Veterans' Health Empowerment, Access, Leadership, and Transparency for our Heroes (HEALTH) Act of 2023



<html><body><pre>[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1315 Introduced in Senate (IS)]

&lt;DOC&gt;






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.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Veterans' Health 
Empowerment, Access, Leadership, and Transparency for our Heroes 
(HEALTH) Act of 2023''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
        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.

        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.

    (a) Eligibility Access Standards.--Section 1703B of title 38, 
United States Code, is amended--
            (1) by striking subsections (a) through (e) and inserting 
        the following:
    ``(a) Eligibility Standards for Access to Community Care.--(1) A 
covered veteran shall be eligible to elect to receive non-Department 
hospital care, medical services, or extended care services, excluding 
nursing home care, through the Veterans Community Care Program under 
section 1703 of this title pursuant to subsection (d)(1)(D) of such 
section using the following eligibility access standards:
            ``(A) With respect to primary care, mental health care, or 
        extended care services, excluding nursing home care, if the 
        Department cannot schedule an appointment for the covered 
        veteran with a health care provider of the Department who can 
        provide the needed service--
                    ``(i) within 30 minutes average driving time (or 
                such shorter average driving time as the Secretary may 
                prescribe) from the residence of the veteran unless a 
                longer average driving time has been agreed to by the 
                veteran in consultation with a health care provider of 
                the veteran; and
                    ``(ii) within 20 days (or such shorter period as 
                the Secretary may prescribe) of the date of request for 
                such an appointment unless a later date has been agreed 
                to by the veteran in consultation with a health care 
                provider of the veteran.
            ``(B) With respect to specialty care, if the Department 
        cannot schedule an appointment for the covered veteran with a 
        health care provider of the Department who can provide the 
        needed service--
                    ``(i) within 60 minutes average driving time (or 
                such shorter average driving time as the Secretary may 
                prescribe) from the residence of the veteran unless a 
                longer average driving time has been agreed to by the 
                veteran in consultation with a health care provider of 
                the veteran; and
                    ``(ii) within 28 days (or such shorter period as 
                the Secretary may prescribe) of the date of request for 
                such an appointment unless a later date has been agreed 
                to by the veteran in consultation with a health care 
                provider of the veteran.
    ``(2) For the purposes of determining the eligibility of a covered 
veteran for care or services under paragraph (1), the Secretary shall 
not take into consideration the availability of telehealth appointments 
from the Department when determining whether the Department is able to 
furnish such care or services in a manner that complies with the 
eligibility access standards under such paragraph.
    ``(3) In the case of a covered veteran who has had an appointment 
with a health care provider of the Department canceled by the 
Department for a reason other than the request of the veteran, in 
calculating a wait time for a subsequent appointment under paragraph 
(1), the Secretary shall calculate such wait time from the date of the 
request for the original, canceled appointment.
    ``(4) If a veteran agrees to a longer average drive time or a later 
date under subparagraph (A) or (B) of paragraph (1), the Secretary 
shall document the agreement to such longer average drive time or later 
date in the electronic health record of the veteran and provide the 
veteran a copy of such documentation. Such copy may be provided 
electronically.
    ``(b) Application.--The Secretary shall ensure that the eligibility 
access standards established under subsection (a) apply--
            ``(1) to all care and services within the medical benefits 
        package of the Department to which a covered veteran is 
        eligible under section 1703 of this title, excluding nursing 
        home care; and
            ``(2) to all covered veterans, regardless of whether a 
        veteran is a new or established patient.
    ``(c) Periodic Review of Access Standards.--Not later than three 
years after the date of the enactment of the Veterans' Health 
Empowerment, Access, Leadership, and Transparency for our Heroes 
(HEALTH) Act of 2023, and not less frequently than once every three 
years thereafter, the Secretary shall--
            ``(1) conduct a review of the eligibility access standards 
        under subsection (a) in consultation with--
                    ``(A) such Federal entities as the Secretary 
                considers appropriate, including the Department of 
                Defense, the Department of Health and Human Services, 
                and the Centers for Medicare & Medicaid Services;
                    ``(B) entities and individuals in the private 
                sector, including--
                            ``(i) veteran patients;
                            ``(ii) veterans service organizations; and
                            ``(iii) health care providers participating 
                        in the Veterans Community Care Program under 
                        section 1703 of this title; and
                    ``(C) other entities that are not part of the 
                Federal Government; and
            ``(2) submit to the appropriate committees of Congress a 
        report on--
                    ``(A) the findings of the Secretary with respect to 
                the review conducted under paragraph (1); and
                    ``(B) such recommendations as the Secretary may 
                have with respect to the eligibility access standards 
                under subsection (a).'';
            (2) by striking subsection (g);
            (3) by redesignating subsections (f), (h), and (i) as 
        subsections (d), (e), and (f), respectively;
            (4) in subsection (d), as redesignated by paragraph (3)--
                    (A) by striking ``established'' each place it 
                appears; and
                    (B) in paragraph (1), by striking ``(1) Subject 
                to'' and inserting ``Compliance by Community Care 
                Providers With Access Standards.--(1) Subject to'';
            (5) in subsection (e), as so redesignated--
                    (A) in paragraph (1)--
                            (i) by striking ``(1) Consistent with'' and 
                        inserting ``Determination Regarding 
                        Eligibility.--(1) Consistent with''; and
                            (ii) by striking ``designated access 
                        standards established under this section'' and 
                        inserting ``eligibility access standards under 
                        subsection (a)''; and
                    (B) in paragraph (2)(B), by striking ``designated 
                access standards established under this section'' and 
                inserting ``eligibility access standards under 
                subsection (a)''; and
            (6) in subsection (f), as redesignated by paragraph (2)--
                    (A) in the matter preceding paragraph (1), by 
                striking ``In this section'' and inserting 
                ``Definitions.--In this section''; and
                    (B) in paragraph (2)--
                            (i) by striking ``covered veterans'' and 
                        inserting ``covered veteran''; and
                            (ii) by striking ``veterans described'' and 
                        inserting ``a veteran described''.
    (b) Conforming Amendments.--Section 1703(d) of such title is 
amended--
            (1) in paragraph (1)(D), by striking ``designated access 
        standards developed by the Secretary under section 1703B of 
        this title'' and inserting ``eligibility access standards under 
        section 1703B(a) of this title''; and
            (2) in paragraph (3), by striking ``designated access 
        standards developed by the Secretary under section 1703B of 
        this title'' and inserting ``eligibility access standards under 
        section 1703B(a) of this title''.

SEC. 102. REQUIREMENT THAT SECRETARY NOTIFY VETERANS OF ELIGIBILITY FOR 
              CARE UNDER VETERANS COMMUNITY CARE PROGRAM.

    Section 1703(a) of title 38, United States Code, is amended by 
adding at the end the following new paragraph:
    ``(5)(A) The Secretary shall notify each covered veteran in writing 
of the eligibility of such veteran for care or services under this 
section as soon as possible, but not later than two business days, 
after the date on which the Secretary is aware that the veteran is 
seeking care or services and is eligible for such care or services 
under this section.
    ``(B) With respect to each covered veteran eligible for care or 
services under subsection (d), the Secretary shall provide such veteran 
periodic reminders, as the Secretary determines appropriate, of their 
ongoing eligibility under such subsection.
    ``(C) Any notification or reminder under this paragraph may be 
provided electronically.''.

SEC. 103. CONSIDERATION UNDER VETERANS COMMUNITY CARE PROGRAM OF 
              VETERAN PREFERENCE FOR CARE AND NEED FOR CAREGIVER OR 
              ATTENDANT.

    Section 1703(d)(2) of title 38, United States Code, is amended by 
adding at the end the following new subparagraphs:
            ``(F) The preference of the covered veteran for where, 
        when, and how to seek hospital care, medical services, or 
        extended care services.
            ``(G) Whether the covered veteran requests or requires the 
        assistance of a caregiver or attendant when seeking hospital 
        care, medical services, or extended care services.''.

SEC. 104. NOTIFICATION OF DENIAL OF REQUEST FOR CARE UNDER VETERANS 
              COMMUNITY CARE PROGRAM.

    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) Notification of Denial of Request for Care and How To 
Appeal.--(1) If a request by a veteran for care or services under this 
section is denied, the Secretary shall notify the veteran in writing as 
soon as possible, but not later than two business days, after the 
denial is made--
            ``(A) of the reason for the denial; and
            ``(B) with instructions on how to appeal such denial using 
        the clinical appeals process of the Veterans Health 
        Administration.
    ``(2) If a denial under paragraph (1) is due to not meeting the 
eligibility access standards under section 1703B(a) of this title, 
notice under such paragraph shall include an explanation for why the 
Secretary does not consider the veteran to have met such standards.
    ``(3) Any notification under this subsection may be provided 
electronically.''.

SEC. 105. DISCUSSION OF TELEHEALTH OPTIONS UNDER VETERANS COMMUNITY 
              CARE PROGRAM.

    Section 1703 of title 38, United States Code, as amended by section 
104, is further amended--
            (1) by redesignating subsection (p) as subsection (q); and
            (2) by inserting after subsection (o) the following new 
        subsection (p):
    ``(p) Discussion of Options for Telehealth.--When discussing 
options for care or services for a covered veteran under this section, 
the Secretary shall ensure that the veteran is informed of the ability 
of the veteran to seek care or services via telehealth, either through 
a medical facility of the Department or under this section, if 
telehealth--
            ``(1) is available to the veteran;
            ``(2) is appropriate for the type of care or services the 
        veteran is seeking, as determined by the Secretary; and
            ``(3) is acceptable to the veteran.''.

SEC. 106. FINALITY OF DECISION BY VETERAN AND VETERAN'S REFERRING 
              PROVIDER.

    (a) In General.--Section 1703 of title 38, United States Code, as 
amended by sections 104 and 105, is further amended--
            (1) by redesignating subsection (q) as subsection (r); and
            (2) by inserting after subsection (p) the following new 
        subsection (q):
    ``(q) Finality of Decision by Veteran and Referring Provider.--An 
agreement by a covered veteran and the covered veteran's referring 
provider under this section regarding the best medical interest of the 
covered veteran or regarding eligibility for care or services under 
this section, including an agreement under subsection (d)(1)(E), is 
final and may not be changed by the Department without the knowledge 
and consent, documented in writing, of the covered veteran and the 
provider unless there is a statutory or regulatory barrier preventing 
the Department from providing the care or services in question.''.
    (b) Conforming Amendment.--Section 1703(d)(1)(E) of title 38, 
United States Code, is amended by striking ``referring clinician'' and 
inserting ``referring provider''.

SEC. 107. OUTREACH REGARDING CARE AND SERVICES UNDER VETERANS COMMUNITY 
              CARE PROGRAM.

    (a) In General.--Section 1703 of title 38, United States Code, as 
amended by sections 104, 105, and 106, is further amended--
            (1) by redesignating subsection (r) as subsection (s); and
            (2) by inserting after subsection (q) the following new 
        subsection (r):
    ``(r) Outreach Regarding Availability of Care and Services.--(1) 
The Secretary shall--
            ``(A) conduct public outreach to inform veterans of--
                    ``(i) the conditions for eligibility for care or 
                services under subsections (d) and (e);
                    ``(ii) how to request such care or services; and
                    ``(iii) how to appeal a denial of a request for 
                such care or services using the clinical appeals 
                process of the Veterans Health Administration; and
            ``(B) ensure that information about eligibility for care or 
        services under subsections (d) and (e) is prominently displayed 
        on the website of the Department and included in other outreach 
        campaigns and activities conducted by the Secretary.
    ``(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 directly inform the veteran of--
            ``(A) the conditions for eligibility for care or services 
        under subsections (d) and (e);
            ``(B) how to request such care or services; and
            ``(C) how to appeal a denial of a request for such care or 
        services using the clinical appeals process of the Veterans 
        Health Administration.
    ``(3) The Secretary shall ensure that each medical facility of the 
Department publicly displays information regarding--
            ``(A) the conditions for eligibility of veterans for care 
        or services under subsections (d) and (e);
            ``(B) how to request such care or services; and
            ``(C) how to appeal a denial of a request for such care or 
        services using the clinical appeals process of the Veterans 
        Health Administration.''.
    (b) Transitional Services Upon Separation From Armed Forces.--
Section 1144(f)(1)(B)(i) of title 10, 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 title 38, the 
ability to seek care and services under sections 1703 and 1710 of such 
title'' before the semicolon.
    (c) 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.
    (d) 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 Department 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 outreach 
conducted under subsection (r) of such section, as added by subsection 
(a) of this section.

SEC. 108. PLAN TO IMPROVE ADMINISTRATION OF CARE UNDER VETERANS 
              COMMUNITY CARE PROGRAM.

    (a) In General.--The Secretary of Veterans Affairs, working with 
Third Party Administrators and acting through the Center for Innovation 
for Care and Payment of the Department of Veterans Affairs under 
section 1703E of title 38, United States Code, shall develop and 
implement a plan--
            (1) to provide monetary and non-monetary incentives to 
        health care providers specified in subsection (c) of section 
        1703 of title 38, United States Code, furnishing care or 
        services under the Veterans Community Care Program under such 
        section pursuant to an agreement with a Third Party 
        Administrator--
                    (A) to allow the Secretary and Third Party 
                Administrators to see the scheduling system of the 
                provider for purposes of assessing availability and 
                assisting with scheduling appointments for veterans 
                under such program, including through synchronous, 
                asynchronous, and asynchronous assisted digital 
                scheduling;
                    (B) to complete training for continuing 
                professional education credit regarding veteran 
                cultural competency and other subjects as determined 
                appropriate by the Secretary and to better account for 
                equivalent or similar non-Department training;
                    (C) to improve the rate of the timely return to the 
                Department of medical record documentation for care or 
                services provided under such program;
                    (D) to improve the timeliness and quality of the 
                delivery of care and services to veterans under such 
                program; and
                    (E) to achieve such other objectives as determined 
                appropriate by the Secretary in consultation with Third 
                Party Administrators;
            (2) to decrease the rate of no-show appointments under such 
        program and consider the feasibility and advisability of 
        appropriately compensating such health care providers for no-
        show appointments under such program; and
            (3) within each region in which such program is carried 
        out, to assess needed specialties and incentivize community 
        providers in those specialties to participate in such program.
    (b) Value-Based Reimbursement Models.--In developing the plan under 
subsection (a), the Secretary and Third Party Administrators shall 
explore value-based reimbursement models authorized to be used under 
section 1703(i)(5) of title 38, United States Code, to achieve the 
goals under such subsection.
    (c) Submittal of Plan.--
            (1) Initial plan.--Not later than 180 days after the date 
        of the enactment of this Act, the Secretary shall submit to the 
        Committee on Veterans' Affairs of the Senate and the Committee 
        on Veterans' Affairs of the House of Representatives the plan 
        developed under subsection (a).
            (2) Quarterly update.--Not less frequently than quarterly 
        during the five-year period following the submittal of the plan 
        under paragraph (1), the Secretary shall submit to the 
        Committee on Veterans' Affairs of the Senate and the Committee 
        on Veterans' Affairs of the House of Representatives a report 
        containing any updates on the implementation of such plan.
            (3) Use of value-based reimbursement models.--The Secretary 
        shall include with the plan submitted under paragraph (1) and 
        any report submitted under paragraph (2)--
                    (A) a complete list of the value-based 
                reimbursement models considered under the plan;
                    (B) an indication of whether any such model has 
                been put into practice; and
                    (C) with respect to any such model that was 
                considered but not put into practice, a description of 
                the reasons such model was not put into practice.
    (d) No Penalty for Not Meeting Objectives.--Health care providers 
specified in section 1703(c) of title 38, United States Code, shall not 
be penalized for not meeting an objective under paragraph (1) of 
subsection (a) included in the plan required under such subsection.
    (e) 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.
    (f) 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. 109. USE OF VALUE-BASED REIMBURSEMENT MODELS UNDER VETERANS 
              COMMUNITY CARE PROGRAM.

    (a) In General.--Section 1703(i)(5) of title 38, United States 
Code, is amended by striking ``may'' and inserting ``shall''.
    (b) Negotiation of Terms.--The Secretary of Veterans Affairs shall 
negotiate with Third Party Administrators to establish the use of 
value-based reimbursement models under the Veterans Community Care 
Program under section 1703 of title 38, United States Code, pursuant to 
the amendment made by subsection (a).
    (c) Report on Value-Based Reimbursement Models.--Not later than one 
year after negotiating under subsection (b) terms to establish the use 
of value-based reimbursement models under the Veterans Community Care 
Program under section 1703 of title 38, United States Code, the 
Secretary, 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, and the Office of Integrated Veteran Care 
of the Department, or successor office, shall submit to the Committee 
on Veterans' Affairs of the Senate and the Committee on Veterans' 
Affairs of the House of Representatives a report containing--
            (1) an assessment of the efforts of the Department pursuant 
        to section 1703(i)(5) of such title, as amended by subsection 
        (a), to incorporate value-based reimbursement models to promote 
        the provision of high-quality care to veterans; and
            (2) such recommendations for legislative or administrative 
        action as the Secretary considers appropriate to increase the 
        use of value-based reimbursement models throughout the Veterans 
        Community Care Program under section 1703 of such title.
    (d) 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.
    (e) 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. EXTENSION OF DEADLINE FOR SUBMITTAL OF CLAIMS BY HEALTH CARE 
              ENTITIES AND PROVIDERS UNDER PROMPT PAYMENT STANDARD.

    Section 1703D(b) of title 38, United States Code, is amended by 
striking ``180 days'' and inserting ``one year''.

SEC. 111. INSPECTOR GENERAL ASSESSMENT OF IMPLEMENTATION OF VETERANS 
              COMMUNITY CARE PROGRAM.

    (a) In General.--Not later than three years after the date of the 
enactment of this Act, and periodically thereafter as the Inspector 
General of the Department of Veterans Affairs considers appropriate, 
the Inspector General shall assess the performance of each medical 
center 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, including, if appropriate and applicable, the 
        availability of such care and services via telehealth;
            (3) delivering such care and services in a timely manner; 
        and
            (4) appropriately coordinating such care and services.
    (b) Commencement of Assessment.--Not later than one year after the 
date of the enactment of this Act, the Inspector General of the 
Department shall commence the initial assessment required by subsection 
(a).

                  TITLE II--OTHER HEALTH CARE MATTERS

SEC. 201. STRATEGIC PLAN ON TRANSITION OF VETERANS HEALTH 
              ADMINISTRATION TO VALUE-BASED HEALTH CARE MODEL.

    (a) Findings.--Congress makes the following findings:
            (1) The final report of the Creating Options for Veterans' 
        Expedited Recovery Commission (commonly referred to as the 
        ``COVER Commission'') established under section 931 of the 
        Jason Simcakoski Memorial and Promise Act (title IX of Public 
        Law 114-198; 38 U.S.C. 1701 note) submitted under subsection 
        (e)(2) of such section made a key recommendation to transform 
        the current health care delivery model of the Department of 
        Veterans Affairs into one that is person-centered, 
        relationship-based, and recovery-focused, and to support that 
        transformation with a system that is value-based and 
        incentivized for continuous innovation and quality improvement.
            (2) The consensus study report of the Health and Medicine 
        Division of the National Academies of Sciences, Engineering, 
        and Medicine dated February 2022 and entitled, ``Achieving 
        Whole Health: A New Approach for Veterans and the Nation'' 
        recommends the Veterans Health Administration adopt a value-
        based model to align with delivering whole health care.
            (3) The consensus study report of the National Academy of 
        Medicine dated October 2020 found that a value-based care model 
        helps reduce physician burnout.
            (4) The National Academy of Medicine has developed a widely 
        accepted approach that describes high-value health care as 
        safe, timely, effective, efficient, equitable, and patient-
        centered (STEEEP). Further, the Institute for Healthcare 
        Improvement has translated that approach into a framework for 
        action known as the ``Quadruple Aim''. The Quadruple Aim is 
        made up of better patient outcomes, improved patient 
        satisfaction, lower costs, and physician and health care 
        professional well-being.
            (5) Health care systems that have made the transition to 
        value-based care have seen a significant decrease in suicides 
        among their patient population, and the top clinical priority 
        of the Veterans Health Administration is suicide prevention.
            (6) Value-based care programs can encourage providers to 
        work together to deliver coordinated, person-centered care, 
        which will improve the overall quality of care.
            (7) A critical component of a successful transition to a 
        value-based care delivery model is an operational electronic 
        health record system in place as a foundation.
    (b) Establishment of Working Group.--
            (1) In general.--Not later than 90 days after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall establish a working group on the shift of the Veterans 
        Health Administration to a value-based care system.
            (2) Membership.--
                    (A) Required members.--The working group shall 
                include, at a minimum, the following members:
                            (i) The Under Secretary of Veterans Affairs 
                        for Health.
                            (ii) The Director of the Office of Mental 
                        Health and Suicide Prevention of the Department 
                        of Veterans Affairs, or successor office.
                            (iii) The Director of the Office of 
                        Integrated Veteran Care of the Department, or 
                        successor office.
                            (iv) The Director of the Office of Rural 
                        Health of the Department, or successor office.
                            (v) The Director of the Office of Connected 
                        Care of the Department, or successor office.
                            (vi) The Director of the Office of 
                        Information and Technology of the Department, 
                        or 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 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.
                    (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) An individual designated by the 
                        Chairman of the Veterans' Expedited Recovery 
                        Commission (commonly referred to as the ``COVER 
                        Commission'') established under section 931 of 
                        the Jason Simcakoski Memorial and Promise Act 
                        (title IX of Public Law 114-198; 38 U.S.C. 1701 
                        note).
                            (iii) Three individuals representing a 
                        private health care system that has made the 
                        transition to value-based care.
                            (iv) Three individuals representing a 
                        health care provider participating in the 
                        Veterans Community Care Program under section 
                        1703 of title 38, United States Code, that 
                        operates under a value-based care model.
                            (v) An individual representing an 
                        organization recognized by the Secretary of 
                        Veterans Affairs under section 5902 of title 
                        38, United States Code.
            (3) Exemption from application of faca.--Chapter 10 of 
        title 5, United States Code, shall not apply to the working 
        group established under paragraph (1).
    (c) Development of Strategic Plan.--
            (1) In general.--Not later than one year after the 
        establishment of the working group under subsection (b), the 
        working group shall develop a strategic plan to shift the 
        Veterans Health Administration to a value-based care system.
            (2) Elements.--The strategic plan required under paragraph 
        (1) shall contain the following elements:
                    (A) An identification of the current state of the 
                Veterans Health Administration, 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 and 
                through the Veterans Community Care Program under 
                section 1703 of title 38, United States Code, in 
                comparison to a value-based care system.
                    (B) An analysis of the leadership of the Veterans 
                Health Administration, including an assessment of 
                leadership acumen and ability to implement a shift with 
                a clear, shared vision and effective change management 
                and care coordination.
                    (C) An identification of goals for the future of 
                the Veterans Health Administration.
                    (D) An identification and classification of the 
                current capabilities and gaps of the health care system 
                of the Department of Veterans Affairs.
                    (E) An analysis of the four main types of value-
                based care models, including--
                            (i) a selection of the model that best fits 
                        a successful transition for the Veterans Health 
                        Administration; and
                            (ii) a thorough justification of the 
                        selection of such model.
                    (F) A definition of what quality means with respect 
                to access to health care and delivery of health care.
                    (G) A definition of what value means with respect 
                to care furnished by the Veterans Health 
                Administration, a system, with metrics, for measuring 
                value within the Veterans Health Administration that 
                includes outcomes, safety, service, access, and total 
                cost of patient care, and an analysis of variable value 
                with respect to patient outcomes across different 
                health care types and specialities.
                    (H) An assessment of the current information 
                technology infrastructure of the Veterans Health 
                Administration and any recommendations to make such 
                infrastructure more robust.
                    (I) An assessment of the workforce challenges and 
                needs of the Veterans Health Administration, including 
                with respect to recruitment and retention and the 
                effectiveness of the ability of the performance 
                appraisal system of the Veterans Health Administration 
                to appropriately incentivize and reward employees and 
                ensure adherence to relevant statutes, regulations, 
                policy directives, and treatment guidelines.
                    (J) An assessment of the current value-driven 
                framework of the Department for evaluating health care 
                innovations and how that framework could be used to 
                propel a shift in the model of care delivery by the 
                Department.
                    (K) A focus on value-based care for primary care, 
                inpatient and outpatient mental health care, and 
                inpatient and outpatient substance use treatment.
                    (L) A description of the timeline, costs, and 
                legislative or administrative action necessary to 
                transition the Veterans Health Administration to a 
                value-based care system.
    (d) Submittal of Strategic Plan to Congress.--Not later than 30 
days after the completion by the working group established under 
subsection (b) of the strategic plan required under subsection (c), the 
Secretary of Veterans Affairs shall submit the strategic plan to the 
Committee on Veterans' Affairs of the Senate and the Committee on 
Veterans' Affairs of the House of Representatives.
    (e) Pilot Program Implementation of Strategic Plan.--
            (1) In general.--Not later than 180 days after the 
        submittal under subsection (d) of the strategic plan required 
        under subsection (c), the Secretary of Veterans Affairs shall 
        commence a five-year pilot program to implement the strategic 
        plan.
            (2) Care included.--The pilot program under paragraph (1) 
        shall include the implementation of the strategic plan for the 
        delivery by the Veterans Health Administration of primary care, 
        inpatient and outpatient mental health treatment, and inpatient 
        and outpatient substance use treatment.
            (3) Locations.--The Secretary shall carry out the pilot 
        program under paragraph (1) 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 with a 
                documented issue with workforce recruitment and 
                retention.
            (4) 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 180 days before 
                the conclusion of the pilot program, the Secretary 
                shall submit to Congress a final report on the pilot 
                program that includes a plan and timeline for full 
                implementation of the strategic plan required under 
                subsection (c) across the entire Veterans Health 
                Administration.

SEC. 202. PLAN ON ESTABLISHMENT OF INTERACTIVE, ONLINE SELF-SERVICE 
              MODULE FOR CARE.

    (a) In General.--The Secretary of Veterans Affairs, working with 
Third Party Administrators and acting through the Center for Innovation 
for Care and Payment of the Department of Veterans Affairs under 
section 1703E of title 38, United States Code, shall develop and 
implement a plan to establish an interactive, online self-service 
module--
            (1) to allow veterans to request appointments, track 
        referrals for health care under the laws administered by the 
        Secretary, whether at a facility of the Department or through a 
        non-Department provider, and receive appointment reminders;
            (2) to allow veterans to appeal and track decisions 
        relating to--
                    (A) denials of requests for care or services under 
                section 1703 of title 38, United States Code; or
                    (B) denials of requests for care or services at 
                facilities of the Department, including under section 
                1710 of such title; and
            (3) to implement such other matters as determined 
        appropriate by the Secretary in consultation with Third Party 
        Administrators.
    (b) Submittal of Plan.--
            (1) Initial plan.--Not later than 180 days after the date 
        of the enactment of this Act, the Secretary shall submit to the 
        Committee on Veterans' Affairs of the Senate and the Committee 
        on Veterans' Affairs of the House of Representatives the plan 
        developed under subsection (a).
            (2) Quarterly update.--Not less frequently than quarterly 
        following the submittal of the plan under paragraph (1) and for 
        two years thereafter, the Secretary shall submit to the 
        Committee on Veterans' Affairs of the Senate and the Committee 
        on Veterans' Affairs of the House of Representatives a report 
        containing any updates on the implementation of such plan.
    (c) 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.
    (d) 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. 203. PUBLICATION OF WAIT TIMES FOR CARE AT MEDICAL CENTERS OF 
              DEPARTMENT OF VETERANS AFFAIRS.

    (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:
``Sec. 1703G. Publication of wait times for care at medical centers
    ``(a) In General.--The Secretary shall publish on a publicly 
available internet website of the Department the average wait time for 
a veteran to schedule an appointment at each medical center of the 
Department for the receipt of primary care, specialty care, and mental 
health care measured from the date of request for the appointment to 
the date on which the care was provided.
    ``(b) Update.--The Secretary shall update the wait times published 
under subsection (a) not less frequently than monthly.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such subchapter is amended by inserting after the item relating to 
section 1703F the following new item:

``1703G. Publication of wait times for care at medical centers.''.

SEC. 204. DOCUMENTATION OF PREFERENCES OF VETERANS FOR SCHEDULING OF 
              APPOINTMENTS FOR CARE.

    (a) In General.--Upon enrollment of a veteran 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, and not less frequently than annually thereafter, the 
Secretary of Veterans Affairs shall solicit from the veteran the 
preference of the veteran for scheduling of appointments for health 
care and related services furnished by the Department, including 
through non-Department providers.
    (b) Documentation of Preference.--Preferences provided 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 
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 by the 
        Department about an appointment for health care.
            (2) Whether the veteran prefers to schedule their own 
        appointments, if able.
            (3) Whether the veteran prefers to select their own 
        provider, if able.
            (4) Whether the veteran prefers appointments to be 
        scheduled during certain days or times.
            (5) Whether the veteran is willing to consider telehealth 
        appointments.
    (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 assisting in the 
appointment scheduling process to use to improve the timeliness of the 
scheduling of appointments for health care and related services 
furnished by the Department, including through non-Department 
providers.

SEC. 205. 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; 
                        and
                            (ii) an analysis of how such staffing model 
                        compares to the staffing models of other 
                        relevant government and private sector health 
                        care systems.
            (2) Report on implementation of staffing model.--Not later 
        than one year after implementing 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 to incorporate appropriate performance metrics 
        and accountability 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) Comptroller General Report.--Not later than two years after 
receiving the report under subsection (a)(2) or the report under 
subsection (b)(3), whichever occurs later, the Comptroller General of 
the United States shall submit to Congress a report--
            (1) assessing 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) containing such recommendations as the Comptroller 
        General considers appropriate relating to improving access to 
        such care.

SEC. 206. MODIFICATION OF REQUIREMENTS FOR CENTER FOR INNOVATION FOR 
              CARE AND PAYMENT OF THE DEPARTMENT OF VETERANS AFFAIRS 
              AND REQUIREMENT FOR PILOT PROGRAM.

    (a) In General.--Section 1703E of title 38, United States Code, is 
amended--
            (1) in subsection (a)--
                    (A) in paragraph (1), by striking ``within the 
                Department'' and inserting ``within the Office of the 
                Secretary'';
                    (B) in paragraph (2), by striking ``may'' and 
                inserting ``shall''; and
                    (C) in paragraph (3)--
                            (i) in subparagraph (A), by striking ``; 
                        and'' and inserting a semicolon;
                            (ii) in subparagraph (B), by striking the 
                        period at the end and inserting ``; or''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
            ``(C) increase productivity, efficiency, and modernization 
        throughout the Department.'';
            (2) by striking subsection (d) and inserting the following 
        new subsection (d):
    ``(d) Budgetary Line Item.--The Secretary shall include in the 
budget justification materials submitted to Congress in support of the 
budget of the Department of Veterans Affairs for a fiscal year (as 
submitted with the budget of the President under section 1105(a) of 
title 31) specific identification, as a budgetary line item, of the 
amounts required to carry out this section.'';
            (3) in subsection (f)--
                    (A) in paragraph (1), by striking ``in subchapters 
                I, II, and III of this chapter'' and inserting ``of 
                this title, of title 38, Code of Federal Regulations, 
                and of any handbooks, directives, or policy documents 
                of the Department''; and
                    (B) in paragraph (2), in the matter preceding 
                subparagraph (A), by striking ``waiving any authority'' 
                and inserting ``waiving any provision of this title'';
            (4) in subsection (g)(1), by inserting ``fewer than three 
        or'' before ``more than 10'';
            (5) in subsection (i)--
                    (A) in paragraph (1), by striking ``the Under 
                Secretary for Health and the Special Medical Advisory 
                Group established pursuant to section 7312 of this 
                title'' and inserting ``the Under Secretary for Health, 
                the Special Medical Advisory Group established pursuant 
                to section 7312 of this title, the Office of Integrated 
                Veteran Care (or successor office), the Office of 
                Finance (or successor office), the Veteran Experience 
                Office (or successor office), the Office of Enterprise 
                Integration (or successor office), and the Office of 
                Information and Technology (or successor office)''; and
                    (B) in paragraph (2), by striking ``representatives 
                of relevant Federal agencies, and clinical and 
                analytical experts with expertise in medicine and 
                health care management'' and inserting 
                ``representatives of relevant Federal agencies, 
                nonprofit organizations, and other public and private 
                sector entities, including those with clinical and 
                analytical experts with expertise in medicine and 
                health care management''; and
            (6) by adding at the end the following new subsection:
    ``(k) Report on Activities of Center for Innovation for Care and 
Payment.--Not less frequently than annually, the Secretary shall submit 
to Congress a report that contains, for the one-year period preceding 
the date of the report--
            ``(1) a full accounting of the activities, staff, budget, 
        and other resources and efforts of the Center; and
            ``(2) an assessment of the outcomes of the efforts of the 
        Center.''.
    (b) Comptroller General Report.--Not later than 18 months after the 
date of the enactment of this Act, the Comptroller General of the 
United States shall submit to Congress a report--
            (1) on the efforts of the Center for Innovation for Care 
        and Payment of the Department of Veterans Affairs in fulfilling 
        the objectives and requirements under section 1703E of title 
        38, United States Code, as amended by subsection (a); and
            (2) containing such recommendations as the Comptroller 
        General considers appropriate.
    (c) Pilot Program.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Center for Innovation for Care 
        and Payment of the Department of Veterans Affairs under section 
        1703E of title 38, United States Code, shall establish a three-
        year pilot program in not fewer than five locations to allow 
        veterans enrolled in the system of annual patient enrollment of 
        the Department established and operated under section 1705(a) 
        of such title to access outpatient mental health and substance 
        use services through health care providers specified under 
        section 1703(c) of such title without referral or pre-
        authorization.
            (2) Priority.--In selecting sites for the pilot program 
        under paragraph (1), the Secretary shall prioritize sites in 
        the following areas:
                    (A) Areas with varying degrees of urbanization, 
                including urban, rural, and highly rural areas.
                    (B) Areas with high rates of suicide among 
                veterans.
                    (C) Areas with high rates of overdose deaths among 
                veterans.
                    (D) Areas with high rates of calls to the Veterans 
                Crisis Line.
                    (E) Areas with long wait times for mental health 
                and substance use services at facilities of the 
                Department.
                    (F) Areas with outpatient mental health and 
                substance use programs that utilize a value-based care 
                model, to the extent practicable.
            (3) Elements.--The Secretary, in implementing the pilot 
        program under paragraph (1), shall ensure the Department has a 
        care coordination system in place that includes--
                    (A) knowledge sharing, including the timely 
                exchange of medical documentation;
                    (B) assistance with transitions of care, including 
                the potential need for inpatient or residential 
                psychiatric services, substance use detoxification 
                services, post-detoxification step-down services, and 
                residential rehabilitation programs;
                    (C) continuous assessment of patient needs and 
                goals; and
                    (D) creating personalized, proactive care plans.
            (4) Oversight and outcomes.--The Secretary shall develop 
        appropriate metrics and measures--
                    (A) to track and oversee sites at which the pilot 
                program under paragraph (1) is carried out;
                    (B) to monitor patient safety and outcomes under 
                the pilot program; and
                    (C) to assess and mitigate any barriers to 
                extending the pilot program across the entire Veterans 
                Health Administration.
            (5) Annual report.--
                    (A) In general.--Not later than one year after the 
                commencement of the pilot program under paragraph (1), 
                and not less frequently than annually thereafter during 
                the duration of the pilot program, the Secretary shall 
                submit to the Committee on Veterans' Affairs of the 
                Senate and Committee on Veterans' Affairs of the House 
                of Representatives a report on the pilot program, which 
                shall include the following:
                            (i) The number of unique veterans who 
                        participated in the pilot program.
                            (ii) The number of health care providers 
                        who participated in the pilot program.
                            (iii) An assessment of the effectiveness of 
                        the pilot program in increasing access to, and 
                        improving outcomes for, mental health and 
                        substance use treatment services.
                            (iv) The cost of the pilot program.
                            (v) Such other matters as the Secretary 
                        considers appropriate.
                    (B) Final report.--The Secretary shall include in 
                the final report submitted under subparagraph (A), in 
                addition to the requirements under such subparagraph, 
                the assessment by the Secretary of the feasibility and 
                advisability of extending the pilot program across the 
                entire Veterans Health Administration, including a 
                plan, timeline, and required resources for such an 
                extension.
            (6) Veterans crisis line defined.--In this subsection, the 
        term ``Veterans Crisis Line'' means the toll-free hotline for 
        veterans established under section 1720F(h) of title 38, United 
        States Code.

SEC. 207. 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 an online health 
education portal that includes interactive online 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 their basic health 
care eligibilities and entitlements under the laws administered by the 
Secretary, including under the Veterans Community Care Program under 
section 1703 of such title.

SEC. 208. REPORTS.

    (a) Report on Improvements to Clinical Appeals Process.--Not later 
than one year after the date of the enactment of this Act, and not less 
frequently than once every three years thereafter, the Secretary of 
Veterans Affairs, in consultation with veterans service organizations, 
veterans, caregivers of veterans, employees of the Department of 
Veterans Affairs, and other stakeholders as determined by the 
Secretary, shall submit to the Committee on Veterans' Affairs of the 
Senate and Committee on Veterans' Affairs of the House of 
Representatives a report containing recommendations for legislative or 
administrative action to improve the clinical appeals process of the 
Department with respect to timeliness, transparency, objectivity, 
consistency, and fairness.
    (b) Report on Required Care and Services Under Community Care 
Program.--Not later than one year after the date of the enactment of 
this Act, and not less frequently than annually thereafter, the 
Secretary shall submit to the Committee on Veterans' Affairs of the 
Senate and Committee on Veterans' Affairs of the House of 
Representatives a report that contains, for the one-year period 
preceding the date of the report, the following:
            (1) The number of veterans eligible for care or services 
        under section 1703 of title 38, United States Code, and the 
        reasons for such eligibility, including multiple such reasons 
        for veterans eligible under more than one eligibility criteria.
            (2) The number of veterans who opt to seek care or services 
        under such section.
            (3) The number of veterans who do not opt to seek care or 
        services under such section.
            (4) An assessment of the timeliness of referrals for care 
        or services under such section.
            (5) The number of times a veteran did not show for an 
        appointment for care or services under such section.
            (6) The number of requests for an appeal of a denial of 
        care or services under such section using the clinical appeals 
        process of the Veterans Health Administration.
            (7) The timeliness of each such appeal.
            (8) The outcome of each such appeal.
    (c) Veterans Service Organization Defined.--In this section, the 
term ``veterans service organization'' means any organization 
recognized by the Secretary under section 5902 of title 38, United 
States Code.
                                 &lt;all&gt;
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