II 

117TH CONGRESS 

2D SESSION S. 5348 

To amend title 38, United States Code, to expand access to the Veterans 

Community Care Program of the Department of Veterans Affairs to 

include certain veterans seeking mental health or substance-use services 

and toxic-exposed veterans, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 21, 2022 

Mr. DAINES (for himself and Ms. LUMMIS) introduced the following bill; which 

was read twice and referred to the Committee on Veterans’ Affairs 

A BILL 

To amend title 38, United States Code, to expand access 

to the Veterans Community Care Program of the Department of Veterans Affairs to include certain veterans 

seeking mental health or substance-use services and 

toxic-exposed veterans, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Protecting Veteran 

5 Community Care Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) On June 6, 2018, the John S. McCain III, 

2 Daniel K. Akaka, and Samuel R. Johnson VA Main3 taining Internal Systems and Strengthening Inte4 grated Outside Networks Act of 2018 (Public Law 

5 115–182) (in this section referred to as the ‘‘VA 

6 MISSION Act’’) became law. 

7 (2) Congressional intent with the VA MISSION 

8 Act was to reform and replace the program under 

9 section 101 of the Veterans Access, Choice, and Ac10 countability Act of 2014 (Public Law 113–146; 38 

11 U.S.C. 1701 note) to ensure access of veterans to 

12 community health care providers. 

13 (3) The eligibility standards established by the 

14 VA MISSION Act were not meant to be used to 

15 limit health care options for veterans or to be ap16 plied to community providers, which would result in 

17 reduced health care options. 

18 (4) Many veterans do not have access to a med19 ical facility of the Department of Veterans Affairs in 

20 their community and each medical facility of the De21 partment may not be able to adequately address the 

22 specific health care needs of a particular veteran. 

23 (5) It was the intent of Congress in the VA 

24 MISSION Act that all medical services, including 

25 mental health treatments and institutional extended 


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1 care services for mental health, were to be available 

2 to veterans in the community. 

3 (6) The Department is limiting access of vet4 erans to community care for mental health treat5 ments. 

6 (7) Despite the best efforts of the Department, 

7 veteran suicide remains at significant levels through8 out the United States. 

9 (8) No veteran should have to wait 30 days for 

10 mental health services to be approved by the Depart11 ment. 

12 (9) Telehealth appointments represent a valu13 able complementary health care option for under14 served veterans, but do not offer the same quality of 

15 care as in-person visits to facilities of the Depart16 ment or in the community. 

17 SEC. 3. EXPANSION OF VETERANS COMMUNITY CARE PRO18 GRAM TO INCLUDE ACCESS TO MENTAL 

19 HEALTH OR SUBSTANCE-USE SERVICES FOR 

20 VETERANS UNABLE TO TIMELY ACCESS MEN21 TAL HEALTH RESIDENTIAL TREATMENT PRO22 GRAMS. 

23 (a) IN GENERAL.—Section 1703 of title 38, United 

24 States Code, is amended— 

25 (1) in subsection (d)— 


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1 (A) in paragraph (1)— 

2 (i) in subparagraph (D), by striking 

3 ‘‘; or’’ and inserting a semicolon; 

4 (ii) in subparagraph (E), by striking 

5 the period at the end and inserting ‘‘; or’’; 

6 and 

7 (iii) by adding at the end the fol8 lowing new subparagraph: 

9 ‘‘(F) in the case of residential mental health or 

10 substance-use services, the covered veteran— 

11 ‘‘(i) meets the criteria of the Department 

12 for priority admission to a Mental Health Resi13 dential Rehabilitation Treatment Program of 

14 the Department and the Department is unable 

15 to accommodate such priority admission; or 

16 ‘‘(ii) has contacted the Department to re17 quest such services from a Mental Health Resi18 dential Rehabilitation Treatment Program of 

19 the Department and the Department is not able 

20 to furnish such services in a manner than com21 plies with the access standards of the Depart22 ment for specialty care provided under this sec23 tion by a health care provider specified in sub24 section (c).’’; and 


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1 (B) by adding at the end the following new 

2 paragraph (4): 

3 ‘‘(4) In the case of a covered veteran entitled to men4 tal health or substance-use services under paragraph 

5 (1)(F), the Secretary shall ensure that referral of a vet6 eran to an alternate Mental Health Residential Rehabilita7 tion Treatment Program of the Department does not take 

8 precedence over timely access to such services under this 

9 section pursuant to such paragraph unless such referral 

10 is requested by the covered veteran.’’; 

11 (2) by redesignating subsection (o) as sub12 section (p); and 

13 (3) by inserting after subsection (n) the fol14 lowing new subsection (o): 

15 ‘‘(o) MINIMUM STANDARDS FOR RESIDENTIAL MEN16 TAL HEALTH OR SUBSTANCE-USE SERVICES.—(1) Sub17 ject to paragraph (2), in furnishing residential mental 

18 health or substance-use services to covered veterans pursu19 ant to subsection (d)(1)(F), the Secretary shall ensure 

20 that programs or facilities providing such services under 

21 this section meet the following standards: 

22 ‘‘(A) A treatment program or facility must be 

23 licensed and accredited by a State for the provision 

24 of the services provided. 


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1 ‘‘(B) A treatment program must be accredited 

2 under either the Joint Commission Behavioral 

3 Health Standards or the Behavioral Health Stand4 ards manual (residential treatment) of the Commis5 sion on Accreditation of Rehabilitation Facilities, or 

6 any successor standards or manual. 

7 ‘‘(2) If a program or facility to which a covered vet8 eran is to be referred pursuant to subsection (d)(1)(F) 

9 does not meet the standards specified under paragraph 

10 (1), the Secretary, acting through the director of the facil11 ity of the Department carrying out the referral— 

12 ‘‘(A) shall consider an alternate program or fa13 cility; and 

14 ‘‘(B) may waive such standards on an indi15 vidual basis if no other alternate program or facility 

16 is available or such waiver is in the best interest of 

17 the veteran.’’. 

18 (b) MODIFICATION OF ACCESS STANDARDS.—Not 

19 later than 90 days after the date of the enactment of this 

20 Act, the Secretary of Veterans Affairs shall develop or 

21 amend existing access standards of the Department of 

22 Veterans Affairs to ensure that access to mental health 

23 care under the Veterans Community Care Program under 

24 section 1703 of title 38, United States Code, as amended 


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1 by subsection (a), is not more restrictive than the access 

2 standards for specialty care under such section. 

3 SEC. 4. REQUIREMENT TO PROVIDE CARE UNDER VET4 ERANS COMMUNITY CARE PROGRAM FOR 

5 TOXIC-EXPOSED VETERANS. 

6 Section 1703(d)(1) of title 38, United States Code, 

7 as amended by section 2(a)(1)(A), is further amended— 

8 (1) in subparagraph (E), by striking ‘‘; or’’ and 

9 inserting a semicolon; 

10 (2) in subparagraph (F), by striking the period 

11 at the end and inserting ‘‘; or’’; and 

12 (3) by adding at the end the following new sub13 paragraph: 

14 ‘‘(G) the covered veteran is a toxic-exposed vet15 eran.’’. 

16 SEC. 5. PROHIBITION ON CERTAIN LIMITATIONS ON AC17 CESS OF VETERANS TO CARE. 

18 Section 1703(n) of title 38, United States Code, is 

19 amended by adding at the end the following new para20 graphs: 

21 ‘‘(3) In applying wait times or access standards 

22 under this section for purposes of determining eligibility 

23 of a covered veteran for care or services under this section, 

24 the Secretary may not determine that the veteran is ineli25 gible for such care or services due solely to the fact that 


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1 health care providers specified in subsection (c) are unable 

2 to provide such care or services in compliance with such 

3 wait times or access standards. 

4 ‘‘(4) If multiple options are available to a covered vet5 eran for care or services under this section, the Secretary 

6 shall permit the veteran to elect the option that the vet7 eran prefers.’’. 

8 SEC. 6. DEVELOPMENT OF COMMUNITY CARE METRICS. 

9 (a) IN GENERAL.—Section 1703(m)(1) of title 38, 

10 United States Code, is amended by adding at the end the 

11 following new subparagraph: 

12 ‘‘(C) The review submitted under subparagraph (A) 

13 shall include, for the year covered by the review, the fol14 lowing: 

15 ‘‘(i) The number of instances of care or services 

16 requested. 

17 ‘‘(ii) The number of such requests that were ap18 proved. 

19 ‘‘(iii) The number of such requests that were 

20 denied. 

21 ‘‘(iv) The number of appeals under subsection 

22 (f) of such requests that were denied, including the 

23 final decision of such appeal. 


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1 ‘‘(v) The eligibility criteria under which each el2 igible veteran has qualified for care or services under 

3 this section. 

4 ‘‘(vi) Data with respect to the following: 

5 ‘‘(I) Requests for care or services relating 

6 to mental health. 

7 ‘‘(II) Authorizations for emergency care, 

8 including whether transportation for such care 

9 was required or whether further care or a hos10 pital stay was required.’’. 

11 (b) APPLICATION.—The amendment made by sub12 section (a) shall apply to each review conducted under sub13 paragraph (A) of such section after the date of the enact14 ment of this Act. 

15 SEC. 7. LIMITATION ON MODIFICATION OF COMMUNITY 

16 CARE ACCESS STANDARDS. 

17 Any modification on or after the date of the enact18 ment of this Act by the Secretary of Veterans Affairs of 

19 the conditions under which care is required to be provided 

20 under section 1703(d) of title 38, United States Code, ei21 ther through a modification of the designated access 

22 standards under paragraph (1)(D) of such section, a 

23 modification of the criteria developed by the Secretary 

24 under paragraph (1)(E) of such section, or otherwise 

25 through regulation, shall not take effect until a joint resoVerDate Sep 11 2014 22:44 Jan 08, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S5348.IS S5348

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1 lution is enacted approving such modification to the condi2 tions under which care is required to be provided under 

3 such section. 

Æ 


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