 of title 5, United States Code, shall not apply to the working group established under paragraph (1).

(b)

Development of Strategic Plan.— The working group shall develop a strategic plan to implement value-based care into the Veterans Health Administration that includes the following:

(1)

An identification of the state of the Veterans Health Administration as of the date of the enactment of this Act, including an assessment of the current model of health care delivery used by the Veterans Health Administration in medical facilities of the Department of Veterans Affairs.

(2)

An assessment of the capacity needs of the Veterans Health Administration during the five-year period beginning on the date of the enactment of this Act.

(3)

An analysis of the leadership of the Veterans Health Administration, including an assessment of leadership acumen and ability to implement a clear, shared vision and effective change management and care coordination.

(4)

An identification of goals for the future of the Veterans Health Administration.

(5)

An identification and classification of the current capabilities, capacity, and gaps in access and quality of the health care system of the Department of Veterans Affairs.

(6)

An analysis of value-based care models, including—

(A)

a selection of potential models that would best work for the Veterans Health Administration;

(B)

the capacity and capabilities of each such model; and

(C)

a thorough justification of the selection of each selected model, including a summary of the ability of such model to improve the metrics described under paragraph (9).

(7)

A definition of what quality means with respect to—

(A)

access to health care under the laws administered by the Secretary of Veterans Affairs; and

(B)

delivery of such health care.

(8)

A definition of what value means with respect to care furnished by the Veterans Health Administration,

(9)

A system for measuring value within the Veterans Health Administration that includes metrics for—

(A)

outcomes;

(B)

safety;

(C)

service;

(D)

access;

(E)

productivity;

(F)

capacity; and

(G)

total cost of patient care.

(10)

With respect to the system described in subparagraph (H), an analysis of variable value with respect to patient outcomes across different health care types and specialties.

(11)

An assessment of—

(A)

previous or ongoing assessments of the current information technology infrastructure of the Veterans Health Administration, including—

(i)

such assessments conducted pursuant to the Electronic Health Record Modernization program of the Department of Veterans Affairs; and

(ii)

any other ongoing information technology modernization programs of such Department and any unimplemented relevant recommendations from such assessments;

(B)

the information technology infrastructure of the Veterans Health Administration in effect as of the date of the enactment of this Act;

(C)

the value-driven framework of the Department, in effect as of the date of the enactment of this Act, for evaluating health care innovations, and how improvements in such framework could be used to encourage innovation; and

(D)

workforce challenges and needs of the Veterans Health Administration based on—

(i)

reviews of workforce assessment data available as of the date of the enactment of this Act; and

(ii)

the findings of—

(I)

the report required by section 301(d) of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146);

(II)

the reports required by section 505 of the John S. McCain III, Daniel K. Akaka and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (Public Law 115–182);

(III)

the report required by section 301 of the VA Choice and Quality Employment Act of 2017 (Public Law 115–46); and

(IV)

any comprehensive health care inspection conducted by the Inspector General of the Department of Veterans Affairs as of the date of the enactment of this Act.

(12)

Any recommendations of the working group with respect to improving the information technology infrastructure described in clause (i) of subparagraph (J).

(13)

An analysis of how the value-driven framework described in clause (iii) of such subparagraph could be used to improve the model of care delivery by the Department.

(14)

A description of how a value-based care system would apply to primary care, inpatient and outpatient mental health care, and inpatient and outpatient substance use treatment, spinal cord injury disorder care, and polytrauma care furnished by the Veterans Health Administration.

(15)

With respect to legislative or administrative action necessary to incorporate value-based care models into the Veterans Health Administration, a description of the estimated timelines, effect on workforce, and costs.

(c)

Pilot Program.—

(1)

In general.— Not later than 180 days after the submission of the strategic plan pursuant to subsection (b), the Secretary of Veterans Affairs, acting through the Center for Innovation for Care and Payment established under section 1703E of title 38, United States Code, shall commence a three-year pilot program under which the Secretary shall implement the elements of such strategic plan relating to the delivery, by the Veterans Health Administration, of primary care, inpatient and outpatient mental health treatment, inpatient and outpatient substance abuse treatment, spinal cord injury disorder care, and polytrauma care.

(2)

Locations.— The Secretary shall carry out such pilot program in four Veterans Integrated Service Networks that are geographically dispersed and shall include the following:

(A)

A Veterans Integrated Service Network that predominately serves veterans in rural and highly rural areas.

(B)

A Veterans Integrated Service Network that predominately serves veterans in urban areas.

(C)

A Veterans Integrated Service Network that has a high rate of suicide among veterans.

(D)

A Veterans Integrated Service Network that has a high rate of substance use disorder among veterans.

(E)

A Veterans Integrated Service Network that has access or productivity challenges.

(3)

Reports to congress.—

(A)

Annual report.— Not later than one year after the commencement of the pilot program, and annually thereafter during the duration of the pilot program, the Secretary shall submit to Congress a report on the pilot program.

(B)

Final report.— Not later than 90 days before the conclusion of the pilot program, the Secretary shall submit to Congress a final report on the pilot program that includes—

(i)

lessons learned during the administration of such pilot program; and

(ii)

specific health outcomes in veteran patient care compared to the Veterans Health Administration system of care in effect as of the date of the enactment of this Act.

SEC. 108. Plan on Adoption of Certain Health Information Standards for Department of Veterans Affairs and Certain Health Care Providers.

(a)

Plan for Certain Health Information Standards.—

(1)

In general.— The Secretary of Veterans Affairs, in consultation with the Secretary of Health and Human Services, the Administrator of the Centers for Medicare & Medicaid Services, and the National Coordinator for Health Information Technology of the Department of Health and Human Services, shall create and implement a plan to adopt, as rapidly and to the most comprehensive extent feasible, national health information interoperability standards for the Department of Veterans Affairs and community care providers with respect to—

(A)

coordination of—

(i)

care; and

(ii)

benefits;

(B)

patient identity matching;

(C)

measurement and reporting of quality;

(D)

population health; and

(E)

public health.

(2)

Consideration.— In developing the plan under paragraph (1), the Secretary of Veterans Affairs shall consider challenges faced by—

(A)

small community care providers; and

(B)

community care providers located in rural areas.

(b)

Plan on Electronic Health Record Exchange.—

(1)

In general.— Not later than one year after the date of enactment of this Act, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a plan to provide, at no cost, to community care providers of the Department, through Third Party Administrators, a capability to facilitate the electronic direct exchange, between such providers and the Department, of—

(A)

the health records of veterans; and

(B)

documents relating to health care of veterans, clinical notes, and any other information the Secretary determines necessary.

(2)

Prioritization.— In developing the plan required under paragraph (1), the Secretary shall prioritize providing the capability described in such paragraph to community care providers that—

(A)

provide care under the laws administered by the Secretary to—

(i)

a lower volume of veterans; and

(ii)

veterans who are located in rural areas; and

(B)

are unable or unwilling to exchange the records and documents described in subparagraphs (A) and (B) of such paragraph with the Department through standards-based or direct exchange mechanisms in effect as of the date of the enactment of this Act.

(c)

Reports on Plan for Interoperability Standards.—

(1)

Initial report.— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives—

(A)

the plan required by subsection (a); and

(B)

a report that includes—

(i)

an analysis of gaps, if any, between the use, by the Department and other agencies, health information exchanges, and technology companies, of national health information interoperability standards and the potential, or optimal, use of such national health information interoperability standards;

(ii)

an analysis and description of the participation by the Department, community care providers, and other relevant entities in the Trusted Exchange Framework and Common Agreement program of the Department of Health and Human Services as of the date of the enactment of this Act;

(iii)

recommendations of the Secretary with respect to development of health information interoperability standards;

(iv)

timelines or schedules to implement the plan required by subsection (a); and

(v)

an identification of any legislative authorities or resources the Secretary requires to implement such plan.

(2)

Recurring report requirement.—

(A)

In general.— Not later than 18 months after the date of the enactment of this Act, and every 180 days thereafter for four years, the Secretary of Veterans Affairs shall submit to Committees on Veterans’ Affairs of the Senate and the House of Representatives a report on the status of implementation of the plan required under subsection (a).

(B)

Elements of subsequent reports.— Each report under subparagraph (A) submitted after the date on which the first report required by such subparagraph is submitted shall include a description of any revisions to—

(i)

the plan required by subsection (a) made during the period covered by the report; and

(ii)

the analysis, recommendations, timelines, and legislative authorities reported pursuant to paragraph (1).

(d)

Definitions.— In this section:

(1)

The term “community care provider” means a non-Department health care provider providing care (including dental care)—

(A)

under section 1703 of title 38, United States Code;

(B)

pursuant to a Veterans Care Agreement under section 1703A of such title; or

(C)

under any other law administered by the Secretary of Veterans Affairs.

(2)

The term “Third Party Administrator” means an entity that manages a provider network and performs administrative services related to such network under section 1703 of title 38, United States Code.

SEC. 109. Report on Use of Value-Based Reimbursement Models under Veterans Community Care Program.

(a)

Report on Value-based Reimbursement Models.— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs, in consultation with the Center for Innovation for Care and Payment of the Department of Veterans Affairs under section 1703E of title 38 United States Code, the Office of Integrated Veteran Care of the Department, or successor office, and Third Party Administrators, shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report containing—

(1)

an assessment of the efforts of the Department pursuant to section 1703(i)(5) of such title, to incorporate value-based reimbursement models under the Veterans Community Care Program to promote the provision of high-quality care to veterans; and

(2)

such recommendations for legislative or administrative action as the Secretary considers appropriate regarding the use of value-based reimbursement models throughout the Veterans Community Care Program under section 1703 of such title.

(b)

Rule of Construction.— This section shall not be construed to be a pilot program subject to the requirements of section 1703E of title 38, United States Code.

(c)

Third Party Administrator Defined.— In this section, the term “Third Party Administrator” means an entity that manages a provider network and performs administrative services related to such network under section 1703 of title 38, United States Code.

SEC. 110. Inspector General Assessment of Implementation of Veterans Community Care Program.

(a)

In General.— Not later than 18 months after the date of the enactment of this Act, and periodically thereafter, the Inspector General shall assess the performance of the Department of Veterans Affairs in—

(1)

appropriately identifying veterans eligible for care and services under section 1703 of title 38, United States Code;

(2)

informing veterans of their eligibility for such care and services; and

(3)

delivering such care and services in a timely manner.

(b)

Briefing on Assessments.— Upon the submission of the assessment required by subsection (a), the Inspector General of the Department of Veterans Affairs shall provide to the Committees on Veterans Affairs of the House of Representatives and the Senate a briefing on the results of such assessment.

SEC. 111. Comptroller General Report on Dentistry under Veterans Community Care Program.

(a)

In General.— Not later than one year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report on dental care furnished by the Secretary of Veterans Affairs under the Veterans Community Care Program under section 1703 of title 38, United States Code, that includes a review of—

(1)

the impact current reimbursement rates provided by the Department of Veterans Affairs to dental providers under such program have on—

(A)

the availability of dental care for veterans; and

(B)

the ability of Third Party Administrators to meet their contractual obligations for network adequacy;

(2)

the satisfaction of dental providers providing dental care under such program with the processes of the Department for approving dental care under such program; and

(3)

the current processes of the Department for approving emergent dental care under such program.

(b)

Subtitle B Matters Relating to Nursing Home and Other Long Term Care and Family Caregivers

SEC. 120. Increase of Expenditure Cap for Noninstitutional Care Alternatives to Nursing Home Care.

(a)

Increase of Expenditure Cap.— Section 1720C(d) of title 38, United States Code, is amended—

(1)

by striking “ The total cost” and inserting “ (1) Except as provided in paragraph (2), the total cost”;

(2)

by striking “ 65 percent” and inserting “ 100 percent”; and

(3)

by adding at the end the following new paragraph:

“(2)

(A) The total cost of providing services or in-kind assistance in the case of any veteran described in subparagraph (B) for any fiscal year under the program may exceed 100 percent of the cost that would otherwise have been incurred as specified in paragraph (1) if the Secretary determines, based on a consideration of clinical need, geographic market factors, and such other matters as the Secretary may prescribe through regulation, that such higher total cost is in the best interest of the veteran.

“(B) A veteran described in this subparagraph is a veteran with amyotrophic lateral sclerosis, a spinal cord injury, or a condition the Secretary determines to be similar to such conditions.”

(b)

Applicability.— The amendments made by subsection (a) shall apply with respect to fiscal years beginning on or after the date of the enactment of this Act.

SEC. 121. Coordination with Program of All-Inclusive Care for the Elderly.

Section 1720C of title 38, United States Code, as amended by section 120, is further amended by adding at the end the following new subsection:

“(f) In furnishing services to a veteran under the program conducted pursuant to subsection (a), if a medical center of the Department through which such program is administered is located in a geographic area in which services are available to the veteran under a PACE program (as such term is defined in sections 1894(a)(2) and 1934(a)(2) of the Social Security Act (42 U.S.C. 1395eee(a)(2); 1396u–4(a)(2))), the Secretary shall seek to enter into an agreement with the PACE program operating in that area for the furnishing of such services.”

SEC. 122. Authority for Secretary of Veterans Affairs to Award Grants or Contracts to Entities to Improve Provision of Mental Health Support to Family Caregivers of Veterans.

Subchapter II of chapter 17 of title 38, United States Code, is amended by adding at the end the following new section (and conforming the table of sections at the beginning of such chapter accordingly):

“§ 1720K. Grants or contracts to provide mental health support to family caregivers of veterans

“(a) Authority.—The Secretary may award grants or contracts to carry out, coordinate, improve, or otherwise enhance mental health counseling, treatment, or support to the family caregivers of veterans participating in the family caregiver program.

“(b) Application.—

(1) To be eligible for a grant or contract under this section, an entity shall submit to the Secretary an application therefor at such time, in such manner, and containing such information as the Secretary may require.

“(2) Each application submitted under paragraph (1) shall include the following:

“(A) A detailed plan for the use of the grant or contract.

“(B) A description of the programs or efforts through which the entity will meet the outcome measures developed by the Secretary under subsection (f).

“(C) A description of how the entity will distribute grant or contract amounts equitably among areas with varying levels of urbanization.

“(D) A plan for how the grant or contract will be used to meet the unique needs of veterans residing in rural areas, Native American, Native Hawaiian, or Alaska Native veterans, elderly veterans, women veterans, and veterans from other underserved communities.

“(c) Distribution.—The Secretary shall seek to ensure that grants and contracts awarded under this section are equitably distributed among entities located in States with varying levels of urbanization.

“(d) Priority.—The Secretary shall prioritize awarding grants or contracts under this section that will serve the following areas:

“(1) Areas with high rates of veterans enrolled in the family caregiver program.

“(2) Areas with high rates of—

“(A) suicide among veterans; or

“(B) referrals to the Veterans Crisis Line.

“(e) Required Activities.—Any grant or contract awarded under this section shall be used—

“(1) to expand existing programs, activities, and services;

“(2) to establish new or additional programs, activities, and services; or

“(3) for travel and transportation to facilitate carrying out paragraph (1) or (2).

“(f) Outcome Measures.—

(1) The Secretary shall develop and provide to each entity that receives a grant or contract under this section written guidance on the following:

“(A) Outcome measures.

“(B) Policies of the Department.

“(2) In developing outcome measures under paragraph (1), the Secretary shall consider the following goals:

“(A) Increasing the utilization of mental health services among family caregivers of veterans participating in the family caregiver program.

“(B) Reducing barriers to mental health services among family caregivers of veterans participating in such program.

“(g) Tracking Requirements.—

(1) The Secretary shall establish appropriate tracking requirements with respect to the entities receiving a grant or contract under this section.

“(2) Not less frequently than annually, the Secretary shall submit to Congress a report on such tracking requirements.

“(h) Performance Review.—The Secretary shall—

“(1) review the performance of each entity that receives a grant or contract under this section; and

“(2) make information regarding such performance publicly available.

“(i) Remediation Plan.—

(1) In the case of an entity that receives a grant or contract under this section and does not meet the outcome measures developed by the Secretary under subsection (f), the Secretary shall require the entity to submit to the Secretary a remediation plan under which the entity shall describe how and when it plans to meet such outcome measures.

“(2) The Secretary may not award a subsequent grant or contract under this section to an entity described in paragraph (1) unless the Secretary approves the remediation plan submitted by the entity under such paragraph.

“(j) Maximum Amount.—The amount of a grant or contract awarded under this section may not exceed 10 percent of amounts made available for grants or contracts under this section for the fiscal year in which the grant or contract is awarded.

“(k) Supplement, Not Supplant.—Any grant or contract awarded under this section shall be used to supplement and not supplant funding that is otherwise available through the Department to provide mental health support among family caregivers of veterans participating in the family caregiver program.

“(l) Outreach to Family Caregivers.—The Secretary shall include, in the outreach materials regularly provided to a family caregiver who participates in the family caregiver program, notice of mental health support provided by recipients of grants or contracts under this section that are located in the relevant Veterans Integrated Service Network.

“(m) Funding.—

(1) Amounts for the activities of the Department under this section shall be budgeted and appropriated through a separate appropriation account.

“(2) In the budget justification materials submitted to Congress in support of the budget of the Department for any fiscal year (as submitted with the budget of the President under section 1105(a) of title 31), the Secretary shall include a separate statement of the amount requested to be appropriated for that fiscal year for the account specified in paragraph (1).

“(n) Authorization of Appropriations.—There is authorized to be appropriated to the Secretary, for each of fiscal years 2025 and 2026, $10,000,000 to carry out this section.

“(o) Definitions.—In this section:

“(1) The terms ‘caregiver’ and ‘family caregiver’ have the meanings given those terms in section 1720G of this title.

“(2) The term ‘family caregiver program’ means the program of comprehensive assistance for family caregivers under section 1720G of this title.

“(3) The term ‘Veterans Crisis Line’ means the toll-free hotline for veterans established under section 1720F of this title.”

SEC. 123. Home and Community-Based Services: Programs.

(a)

Programs.— Such subchapter is further amended by inserting after section 1720K (as added by section 122) the following new section (and conforming the table of sections at the beginning of such chapter accordingly):

“§ 1720L. Home- and community-based services: programs

“(a) In General.—In furnishing noninstitutional alternatives to nursing home care pursuant to the authority of section 1720C of this title (or any other authority under this chapter or other provision of law administered by the Secretary of Veterans Affairs), the Secretary shall carry out each of the programs specified in this section in accordance with such relevant authorities except as otherwise provided in this section.

“(b) Veteran-Directed Care Program.—

(1) The Secretary of Veterans Affairs, in collaboration with the Secretary of Health and Human Services, shall carry out a program to be known as the ‘Veteran-Directed Care program’. Under such program, the Secretary of Veterans Affairs may enter into agreements with the providers described in paragraph (2) to provide to eligible veterans funds, to the extent practicable, to obtain such in-home care services and related items that support clinical need and improve quality of life, as may be determined appropriate by the Secretary of Veterans Affairs and selected by the veteran, including through the veteran hiring individuals to provide such services and items or directly purchasing such services and items.

“(2) The providers described in this paragraph are the following:

“(A) An Aging and Disability Resource Center, an area agency on aging, or a State agency.

“(B) A center for independent living.

“(C) An Indian tribe or tribal organization receiving assistance under title VI of the Older Americans Act of 1965 (42 U.S.C. 3057 et seq.).

“(D) Any other entity that the Secretary, in consultation with the Secretary of Health and Human Services, determines appropriate.

“(3) In carrying out the Veteran-Directed Care program, the Secretary of Veterans Affairs shall—

“(A) administer such program through each medical center of the Department of Veterans Affairs;

“(B) seek to ensure the availability of such program in American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the Commonwealth of Puerto Rico, the Virgin Islands of the United States, and any other territory or possession of the United States, to the extent practicable; and

“(C) seek to ensure the availability of such program for eligible veterans who are Native American veterans receiving care and services furnished by the Indian Health Service, a tribal health program, an Urban Indian organization, or (in the case of a Native Hawaiian veteran) a Native Hawaiian health care system, to the extent practicable.

“(4) If a veteran participating in the Veteran-Directed Care program is hospitalized, the veteran may continue to use funds under the program during a period of hospitalization in the same manner that the veteran would be authorized to use such funds under the program if the veteran were not hospitalized.

“(c) Homemaker and Home Health Aide Program.—

(1) The Secretary shall carry out a program to be known as the ‘Homemaker and Home Health Aide program’ under which the Secretary may enter into agreements with home health agencies to provide to eligible veterans such home health aide services as may be determined appropriate by the Secretary.

“(2) In carrying out the Homemaker and Home Health Aide program, the Secretary shall—

“(A) administer such program in the locations specified in subparagraph (A) of subsection (b)(3);

“(B) seek to ensure the availability of such program in the locations specified in subparagraph (B) of subsection (b)(3); and

“(C) seek to ensure the availability of such program for the veteran populations specified in subparagraph (C) of subsection (b)(3).

“(d) Home-Based Primary Care Program.—The Secretary shall carry out a program to be known as the ‘Home-Based Primary Care program’ under which the Secretary may furnish to eligible veterans in-home health care, the provision of which is overseen by a provider of the Department.

“(e) Purchased Skilled Home Care Program.—The Secretary shall carry out a program to be known as the ‘Purchased Skilled Home Care program’ under which the Secretary may furnish to eligible veterans such in-home care services as may be determined appropriate and selected by the Secretary for the veteran.

“(f) Caregiver Support.—

(1) With respect to a resident eligible caregiver of a veteran participating in a program under this section, the Secretary shall—

“(A) if the veteran meets the requirements of a covered veteran under section 1720G(b) of this title, provide to such caregiver the option of enrolling in the program of general caregiver support services under such section;

“(B) provide to such caregiver covered respite care of not less than 30 days annually; and

“(C) conduct on an annual basis (and, to the extent practicable, in connection with in-person services provided under the program in which the veteran is participating), a wellness contact of such caregiver.

“(2) Covered respite care provided to a resident eligible caregiver of a veteran under paragraph (1) may exceed 30 days annually if such extension is requested by the resident eligible caregiver or veteran and determined medically appropriate by the Secretary.

“(g) Rule of Construction.—Nothing in this section shall be construed to limit the authority of the Secretary to carry out programs providing home- and community-based services under any other provision of law.

“(h) Definitions.—In this section:

“(1) The terms ‘Aging and Disability Resource Center’, ‘area agency on aging’, and ‘State agency’ have the meanings given those terms in section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002).

“(2) The terms ‘caregiver’ and ‘family caregiver’, with respect to a veteran, have the meanings given those terms, respectively, under subsection (e) of section 1720G of this title with respect to an eligible veteran under subsection (a) of such section or a covered veteran under subsection (b) of such section, as the case may be.

“(3) The term ‘center for independent living’ has the meaning given that term in section 702 of the Rehabilitation Act of 1973 (29 U.S.C. 796a).

“(4) The term ‘covered respite care’ has the meaning given such term in section 1720G(d) of this title.

“(5) The term ‘eligible veteran’ means any veteran—

“(A) for whom the Secretary determines participation in a specific program under this section is medically necessary to promote, preserve, or restore the health of the veteran; and

“(B) who absent such participation would be at increased risk for hospitalization, placement in a nursing home, or emergency room care.

“(6) The term ‘home health aide’ means an individual employed by a home health agency to provide in-home care services.

“(7) The term ‘in-home care service’ means any service, including a personal care service, provided to enable the recipient of such service to live at home.

“(8) The terms ‘Indian tribe’ and ‘tribal organization’ have the meanings given those terms in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304).

“(9) The terms ‘Native American’ and ‘Native American veteran’ have the meanings given those terms in section 3765 of this title.

“(10) The terms ‘Native Hawaiian’ and ‘Native Hawaiian health care system’ have the meanings given those terms in section 12 of the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11711).

“(11) The terms ‘tribal health programs’ and ‘Urban Indian organizations’ have the meanings given those terms in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603).

“(12) The term ‘resident eligible caregiver’ means an individual who—

“(A) is a caregiver, or a family caregiver, of a veteran and resides with that veteran; and

“(B) has not entered into a contract, agreement, or other arrangement for such individual to act as a caregiver for that veteran unless such individual is a family member of the veteran or is furnishing caregiver services through a medical foster home.”

(b)

Deadline for Improved Administration.— The Secretary of Veterans Affairs shall ensure that the Veteran-Directed Care program and the Homemaker and Home Health Aide program are administered through each medical center of the Department of Veterans Affairs in accordance with section 1720L of title 38, United States Code (as added by subsection (a)), by not later than two years after the date of the enactment of this Act.

(c)

Administration of Veteran-Directed Care Program.—

(1)

Procedures.—

(A)

The Secretary shall establish procedures to—

(i)

identify the staffing needs for the Veteran-Directed Care program of the Department of Veterans Affairs under such section (as added by subsection (a)); and

(ii)

define the roles and responsibilities for personnel of the Department responsible for the administration of such program, including such personnel employed at the national, Veterans Integrated Service Network, or medical facility level.

(B)

The responsibilities described in clause (ii) of subparagraph (A) shall include responsibilities for engagement with—

(i)

veterans participating in such program;

(ii)

veterans interested in participating in such program; and

(iii)

providers described in section 1720L(b)(2) (as added by subsection (a)).

(2)

Staffing model; report.— Not later than two years after enactment of this Act, the Secretary of Veterans Affairs shall—

(A)

establish a staffing model for the administration of such program at each medical facility of the Department of Veterans Affairs; and

(B)

submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report containing the following:

(i)

A description of—

(I)

the staffing model described in subparagraph (A); and

(II)

the rationale for such staffing model.

(ii)

An identification of the ratio of staff required to administer such program to the number of veterans served by such program, disaggregated by each medical facility of the Department of Veterans Affairs.

(iii)

A description of budgetary resources or other support, if any, required to accommodate an increase in staffing at medical facilities of the Department of Veterans Affairs pursuant to the requirements of the staffing model described in subparagraph (A).

(iv)

Such other matters as the Secretary of Veterans Affairs determines appropriate.

SEC. 124. Coordination with Assistance and Support Services for Caregivers.

(a)

Coordination With Program of Comprehensive Assistance for Family Caregivers.—

(1)

Coordination.— Section 1720G(a) of title 38, United States Code, is amended by adding at the end the following new paragraph:

“(14)

(A) In the case of a veteran or caregiver who seeks services under this subsection and is denied such services, or a veteran or the family caregiver of a veteran who is discharged from the program under this subsection, the Secretary shall—

“(i) if the veteran meets the requirements of a covered veteran under subsection (b), provide to such caregiver the option of enrolling in the program of general caregiver support services under such subsection;

“(ii) assess the veteran or caregiver for participation in any other available program of the Department for home- and community-based services (including the programs specified in section 1720L of this title) for which the veteran or caregiver may be eligible and, with respect to the veteran, store (and make accessible to the veteran) the results of such assessment in the electronic medical record of the veteran; and

“(iii) provide to the veteran or caregiver written information on any such program identified pursuant to the assessment under clause (ii), including information about facilities, eligibility requirements, and relevant contact information for each such program.

“(B) The Secretary shall, to the extent practicable, provide to a veteran or family caregiver the option of obtaining clinically appropriate services under any other available program of the Department for home- and community-based services (including the programs specified in section 1720L of this title) for which the veteran or family caregiver may be eligible prior to discharging the veteran or family caregiver from the program under this subsection.

“(C) For each veteran or family caregiver who is discharged from the program under this subsection, a caregiver support coordinator shall provide for a smooth and personalized transition from such program to an appropriate program of the Department for home- and community-based services (including the programs specified in section 1720L of this title), including by integrating caregiver support across programs.”

(2)

Applicability.— The amendments made by paragraph (1) shall apply with respect to denials and discharges occurring on or after the date that is 180 days after the date of the enactment of this Act.

(3)

Technical and conforming amendments.— Section 1720G(d) of such title is amended—

(A)

by striking “ or a covered veteran” each place it appears and inserting “ , a veteran denied or discharged as specified in paragraph (14) of such subsection, or a covered veteran”; and

(B)

by striking “ under subsection (a), means” each place it appears and inserting “ under subsection (a) or a veteran denied or discharged as specified in paragraph (14) of such subsection, means”.

(b)

Conformity of Respite Care Across Programs.— Section 1720G of title 38, United States Code, as amended by subsection (a)(3), is further amended—

(1)

in subsection (a)(3)—

(A)

by amending subparagraph (A)(ii)(III) to read as follows:

“(III) covered respite care of not less than 30 days annually;”

; and

(B)

by striking subparagraph (B) and redesignating subparagraphs (C) and (D) as subparagraphs (B) through (C), respectively; and

(2)

by amending subsection (b)(3)(A)(iii) to read as follows:

“(iii) Covered respite care of not less than 30 days annually.”

; and

(3)

in subsection (d)—

(A)

by redesignating paragraphs (2) through (4) as paragraphs (3) through (5), respectively; and

(B)

by inserting after paragraph (1) the following new paragraph:

“(2) The term ‘covered respite care’ means, with respect to a caregiver of a veteran, respite care under section 1720B of this title that—

“(A) is medically and age appropriate for the veteran (including 24-hour per day care of the veteran commensurate with the care provided by the caregiver); and

“(B) includes in-home care.”

(c)

Review Relating to Caregiver Contact.— The Secretary shall conduct a review of the capacity of the Department to establish a streamlined system for contacting all caregivers enrolled in the program of general caregiver support services under section 1720G(b) of title 38, United States Code, to provide to such caregivers program updates and alerts relating to emerging services for which such caregivers or the veterans for which they provide care may be eligible.

SEC. 125. Improvements to Program of Comprehensive Assistance for Family Caregivers.

Section 1720G(a) of title 38, United States Code, as amended by section 124, is further amended—

(1)

in paragraph (12)—

(A)

in subparagraph (A), by inserting “ , which shall include all criteria used to determine eligibility for such assistance and, in the case of a completed evaluation, how such criteria were used to evaluate information provided in assessments to determine such eligibility” before the period at the end; and

(B)

in subparagraph (C)(i), by striking “ who submits” and all that follows through the end of the clause and inserting the following:

“(I) submits an application for the program established under paragraph (1); or

“(II) is being reassessed for eligibility to continue in such program.”

; and

(2)

by adding at the end the following new paragraph:

“(15)

(A) Not less frequently than annually, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a comprehensive report on the program required by paragraph (1) that includes, with respect to the one-year period preceding the date of the submission of such report, the following:

“(i) The number of applications received for such program.

“(ii) The number, disaggregated by race, sex, and era and branch of service in the Armed Forces of the applicant, of—

“(I) approvals of such applications; and

“(II) denials of such applications.

“(iii) The number of reassessments conducted for such program.

“(iv) An identification of each decision made with respect to a reassessment conducted for such program, disaggregated by decisions resulting in—

“(I) disenrollment, including removal, discharge, or voluntary withdrawal;

“(II) tier reduction; and

“(III) tier continuation.

“(v) The number of appeals of decisions made with respect to such program, disaggregated by type of appeal.

“(vi) With respect to each appeal described in clause (v), the decision rendered, if any.

“(vii) A description of all tools used in assessments conducted for such program, including an explanation of how and by whom such tools are administered.

“(viii) A description of procedures used under such program for reviewing and integrating clinical records from health care providers that includes an explanation of how such records are used in determinations of eligibility for such program.

“(ix) A description of procedures available under such program for health care providers to communicate medical opinions to the teams conducting assessments to determine eligibility for such program, including health care providers in the private sector and health care providers specified in subsection (c) of section 1703 of this title.

“(x) A description of information technology systems and processes used under such program to upload and integrate all clinical records from all non-Department providers, including providers in the private sector and providers under the Veterans Community Care Program established under such section.

“(B) The Secretary shall ensure that all data included in a report under subparagraph (A)—

“(i) relating to a decision made under the program required by paragraph (1), are disaggregated by the specific reason for the decision;

“(ii) relating to a veteran, include comprehensive demographic information of the veteran, including the time period of the injuries, if any, of the veteran and the Veterans Integrated Service Network in which the veteran is located; and

“(iii) with respect to eligibility determinations relating to a serious injury of a veteran, specify—

“(I) how many such determinations relate to the ability of the veteran to perform activities of daily living; and

“(II) how many such determinations relate to the need of a veteran for supervision and protection.

“(C) The Secretary shall provide the data under paragraph (B) pursuant to Federal laws and in a manner that is wholly consistent with applicable Federal privacy and confidentiality laws, including the Privacy Act (5 U.S.C. 552a), the Health Insurance Portability and Accountability Act (Public Law 104–191; 42 U.S.C. 201 note) and regulations (title 45, Code of Federal Regulations, parts 160 and 164, or successor regulations), and sections 5701, 5705, and 7332 of this title to ensure that the provided data, or some portion of the data, will not undermine the anonymity of a veteran.”

SEC. 126. Improvements Relating to Homemaker and Home Health Aide Program.

(a)

Pilot Program for Communities With Shortage of Home Health Aides.—

(1)

Program.— Beginning not later than 18 months after the date of the enactment of this Act, the Secretary shall carry out a three-year pilot program under which the Secretary shall provide homemaker and home health aide services to veterans who reside in communities with a shortage of home health aides.

(2)

Locations.— The Secretary shall select not fewer than five geographic locations in which the Secretary determines there is a shortage of home health aides at which to carry out the pilot program under paragraph (1).

(3)

Nursing assistants.—

(A)

In general.— In carrying out the pilot program under paragraph (1), the Secretary may hire nursing assistants as new employees of the Department of Veterans Affairs, or reassign nursing assistants who are existing employees of the Department, to provide to veterans in-home care services (including basic tasks authorized by the State certification of the nursing assistant) under the pilot program, in lieu of or in addition to the provision of such services through non-Department home health aides.

(B)

Relationship to home-based primary care program.— Nursing assistants hired or reassigned under subparagraph (A) may provide services to a veteran under the pilot program under paragraph (1) while serving as part of a health care team for the veteran under the Home-Based Primary Care program.

(4)

Report to congress.— Not later than one year before the date of the termination of the pilot program under paragraph (1), the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report that includes—

(A)

a statement of the results of such pilot program; and

(B)

an assessment of the feasibility and advisability of—

(i)

extending such pilot program; or

(ii)

making such pilot program a permanent program of the Department of Veterans Affairs.

(b)

Report on Use of Funds.— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report containing, with respect to the period beginning in fiscal year 2012 and ending in fiscal year 2024, the following:

(1)

An identification of the amount of funds that were included in a budget of the Department of Veterans Affairs during such period for the provision of in-home care to veterans under the Homemaker and Home Health Aide program but were not expended for such provision, disaggregated by medical center of the Department for which such unexpended funds were budgeted (if such disaggregation is possible).

(2)

To the extent practicable, an identification of the number of veterans for whom, during such period, the hours during which a home health aide was authorized to provide services to the veteran under the Homemaker and Home Health Aide program were reduced for a reason other than a change in the health care needs of the veteran, and a detailed description of the reasons why any such reductions may have occurred.

(c)

Updated Guidance on Program.— Not later than one year after the date of the enactment of this Act, the Secretary shall issue updated guidance for the Homemaker and Home Health Aide program. Such updated guidance shall include the following:

(1)

A process for the transition of veterans from the Homemaker and Home Health Aide program to other covered programs.

(2)

A requirement for the directors of the medical facilities of the Department to complete such process whenever a veteran with care needs has been denied services from home health agencies under the Homemaker and Home Health Aide program as a result of the clinical needs or behavioral issues of the veteran.

SEC. 127. Pilot Program to Furnish Assisted Living Services to Certain Veterans.

(a)

Establishment.— Beginning not later than two years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall carry out a pilot program to assess—

(1)

the effectiveness of providing assisted living services to eligible veterans, at the election of such veterans; and

(2)

the satisfaction with the pilot program of veterans participating in such pilot program.

(b)

Program Locations.—

(1)

Veterans integrated service networks.— The Secretary shall select two Veterans Integrated Service Networks of the Department of Veterans Affairs at which to carry out the pilot program under subsection (a).

(2)

Facilities.—

(A)

In general.— Within the Veterans Integrated Service Networks selected under paragraph (1), the Secretary shall select facilities at which to carry out the pilot program under subsection (a)(1).

(B)

Selection criteria.— In selecting facilities under subparagraph (A) at which to carry out the pilot program under subsection (a)(1), the Secretary shall ensure that—

(i)

the locations of such facilities are in geographically diverse areas;

(ii)

not fewer than one such facility serves veterans in rural or highly rural areas (as determined through the use of the Rural-Urban Commuting Areas coding system of the Department of Agriculture);

(iii)

not fewer than one such facility is located in each Veterans Integrated Service Network selected under paragraph (1); and

(iv)

not fewer than one such facility is a State home.

(c)

Program Participants.— Not more than 60 eligible veterans may participate in the pilot program under subsection (a)(1) in each Veterans Integrated Service Network selected under subsection (b)(1).

(d)

Provision of Assisted Living Services.—

(1)

Agreements.— In carrying out the pilot program under subsection (a)(1), the Secretary may enter into agreements for the provision of assisted living services on behalf of eligible veterans with—

(A)

a provider participating under a State plan or waiver under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.); or

(B)

a State home recognized and certified under subpart B of part 51 of title 38, Code of Federal Regulations, or successor regulations.

(2)

Standards.— The Secretary may not place, transfer, or admit a veteran to any facility for assisted living services under the pilot program under subsection (a)(1) unless the Secretary determines that—

(A)

the facility meets the standards for community residential care established under sections 17.61 through 17.72 of title 38, Code of Federal Regulations, or successor regulations, and any additional standards of care as the Secretary may specify; or

(B)

in the case of a facility that is a State home, the State home meets such standards of care as the Secretary may specify.

(3)

Inspection.— The Secretary shall inspect facilities at which veterans are placed under the pilot program under subsection (a)(1)—

(A)

with respect to a facility that is a State home, not less frequently than annually and in the same manner as the Secretary conducts inspection of State homes under section 1742 of title 38, United States Code; and

(B)

with respect to any other facility, not less frequently than annually and in the same manner as the Secretary conducts inspection of facilities under section 1730 of such title.

(4)

Payment to certain facilities.—

(A)

State homes.— In the case of a facility participating in the pilot program under subsection (a)(1) that is a State home, the Secretary shall pay to the State home a per diem for each veteran participating in the pilot program at a rate agreed to by the Secretary and the State home.

(B)

Community assisted living facilities.— In the case of a facility participating in the pilot program under subsection (a)(1) that is a community assisted living facility, the Secretary shall—

(i)

pay to the facility an amount that is less than the average rate paid by the Department for placement in a community nursing home in the same Veterans Integrated Service Network; and

(ii)

re-evaluate payment rates annually to account for current economic conditions and current costs of assisted living services.

(e)

Continuity of Care.— Upon the termination of the pilot program under subsection (a)(1), the Secretary shall—

(1)

provide to all veterans participating in the pilot program at the time of such termination the option to continue to receive assisted living services at the site they were assigned to under the pilot program, at the expense of the Department; and

(2)

for such veterans who do not opt to continue to receive such services—

(A)

ensure such veterans do not experience lapses in care; and

(B)

provide such veterans with information on, and furnish such veterans with, other extended care services based on their preferences and best medical interest.

(f)

Determination of Quality.— The Secretary shall determine a method for assessment of quality of care provided to veterans participating in the pilot program under subsection (a)(1) and shall communicate that method to providers of services under the pilot program.

(g)

Annual Report.— Not later than one year after the initiation of the pilot program under subsection (a)(1), and annually thereafter for the duration of such pilot program, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the pilot program that includes—

(1)

an identification of Veterans Integrated Services Networks and facilities of the Department participating in the pilot program and assisted living facilities and State homes at which veterans are placed under the pilot program;

(2)

the number of participants in the pilot program, disaggregated by facility;

(3)

general demographic information of participants in the pilot program, including average age, sex, and race or ethnicity;

(4)

disability status of participants in the pilot program;

(5)

an identification of any barriers or challenges to furnishing care to veterans under the pilot program, conducting oversight of the pilot program, or any other barriers or challenges;

(6)

the cost of care at each assisted living facility and State home participating in the pilot program, including an analysis of any cost savings by the Department when comparing that cost to the cost of nursing home care;

(7)

aggregated feedback from participants in the pilot program, including from veteran resident surveys and interviews; and

(8)

such other matters the Secretary considers appropriate.

(h)

Final Report.— Not later than one year after the pilot program terminates under subsection (j), the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the pilot program that—

(1)

includes the matters required under paragraphs (1) through (8) of subsection (g);

(2)

includes recommendations on whether the model studied in the pilot program should be continued or adopted throughout the Department; and

(3)

indicates whether the Secretary requests action by Congress to make the pilot program permanent.

(i)

Inspector General Report.—

(1)

In general.— Not later than three years after the initiation of the pilot program under subsection (a)(1), the Inspector General of the Department of Veterans Affairs shall submit to the Secretary of Veterans Affairs and the Committees on Veterans’ Affairs of House of Representatives and the Senate a report on the pilot program.

(2)

Elements.— The report required by paragraph (1) shall include an assessment of—

(A)

the quality of care provided to veterans at facilities participating in the pilot program, measured pursuant to the method determined under subsection (f);

(B)

the oversight of such facilities, as conducted by the Department, the Centers for Medicare & Medicaid Services, State agencies, and other relevant entities; and

(C)

such other matters as the Inspector General considers appropriate.

(3)

Plan required.— Not later than 90 days after the submission of the report under paragraph (1), the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a plan to address the deficiencies identified in the report, if any.

(j)

Termination.—

(1)

In general.— Subject to paragraph (2), the pilot program under subsection (a)(1) shall terminate on September 30, 2028.

(2)

Extension.— The Secretary may extend the duration of the pilot program for an additional two-year period if the Secretary, based on the results of the reports submitted under subsection (g), determines such an extension is appropriate.

(k)

Definitions.— In this section:

(1)

The term “assisted living services” means services of a facility in providing room, board, and personal care for and supervision of residents for their health, safety, and welfare.

(2)

The term “eligible veteran” means a veteran who is—

(A)

receiving nursing home care paid for by the Department of Veterans Affairs, eligible to receive such care pursuant to section 1710A of title 38, United States Code, or requires a higher level of care than the domiciliary care provided by the Department of Veterans Affairs, but does not meet the requirements for nursing home level care provided by the Department pursuant to such section; and

(B)

eligible for assisted living services, as determined by the Secretary or meets such additional criteria for eligibility for the pilot program under subsection (a)(1) as the Secretary may establish.

(3)

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

SEC. 128. Provision of Medicine, Equipment, and Supplies Available to Department of Veterans Affairs to State Homes.

(a)

Provision Authorized.— The Secretary of Veterans Affairs may provide to State homes medicine, personal protective equipment, medical supplies, and any other equipment, supplies, and assistance available to the Department of Veterans Affairs.

(b)

Definition.— In this section:

(1)

The term “personal protective equipment” means any protective equipment required to prevent the wearer from contracting an infectious disease, including gloves, N–95 respirator masks, gowns, goggles, face shields, or other equipment required for safety.

(2)

The term “State home” has the meaning given such term in section 101 of title 38, United States Code.

SEC. 129. Recognition of Organizations and Individuals to Assist Veterans, Family Members, and Caregivers Navigating Programs and Services of Veterans Health Administration.

(a)

In General.— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall establish a process through which the Department of Veterans Affairs may recognize organizations and individuals to assist a veteran, a family member of a veteran, or a caregiver of a veteran (as defined in section 1720G(d) of title 38, United States Code) in navigating the programs and services of the Veterans Health Administration.

(b)

Solicitation of Feedback.— The Secretary shall solicit feedback and recommendations in the creation of the process under subsection (a) from such organizations as the Secretary may consider relevant.

(c)

Limitation.— The Secretary may not recognize an organization or individual pursuant to the process established under subsection (a) unless the organization or individual has certified to the Secretary that no fee or compensation of any nature will be charged to any individual for services rendered in providing assistance pursuant to such subsection.

SEC. 130. Reviews and Other Improvements Relating to Home and Community-Based Services.

(a)

Office of Geriatric and Extended Care.—

(1)

Review of programs.— The Under Secretary for Health of the Department of Veterans Affairs shall conduct a review of each program administered through the Office of Geriatric and Extended Care of the Department and the Caregiver Support Program Office of the Department, or any successor offices, to—

(A)

eliminate service gaps at the medical center level; and

(B)

ensure—

(i)

the clinical needs of veterans are met;

(ii)

consistency in program management;

(iii)

the availability of, and the access by veterans to, home- and community-based services, including for veterans living in rural areas; and

(iv)

proper coordination between covered programs.

(2)

Assessment of staffing needs.— The Secretary of Veterans Affairs shall conduct an assessment of the staffing needs of the Office of Geriatric and Extended Care of the Department and the Caregiver Support Program Office of the Department, or any successor offices.

(3)

Goals for geographic alignment of care.—

(A)

Establishment of goals.— The Director of the Office of Geriatric and Extended Care, or successor office, shall establish quantitative goals to enable aging or disabled veterans who are not located near medical centers of the Department to access extended care services (including by improving access to home- and community-based services for such veterans).

(B)

Implementation timeline.— Each goal established under subparagraph (A) shall include a timeline for the implementation of the goal at each medical center of the Department.

(4)

Goals for in-home specialty care.— The Director of the Office of Geriatric and Extended Care, or successor office, shall establish quantitative goals to address the specialty care needs of veterans through in-home care, including by ensuring the education of home health aides and caregivers of veterans in the following areas:

(A)

Dementia care.

(B)

Care for spinal cord injuries and diseases.

(C)

Ventilator care.

(D)

Other speciality care areas as determined by the Secretary.

(5)

Input on goals.— To the extent practicable, the head of the Caregiver Support Program Office, or successor office, shall provide to the Director of the Office of Geriatric and Extended Care, or successor office, input with respect to the establishment of the goals under paragraphs (3) and (4).

(6)

Report to congress.— Not later than one year after the date of the enactment of this Act, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report containing the findings of the review under paragraph (1), the results of the assessment under paragraph (2), and the goals established under paragraphs (3) and (4).

(b)

Review of Incentives and Efforts Relating to Home- and Community-based Services.—

(1)

Review.— The Secretary of Veterans Affairs shall conduct a review of the following:

(A)

The financial and organizational incentives or disincentives for the directors of medical centers of the Department to establish or expand covered programs at such medical centers.

(B)

Any incentives or disincentives for such directors to provide to veterans home- and community-based services in lieu of institutional care.

(C)

The efforts taken by the Secretary to enhance spending of the Department for extended care by balancing spending between institutional care and home- and community-based services consistent with the demand for such services.

(D)

The plan of the Under Secretary for Health of the Department to accelerate efforts to enhance spending as specified in subparagraph (C), to match the progress of similar efforts taken by the Administrator of the Centers for Medicare & Medicaid Services with respect to spending of the Centers for Medicare & Medicaid Services for extended care.

(2)

(c)

Review of Respite Care Services.— Not later than two years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall conduct a review of the use, availability, cost, and effectiveness, of the respite care services furnished by the Secretary under chapter 17 of title 38, United States Code, including—

(1)

the frequency at which the Department of Veterans Affairs is unable to meet demand for such services;

(2)

a detailed description of—

(A)

the reasons the Department of Veterans Affairs is unable to meet the demand for such services; and

(B)

any actions, or planned actions, of the Secretary of Veterans Affairs to ensure such demand is met.

(d)

Collaboration to Improve Home- and Community-based Services.—

(1)

Recommendations.—

(A)

Development.— The Secretary of Veterans Affairs shall develop recommendations as follows:

(i)

With respect to home- and community-based services for veterans, the Secretary of Veterans Affairs shall develop recommendations regarding new services (in addition to those furnished as of the date of enactment of this Act) in collaboration with the Secretary of Health and Human Services.

(ii)

With respect to the national shortage of home health aides, the Secretary of Veterans Affairs shall develop recommendations regarding methods to address such shortage in collaboration with the Secretary of Health and Human Services and the Secretary of Labor.

(B)

Submission to congress.— The Secretary of Veterans Affairs shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report containing the recommendations developed under subparagraph (A) and an identification of any changes in existing law or new statutory authority necessary to implement the recommendations, as determined by the Secretary.

(C)

Consultation with secretary of labor.— In carrying out this paragraph, the Secretary of Veterans Affairs shall consult with the Secretary of Labor.

(2)

Feedback and recommendations on caregiver support.—

(A)

Feedback and recommendations.— The Secretary of Veterans Affairs shall solicit from the entities described in subparagraph (B) feedback and recommendations regarding opportunities for the Secretary to enhance home- and community-based services for veterans and the caregivers of veterans, including through the potential provision by the entity of care and respite services to veterans and caregivers who may not be eligible for any program under section 1720G of title 38, United States Code, or section 1720L of such title (as added by section 123), but have a need for assistance.

(B)

Covered entities.— The entities described in this subparagraph are veterans service organizations and nonprofit organizations with a focus on caregiver support or long term care (as determined by the Secretary).

(3)

Collaboration for certain veterans.— The Secretary of Veterans Affairs shall collaborate with the Director of the Indian Health Service and representatives from tribal health programs and Urban Indian organizations to ensure the availability of home- and community-based services for—

(A)

Native American veterans, including Native American veterans receiving health care and medical services under multiple health care systems; and

(B)

Native Hawaiian veterans, including Native Hawaiian veterans receiving health care and medical services under the Native Hawaiian health care system.

SEC. 131. Gao Report on Mental Health Support for Caregivers.

(a)

Report Required.— Not later than one year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the provision of mental health support to caregivers of veterans.

(b)

Contents.— The report submitted under subsection (a) shall include the following:

(1)

An assessment of the need for mental health support among caregivers participating in the caregiver programs.

(2)

An assessment of options for mental health support in facilities of the Department of Veterans Affairs and in the community for caregivers participating in the caregiver programs.

(3)

An assessment of the availability and accessibility of mental health support in facilities of the Department and in the community for caregivers participating in the caregiver programs.

(4)

An assessment of the awareness among caregivers of the availability of mental health support in facilities of the Department and in the community for caregivers participating in the caregiver programs.

(5)

An assessment of barriers to mental health support in facilities of the Department and in the community for caregivers participating in the caregiver programs.

(c)

Definitions.— In this section:

(1)

The term “caregiver” has the meaning given that term in section 1720G of title 38, United States Code.

(2)

The term “caregiver programs” means—

(A)

the program of comprehensive assistance for family caregivers under subsection (a) of section 1720G of title 38, United States Code; and

(B)

the program of support services for caregivers under subsection (b) of such section.

SEC. 132. Development of Centralized Website for Program Information.

(a)

Centralized Website.— The Secretary shall develop and maintain a centralized and publically accessible internet website of the Department as a clearinghouse for information and resources relating to covered programs.

(b)

Contents.— The website under subsection (a) shall contain the following:

(1)

A description of each covered program.

(2)

An informational assessment tool that—

(A)

explains the administrative eligibility, if applicable, of a veteran, or a caregiver of a veteran, for any covered program; and

(B)

provides information, as a result of such explanation, on any covered program for which the veteran or caregiver (as the case may be) may be eligible.

(3)

A list of required procedures for the directors of the medical facilities of the Department to follow in determining the eligibility and suitability of veterans for participation in a covered program, including procedures applicable to instances in which the resource constraints of a facility (or of a community in which a facility is located) may result in the inability to address the health needs of a veteran under a covered program in a timely manner.

(c)

Updates.— The Secretary shall ensure the website under subsection (a) is updated on a periodic basis.

SEC. 133. Definitions.

In this subtitle:

(1)

The terms “caregiver” and “family caregiver” have the meanings given those terms under section 1720L(h) of title 38, United States Code (as added by section 123).

(2)

The term “covered program”—

(A)

means any program of the Department of Veterans Affairs for home- and community-based services; and

(B)

includes the programs specified in section 1720L of title 38, United States Code (as added by section 123).

(3)

The term “home- and community-based services”—

(A)

means the services referred to in section 1701(6)(E) of title 38, United States Code; and

(B)

includes services furnished under a program specified in section 1720L of such title (as added by section 123).

(4)

The terms “Home-Based Primary Care program”, “Homemaker and Home Health Aide program”, and “Veteran-Directed Care program” mean the programs of the Department of Veterans Affairs specified in subsection (d), (c), and (b) of such section 1720L, respectively.

(5)

The terms “home health aide”, “Native American”, “Native American veteran”, “tribal health programs”, and “Urban Indian organizations” have the meanings given those terms in subsection (h) of such section 1720L.

(6)

The term “veterans service organization” means any organization recognized by the Secretary under section 5902 of such title.

Subtitle C Medical Treatment and Other Matters

SEC. 140. Quarterly Report on Referrals for Non-Department of Veterans Affairs Health Care.

(a)

In General.— Subchapter I of chapter 17 of title 38, United States Code, is amended by inserting after section 1703F the following new section (and amending the table of sections at the beginning of such chapter accordingly):

“§ 1703G. Quarterly report on referrals for non-Department health care

“The Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a quarterly report containing, with respect to referrals for non-Department health care originating from a medical facility of the Department during the quarter preceding the date of the submission of the report, a measurement of, for each such medical facility—

“(1) the period of time between—

“(A) the date on which a clinician employed by the Department determines that a veteran requires care, or a veteran presents to the Department requesting care, and the date on which the referral for care is sent to a non-Department health care provider;

“(B) the date on which such referral is sent to a non-Department health care provider and the date on which such non-Department health care provider accepts such referral;

“(C) the date on which such non-Department health care provider accepts such referral and the date on which such referral is completed;

“(D) the date on which such referral is completed and the date on which an appointment with a non-Department health care provider is made; and

“(E) the date on which such an appointment is made and the date on which such appointment occurs; and

“(2) any other period of time that the Secretary determines necessary.”

(b)

Effective Date.— The first report under section 1703G, as added by this section, shall be due not later than 180 days after the date of the enactment of this section.

SEC. 141. Elimination of Certain Requirements for Certain Department of Veterans Affairs Assistant under Secretaries.

Section 7306 of title 38, United States Code, is amended—

(1)

by striking subsection (b);

(2)

by redesignating subsections (c) through (g) as subsections (b) through (f), respectively; and

(3)

in subsection (c) (as so redesignated), by striking “ subsection (e)” and inserting “ subsection (d)”.

SEC. 142. Modification of Pay Limitation for Physicians, Podiatrists, Optometrists, and Dentists of Department of Veterans Affairs.

(a)

Pay.—

(1)

In general.— Section 7431 of title 38, United States Code, is amended—

(A)

by inserting “ optometrists,” after “ podiatrists,” each place it appears;

(B)

by inserting “ optometrist” after “ podiatrist,” each place it appears;

(C)

in subsection (c)—

(i)

in paragraph (5), by adding at the end the following new sentence: “ Such a notice shall include a statement of whether the market pay will increase, decrease, or remain unchanged following such evaluation.”; and

(ii)

by adding at the end the following new paragraphs:

“(7) The Secretary shall ensure that each physician, podiatrist, optometrist, and dentist in the Veterans Health Administration is—

“(A) advised, on an annual basis, of the criteria described in subparagraph (F) of paragraph (4);

“(B) evaluated in accordance with such criteria; and

“(C) compensated in accordance with—

“(i) applicable assignment and pay levels, subject to relevant pay limitations; and

“(ii) the extent to which such criteria are met.

“(8) Not later than 120 days after the end of each fiscal year, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report that includes the following:

“(A) A list of each facility and specialty that conducted an evaluation of pay during the period covered by the report.

“(B) For each evaluation described in subparagraph (A)—

“(i) a list of occupations for which pay was evaluated, disaggregated by medical specialty, number of authorized full-time employees, and onsite full-time employees as of the date of the evaluation;

“(ii) the date such evaluation was completed;

“(iii) whether a market pay adjustment was made following the evaluation per each occupation and specialty evaluated;

“(iv) whether applicable employees were notified of such evaluation;

“(v) whether local labor partners were notified of such evaluation; and

“(vi) in the case of an evaluation that resulted in an adjustment of pay—

“(I) the date such adjustment—

“(aa) was implemented; and

“(bb) became effective; and

“(II) the percentage of employees of each occupation and specialty for which pay was adjusted pursuant to such evaluation.

“(C) A list of facilities of the Department that have not conducted an evaluation of market pay, pursuant to paragraph (5), during the 18-month-period that precedes the date of the submission of such report.”

; and

(D)

in subsection (e), by adding at the end the following new paragraphs:

“(5) Notwithstanding any compensation or pay limitations under this title or title 5, the Secretary may authorize the Under Secretary for Health to pay physicians, podiatrists, optometrists, and dentists—

“(A) awards authorized under this title;

“(B) advance payments, recruitment or relocation bonuses, and retention allowances authorized under section 7410(a) of this title or as otherwise provided by law;

“(C) incentives or bonuses under section 706 of this title or as otherwise provided by law; and

“(D) earnings from fee-basis appointments under section 7405(a)(2) of this title.

“(6)

(A) The Secretary may waive any pay limitation described in this section (including tier limitations) that the Secretary determines necessary for the recruitment or retention of critical health care personnel whom the Secretary determines would provide direct patient care.

“(B) Priority for such waivers shall be given for positions, locations, and care provided through agreements that are costly to the Department.

“(C) The Chief Human Capital Officer of the Department, the Chief Financial Officer of the Department, and the Office of the General Counsel of the Department shall review any waiver issued under subparagraph (A).

“(D) During the period the authority under subparagraph (A) is effective, the Secretary may not issue more than 300 waivers under such subparagraph.

“(E) The Secretary may prescribe requirements, limitations, and other considerations for waivers under such subparagraph.

“(F) Not later than 180 days after the date of the enactment of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act, and annually thereafter, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report that includes—

“(i) any updates to the requirements, limitations, and considerations prescribed under subparagraph (B) during the period covered by the report;

“(ii) a description of the findings of each review, if any, conducted pursuant to subparagraph (C);

“(iii) a description of each waiver under subparagraph (A) in effect as of the date of the submission of the report, including the—

“(I) duty location, position, specialty, market and performance considerations for the waiver; and

“(II) impact, if any, of the waiver on care furnished by the Department pursuant to an agreement regarding the geographic area; and

“(iv) a list of any separation actions during the period covered by the report with respect to a position for which a waiver under subparagraph (A) is in effect.

“(G) The authority of the Secretary under subparagraph (A) shall terminate on the last day of the third full fiscal year following the date of the enactment of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act.”

(2)

Report on waiver authority.— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report that includes a description of the requirements, limitations, and other considerations prescribed under section 7431(b)(6)(D) of title 38, United States Code, as added by paragraph (1).

(3)

Conforming amendments.—

(A)

Pay of under secretary for health.— Section 7432(b)(1) of such title is amended by inserting “ , podiatrist, optometrist,” after “ physician”.

(B)

Administrative matters.— Section 7433 of such title is amended by inserting “ optometrists,” after “ physicians,” each place it appears.

(C)

Competitive pay.— Section 7451(a)(2)(C) of such title is amended by inserting “ optometrist,” after “ physician,”.

(4)

Clerical amendments.—

(A)

Subchapter heading.— Subchapter III of chapter 74 of such title is amended in the heading by inserting “ Optometrists,” after “ PODIATRISTS,”.

(B)

Table of sections.— The table of sections for such chapter is amended by striking the item relating to subchapter III and inserting the following:

“subchapter iii— pay for physicians and other health-care personnel”.

(5)

Applicability dates.— The amendments made by this subsection shall apply to any pay period of the Department of Veterans Affairs beginning on or after the date that is 180 days after the date of the enactment of this Act.

(b)

Modification and Clarification of Pay Grade for Optometrists.— Section 7404 of title 38, United States Code, is amended—

(1)

in subsection (a)(2)(A), by striking “ podiatrists, and dentists” and inserting “ podiatrists, optometrists, and dentists”; and

(2)

in subsection (b)—

(A)

by striking “ podiatrist (dpm), and dentist” and inserting “ podiatrist (dpm), optometrist (od), and dentist”;

(B)

by striking “ clinical chiropractor and optometrist schedule,” and inserting “ clinical chiropractor schedule”; and

(C)

by inserting “ optometrist grade” after “ Podiatrist grade”.

(c)

Retroactive Authority for Compensation.—

(1)

In general.— The Secretary of Veterans Affairs may pay retroactive compensation to a covered employee in an amount that equals the amount of compensation that was authorized to be paid to such covered employee during the period specified in paragraph (2), but was deferred and paid to such employee in the calendar year following the calender year in which such compensation was authorized because the payment such compensation would have exceeded an applicable cap on annual compensation.

(2)

Period specified.— The period specified in this paragraph is the period beginning on January 8, 2006, and ending on December 31, 2017.

(3)

Exclusion.— Compensation authorized under this subsection shall not be included in the calculation of any aggregate limit on compensation for a covered employee for the year in which it is paid.

(4)

Charging of compensation.— Compensation authorized under this subsection shall be charged to the appropriate medical care appropriation account of the Department of Veterans Affairs for the fiscal year in which the work was performed except as follows:

(A)

In the case of an account that has closed pursuant to section 1552 of title 31, United States Code, the compensation shall be charged to a current appropriation account in accordance with section 1553 of such title.

(B)

In the case of an expired account that has not closed, if charging the compensation to the expired account would cause such account to have a negative unliquidated or unexpended balance, the compensation may be charged to a current appropriation account available for the same purpose.

(5)

Definitions.— In this subsection:

(A)

The term “compensation” means any pay, including salary, awards, and incentives.

(B)

The term “covered employee” means a physician, podiatrist, or dentist subject to market pay under section 7431 of title 38, United States Code.

SEC. 143. Reimbursement of Ambulance Cost for Care for Certain Rural Veterans.

(a)

In General.— The Secretary of Veterans Affairs shall pay, or reimburse a covered veteran for, the cost of transporting the veteran by ambulance, including air ambulance, from a covered location to a provider of the Department of Veterans Affairs, a non-Department provider, or the nearest hospital that can meet the needs of the veteran (including a hospital that compacts with the Indian Health Service) for covered care.

(b)

Amount Covered.— The maximum cumulative amount covered under this section for a covered veteran is $46,000.

(c)

Sunset.— This section shall cease to be effective on September 30, 2026.

(d)

Definitions.— In this section:

(1)

The term “covered care” means care for a veteran eligible for care provided by the Department of Veterans Affairs under title 38, United States Code, or any other law administered by the Secretary of Veterans Affairs, even if the care associated with the transport described in subsection (a) is not authorized by the Department.

(2)

The term “covered location” means a location that is—

(A)

in a State that is 100 miles or more from the nearest medical center of the Department of Veterans Affairs; and

(B)

in an area rated as a 10 or higher under the rural-urban commuting areas coding system of the Department of Agriculture.

(3)

The term “covered veteran” means a veteran who—

(A)

has a service-connected disability rated by the Secretary as between 0 and 30 percent disabling;

(B)

is not eligible for payments or reimbursements for beneficiary travel or other transportation under the laws administered by the Secretary of Veterans Affairs, other than under this section; and

(C)

is not entitled to care or services under a non-Department of Veterans Affairs health-plan contract.

(4)

The term “health-plan contract” has the meaning given that term in section 1725 of title 38, United States Code.

(5)

The term “service-connected” has the meaning given that term in section 101 of such title.

SEC. 144. Pilot Program to Furnish Dental Care from the Department of Veterans Affairs to Certain Veterans Diagnosed with Ischemic Heart Disease.

(a)

In General.— Beginning not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall carry out a two-year pilot program (in this section referred to as the “pilot program”) under which the Secretary shall furnish covered care to covered veterans through means that include the use of community care.

(b)

Locations.—

(1)

In general.— The Secretary shall select not more than four States in which to carry out the pilot program.

(2)

Selection criteria.— In selecting States under paragraph (1), the Secretary shall prioritize States in which—

(A)

the Department of Veterans Affairs serves a high proportion, as determined by the Secretary, of veterans residing in rural or highly rural areas (as determined through the use of the Rural-Urban Commuting Areas coding system of the Department of Agriculture);

(B)

dental clinics operated by the Department of Veterans Affairs currently utilize teledentistry;

(C)

the Department of Veterans Affairs does not currently operate a dental clinic; or

(D)

the Secretary determines a large percentage of veterans enrolled in the system of annual patient enrollment of the Department of Veterans Affairs established and operated under paragraphs (1) or (2) of section 1705(a) of title 38, United States Code, visit emergency rooms for dental emergencies at high rates.

(c)

Participation Limitation.— Participation in a pilot program established pursuant to this section shall be limited to a covered veteran who receives health care in a facility of the Department located in a State selected under subsection (b).

(d)

Use of Certain Methods to Provide Care.—

(1)

Mobile dental clinics.— In carrying out the pilot program, the Secretary shall test the efficacy of mobile dental clinics to service rural areas that do not have a population base to warrant a full-time clinic but where there are covered veterans in need of dental care.

(2)

Home-based dental care.— In carrying out the pilot program, the Secretary shall test the efficacy of portable dental care units to service rural veterans in their homes, as the Secretary considers medically appropriate.

(e)

Administration.—

(1)

Community care network review.—

(A)

In general.— Before commencing the pilot program, the Secretary shall work with third party administrators to conduct a review of dental providers who are part of the community care network of the Department in each State selected under subsection (b)(1) to ensure—

(i)

dental providers who are no longer accepting patients from the Department—

(I)

are not still listed as providers accepting referrals from the Department; and

(II)

are not sent referrals from the Department; and

(ii)

dental providers participating in each such network are capable of receiving an influx of patients from the Department under the pilot program.

(B)

Expansion of network.— If, pursuant to a review under subparagraph (A), the Secretary determines the community care network in a State selected under subsection (b)(1) is not capable of receiving an influx of patients under the pilot program, the Secretary shall coordinate with the Third Party Administrator for such State to ensure the dental provider network of such community care network is sufficiently expanded before the initiation of the pilot program.

(2)

Notice to covered veterans.— In carrying out the pilot program, the Secretary shall inform all covered veterans in States selected under subsection (b)(1) of the covered care available under the pilot program.

(3)

Loss of eligibility.— Any veteran participating in the pilot program who ceases to be a covered veteran shall be removed from the pilot program on the date that is 90 days after the Secretary determines the participant is no longer a covered veteran.

(4)

Continuity of care.—

(A)

In general.— Upon the termination of the pilot program, the Secretary shall provide to all veterans participating in the pilot program at the time of such termination—

(i)

information on how to enroll in the dental insurance plan of the Department of Veterans Affairs under section 1712C of title 38, United States Code;

(ii)

if appropriate, information on the VETSmile program of the Department of Veterans Affairs, or any successor program; and

(iii)

contact information for dental providers in the surrounding community who provide low- or no-cost dental care and whom the Secretary has confirmed are available to take on new patients.

(B)

Continuation of treatment plan.— Any veteran participating in the pilot program may continue to receive services under the pilot program after the termination of the pilot program to complete a treatment plan commenced under the pilot program, as determined necessary by the Secretary.

(f)

Reports.—

(1)

Annual report.— Not later than one year after the commencement of the pilot program, and annually thereafter for the duration of the pilot program, the Secretary of Veterans Affairs shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the pilot program that includes—

(A)

an identification of the States participating in the pilot program;

(B)

a description of the implementation and operation of the pilot program;

(C)

the number of participants in the pilot program, disaggregated by—

(i)

State; and

(ii)

disability rating;

(D)

an identification of any barriers or challenges to implementing the pilot program;

(E)

aggregated feedback from participants in the pilot program, including from interviews and surveys;

(F)

the average annual cost of providing covered care to a participant in the pilot program, disaggregated by—

(i)

State;

(ii)

disability rating; and

(iii)

whether the care was provided through the community care network or through a provider of the Department;

(G)

an analysis of the communication and collaboration of the Department with Third Party Administrators and community care dental providers, disaggregated by State;

(H)

an analysis of any cost savings by the Department with respect to the treatment of ischemic heart disease;

(I)

an assessment of the impact of the pilot program on appointments for care, prescriptions, hospitalizations, emergency room visits, wellness, employability, satisfaction, and perceived quality of life of covered veterans related to their diagnosis of ischemic heart disease;

(J)

an analysis and assessment of the efficacy of mobile clinics and portable dental care units, to the extent such modalities are used, to service the needs of covered veterans under the pilot program;

(K)

an analysis and assessment of the usage of teledentistry to service the needs of covered veterans under the pilot program, to include a cost benefit analysis of such services; and

(L)

such other matters as the Secretary considers appropriate.

(2)

Final report.— Not later than 90 days before the completion of the pilot program, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the pilot program that—

(A)

includes the matters required under paragraph (1);

(B)

includes recommendations on whether the pilot program should be continued, expanded, or adopted throughout the Department; and

(C)

indicates whether the Secretary requests action by Congress to make the pilot program permanent.

(g)

Impact on Community Care.— Participants in the pilot program shall be able to access covered care in the community under section 1703 of title 38, United States Code.

(h)

Definitions.— In this section:

(1)

The term “covered care” means dental care that is consistent with the dental services and treatment furnished by the Secretary of Veterans Affairs to veterans pursuant to section 1712(a)(1)(G) of title 38, United States Code.

(2)

The term “covered veteran” means a veteran who—

(A)

is enrolled in the system of annual patient enrollment of the Department established and operated under paragraphs (1) or (2) of section 1705(a) of title 38, United States Code;

(B)

is not eligible for dental services and treatment and related dental appliances under the laws administered by the Secretary as of the date of the enactment of this Act; and

(C)

has a diagnosis of ischemic heart disease.

(3)

The term “Third Party Administrator” has the meaning given such term in section 1703F of such title.

SEC. 145. Documentation of Preferences of Veterans for Scheduling of Appointments for Health Care under Laws Administered by Secretary of Veterans Affairs.

(a)

In General.— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall develop a mechanism to solicit information regarding the preference of veterans enrolled in the system of annual patient enrollment of the Department of Veterans Affairs established and operated under section 1705(a) of title 38, United States Code, for scheduling of appointments for health care and related services under the laws administered by the Secretary, including through non-Department providers.

(b)

Documentation of Preference.— Preferences provided voluntarily by a veteran pursuant to subsection (a) shall be documented on My HealtheVet or another system designated by the Secretary that allows the veteran to view and change such preferences at any time.

(c)

Inclusion in Preference.— Preferences solicited under subsection (a) shall include the following:

(1)

How and when the veteran prefers to be contacted about an appointment for health care.

(2)

Whether the veteran prefers to schedule appointments without the assistance of the Department, if able.

(3)

Whether the veteran prefers to select a provider without the assistance of the Department, if able.

(4)

Whether the veteran prefers appointments to be scheduled during certain days or times.

(d)

Use of Preference.— The Secretary shall make the preferences provided under subsection (a) easily accessible to medical support assistants and other staff of the Department, or non-Department staff, as the Secretary determines appropriate, who assist in the appointment scheduling process.

(e)

Deployment of Mechanism.—

(1)

In general.— Beginning after the date on which the Secretary develops the mechanism required under subsection (a), the Secretary shall—

(A)

test the mechanism in not fewer than three geographically diverse Veterans Integrated Service Networks; and

(B)

gather feedback about the effectiveness of such mechanism from veterans, medical support assistants, staff and other stakeholders as the Secretary determines appropriate.

(2)

Limitation.— The Secretary may not implement such mechanism across the Veterans Health Administration of the Department before the Secretary addresses the feedback described in paragraph (1)(B).

SEC. 146. Staffing Model and Performance Metrics for Certain Employees of the Department of Veterans Affairs.

(a)

Staffing Model.—

(1)

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

(A)

develop, validate, and implement a staffing model for the Office of Integrated Veteran Care of the Department of Veterans Affairs, or successor office, Veterans Integrated Services Networks, and medical centers of the Department that includes appropriate target staffing levels nationally, regionally, and locally to ensure timely access to care and effectively oversee the provision of care by the Department, whether at a facility of the Department or through a non-Department provider; and

(B)

provide to Congress a briefing on such staffing model, which shall include—

(i)

the metrics and measures used by the Secretary in developing such staffing model;

(ii)

an analysis of how such staffing model compares to the staffing models of other relevant Government-owned and private sector health care systems; and

(iii)

an estimate of the portion of the roles in such staffing model that will be filled by contracted staff at any given time.

(2)

Report on implementation of staffing model.— Not later than one year after the date on which the Secretary implements the staffing model required under paragraph (1), the Secretary shall submit to Congress and the Comptroller General of the United States a report containing—

(A)

an update on such implementation; and

(B)

information on the outcomes yielded by such staffing model in terms of improved access to care for veterans and improved compliance with relevant laws, regulations, policy directives, and guidance governing access to care.

(b)

Performance Metrics.—

(1)

In general.— Not later than one year after the date of the enactment of this Act, the Secretary shall develop and implement a plan, with an appropriate tracking system, to incorporate appropriate standardized performance metrics and oversight measures within the performance appraisal systems for employees of the Department specified in paragraph (2).

(2)

Employees of the department specified.— Employees of the Department specified in this paragraph are employees who are responsible for ensuring timely access to care from the Department, compliance with relevant statutes and regulations relating to the provision of care, including section 1703 of title 38, United States Code, and overseeing the provision of care, whether at a facility of the Department or through a non-Department provider, including employees within the Office of Integrated Veteran Care of the Department, or successor office, employees of a Veterans Integrated Service Network, and employees of a medical center of the Department.

(3)

Report on implementation of performance metrics.— Not later than one year after implementing the performance metrics required under paragraph (1), the Secretary shall submit to Congress and the Comptroller General of the United States a report containing—

(A)

an update on such implementation; and

(B)

information on the outcomes yielded by such performance metrics in terms of improved access to care for veterans and improved compliance with relevant laws, policy directives, and guidance governing access to care.

(c)

GAO Report.— Not later than two years after the later of the date on which the Comptroller General receives the report under subsection (a)(2) or the report under subsection (b)(3), the Comptroller General shall submit to Congress a report that includes—

(1)

an assessment of the performance of the Office of Integrated Veteran Care of the Department, or successor office, in improving access to care for veterans in facilities of the Department and pursuant to section 1703 of title 38, United States Code; and

(2)

such recommendations as the Comptroller General considers appropriate with respect to improving access to the care described in paragraph (1) for veterans.

SEC. 147. Online Health Education Portal for Veterans Enrolled in Patient Enrollment System of Department of Veterans Affairs.

Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall establish, on an Internet website of the Department, a health education portal that includes interactive educational modules to ensure veterans enrolled in the patient enrollment system of the Department of Veterans Affairs established and operated under section 1705(a) of title 38, United States Code, understand the basic health care eligibilities and entitlements of veterans under the laws administered by the Secretary, including under the Veterans Community Care Program under section 1703 of such title.

SEC. 148. Limitation on Detail of Directors of Medical Centers of Department of Veterans Affairs to Different Positions.

(a)

Notification.—

(1)

In general.— Not later than 90 days after detailing a director of a medical center of the Department of Veterans Affairs to a different position within the Department, the Secretary of Veterans Affairs shall notify the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives of such detail.

(2)

Matters to be included.— The notification required by paragraph (1) shall include, with respect to a director of a medical center who is detailed to a different position within the Department, the following information:

(A)

The location at which the director is detailed.

(B)

The position title of the detail.

(C)

The estimated time the director is expected to be absent from their duties at the medical center.

(D)

Such other information as the Secretary may determine appropriate.

(b)

Appointment of Acting Director.— Not later than 120 days after detailing a director of a medical center of the Department to a different position within the Department, the Secretary shall appoint an individual as acting director of such medical center with all of the authority and responsibilities of the detailed director.

(c)

Update on Detail.— Not later than 120 days after detailing a director of a medical center of the Department to a different position within the Department, and not less frequently than every 30 days thereafter while the detail is in effect or while the director position at the medical center is vacant, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives an update regarding the status of the detail.

(d)

Return to Position or Reassignment.—

(1)

In general.— Except as provided in paragraph (2), not later than 180 days after detailing a director of a medical center of the Department to a different position within the Department, for a reason other than an ongoing investigation or administrative action with respect to the director, the Secretary shall—

(A)

return the individual to the position as director of the medical center; or

(B)

reassign the individual from the position as director of the medical center and begin the process of hiring a new director for such position.

(2)

Waiver.—

(A)

In general.— The Secretary may waive the requirement under paragraph (1) with respect to an individual for successive 90-day increments for a total period of not more than 540 days from the original date the individual was detailed away from their position as director of a medical center.

(B)

Notification.— Not later than 30 days after exercising a waiver under subparagraph (A), the Secretary shall notify Congress of the waiver and provide to Congress information as to why the waiver is necessary.

SEC. 149. National Veteran Suicide Prevention Annual Report.

(a)

National Veteran Suicide Prevention Annual Report.—

(1)

In general.— Not later than 18 months after the date of the enactment of this Act, and not later than September 30 of each year thereafter, the Secretary of Veterans Affairs shall submit to the appropriate congressional committees and publish on a publicly available website of the Department of Veterans Affairs a report to be known as the “National Veteran Suicide Prevention Annual Report”.

(2)

Extension.—

(A)

In general.— If the Secretary requires an extension of the deadline for a report under subsection (a), the Secretary shall submit to the appropriate congressional committees a written request for such an extension.

(B)

Elements.— Each written request under paragraph (1) for an extension for a report shall include the following:

(i)

The rationale for the delay in the submission of the report.

(ii)

An explanation of the need for an extension.

(iii)

A proposed amended date for the submission and publication of the report.

(3)

Briefing.— With respect to each report required under paragraph (1), the Secretary shall, before the date on which the Secretary submits such report, provide to the appropriate congressional committees a briefing on such report.

(4)

Elements.—

(A)

In general.— Each report required under paragraph (1) shall include—

(i)

the findings of the national analysis of veteran suicide rates for the latest year for which data is available;

(ii)

an identification of trends, if any, demonstrated by such data; and

(iii)

a comparison of such data to data on veteran suicide rates during preceding years.

(B)

Additional elements.— Each report under paragraph (1) shall include, for the year covered by the report, the following:

(i)

Suicide rates of veterans disaggregated by age, gender, and race or ethnicity.

(ii)

Trends in suicide rates of veterans compared to engagement of those veterans with health care from the Veterans Health Administration, including an examination of trends in suicide rates or deaths among—

(I)

veterans who have recently received health care from the Veterans Health Administration as compared to veterans who have never received health care from the Veterans Health Administration;

(II)

veterans who are enrolled in the patient enrollment system of the Department of Veterans Affairs under section 1705(a) of title 38, United States Code, as compared to veterans who have never enrolled in such system;

(III)

veterans who have recently used services from a Vet Center as compared to veterans who have never used such services;

(IV)

to the extent practicable, veterans who have a diagnosis of substance use disorder; and

(V)

other groups of veterans relating to engagement with health care from the Veterans Health Administration, as the Secretary considers practicable.

(iii)

To the extent practicable, trends in suicide rates of veterans compared to engagement of those veterans with benefits from the Veterans Benefits Administration, including an examination of trends in suicide rates or deaths among—

(I)

veterans who are currently using, have previously used, or have never used educational assistance under the laws administered by the Secretary;

(II)

veterans who are currently receiving, have previously received, or have never received services or assistance under chapter 31 of title 38, United States Code;

(III)

with respect to compensation under chapter 11 of such title—

(aa)

veterans who were recipients of such compensation as compared to veterans who never applied for such compensation prior to death;

(bb)

veterans who had a claim denied for such compensation prior to death;

(cc)

veterans who had a pending claim for such compensation at time of death; and

(dd)

veterans who had an entitlement for such compensation reduced prior to death;

(IV)

veterans who are currently receiving or have never received pension under chapter 15 of title 38, United States Code;

(V)

veterans who are currently using, have recently used, or have never used programs or services provided by the Homeless Programs Office of the Department, including an examination of trends in suicide rates or deaths among veterans who made contact with such office but were denied or deemed ineligible for any such program or service;

(VI)

with respect to housing loans guaranteed by the Secretary under chapter 37 of title 38, United States Code, veterans who are current recipients of, were recent recipients of, or have never received such a loan;

(VII)

veterans owing debts to the Department;

(VIII)

veterans who were involved in a veterans treatment court program, whether they graduated successfully or not; and

(IX)

veterans who were successfully contacted, unsuccessfully contacted, or never contacted by the Department through the Solid Start program under section 6320 of title 38, United States Code.

(C)

Strategy and recommendations.—

(i)

Initial report.— The initial report under paragraph (1) shall include a strategy and recommendations developed by the Secretary of Veterans Affairs, in collaboration with the Director of the Centers for Disease Control and Prevention, for—

(I)

improving data collection at the State and local levels to accurately capture suicide deaths of veterans;

(II)

improving the timeliness, efficacy, and standardization of data reporting on suicide deaths of veterans at the Federal level, including by the Centers for Disease Control and Prevention and the Department of Veterans Affairs;

(III)

improving the timeliness of identification and analysis of suicide deaths of veterans by Federal agencies, including the Centers for Disease Control and Prevention, and the Department of Veterans Affairs; and

(IV)

any other necessary process improvements for improving the timeliness, efficacy, and standardization of reporting of data relating to suicide deaths of veterans, particularly with respect to the annual report under this section.

(ii)

Subsequent reports.— Each report after the initial report under paragraph (1) shall include updates on actions taken to meet the strategy and recommendations developed under subparagraph (A).

(5)

Definitions.— In this subsection:

(A)

The term “appropriate congressional committees” means the Committees on Veterans’ Affairs of the Senate and the House of Representatives.

(B)

The term “Vet Center” means a center for readjustment counseling and related mental health services for veterans under section 1712A of title 38, United States Code.

(b)

Independent Assessment of National Veteran Suicide Prevention Annual Report.—

(1)

In general.— Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall enter into one or more contracts with a private sector entity described in paragraph (5) to conduct an independent assessment of the National Veteran Suicide Prevention Annual Report required under subsection (a).

(2)

Frequency.— The private sector entity or entities carrying out the assessment required under paragraph (1) shall complete such assessment not later than 240 days after entering into the contract described in such subsection and not less frequently than every five years thereafter.

(3)

Elements.— Each assessment required under paragraph (1) shall analyze the following:

(A)

The methodology used by the Department to track, analyze, categorize, and report suicide deaths and suicide rates among veterans.

(B)

Whether data sources used by the Department to compile data on suicide deaths and suicide rates among veterans are accurately reflecting such data.

(C)

Vulnerabilities in the methodology used by the Department that could lead to inaccurate counting of suicide deaths and suicide rates among veterans.

(D)

The ability of the Department to cross reference suicide deaths and suicide rates among veterans with trends in usage of programs of the Veterans Health Administration or the Veterans Benefits Administration or other programs that could serve as widespread protective factors against suicide.

(E)

Improvements that could be made to ensure the National Veteran Suicide Prevention Annual Report required under subsection (a) is accurate and comprehensive and provides insights for making improvements to the suicide prevention efforts of the Department.

(4)

Report on assessment.—

(A)

Report on findings and recommendations.— Not later than 60 days after completing an assessment required by paragraph (1), the private sector entity or entities carrying out the assessment shall submit to the Secretary of Veterans Affairs and the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report on the findings and recommendations of the private sector entity or entities with respect to such assessment.

(B)

Report on planned improvements.— Not later than 60 days after receiving a report under paragraph (1) with respect to an assessment required by paragraph (1), the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report on how the Department plans to improve the National Veteran Suicide Prevention Annual Report required under subsection (a) based on such assessment.

(5)

Private sector entity described.— A private sector entity described in this paragraph is a private entity that—

(A)

specializes in analyzing large-scale organizational data collection and analysis efforts, especially with respect to the health care sector; and

(B)

has experience and proven outcomes in optimizing the accuracy and comprehensiveness of data collection and analysis related to suicide.

(c)

Report on Additional Benefits and Services From Department of Veterans Affairs to Prevent Veteran Suicide.—

(1)

In general.— Not later than three years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives and publish on a publicly available website of the Department of Veterans Affairs a report that analyzes which benefits and services under the laws administered by such Secretary, including such benefits and services furnished by the Veterans Benefits Administration, have the greatest impact on the prevention of suicide among veterans, including recommendations for potential expansion of services and benefits to reduce the number of veteran suicides.

(2)

Assessment of solid start program.— The report required by paragraph (1) shall include an analysis of the effectiveness of the Solid Start program under section 6320 of title 38, United States Code, on prevention of suicide among veterans.

(d)

Toolkit for State and Local Coroners and Medical Examiners on Best Practices for Identifying and Reporting on Suicide Deaths of Veterans.—

(1)

In general.— The Secretary of Veterans Affairs, in collaboration with the Director of the Centers for Disease Control and Prevention, shall develop a toolkit for State and local coroners and medical examiners that contains best practices for—

(A)

accurately identifying and reporting suicide deaths of veterans, including how to identify veteran status; and

(B)

reporting such deaths to the Centers for Disease Control and Prevention and other applicable entities.

(2)

Availability.— Not later than two years after the date of the enactment of this Act, the Secretary shall make the toolkit developed under paragraph (1) available on a publicly available website of the Department of Veterans Affairs.

(3)

Outreach.— The Secretary, in collaboration with the Director of the Centers for Disease Control and Prevention, shall conduct outreach to appropriate State and local agencies to promote the availability and use of the toolkit developed under paragraph (1).

SEC. 150. Report on Physical Infrastructure Required by Medical Facilities of Department of Veterans Affairs to Provide Dental Care Services.

Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report, for each medical center or other relevant health care facility of the Department of Veterans Affairs, that includes—

(1)

an identification of the physical infrastructure, including new facilities, renovations, remodels, leases, or other infrastructure, such medical center or health care facility requires to provide dental care services to veterans eligible for such services under the laws administered by the Secretary; and

(2)

an analysis of the physical infrastructure such medical center or health care facility would require if a greater number of veterans became eligible for such dental care services pursuant to a modification of the laws administered by the Secretary.

SEC. 151. Comptroller General Report on Certain Oral Health Care Programs under Laws Administered by Secretary of Veterans Affairs.

(a)

In General.— Not later than one year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report on the status of the oral health care programs of the Department of Veterans Affairs, that includes an assessment of—

(1)

any issues with information technology programs, including Dental Record Manager Plus, that affect dental care staff of the Department;

(2)

the implementation of the dental insurance plan of the Department under section 1712C of title 38, United States Code;

(3)

the implementation and expansion of the VETSmile program of the Department;

(4)

barriers preventing the Department from expanding dental care eligibility to all veterans with ischemic heart disease, including such barriers relating to physical infrastructure, workforce, and cost of such dental care;

(5)

barriers preventing dental clinics of the Department, if any, from adopting teledentistry;

(6)

the demographic makeup of veterans eligible for dental care paid for by the Department as of the commencement of the pilot program under section 144 of this Act, including information on—

(A)

age;

(B)

gender;

(C)

race or ethnicity, disaggregated by—

(i)

membership in an Indian Tribe; and

(ii)

the major race groups used in the decennial census;

(D)

employment status; and

(E)

location of residence, disaggregated by rural, highly rural, and urban locations; and

(7)

changes to such demographic makeup if any, that would result from an expansion of eligibility for dental care under the laws administered by the Secretary to all veterans with ischemic heart disease including changes to demographics specified in paragraph (6).

(b)

SEC. 152. Review of Workflows Associated with Processing Referrals Between Facilities of the Veterans Health Administration.

(a)

In General.— The Secretary of Veterans Affairs shall conduct a review of the workflows directly associated with processing referrals of patients between facilities of the Veterans Health Administration of the Department of Veterans Affairs to identify specific delays or bottlenecks in such referrals.

(b)

Elements of Review.— The review required under subsection (a) shall include a review of—

(1)

the interfacility consult management guidance of the Veterans Health Administration that assists facilities described in subsection (a) in constructing a workflow for consults between such facilities; and

(2)

the roles and responsibilities of the individuals involved in the consult management process in managing such consults, including the role of the referral coordination team.

(c)

Report.— Not later than 180 days after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the results of the review required under subsection (a).

SEC. 153. Plan for Timely Scheduling of Appointments at Medical Facilities of Department of Veterans Affairs.

(a)

Plan Required.— To improve responsiveness in the provision of hospital care and medical services at medical facilities of the Department of Veterans Affairs, the Secretary of Veterans Affairs shall develop a plan to—

(1)

ensure that whenever a covered veteran contacts the Department by telephone to request the scheduling of an appointment for care or services for the covered veteran at such a facility, the scheduling for the appointment occurs during that telephone call (regardless of the prospective date of the appointment being scheduled); and

(2)

provide timely and, where applicable, same-day scheduling for an appointment 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 Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the plan under subsection (a).

(c)

Covered Veteran Defined.— In this section, the term “covered veteran” means a veteran who is enrolled in the system of patient enrollment of the Department under section 1705(a) of title 38, United States Code.

SEC. 154. Authorization of Appropriations to Support Initiatives for Mobile Mammography Services for Veterans.

There is authorized to be appropriated to the Secretary of Veterans Affairs $5,000,000 for fiscal year 2025 for the Office of Women’s Health of the Department of Veterans Affairs under section 7310 of title 38, United States Code, to be used by the Secretary to expand access of women veterans to—

(1)

mobile mammography initiatives;

(2)

advanced mammography equipment; and

(3)

outreach activities to publicize those initiatives and equipment.