Veteran Care Improvement Act of 2023

Subjects: Armed Forces and National Security


<html><body><pre>[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3520 Introduced in House (IH)]

&lt;DOC&gt;






118th CONGRESS
  1st Session
                                H. R. 3520

   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 HOUSE OF REPRESENTATIVES

                              May 18, 2023

Mrs. Miller-Meeks (for herself, Mr. Bost, Mr. Bergman, Mrs. Radewagen, 
  Mrs. Kiggans of Virginia, Ms. Mace, Mr. Murphy, and Mr. Van Orden) 
 introduced the following bill; which was 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.

    This Act may be cited as the ``Veteran Care Improvement Act of 
2023''.

SEC. 2. CODIFICATION OF ACCESS STANDARDS FOR COMMUNITY CARE FURNISHED 
              BY THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) Access Standards.--Section 1703B of title 38, United States 
Code, is amended--
            (1) by striking subsections (a) through (e) and inserting 
        the following:
    ``(a) Access Standards for Community Care.--(1) A covered veteran 
may receive hospital care, medical services, or extended care services 
under section 1703(d)(1)(D) of this title if the Secretary determines 
the following:
            ``(A) With respect to primary care, mental health care, or 
        extended care services, the Secretary cannot schedule an in-
        person appointment for the covered veteran with a health care 
        provider of the Department for such care or services--
                    ``(i) at a facility of the Department that is 
                located less than a 30-minute drive from the residence 
                of the covered veteran; or
                    ``(ii) during the 20-day period after the date on 
                which the covered veteran requests such appointment.
            ``(B) With respect to specialty care, the Secretary cannot 
        schedule an in-person appointment for the covered veteran with 
        a health care provider of the Department who can provide such 
        care--
                    ``(i) at a facility of the Department that is 
                located less than a 60-minute drive from the residence 
                of the covered veteran; or
                    ``(ii) during the 28-day period after the date on 
                which the covered veteran requests such appointment.
            ``(C) With respect to residential treatment and 
        rehabilitative services for alcohol or drug dependence, the 
        Secretary cannot provide the covered veteran such services at a 
        facility of the Department--
                    ``(i) that is located less than a 30-minute drive 
                from the residence of the covered veteran; or
                    ``(ii) during the 10-day period after the date on 
                which the covered veteran requests such services.
    ``(2)(A) The Secretary may prescribe regulations that establish a 
shorter drive or time period than those established by paragraph (1).
    ``(B) A covered veteran may consent to a longer drive or time 
period than established by paragraph (1) (or pursuant to regulations 
prescribed under paragraph (2)). If a covered veteran so consents, the 
Secretary shall document such consent in the electronic health record 
of the covered veteran and provide the covered veteran with a copy of 
such documentation in writing or through electronic means.
    ``(3) In making any determination under paragraph (1), the 
Secretary may not consider--
            ``(A) a telehealth appointment; or
            ``(B) the cancellation of an appointment unless such 
        cancellation was at the request of the covered veteran.
    ``(b) Applicability.--The Secretary shall ensure that the access 
standards established under subsection (a) apply--
            ``(1) to all care and services (except nursing home care) 
        within the medical benefits package of the Department to which 
        a covered veteran is eligible under section 1703 of this title; 
        and
            ``(2) to all covered veterans.
    ``(c) Periodic Review of Access Standards.--Not later than three 
years after the date of the enactment of the Veteran Care Improvement 
Act of 2023, and not less frequently than once every three years 
thereafter, the Secretary shall--
            ``(1) conduct a review of the access standards under 
        subsection (a) in consultation with--
                    ``(A) Federal entities (including the Department of 
                Defense, the Department of Health and Human Services, 
                and the Centers for Medicare & Medicaid Services) that 
                the Secretary determines appropriate;
                    ``(B) entities and individuals in the private 
                sector, including--
                            ``(i) veterans who receive hospital care, 
                        medical services, and extended care services 
                        furnished by the Secretary;
                            ``(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 under such 
                review; and
                    ``(B) recommendations of the Secretary regarding 
                such access standards.'';
            (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 ``access standards under subsection 
                        (a)''; and
                    (B) in paragraph (2)(B), by striking ``designated 
                access standards established under this section'' and 
                inserting ``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.--Subsection (d) of section 1703 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 ``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 ``access standards under section 
        1703B(a) of this title''.

SEC. 3. REQUIREMENT THAT SECRETARY NOTIFY VETERANS OF ELIGIBILITY FOR 
              CARE UNDER VETERANS COMMUNITY CARE PROGRAM.

    Section 1703 of title 38, United States Code, is further amended, 
in subsection (a), by adding at the end the following new paragraph:
    ``(5)(A) The Secretary shall notify a covered veteran in writing of 
the eligibility of such veteran for care or services under this section 
not later than two business days after the date on which--
            ``(i) the veteran seeks care or services under this 
        chapter; and
            ``(ii) the Secretary determines that the veteran is a 
        covered veteran.
    ``(B) The Secretary may provide a covered veteran with a periodic 
notification of the eligibility of such covered veteran for care under 
subsection (d).
    ``(C) Any notification under this paragraph may be provided through 
electronic means.''.

SEC. 4. CONSIDERATION UNDER VETERANS COMMUNITY CARE PROGRAM OF VETERAN 
              PREFERENCE FOR CARE AND NEED FOR CAREGIVER OR ATTENDANT.

    Section 1703 of title 38, United States Code, is further amended, 
in subsection (d)(2), by adding at the end the following new 
subparagraphs:
            ``(F) The preference of the covered veteran regarding 
        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. 5. NOTIFICATION OF DENIAL OF REQUEST FOR CARE UNDER VETERANS 
              COMMUNITY CARE PROGRAM.

    Section 1703 of title 38, United States Code, is further 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 because the Secretary 
determines that access standards under section 1703B(a) of this title 
are not met, notice under such paragraph shall include an explanation 
of such determination.
    ``(3) Any notification under this subsection may be provided 
electronically.''.

SEC. 6. PROVISION OF INFORMATION REGARDING OPTION FOR TELEHEALTH UNDER 
              VETERANS COMMUNITY CARE PROGRAM.

    Section 1703 of title 38, United States Code, is further amended--
            (1) by redesignating subsection (p) as subsection (q); and
            (2) by inserting after subsection (o) the following new 
        subsection (p):
    ``(p) Provision of Information Regarding Option for Telehealth.--
With regards to options for care or services for a covered veteran 
under this section, the Secretary shall ensure that the veteran is 
informed that the veteran may elect to seek care or services via 
telehealth, either through a medical facility of the Department or 
under this section, if--
            ``(1) a health care provider described in subsection (c) 
        provides such care or services via telehealth; and
            ``(2) the Secretary determines telehealth is appropriate 
        for the type of care or services the veteran seeks; and''.

SEC. 7. FINALITY OF DECISION BY VETERAN AND VETERAN'S REFERRING 
              PROVIDER.

    (a) In General.--Section 1703 of title 38, United States Code, 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 Agreement Between Covered Veteran and Referring 
Provider.--The Secretary may not override an agreement under subsection 
(d)(1)(E) unless the Secretary notifies the covered veteran and 
referring provider in writing that the Secretary may not provide the 
care or services described in such agreement.''.
    (b) Conforming Amendment.--Subsection (d)(1)(E) such section is 
amended by striking ``referring clinician'' and inserting ``referring 
provider''.

SEC. 8. OUTREACH REGARDING CARE AND SERVICES UNDER VETERANS COMMUNITY 
              CARE PROGRAM.

    (a) Requirement.--Section 1703 of title 38, United States Code, 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 conduct outreach to inform veterans of the 
following:
            ``(A) The conditions for care or services under subsections 
        (d) and (e).
            ``(B) How to request such care or services.
            ``(C) How to appeal a denial of a request for such care or 
        services using the clinical appeals process of the Veterans 
        Health Administration.
    ``(2) Upon enrollment of a veteran in the system of annual patient 
enrollment established and operated under section 1705 of this title, 
and not less frequently than every two years thereafter, the Secretary 
shall inform the veteran of information described in paragraph (1).
    ``(3) The Secretary shall ensure that information described in 
paragraph (1) is--
            ``(A) publicly displayed in each medical facility of the 
        Department;
            ``(B) prominently displayed on a website of the Department; 
        and
            ``(C) included in other outreach campaigns and activities 
        conducted by the Secretary.''.
    (b) Solid Start Program.--Section 6320(a)(2)(A) of title 38, United 
States Code, is amended by inserting ``, including how to enroll in the 
system of annual patient enrollment established and operated under 
section 1705 of this title and the ability to seek care and services 
under sections 1703 and 1710 of this title'' before the semicolon.

SEC. 9. USE OF VALUE-BASED REIMBURSEMENT MODELS UNDER VETERANS 
              COMMUNITY CARE PROGRAM.

    (a) Mandatory Use.--Section 1703 of title 38, United States Code, 
is further amended, in paragraph (5) of subsection (i), 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 such paragraph, as amended by this section.
    (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 such section, 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. 10. EXTENSION OF DEADLINE FOR SUBMISSION OF CLAIMS BY HEALTH CARE 
              ENTITIES AND PROVIDERS UNDER PROMPT PAYMENT STANDARD.

    Subsection (b) of section 1703D of title 38, United States Code, is 
amended--
            (1) by striking ``180 days'' and inserting ``one year''; 
        and
            (2) in the heading, by striking ``Submittal'' and inserting 
        ``Submission''.

SEC. 11. TREATMENT AND REHABILITATIVE SERVICES FOR VETERANS WITH DRUG 
              OR ALCOHOL DEPENDENCY.

    Section 1720A of title 38, United States Code, is amended by adding 
at the end the following new subsection:
    ``(e) The Secretary shall determine whether a veteran who requests 
residential treatment and rehabilitative services for alcohol or drug 
dependence under this section requires such services not later than 72 
hours after receipt of such request.''.

SEC. 12. PILOT PROGRAM TO IMPROVE ADMINISTRATION OF CARE UNDER VETERANS 
              COMMUNITY CARE PROGRAM.

    (a) Establishment.--Pursuant to section 1703E of title 38, United 
States Code, the Secretary of Veterans Affairs, acting through the 
Center for Innovation for Care and Payment of the Department of 
Veterans Affairs, shall seek to develop and implement a plan with a 
third party administrator--
            (1) to provide incentives to a covered health care 
        provider, pursuant to an agreement with such third party 
        administrator--
                    (A) to allow the Secretary and the third party 
                administrator to see the scheduling system of the 
                provider, to assess the availability of, and to assist 
                in scheduling appointments for, veterans under the 
                Veterans Community Care Program under section 1703 of 
                such title, including through synchronous, 
                asynchronous, and asynchronous assisted digital 
                scheduling;
                    (B) to complete continuing professional educational 
                training regarding veteran cultural competency and 
                other subjects determined appropriate by the Secretary;
                    (C) to improve the rate of the timely return to the 
                Secretary 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 other objectives 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 to provide incentives to 
        community providers in such specialties to participate in such 
        program.
    (b) Value-Based Reimbursement Models.--In developing a plan under 
subsection (a), the Secretary and third party administrators shall 
consider value-based reimbursement models under section 1703(i)(5) of 
such title, as amended by section 9, to achieve the goals under such 
subsection.
    (c) Reporting.--
            (1) Progress report.--Not later than 180 days after the 
        date of the enactment of this Act, the Secretary shall submit 
        to the Committees on Veterans' Affairs of the Senate and House 
        of Representatives a report on progress in developing the plan 
        under subsection (a).
            (2) Submission.--Not later than 90 days after completing 
        development of a plan under subsection (a), the Secretary shall 
        submit to the Committees on Veterans' Affairs of the Senate and 
        House of Representatives a copy of such plan.
            (3) Quarterly update.--Not less frequently than quarterly 
        during the term of the pilot program, the Secretary shall 
        submit to the Committees on Veterans' Affairs of the Senate and 
        House of Representatives a report containing any updates on the 
        implementation of such plan.
            (4) Use of value-based reimbursement models.--The Secretary 
        shall include with a plan submitted under paragraph (2) and any 
        report submitted under paragraph (3)--
                    (A) a complete list of the value-based 
                reimbursement models considered under the plan;
                    (B) an indication of whether any such model has 
                been implemented; and
                    (C) with respect to any such model that was 
                considered but not implemented, a description of the 
                reasons such model was not implemented.
    (d) No Penalty for Not Meeting Objectives.--No health care provider 
or third party administrator may be penalized for not carrying out any 
part of a plan under subsection (a).
    (e) Termination.--The pilot program under this section shall 
terminate five years after the date of the enactment of this Act.
    (f) Definitions.--In this section:
            (1) The term ``covered health care provider'' means a 
        health care provider--
                    (A) described in subsection (c) of section 1703 of 
                such title;
                    (B) that furnishes care or services under the 
                Veterans Community Care Program under such section; and
                    (C) that is served by third party administrator.
            (2) The term ``third party administrator'' means an entity 
        that manages a network of health care providers and performs 
        administrative services related to such network under section 
        1703 of such title.

SEC. 13. 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 determines 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 shall commence 
the initial assessment required by subsection (a).
                                 &lt;all&gt;
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