II 

118TH CONGRESS 

1ST SESSION S. 1315 

To improve the provision of care and services under the Veterans Community 

Care Program of the Department of Veterans Affairs, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 26, 2023 

Mr. MORAN (for himself and Ms. SINEMA) introduced the following bill; which 

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

A BILL 

To improve the provision of care and services under the 

Veterans Community Care Program of the Department 

of Veterans Affairs, and for other purposes. 

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Veterans’ Health Empowerment, Access, Leadership, 

6 and Transparency for our Heroes (HEALTH) Act of 

7 2023’’. 

8 (b) TABLE OF CONTENTS.—The table of contents for 

9 this Act is as follows: 

Sec. 1. Short title; table of contents. 


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TITLE I—IMPROVEMENT OF VETERANS COMMUNITY CARE 

PROGRAM 

Sec. 101. Codification of requirements for eligibility standards for access to 

community care from Department of Veterans Affairs. 

Sec. 102. Requirement that Secretary notify veterans of eligibility for care 

under Veterans Community Care Program. 

Sec. 103. Consideration under Veterans Community Care Program of veteran 

preference for care and need for caregiver or attendant. 

Sec. 104. Notification of denial of request for care under Veterans Community 

Care Program. 

Sec. 105. Discussion of telehealth options under Veterans Community Care 

Program. 

Sec. 106. Finality of decision by veteran and veteran’s referring provider. 

Sec. 107. Outreach regarding care and services under Veterans Community 

Care Program. 

Sec. 108. Plan to improve administration of care under Veterans Community 

Care Program. 

Sec. 109. Use of value-based reimbursement models under Veterans Community 

Care Program. 

Sec. 110. Extension of deadline for submittal of claims by health care entities 

and providers under prompt payment standard. 

Sec. 111. Inspector General assessment of implementation of Veterans Community Care Program. 

TITLE II—OTHER HEALTH CARE MATTERS 

Sec. 201. Strategic plan on transition of Veterans Health Administration to 

value-based health care model. 

Sec. 202. Plan on establishment of interactive, online self-service module for 

care. 

Sec. 203. Publication of wait times for care at medical centers of Department 

of Veterans Affairs. 

Sec. 204. Documentation of preferences of veterans for scheduling of appointments for care. 

Sec. 205. Staffing model and performance metrics for certain employees of the 

Department of Veterans Affairs. 

Sec. 206. Modification of requirements for Center for Innovation for Care and 

Payment of the Department of Veterans Affairs and requirement for pilot program. 

Sec. 207. Online health education portal for veterans enrolled in patient enrollment system of Department of Veterans Affairs. 

Sec. 208. Reports. 


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1 TITLE I—IMPROVEMENT OF VET2 ERANS COMMUNITY CARE 

3 PROGRAM 

4 SEC. 101. CODIFICATION OF REQUIREMENTS FOR ELIGI5 BILITY STANDARDS FOR ACCESS TO COMMU6 NITY CARE FROM DEPARTMENT OF VET7 ERANS AFFAIRS. 

8 (a) ELIGIBILITY ACCESS STANDARDS.—Section 

9 1703B of title 38, United States Code, is amended— 

10 (1) by striking subsections (a) through (e) and 

11 inserting the following: 

12 ‘‘(a) ELIGIBILITY STANDARDS FOR ACCESS TO COM13 MUNITY CARE.—(1) A covered veteran shall be eligible to 

14 elect to receive non-Department hospital care, medical 

15 services, or extended care services, excluding nursing home 

16 care, through the Veterans Community Care Program 

17 under section 1703 of this title pursuant to subsection 

18 (d)(1)(D) of such section using the following eligibility ac19 cess standards: 

20 ‘‘(A) With respect to primary care, mental 

21 health care, or extended care services, excluding 

22 nursing home care, if the Department cannot sched23 ule an appointment for the covered veteran with a 

24 health care provider of the Department who can pro25 vide the needed service— 


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1 ‘‘(i) within 30 minutes average driving 

2 time (or such shorter average driving time as 

3 the Secretary may prescribe) from the residence 

4 of the veteran unless a longer average driving 

5 time has been agreed to by the veteran in con6 sultation with a health care provider of the vet7 eran; and 

8 ‘‘(ii) within 20 days (or such shorter pe9 riod as the Secretary may prescribe) of the date 

10 of request for such an appointment unless a 

11 later date has been agreed to by the veteran in 

12 consultation with a health care provider of the 

13 veteran. 

14 ‘‘(B) With respect to specialty care, if the De15 partment cannot schedule an appointment for the 

16 covered veteran with a health care provider of the 

17 Department who can provide the needed service— 

18 ‘‘(i) within 60 minutes average driving 

19 time (or such shorter average driving time as 

20 the Secretary may prescribe) from the residence 

21 of the veteran unless a longer average driving 

22 time has been agreed to by the veteran in con23 sultation with a health care provider of the vet24 eran; and 


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1 ‘‘(ii) within 28 days (or such shorter pe2 riod as the Secretary may prescribe) of the date 

3 of request for such an appointment unless a 

4 later date has been agreed to by the veteran in 

5 consultation with a health care provider of the 

6 veteran. 

7 ‘‘(2) For the purposes of determining the eligibility 

8 of a covered veteran for care or services under paragraph 

9 (1), the Secretary shall not take into consideration the 

10 availability of telehealth appointments from the Depart11 ment when determining whether the Department is able 

12 to furnish such care or services in a manner that complies 

13 with the eligibility access standards under such paragraph. 

14 ‘‘(3) In the case of a covered veteran who has had 

15 an appointment with a health care provider of the Depart16 ment canceled by the Department for a reason other than 

17 the request of the veteran, in calculating a wait time for 

18 a subsequent appointment under paragraph (1), the Sec19 retary shall calculate such wait time from the date of the 

20 request for the original, canceled appointment. 

21 ‘‘(4) If a veteran agrees to a longer average drive 

22 time or a later date under subparagraph (A) or (B) of 

23 paragraph (1), the Secretary shall document the agree24 ment to such longer average drive time or later date in 

25 the electronic health record of the veteran and provide the 


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1 veteran a copy of such documentation. Such copy may be 

2 provided electronically. 

3 ‘‘(b) APPLICATION.—The Secretary shall ensure that 

4 the eligibility access standards established under sub5 section (a) apply— 

6 ‘‘(1) to all care and services within the medical 

7 benefits package of the Department to which a cov8 ered veteran is eligible under section 1703 of this 

9 title, excluding nursing home care; and 

10 ‘‘(2) to all covered veterans, regardless of 

11 whether a veteran is a new or established patient. 

12 ‘‘(c) PERIODIC REVIEW OF ACCESS STANDARDS.— 

13 Not later than three years after the date of the enactment 

14 of the Veterans’ Health Empowerment, Access, Leader15 ship, and Transparency for our Heroes (HEALTH) Act 

16 of 2023, and not less frequently than once every three 

17 years thereafter, the Secretary shall— 

18 ‘‘(1) conduct a review of the eligibility access 

19 standards under subsection (a) in consultation 

20 with— 

21 ‘‘(A) such Federal entities as the Secretary 

22 considers appropriate, including the Depart23 ment of Defense, the Department of Health and 

24 Human Services, and the Centers for Medicare 

25 & Medicaid Services; 


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1 ‘‘(B) entities and individuals in the private 

2 sector, including— 

3 ‘‘(i) veteran patients; 

4 ‘‘(ii) veterans service organizations; 

5 and 

6 ‘‘(iii) health care providers partici7 pating in the Veterans Community Care 

8 Program under section 1703 of this title; 

9 and 

10 ‘‘(C) other entities that are not part of the 

11 Federal Government; and 

12 ‘‘(2) submit to the appropriate committees of 

13 Congress a report on— 

14 ‘‘(A) the findings of the Secretary with re15 spect to the review conducted under paragraph 

16 (1); and 

17 ‘‘(B) such recommendations as the Sec18 retary may have with respect to the eligibility 

19 access standards under subsection (a).’’; 

20 (2) by striking subsection (g); 

21 (3) by redesignating subsections (f), (h), and (i) 

22 as subsections (d), (e), and (f), respectively; 

23 (4) in subsection (d), as redesignated by para24 graph (3)— 


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1 (A) by striking ‘‘established’’ each place it 

2 appears; and 

3 (B) in paragraph (1), by striking ‘‘(1) 

4 Subject to’’ and inserting ‘‘COMPLIANCE BY

5 COMMUNITY CARE PROVIDERS WITH ACCESS

6 STANDARDS.—(1) Subject to’’; 

7 (5) in subsection (e), as so redesignated— 

8 (A) in paragraph (1)— 

9 (i) by striking ‘‘(1) Consistent with’’ 

10 and inserting ‘‘DETERMINATION REGARD11 ING ELIGIBILITY.—(1) Consistent with’’; 

12 and 

13 (ii) by striking ‘‘designated access 

14 standards established under this section’’ 

15 and inserting ‘‘eligibility access standards 

16 under subsection (a)’’; and 

17 (B) in paragraph (2)(B), by striking ‘‘des18 ignated access standards established under this 

19 section’’ and inserting ‘‘eligibility access stand20 ards under subsection (a)’’; and 

21 (6) in subsection (f), as redesignated by para22 graph (2)— 

23 (A) in the matter preceding paragraph (1), 

24 by striking ‘‘In this section’’ and inserting 

25 ‘‘DEFINITIONS.—In this section’’; and 


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1 (B) in paragraph (2)— 

2 (i) by striking ‘‘covered veterans’’ and 

3 inserting ‘‘covered veteran’’; and 

4 (ii) by striking ‘‘veterans described’’ 

5 and inserting ‘‘a veteran described’’. 

6 (b) CONFORMING AMENDMENTS.—Section 1703(d) 

7 of such title is amended— 

8 (1) in paragraph (1)(D), by striking ‘‘des9 ignated access standards developed by the Secretary 

10 under section 1703B of this title’’ and inserting ‘‘eli11 gibility access standards under section 1703B(a) of 

12 this title’’; and 

13 (2) in paragraph (3), by striking ‘‘designated 

14 access standards developed by the Secretary under 

15 section 1703B of this title’’ and inserting ‘‘eligibility 

16 access standards under section 1703B(a) of this 

17 title’’. 

18 SEC. 102. REQUIREMENT THAT SECRETARY NOTIFY VET19 ERANS OF ELIGIBILITY FOR CARE UNDER 

20 VETERANS COMMUNITY CARE PROGRAM. 

21 Section 1703(a) of title 38, United States Code, is 

22 amended by adding at the end the following new para23 graph: 

24 ‘‘(5)(A) The Secretary shall notify each covered vet25 eran in writing of the eligibility of such veteran for care 


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1 or services under this section as soon as possible, but not 

2 later than two business days, after the date on which the 

3 Secretary is aware that the veteran is seeking care or serv4 ices and is eligible for such care or services under this 

5 section. 

6 ‘‘(B) With respect to each covered veteran eligible for 

7 care or services under subsection (d), the Secretary shall 

8 provide such veteran periodic reminders, as the Secretary 

9 determines appropriate, of their ongoing eligibility under 

10 such subsection. 

11 ‘‘(C) Any notification or reminder under this para12 graph may be provided electronically.’’. 

13 SEC. 103. CONSIDERATION UNDER VETERANS COMMUNITY 

14 CARE PROGRAM OF VETERAN PREFERENCE 

15 FOR CARE AND NEED FOR CAREGIVER OR AT16 TENDANT. 

17 Section 1703(d)(2) of title 38, United States Code, 

18 is amended by adding at the end the following new sub19 paragraphs: 

20 ‘‘(F) The preference of the covered veteran for 

21 where, when, and how to seek hospital care, medical 

22 services, or extended care services. 

23 ‘‘(G) Whether the covered veteran requests or 

24 requires the assistance of a caregiver or attendant 


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1 when seeking hospital care, medical services, or ex2 tended care services.’’. 

3 SEC. 104. NOTIFICATION OF DENIAL OF REQUEST FOR 

4 CARE UNDER VETERANS COMMUNITY CARE 

5 PROGRAM. 

6 Section 1703 of title 38, United States Code, is 

7 amended— 

8 (1) by redesignating subsection (o) as sub9 section (p); and 

10 (2) by inserting after subsection (n) the fol11 lowing new subsection (o): 

12 ‘‘(o) NOTIFICATION OF DENIAL OF REQUEST FOR

13 CARE AND HOW TO APPEAL.—(1) If a request by a vet14 eran for care or services under this section is denied, the 

15 Secretary shall notify the veteran in writing as soon as 

16 possible, but not later than two business days, after the 

17 denial is made— 

18 ‘‘(A) of the reason for the denial; and 

19 ‘‘(B) with instructions on how to appeal such 

20 denial using the clinical appeals process of the Vet21 erans Health Administration. 

22 ‘‘(2) If a denial under paragraph (1) is due to not 

23 meeting the eligibility access standards under section 

24 1703B(a) of this title, notice under such paragraph shall 


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1 include an explanation for why the Secretary does not con2 sider the veteran to have met such standards. 

3 ‘‘(3) Any notification under this subsection may be 

4 provided electronically.’’. 

5 SEC. 105. DISCUSSION OF TELEHEALTH OPTIONS UNDER 

6 VETERANS COMMUNITY CARE PROGRAM. 

7 Section 1703 of title 38, United States Code, as 

8 amended by section 104, is further amended— 

9 (1) by redesignating subsection (p) as sub10 section (q); and 

11 (2) by inserting after subsection (o) the fol12 lowing new subsection (p): 

13 ‘‘(p) DISCUSSION OF OPTIONS FOR TELEHEALTH.— 

14 When discussing options for care or services for a covered 

15 veteran under this section, the Secretary shall ensure that 

16 the veteran is informed of the ability of the veteran to 

17 seek care or services via telehealth, either through a med18 ical facility of the Department or under this section, if 

19 telehealth— 

20 ‘‘(1) is available to the veteran; 

21 ‘‘(2) is appropriate for the type of care or serv22 ices the veteran is seeking, as determined by the 

23 Secretary; and 

24 ‘‘(3) is acceptable to the veteran.’’. 


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1 SEC. 106. FINALITY OF DECISION BY VETERAN AND VET2 ERAN’S REFERRING PROVIDER. 

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

4 States Code, as amended by sections 104 and 105, is fur5 ther amended— 

6 (1) by redesignating subsection (q) as sub7 section (r); and 

8 (2) by inserting after subsection (p) the fol9 lowing new subsection (q): 

10 ‘‘(q) FINALITY OF DECISION BY VETERAN AND RE11 FERRING PROVIDER.—An agreement by a covered veteran 

12 and the covered veteran’s referring provider under this 

13 section regarding the best medical interest of the covered 

14 veteran or regarding eligibility for care or services under 

15 this section, including an agreement under subsection 

16 (d)(1)(E), is final and may not be changed by the Depart17 ment without the knowledge and consent, documented in 

18 writing, of the covered veteran and the provider unless 

19 there is a statutory or regulatory barrier preventing the 

20 Department from providing the care or services in ques21 tion.’’. 

22 (b) CONFORMING AMENDMENT.—Section 

23 1703(d)(1)(E) of title 38, United States Code, is amended 

24 by striking ‘‘referring clinician’’ and inserting ‘‘referring 

25 provider’’. 


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1 SEC. 107. OUTREACH REGARDING CARE AND SERVICES 

2 UNDER VETERANS COMMUNITY CARE PRO3 GRAM. 

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

5 States Code, as amended by sections 104, 105, and 106, 

6 is further amended— 

7 (1) by redesignating subsection (r) as sub8 section (s); and 

9 (2) by inserting after subsection (q) the fol10 lowing new subsection (r): 

11 ‘‘(r) OUTREACH REGARDING AVAILABILITY OF CARE

12 AND SERVICES.—(1) The Secretary shall— 

13 ‘‘(A) conduct public outreach to inform veterans 

14 of— 

15 ‘‘(i) the conditions for eligibility for care or 

16 services under subsections (d) and (e); 

17 ‘‘(ii) how to request such care or services; 

18 and 

19 ‘‘(iii) how to appeal a denial of a request 

20 for such care or services using the clinical ap21 peals process of the Veterans Health Adminis22 tration; and 

23 ‘‘(B) ensure that information about eligibility 

24 for care or services under subsections (d) and (e) is 

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1 ment and included in other outreach campaigns and 

2 activities conducted by the Secretary. 

3 ‘‘(2) Upon enrollment of a veteran in the system of 

4 annual patient enrollment established and operated under 

5 section 1705 of this title, and not less frequently than 

6 every two years thereafter, the Secretary shall directly in7 form the veteran of— 

8 ‘‘(A) the conditions for eligibility for care or 

9 services under subsections (d) and (e); 

10 ‘‘(B) how to request such care or services; and 

11 ‘‘(C) how to appeal a denial of a request for 

12 such care or services using the clinical appeals proc13 ess of the Veterans Health Administration. 

14 ‘‘(3) The Secretary shall ensure that each medical fa15 cility of the Department publicly displays information re16 garding— 

17 ‘‘(A) the conditions for eligibility of veterans for 

18 care or services under subsections (d) and (e); 

19 ‘‘(B) how to request such care or services; and 

20 ‘‘(C) how to appeal a denial of a request for 

21 such care or services using the clinical appeals proc22 ess of the Veterans Health Administration.’’. 

23 (b) TRANSITIONAL SERVICES UPON SEPARATION

24 FROM ARMED FORCES.—Section 1144(f)(1)(B)(i) of title 

25 10, United States Code, is amended by inserting ‘‘, includVerDate Sep 11 2014 02:39 May 03, 2023 Jkt 039200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S1315.IS S1315

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1 ing how to enroll in the system of annual patient enroll2 ment established and operated under section 1705 of title 

3 38, the ability to seek care and services under sections 

4 1703 and 1710 of such title’’ before the semicolon. 

5 (c) SOLID START PROGRAM.—Section 6320(a)(2)(A) 

6 of title 38, United States Code, is amended by inserting 

7 ‘‘, including how to enroll in the system of annual patient 

8 enrollment established and operated under section 1705 

9 of this title and the ability to seek care and services under 

10 sections 1703 and 1710 of this title’’ before the semicolon. 

11 (d) COMPTROLLER GENERAL REPORT ON OUT12 REACH.—Not later than two years after the date of the 

13 enactment of this Act, the Comptroller General of the 

14 United States shall submit to Congress a report on the 

15 efforts of the Department of Veterans Affairs to ensure 

16 that veterans are informed of the conditions for eligibility 

17 for care and services under section 1703 of title 38, 

18 United States Code, including outreach conducted under 

19 subsection (r) of such section, as added by subsection (a) 

20 of this section. 

21 SEC. 108. PLAN TO IMPROVE ADMINISTRATION OF CARE 

22 UNDER VETERANS COMMUNITY CARE PRO23 GRAM. 

24 (a) IN GENERAL.—The Secretary of Veterans Af25 fairs, working with Third Party Administrators and acting 


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1 through the Center for Innovation for Care and Payment 

2 of the Department of Veterans Affairs under section 

3 1703E of title 38, United States Code, shall develop and 

4 implement a plan— 

5 (1) to provide monetary and non-monetary in6 centives to health care providers specified in sub7 section (c) of section 1703 of title 38, United States 

8 Code, furnishing care or services under the Veterans 

9 Community Care Program under such section pursu10 ant to an agreement with a Third Party Adminis11 trator— 

12 (A) to allow the Secretary and Third Party 

13 Administrators to see the scheduling system of 

14 the provider for purposes of assessing avail15 ability and assisting with scheduling appoint16 ments for veterans under such program, includ17 ing through synchronous, asynchronous, and 

18 asynchronous assisted digital scheduling; 

19 (B) to complete training for continuing 

20 professional education credit regarding veteran 

21 cultural competency and other subjects as de22 termined appropriate by the Secretary and to 

23 better account for equivalent or similar non-De24 partment training; 


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1 (C) to improve the rate of the timely re2 turn to the Department of medical record docu3 mentation for care or services provided under 

4 such program; 

5 (D) to improve the timeliness and quality 

6 of the delivery of care and services to veterans 

7 under such program; and 

8 (E) to achieve such other objectives as de9 termined appropriate by the Secretary in con10 sultation with Third Party Administrators; 

11 (2) to decrease the rate of no-show appoint12 ments under such program and consider the feasi13 bility and advisability of appropriately compensating 

14 such health care providers for no-show appointments 

15 under such program; and 

16 (3) within each region in which such program 

17 is carried out, to assess needed specialties and 

18 incentivize community providers in those specialties 

19 to participate in such program. 

20 (b) VALUE-BASED REIMBURSEMENT MODELS.—In 

21 developing the plan under subsection (a), the Secretary 

22 and Third Party Administrators shall explore value-based 

23 reimbursement models authorized to be used under section 

24 1703(i)(5) of title 38, United States Code, to achieve the 

25 goals under such subsection. 


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1 (c) SUBMITTAL OF PLAN.— 

2 (1) INITIAL PLAN.—Not later than 180 days 

3 after the date of the enactment of this Act, the Sec4 retary shall submit to the Committee on Veterans’ 

5 Affairs of the Senate and the Committee on Vet6 erans’ Affairs of the House of Representatives the 

7 plan developed under subsection (a). 

8 (2) QUARTERLY UPDATE.—Not less frequently 

9 than quarterly during the five-year period following 

10 the submittal of the plan under paragraph (1), the 

11 Secretary shall submit to the Committee on Vet12 erans’ Affairs of the Senate and the Committee on 

13 Veterans’ Affairs of the House of Representatives a 

14 report containing any updates on the implementa15 tion of such plan. 

16 (3) USE OF VALUE-BASED REIMBURSEMENT

17 MODELS.—The Secretary shall include with the plan 

18 submitted under paragraph (1) and any report sub19 mitted under paragraph (2)— 

20 (A) a complete list of the value-based reim21 bursement models considered under the plan; 

22 (B) an indication of whether any such 

23 model has been put into practice; and 

24 (C) with respect to any such model that 

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1 scription of the reasons such model was not put 

2 into practice. 

3 (d) NO PENALTY FOR NOT MEETING OBJECTIVES.— 

4 Health care providers specified in section 1703(c) of title 

5 38, United States Code, shall not be penalized for not 

6 meeting an objective under paragraph (1) of subsection 

7 (a) included in the plan required under such subsection. 

8 (e) RULE OF CONSTRUCTION.—This section shall not 

9 be construed to be a pilot program subject to the require10 ments of section 1703E of title 38, United States Code. 

11 (f) THIRD PARTY ADMINISTRATOR DEFINED.—In 

12 this section, the term ‘‘Third Party Administrator’’ means 

13 an entity that manages a provider network and performs 

14 administrative services related to such network under sec15 tion 1703 of title 38, United States Code. 

16 SEC. 109. USE OF VALUE-BASED REIMBURSEMENT MODELS 

17 UNDER VETERANS COMMUNITY CARE PRO18 GRAM. 

19 (a) IN GENERAL.—Section 1703(i)(5) of title 38, 

20 United States Code, is amended by striking ‘‘may’’ and 

21 inserting ‘‘shall’’. 

22 (b) NEGOTIATION OF TERMS.—The Secretary of Vet23 erans Affairs shall negotiate with Third Party Administra24 tors to establish the use of value-based reimbursement 

25 models under the Veterans Community Care Program 


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1 under section 1703 of title 38, United States Code, pursu2 ant to the amendment made by subsection (a). 

3 (c) REPORT ON VALUE-BASED REIMBURSEMENT

4 MODELS.—Not later than one year after negotiating 

5 under subsection (b) terms to establish the use of value6 based reimbursement models under the Veterans Commu7 nity Care Program under section 1703 of title 38, United 

8 States Code, the Secretary, in consultation with the Cen9 ter for Innovation for Care and Payment of the Depart10 ment of Veterans Affairs under section 1703E of title 38, 

11 United States Code, and the Office of Integrated Veteran 

12 Care of the Department, or successor office, shall submit 

13 to the Committee on Veterans’ Affairs of the Senate and 

14 the Committee on Veterans’ Affairs of the House of Rep15 resentatives a report containing— 

16 (1) an assessment of the efforts of the Depart17 ment pursuant to section 1703(i)(5) of such title, as 

18 amended by subsection (a), to incorporate value19 based reimbursement models to promote the provi20 sion of high-quality care to veterans; and 

21 (2) such recommendations for legislative or ad22 ministrative action as the Secretary considers appro23 priate to increase the use of value-based reimburse24 ment models throughout the Veterans Community 

25 Care Program under section 1703 of such title. 


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1 (d) RULE OF CONSTRUCTION.—This section shall not 

2 be construed to be a pilot program subject to the require3 ments of section 1703E of title 38, United States Code. 

4 (e) THIRD PARTY ADMINISTRATOR DEFINED.—In 

5 this section, the term ‘‘Third Party Administrator’’ means 

6 an entity that manages a provider network and performs 

7 administrative services related to such network under sec8 tion 1703 of title 38, United States Code. 

9 SEC. 110. EXTENSION OF DEADLINE FOR SUBMITTAL OF 

10 CLAIMS BY HEALTH CARE ENTITIES AND 

11 PROVIDERS UNDER PROMPT PAYMENT 

12 STANDARD. 

13 Section 1703D(b) of title 38, United States Code, is 

14 amended by striking ‘‘180 days’’ and inserting ‘‘one year’’. 

15 SEC. 111. INSPECTOR GENERAL ASSESSMENT OF IMPLE16 MENTATION OF VETERANS COMMUNITY 

17 CARE PROGRAM. 

18 (a) IN GENERAL.—Not later than three years after 

19 the date of the enactment of this Act, and periodically 

20 thereafter as the Inspector General of the Department of 

21 Veterans Affairs considers appropriate, the Inspector Gen22 eral shall assess the performance of each medical center 

23 of the Department of Veterans Affairs in— 


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1 (1) appropriately identifying veterans eligible 

2 for care and services under section 1703 of title 38, 

3 United States Code; 

4 (2) informing veterans of their eligibility for 

5 such care and services, including, if appropriate and 

6 applicable, the availability of such care and services 

7 via telehealth; 

8 (3) delivering such care and services in a timely 

9 manner; and 

10 (4) appropriately coordinating such care and 

11 services. 

12 (b) COMMENCEMENT OF ASSESSMENT.—Not later 

13 than one year after the date of the enactment of this Act, 

14 the Inspector General of the Department shall commence 

15 the initial assessment required by subsection (a). 

16 TITLE II—OTHER HEALTH CARE 

17 MATTERS 

18 SEC. 201. STRATEGIC PLAN ON TRANSITION OF VETERANS 

19 HEALTH ADMINISTRATION TO VALUE-BASED 

20 HEALTH CARE MODEL. 

21 (a) FINDINGS.—Congress makes the following find22 ings: 

23 (1) The final report of the Creating Options for 

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1 tablished under section 931 of the Jason Simcakoski 

2 Memorial and Promise Act (title IX of Public Law 

3 114–198; 38 U.S.C. 1701 note) submitted under 

4 subsection (e)(2) of such section made a key rec5 ommendation to transform the current health care 

6 delivery model of the Department of Veterans Af7 fairs into one that is person-centered, relationship8 based, and recovery-focused, and to support that 

9 transformation with a system that is value-based 

10 and incentivized for continuous innovation and qual11 ity improvement. 

12 (2) The consensus study report of the Health 

13 and Medicine Division of the National Academies of 

14 Sciences, Engineering, and Medicine dated February 

15 2022 and entitled, ‘‘Achieving Whole Health: A New 

16 Approach for Veterans and the Nation’’ recommends 

17 the Veterans Health Administration adopt a value18 based model to align with delivering whole health 

19 care. 

20 (3) The consensus study report of the National 

21 Academy of Medicine dated October 2020 found that 

22 a value-based care model helps reduce physician 

23 burnout. 

24 (4) The National Academy of Medicine has de25 veloped a widely accepted approach that describes 


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1 high-value health care as safe, timely, effective, effi2 cient, equitable, and patient-centered (STEEEP). 

3 Further, the Institute for Healthcare Improvement 

4 has translated that approach into a framework for 

5 action known as the ‘‘Quadruple Aim’’. The Quad6 ruple Aim is made up of better patient outcomes, 

7 improved patient satisfaction, lower costs, and physi8 cian and health care professional well-being. 

9 (5) Health care systems that have made the 

10 transition to value-based care have seen a significant 

11 decrease in suicides among their patient population, 

12 and the top clinical priority of the Veterans Health 

13 Administration is suicide prevention. 

14 (6) Value-based care programs can encourage 

15 providers to work together to deliver coordinated, 

16 person-centered care, which will improve the overall 

17 quality of care. 

18 (7) A critical component of a successful transi19 tion to a value-based care delivery model is an oper20 ational electronic health record system in place as a 

21 foundation. 

22 (b) ESTABLISHMENT OF WORKING GROUP.— 

23 (1) IN GENERAL.—Not later than 90 days after 

24 the date of the enactment of this Act, the Secretary 

25 of Veterans Affairs shall establish a working group 


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1 on the shift of the Veterans Health Administration 

2 to a value-based care system. 

3 (2) MEMBERSHIP.— 

4 (A) REQUIRED MEMBERS.—The working 

5 group shall include, at a minimum, the fol6 lowing members: 

7 (i) The Under Secretary of Veterans 

8 Affairs for Health. 

9 (ii) The Director of the Office of Men10 tal Health and Suicide Prevention of the 

11 Department of Veterans Affairs, or suc12 cessor office. 

13 (iii) The Director of the Office of In14 tegrated Veteran Care of the Department, 

15 or successor office. 

16 (iv) The Director of the Office of 

17 Rural Health of the Department, or suc18 cessor office. 

19 (v) The Director of the Office of Con20 nected Care of the Department, or suc21 cessor office. 

22 (vi) The Director of the Office of In23 formation and Technology of the Depart24 ment, or successor office. 


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1 (vii) The Chief Officer of the Office of 

2 Healthcare Innovation and Learning of the 

3 Office of Discovery, Education, and Affil4 iate Networks of the Veterans Health Ad5 ministration, or successor office. 

6 (viii) An individual designated by the 

7 Secretary from the Center for Innovation 

8 for Care and Payment of the Department 

9 under section 1703E of title 38, United 

10 States Code. 

11 (ix) An individual designated by the 

12 Administrator of the Centers for Medicare 

13 & Medicaid Services from the Center for 

14 Medicare and Medicaid Innovation. 

15 (x) An individual designated by the 

16 Secretary of Health and Human Services 

17 from the Federal Office of Rural Health 

18 Policy of the Health Resources and Serv19 ices Administration. 

20 (B) OPTIONAL MEMBERS.—The Secretary 

21 of Veterans Affairs may appoint any of the fol22 lowing individuals as members of the working 

23 group: 

24 (i) An individual representing the 

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1 tional Academies of Sciences, Engineering, 

2 and Medicine. 

3 (ii) An individual designated by the 

4 Chairman of the Veterans’ Expedited Re5 covery Commission (commonly referred to 

6 as the ‘‘COVER Commission’’) established 

7 under section 931 of the Jason Simcakoski 

8 Memorial and Promise Act (title IX of 

9 Public Law 114–198; 38 U.S.C. 1701 

10 note). 

11 (iii) Three individuals representing a 

12 private health care system that has made 

13 the transition to value-based care. 

14 (iv) Three individuals representing a 

15 health care provider participating in the 

16 Veterans Community Care Program under 

17 section 1703 of title 38, United States 

18 Code, that operates under a value-based 

19 care model. 

20 (v) An individual representing an or21 ganization recognized by the Secretary of 

22 Veterans Affairs under section 5902 of 

23 title 38, United States Code. 

24 (3) EXEMPTION FROM APPLICATION OF

25 FACA.—Chapter 10 of title 5, United States Code, 


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1 shall not apply to the working group established 

2 under paragraph (1). 

3 (c) DEVELOPMENT OF STRATEGIC PLAN.— 

4 (1) IN GENERAL.—Not later than one year 

5 after the establishment of the working group under 

6 subsection (b), the working group shall develop a 

7 strategic plan to shift the Veterans Health Adminis8 tration to a value-based care system. 

9 (2) ELEMENTS.—The strategic plan required 

10 under paragraph (1) shall contain the following ele11 ments: 

12 (A) An identification of the current state 

13 of the Veterans Health Administration, includ14 ing an assessment of the current model of 

15 health care delivery used by the Veterans 

16 Health Administration in medical facilities of 

17 the Department of Veterans Affairs and 

18 through the Veterans Community Care Pro19 gram under section 1703 of title 38, United 

20 States Code, in comparison to a value-based 

21 care system. 

22 (B) An analysis of the leadership of the 

23 Veterans Health Administration, including an 

24 assessment of leadership acumen and ability to 

25 implement a shift with a clear, shared vision 


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1 and effective change management and care co2 ordination. 

3 (C) An identification of goals for the fu4 ture of the Veterans Health Administration. 

5 (D) An identification and classification of 

6 the current capabilities and gaps of the health 

7 care system of the Department of Veterans Af8 fairs. 

9 (E) An analysis of the four main types of 

10 value-based care models, including— 

11 (i) a selection of the model that best 

12 fits a successful transition for the Veterans 

13 Health Administration; and 

14 (ii) a thorough justification of the se15 lection of such model. 

16 (F) A definition of what quality means 

17 with respect to access to health care and deliv18 ery of health care. 

19 (G) A definition of what value means with 

20 respect to care furnished by the Veterans 

21 Health Administration, a system, with metrics, 

22 for measuring value within the Veterans Health 

23 Administration that includes outcomes, safety, 

24 service, access, and total cost of patient care, 

25 and an analysis of variable value with respect to 


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1 patient outcomes across different health care 

2 types and specialities. 

3 (H) An assessment of the current informa4 tion technology infrastructure of the Veterans 

5 Health Administration and any recommenda6 tions to make such infrastructure more robust. 

7 (I) An assessment of the workforce chal8 lenges and needs of the Veterans Health Ad9 ministration, including with respect to recruit10 ment and retention and the effectiveness of the 

11 ability of the performance appraisal system of 

12 the Veterans Health Administration to appro13 priately incentivize and reward employees and 

14 ensure adherence to relevant statutes, regula15 tions, policy directives, and treatment guide16 lines. 

17 (J) An assessment of the current value18 driven framework of the Department for evalu19 ating health care innovations and how that 

20 framework could be used to propel a shift in the 

21 model of care delivery by the Department. 

22 (K) A focus on value-based care for pri23 mary care, inpatient and outpatient mental 

24 health care, and inpatient and outpatient sub25 stance use treatment. 


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1 (L) A description of the timeline, costs, 

2 and legislative or administrative action nec3 essary to transition the Veterans Health Ad4 ministration to a value-based care system. 

5 (d) SUBMITTAL OF STRATEGIC PLAN TO CON6 GRESS.—Not later than 30 days after the completion by 

7 the working group established under subsection (b) of the 

8 strategic plan required under subsection (c), the Secretary 

9 of Veterans Affairs shall submit the strategic plan to the 

10 Committee on Veterans’ Affairs of the Senate and the 

11 Committee on Veterans’ Affairs of the House of Rep12 resentatives. 

13 (e) PILOT PROGRAM IMPLEMENTATION OF STRA14 TEGIC PLAN.— 

15 (1) IN GENERAL.—Not later than 180 days 

16 after the submittal under subsection (d) of the stra17 tegic plan required under subsection (c), the Sec18 retary of Veterans Affairs shall commence a five19 year pilot program to implement the strategic plan. 

20 (2) CARE INCLUDED.—The pilot program under 

21 paragraph (1) shall include the implementation of 

22 the strategic plan for the delivery by the Veterans 

23 Health Administration of primary care, inpatient 

24 and outpatient mental health treatment, and inpa25 tient and outpatient substance use treatment. 


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1 (3) LOCATIONS.—The Secretary shall carry out 

2 the pilot program under paragraph (1) in four Vet3 erans Integrated Service Networks that are geo4 graphically dispersed and shall include the following: 

5 (A) A Veterans Integrated Service Net6 work that predominately serves veterans in 

7 rural and highly rural areas. 

8 (B) A Veterans Integrated Service Net9 work that predominately serves veterans in 

10 urban areas. 

11 (C) A Veterans Integrated Service Net12 work that has a high rate of suicide among vet13 erans. 

14 (D) A Veterans Integrated Service Net15 work that has a high rate of substance use dis16 order among veterans. 

17 (E) A Veterans Integrated Service Net18 work with a documented issue with workforce 

19 recruitment and retention. 

20 (4) REPORTS TO CONGRESS.— 

21 (A) ANNUAL REPORT.—Not later than one 

22 year after the commencement of the pilot pro23 gram, and annually thereafter during the dura24 tion of the pilot program, the Secretary shall 


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1 submit to Congress a report on the pilot pro2 gram. 

3 (B) FINAL REPORT.—Not later than 180 

4 days before the conclusion of the pilot program, 

5 the Secretary shall submit to Congress a final 

6 report on the pilot program that includes a plan 

7 and timeline for full implementation of the stra8 tegic plan required under subsection (c) across 

9 the entire Veterans Health Administration. 

10 SEC. 202. PLAN ON ESTABLISHMENT OF INTERACTIVE, ON11 LINE SELF-SERVICE MODULE FOR CARE. 

12 (a) IN GENERAL.—The Secretary of Veterans Af13 fairs, working with Third Party Administrators and acting 

14 through the Center for Innovation for Care and Payment 

15 of the Department of Veterans Affairs under section 

16 1703E of title 38, United States Code, shall develop and 

17 implement a plan to establish an interactive, online self18 service module— 

19 (1) to allow veterans to request appointments, 

20 track referrals for health care under the laws admin21 istered by the Secretary, whether at a facility of the 

22 Department or through a non-Department provider, 

23 and receive appointment reminders; 

24 (2) to allow veterans to appeal and track deci25 sions relating to— 


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1 (A) denials of requests for care or services 

2 under section 1703 of title 38, United States 

3 Code; or 

4 (B) denials of requests for care or services 

5 at facilities of the Department, including under 

6 section 1710 of such title; and 

7 (3) to implement such other matters as deter8 mined appropriate by the Secretary in consultation 

9 with Third Party Administrators. 

10 (b) SUBMITTAL OF PLAN.— 

11 (1) INITIAL PLAN.—Not later than 180 days 

12 after the date of the enactment of this Act, the Sec13 retary shall submit to the Committee on Veterans’ 

14 Affairs of the Senate and the Committee on Vet15 erans’ Affairs of the House of Representatives the 

16 plan developed under subsection (a). 

17 (2) QUARTERLY UPDATE.—Not less frequently 

18 than quarterly following the submittal of the plan 

19 under paragraph (1) and for two years thereafter, 

20 the Secretary shall submit to the Committee on Vet21 erans’ Affairs of the Senate and the Committee on 

22 Veterans’ Affairs of the House of Representatives a 

23 report containing any updates on the implementa24 tion of such plan. 


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1 (c) RULE OF CONSTRUCTION.—This section shall not 

2 be construed to be a pilot program subject to the require3 ments of section 1703E of title 38, United States Code. 

4 (d) THIRD PARTY ADMINISTRATOR DEFINED.—In 

5 this section, the term ‘‘Third Party Administrator’’ means 

6 an entity that manages a provider network and performs 

7 administrative services related to such network under sec8 tion 1703 of title 38, United States Code. 

9 SEC. 203. PUBLICATION OF WAIT TIMES FOR CARE AT MED10 ICAL CENTERS OF DEPARTMENT OF VET11 ERANS AFFAIRS. 

12 (a) IN GENERAL.—Subchapter I of chapter 17 of title 

13 38, United States Code, is amended by inserting after sec14 tion 1703F the following new section: 

15 ‘‘§ 1703G. Publication of wait times for care at med16 ical centers 

17 ‘‘(a) IN GENERAL.—The Secretary shall publish on 

18 a publicly available internet website of the Department the 

19 average wait time for a veteran to schedule an appoint20 ment at each medical center of the Department for the 

21 receipt of primary care, specialty care, and mental health 

22 care measured from the date of request for the appoint23 ment to the date on which the care was provided. 


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1 ‘‘(b) UPDATE.—The Secretary shall update the wait 

2 times published under subsection (a) not less frequently 

3 than monthly.’’. 

4 (b) CLERICAL AMENDMENT.—The table of sections 

5 at the beginning of such subchapter is amended by insert6 ing after the item relating to section 1703F the following 

7 new item: 

‘‘1703G. Publication of wait times for care at medical centers.’’. 

8 SEC. 204. DOCUMENTATION OF PREFERENCES OF VET9 ERANS FOR SCHEDULING OF APPOINTMENTS 

10 FOR CARE. 

11 (a) IN GENERAL.—Upon enrollment of a veteran in 

12 the system of annual patient enrollment of the Depart13 ment of Veterans Affairs established and operated under 

14 section 1705(a) of title 38, United States Code, and not 

15 less frequently than annually thereafter, the Secretary of 

16 Veterans Affairs shall solicit from the veteran the pref17 erence of the veteran for scheduling of appointments for 

18 health care and related services furnished by the Depart19 ment, including through non-Department providers. 

20 (b) DOCUMENTATION OF PREFERENCE.—Pref21 erences provided by a veteran pursuant to subsection (a) 

22 shall be documented on My HealtheVet or another system 

23 designated by the Secretary that allows the veteran to 

24 change such preferences at any time. 


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1 (c) INCLUSION IN PREFERENCE.—Preferences solic2 ited under subsection (a) shall include the following: 

3 (1) How and when the veteran prefers to be 

4 contacted by the Department about an appointment 

5 for health care. 

6 (2) Whether the veteran prefers to schedule 

7 their own appointments, if able. 

8 (3) Whether the veteran prefers to select their 

9 own provider, if able. 

10 (4) Whether the veteran prefers appointments 

11 to be scheduled during certain days or times. 

12 (5) Whether the veteran is willing to consider 

13 telehealth appointments. 

14 (d) USE OF PREFERENCE.—The Secretary shall 

15 make the preferences provided under subsection (a) easily 

16 accessible to medical support assistants and other staff of 

17 the Department assisting in the appointment scheduling 

18 process to use to improve the timeliness of the scheduling 

19 of appointments for health care and related services fur20 nished by the Department, including through non-Depart21 ment providers. 

22 SEC. 205. STAFFING MODEL AND PERFORMANCE METRICS 

23 FOR CERTAIN EMPLOYEES OF THE DEPART24 MENT OF VETERANS AFFAIRS. 

25 (a) STAFFING MODEL.— 


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1 (1) IN GENERAL.—Not later than one year 

2 after the date of the enactment of this Act, the Sec3 retary of Veterans Affairs shall— 

4 (A) develop, validate, and implement a 

5 staffing model for the Office of Integrated Vet6 eran Care of the Department of Veterans Af7 fairs, or successor office, Veterans Integrated 

8 Services Networks, and medical centers of the 

9 Department that includes appropriate target 

10 staffing levels nationally, regionally, and locally 

11 to ensure timely access to care and effectively 

12 oversee the provision of care by the Depart13 ment, whether at a facility of the Department 

14 or through a non-Department provider; and 

15 (B) provide to Congress a briefing on such 

16 staffing model, which shall include— 

17 (i) the metrics and measures used by 

18 the Secretary in developing such staffing 

19 model; and 

20 (ii) an analysis of how such staffing 

21 model compares to the staffing models of 

22 other relevant government and private sec23 tor health care systems. 

24 (2) REPORT ON IMPLEMENTATION OF STAFF25 ING MODEL.—Not later than one year after impleVerDate Sep 11 2014 02:39 May 03, 2023 Jkt 039200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\S1315.IS S1315

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1 menting the staffing model required under para2 graph (1), the Secretary shall submit to Congress 

3 and the Comptroller General of the United States a 

4 report containing— 

5 (A) an update on such implementation; 

6 and 

7 (B) information on the outcomes yielded 

8 by such staffing model in terms of improved ac9 cess to care for veterans and improved compli10 ance with relevant laws, regulations, policy di11 rectives, and guidance governing access to care. 

12 (b) PERFORMANCE METRICS.— 

13 (1) IN GENERAL.—Not later than one year 

14 after the date of the enactment of this Act, the Sec15 retary shall develop and implement a plan to incor16 porate appropriate performance metrics and ac17 countability measures within the performance ap18 praisal systems for employees of the Department 

19 specified in paragraph (2). 

20 (2) EMPLOYEES OF THE DEPARTMENT SPECI21 FIED.—Employees of the Department specified in 

22 this paragraph are employees who are responsible 

23 for ensuring timely access to care from the Depart24 ment, compliance with relevant statutes and regula25 tions relating to the provision of care, including secVerDate Sep 11 2014 02:39 May 03, 2023 Jkt 039200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\S1315.IS S1315

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1 tion 1703 of title 38, United States Code, and over2 seeing the provision of care, whether at a facility of 

3 the Department or through a non-Department pro4 vider, including employees within the Office of Inte5 grated Veteran Care of the Department, or suc6 cessor office, employees of a Veterans Integrated 

7 Service Network, and employees of a medical center 

8 of the Department. 

9 (3) REPORT ON IMPLEMENTATION OF PER10 FORMANCE METRICS.—Not later than one year after 

11 implementing the performance metrics required 

12 under paragraph (1), the Secretary shall submit to 

13 Congress and the Comptroller General of the United 

14 States a report containing— 

15 (A) an update on such implementation; 

16 and 

17 (B) information on the outcomes yielded 

18 by such performance metrics in terms of im19 proved access to care for veterans and improved 

20 compliance with relevant laws, policy directives, 

21 and guidance governing access to care. 

22 (c) COMPTROLLER GENERAL REPORT.—Not later 

23 than two years after receiving the report under subsection 

24 (a)(2) or the report under subsection (b)(3), whichever ocVerDate Sep 11 2014 02:39 May 03, 2023 Jkt 039200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\S1315.IS S1315

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1 curs later, the Comptroller General of the United States 

2 shall submit to Congress a report— 

3 (1) assessing the performance of the Office of 

4 Integrated Veteran Care of the Department, or suc5 cessor office, in improving access to care for vet6 erans in facilities of the Department and pursuant 

7 to section 1703 of title 38, United States Code; and 

8 (2) containing such recommendations as the 

9 Comptroller General considers appropriate relating 

10 to improving access to such care. 

11 SEC. 206. MODIFICATION OF REQUIREMENTS FOR CENTER 

12 FOR INNOVATION FOR CARE AND PAYMENT 

13 OF THE DEPARTMENT OF VETERANS AF14 FAIRS AND REQUIREMENT FOR PILOT PRO15 GRAM. 

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

17 States Code, is amended— 

18 (1) in subsection (a)— 

19 (A) in paragraph (1), by striking ‘‘within 

20 the Department’’ and inserting ‘‘within the Of21 fice of the Secretary’’; 

22 (B) in paragraph (2), by striking ‘‘may’’ 

23 and inserting ‘‘shall’’; and 

24 (C) in paragraph (3)— 


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1 (i) in subparagraph (A), by striking ‘‘; 

2 and’’ and inserting a semicolon; 

3 (ii) in subparagraph (B), by striking 

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

5 and 

6 (iii) by adding at the end the fol7 lowing new subparagraph: 

8 ‘‘(C) increase productivity, efficiency, and mod9 ernization throughout the Department.’’; 

10 (2) by striking subsection (d) and inserting the 

11 following new subsection (d): 

12 ‘‘(d) BUDGETARY LINE ITEM.—The Secretary shall 

13 include in the budget justification materials submitted to 

14 Congress in support of the budget of the Department of 

15 Veterans Affairs for a fiscal year (as submitted with the 

16 budget of the President under section 1105(a) of title 31) 

17 specific identification, as a budgetary line item, of the 

18 amounts required to carry out this section.’’; 

19 (3) in subsection (f)— 

20 (A) in paragraph (1), by striking ‘‘in sub21 chapters I, II, and III of this chapter’’ and in22 serting ‘‘of this title, of title 38, Code of Fed23 eral Regulations, and of any handbooks, direc24 tives, or policy documents of the Department’’; 

25 and 


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1 (B) in paragraph (2), in the matter pre2 ceding subparagraph (A), by striking ‘‘waiving 

3 any authority’’ and inserting ‘‘waiving any pro4 vision of this title’’; 

5 (4) in subsection (g)(1), by inserting ‘‘fewer 

6 than three or’’ before ‘‘more than 10’’; 

7 (5) in subsection (i)— 

8 (A) in paragraph (1), by striking ‘‘the 

9 Under Secretary for Health and the Special 

10 Medical Advisory Group established pursuant to 

11 section 7312 of this title’’ and inserting ‘‘the 

12 Under Secretary for Health, the Special Med13 ical Advisory Group established pursuant to 

14 section 7312 of this title, the Office of Inte15 grated Veteran Care (or successor office), the 

16 Office of Finance (or successor office), the Vet17 eran Experience Office (or successor office), the 

18 Office of Enterprise Integration (or successor 

19 office), and the Office of Information and Tech20 nology (or successor office)’’; and 

21 (B) in paragraph (2), by striking ‘‘rep22 resentatives of relevant Federal agencies, and 

23 clinical and analytical experts with expertise in 

24 medicine and health care management’’ and in25 serting ‘‘representatives of relevant Federal 


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1 agencies, nonprofit organizations, and other 

2 public and private sector entities, including 

3 those with clinical and analytical experts with 

4 expertise in medicine and health care manage5 ment’’; and 

6 (6) by adding at the end the following new sub7 section: 

8 ‘‘(k) REPORT ON ACTIVITIES OF CENTER FOR INNO9 VATION FOR CARE AND PAYMENT.—Not less frequently 

10 than annually, the Secretary shall submit to Congress a 

11 report that contains, for the one-year period preceding the 

12 date of the report— 

13 ‘‘(1) a full accounting of the activities, staff, 

14 budget, and other resources and efforts of the Cen15 ter; and 

16 ‘‘(2) an assessment of the outcomes of the ef17 forts of the Center.’’. 

18 (b) COMPTROLLER GENERAL REPORT.—Not later 

19 than 18 months after the date of the enactment of this 

20 Act, the Comptroller General of the United States shall 

21 submit to Congress a report— 

22 (1) on the efforts of the Center for Innovation 

23 for Care and Payment of the Department of Vet24 erans Affairs in fulfilling the objectives and requireVerDate Sep 11 2014 02:39 May 03, 2023 Jkt 039200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\S1315.IS S1315

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1 ments under section 1703E of title 38, United 

2 States Code, as amended by subsection (a); and 

3 (2) containing such recommendations as the 

4 Comptroller General considers appropriate. 

5 (c) PILOT PROGRAM.— 

6 (1) IN GENERAL.—Not later than one year 

7 after the date of the enactment of this Act, the Cen8 ter for Innovation for Care and Payment of the De9 partment of Veterans Affairs under section 1703E 

10 of title 38, United States Code, shall establish a 

11 three-year pilot program in not fewer than five loca12 tions to allow veterans enrolled in the system of an13 nual patient enrollment of the Department estab14 lished and operated under section 1705(a) of such 

15 title to access outpatient mental health and sub16 stance use services through health care providers 

17 specified under section 1703(c) of such title without 

18 referral or pre-authorization. 

19 (2) PRIORITY.—In selecting sites for the pilot 

20 program under paragraph (1), the Secretary shall 

21 prioritize sites in the following areas: 

22 (A) Areas with varying degrees of urban23 ization, including urban, rural, and highly rural 

24 areas. 


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1 (B) Areas with high rates of suicide among 

2 veterans. 

3 (C) Areas with high rates of overdose 

4 deaths among veterans. 

5 (D) Areas with high rates of calls to the 

6 Veterans Crisis Line. 

7 (E) Areas with long wait times for mental 

8 health and substance use services at facilities of 

9 the Department. 

10 (F) Areas with outpatient mental health 

11 and substance use programs that utilize a 

12 value-based care model, to the extent prac13 ticable. 

14 (3) ELEMENTS.—The Secretary, in imple15 menting the pilot program under paragraph (1), 

16 shall ensure the Department has a care coordination 

17 system in place that includes— 

18 (A) knowledge sharing, including the time19 ly exchange of medical documentation; 

20 (B) assistance with transitions of care, in21 cluding the potential need for inpatient or resi22 dential psychiatric services, substance use de23 toxification services, post-detoxification step24 down services, and residential rehabilitation 

25 programs; 


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1 (C) continuous assessment of patient needs 

2 and goals; and 

3 (D) creating personalized, proactive care 

4 plans. 

5 (4) OVERSIGHT AND OUTCOMES.—The Sec6 retary shall develop appropriate metrics and meas7 ures— 

8 (A) to track and oversee sites at which the 

9 pilot program under paragraph (1) is carried 

10 out; 

11 (B) to monitor patient safety and out12 comes under the pilot program; and 

13 (C) to assess and mitigate any barriers to 

14 extending the pilot program across the entire 

15 Veterans Health Administration. 

16 (5) ANNUAL REPORT.— 

17 (A) IN GENERAL.—Not later than one year 

18 after the commencement of the pilot program 

19 under paragraph (1), and not less frequently 

20 than annually thereafter during the duration of 

21 the pilot program, the Secretary shall submit to 

22 the Committee on Veterans’ Affairs of the Sen23 ate and Committee on Veterans’ Affairs of the 

24 House of Representatives a report on the pilot 

25 program, which shall include the following: 


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1 (i) The number of unique veterans 

2 who participated in the pilot program. 

3 (ii) The number of health care pro4 viders who participated in the pilot pro5 gram. 

6 (iii) An assessment of the effective7 ness of the pilot program in increasing ac8 cess to, and improving outcomes for, men9 tal health and substance use treatment 

10 services. 

11 (iv) The cost of the pilot program. 

12 (v) Such other matters as the Sec13 retary considers appropriate. 

14 (B) FINAL REPORT.—The Secretary shall 

15 include in the final report submitted under sub16 paragraph (A), in addition to the requirements 

17 under such subparagraph, the assessment by 

18 the Secretary of the feasibility and advisability 

19 of extending the pilot program across the entire 

20 Veterans Health Administration, including a 

21 plan, timeline, and required resources for such 

22 an extension. 

23 (6) VETERANS CRISIS LINE DEFINED.—In this 

24 subsection, the term ‘‘Veterans Crisis Line’’ means 


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1 the toll-free hotline for veterans established under 

2 section 1720F(h) of title 38, United States Code. 

3 SEC. 207. ONLINE HEALTH EDUCATION PORTAL FOR VET4 ERANS ENROLLED IN PATIENT ENROLLMENT 

5 SYSTEM OF DEPARTMENT OF VETERANS AF6 FAIRS. 

7 Not later than one year after the date of the enact8 ment of this Act, the Secretary of Veterans Affairs shall 

9 establish an online health education portal that includes 

10 interactive online educational modules to ensure veterans 

11 enrolled in the patient enrollment system of the Depart12 ment of Veterans Affairs established and operated under 

13 section 1705(a) of title 38, United States Code, under14 stand their basic health care eligibilities and entitlements 

15 under the laws administered by the Secretary, including 

16 under the Veterans Community Care Program under sec17 tion 1703 of such title. 

18 SEC. 208. REPORTS. 

19 (a) REPORT ON IMPROVEMENTS TO CLINICAL AP20 PEALS PROCESS.—Not later than one year after the date 

21 of the enactment of this Act, and not less frequently than 

22 once every three years thereafter, the Secretary of Vet23 erans Affairs, in consultation with veterans service organi24 zations, veterans, caregivers of veterans, employees of the 

25 Department of Veterans Affairs, and other stakeholders 


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1 as determined by the Secretary, shall submit to the Com2 mittee on Veterans’ Affairs of the Senate and Committee 

3 on Veterans’ Affairs of the House of Representatives a 

4 report containing recommendations for legislative or ad5 ministrative action to improve the clinical appeals process 

6 of the Department with respect to timeliness, trans7 parency, objectivity, consistency, and fairness. 

8 (b) REPORT ON REQUIRED CARE AND SERVICES

9 UNDER COMMUNITY CARE PROGRAM.—Not later than 

10 one year after the date of the enactment of this Act, and 

11 not less frequently than annually thereafter, the Secretary 

12 shall submit to the Committee on Veterans’ Affairs of the 

13 Senate and Committee on Veterans’ Affairs of the House 

14 of Representatives a report that contains, for the one-year 

15 period preceding the date of the report, the following: 

16 (1) The number of veterans eligible for care or 

17 services under section 1703 of title 38, United 

18 States Code, and the reasons for such eligibility, in19 cluding multiple such reasons for veterans eligible 

20 under more than one eligibility criteria. 

21 (2) The number of veterans who opt to seek 

22 care or services under such section. 

23 (3) The number of veterans who do not opt to 

24 seek care or services under such section. 


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1 (4) An assessment of the timeliness of referrals 

2 for care or services under such section. 

3 (5) The number of times a veteran did not 

4 show for an appointment for care or services under 

5 such section. 

6 (6) The number of requests for an appeal of a 

7 denial of care or services under such section using 

8 the clinical appeals process of the Veterans Health 

9 Administration. 

10 (7) The timeliness of each such appeal. 

11 (8) The outcome of each such appeal. 

12 (c) VETERANS SERVICE ORGANIZATION DEFINED.— 

13 In this section, the term ‘‘veterans service organization’’ 

14 means any organization recognized by the Secretary under 

15 section 5902 of title 38, United States Code. 

Æ 


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