II 
118TH CONGRESS 
2D SESSION 
H. R. 8371 
IN THE SENATE OF THE UNITED STATES 
NOVEMBER 19, 2024 
Received 
AN ACT 
To make certain improvements in the laws administered by 
the Secretary of Veterans Affairs, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Senator 
Elizabeth 
Dole 
21st 
Century 
Veterans 
Healthcare and Benefits Improvement Act’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—HEALTH CARE MATTERS 
Subtitle A—Veterans Community Care Program Matters 
Sec. 101. Implementation of provision of care under Veterans Community Care 
Program upon determination of eligibility by veteran and vet-
eran’s referring clinician. 
Sec. 102. Outreach regarding care and services under Veterans Community 
Care Program. 
Sec. 103. Annual review and report on waivers of certain payment rates under 
Veterans Community Care Program. 
Sec. 104. Modification of requirements for standards for quality of care from 
Department of Veterans Affairs. 
Sec. 105. Pilot program to improve administration of care under Veterans 
Community Care Program. 
Sec. 106. Pilot program on consolidating approval process of Department of 
Veterans Affairs for covered dental care. 
Sec. 107. Strategic plan on value-based health care system for Veterans Health 
Administration; pilot program. 
Sec. 108. Plan on adoption of certain health information standards for Depart-
ment of Veterans Affairs and certain health care providers. 
Sec. 109. Report on use of value-based reimbursement models under Veterans 
Community Care Program. 
Sec. 110. Inspector General assessment of implementation of Veterans Commu-
nity Care Program. 
Sec. 111. Comptroller General report on dentistry under Veterans Community 
Care Program. 
Subtitle B—Matters Relating to Nursing Home and Other Long Term Care 
and Family Caregivers 
Sec. 120. Increase of expenditure cap for noninstitutional care alternatives to 
nursing home care. 
Sec. 121. Coordination with Program of All-Inclusive Care for the Elderly. 
Sec. 122. Authority for Secretary of Veterans Affairs to award grants or con-
tracts to entities to improve provision of mental health support 
to family caregivers of veterans. 
Sec. 123. Home- and community-based services: programs. 
Sec. 124. Coordination with assistance and support services for caregivers. 
Sec. 125. Improvements to program of comprehensive assistance for family 
caregivers. 
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Sec. 126. Improvements relating to Homemaker and Home Health Aide pro-
gram. 
Sec. 127. Pilot program to furnish assisted living services to certain veterans. 
Sec. 128. Provision of medicine, equipment, and supplies available to Depart-
ment of Veterans Affairs to State homes. 
Sec. 129. Recognition of organizations and individuals to assist veterans, family 
members, and caregivers navigating programs and services of 
Veterans Health Administration. 
Sec. 130. Reviews and other improvements relating to home- and community- 
based services. 
Sec. 131. GAO report on mental health support for caregivers. 
Sec. 132. Development of centralized website for program information. 
Sec. 133. Definitions. 
Subtitle C—Medical Treatment and Other Matters 
Sec. 140. Quarterly report on referrals for non-Department of Veterans Affairs 
health care. 
Sec. 141. Elimination of certain requirements for certain Department of Vet-
erans Affairs Assistant Under Secretaries. 
Sec. 142. Modification of pay limitation for physicians, podiatrists, optom-
etrists, and dentists of Department of Veterans Affairs. 
Sec. 143. Reimbursement of ambulance cost for care for certain rural veterans. 
Sec. 144. Pilot program to furnish dental care from the Department of Vet-
erans Affairs to certain veterans diagnosed with ischemic heart 
disease. 
Sec. 145. Documentation of preferences of veterans for scheduling of appoint-
ments for health care under laws administered by Secretary of 
Veterans Affairs. 
Sec. 146. Staffing model and performance metrics for certain employees of the 
Department of Veterans Affairs. 
Sec. 147. Online health education portal for veterans enrolled in patient enroll-
ment system of Department of Veterans Affairs. 
Sec. 148. Limitation on detail of directors of medical centers of Department of 
Veterans Affairs to different positions. 
Sec. 149. National Veteran Suicide Prevention Annual Report. 
Sec. 150. Report on physical infrastructure required by medical facilities of De-
partment of Veterans Affairs to provide dental care services. 
Sec. 151. Comptroller General report on certain oral health care programs 
under laws administered by Secretary of Veterans Affairs. 
Sec. 152. Review of workflows associated with processing referrals between fa-
cilities of the Veterans Health Administration. 
Sec. 153. Plan for timely scheduling of appointments at medical facilities of 
Department of Veterans Affairs. 
Sec. 154. Authorization of appropriations to support initiatives for mobile 
mammography services for veterans. 
TITLE II—ECONOMIC OPPORTUNITY MATTERS 
Subtitle A—Educational Assistance 
Sec. 201. Temporary expansion of eligibility for Marine Gunnery Sergeant John 
David Fry Scholarship. 
Sec. 202. Removal of expiration on entitlement to Marine Gunnery Sergeant 
John David Fry Scholarship for surviving spouses. 
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Sec. 203. Sole liability for transferred educational assistance by an individual 
who fails to complete a service agreement. 
Sec. 204. Notice to educational institutions of risk-based surveys. 
Sec. 205. Relationship of participation by an educational institution in certain 
Federal student financial aid programs to approval of such in-
stitution for purposes of Department of Veterans Affairs edu-
cational assistance programs. 
Sec. 206. Expansion of Department of Veterans Affairs oversight of certain 
educational institutions. 
Sec. 207. Requirement that educational institutions approved for purposes of 
Department of Veterans Affairs educational assistance pro-
grams provide digital official transcripts. 
Sec. 208. Payment of full monthly housing stipend for veterans enrolled in final 
semester using educational assistance under Post-9/11 Edu-
cational Assistance Program. 
Sec. 209. Modification of rules for approval of commercial driver education pro-
grams for purposes of educational assistance programs of the 
Department of Veterans Affairs. 
Sec. 210. Provision of certificates of eligibility and award letters using elec-
tronic means. 
Sec. 211. Retroactive effective date of law regarding charge to entitlement to 
educational assistance for individuals who do not transfer cred-
its from certain closed or disapproved programs of education. 
Sec. 212. Department of Veterans Affairs high technology program. 
Sec. 213. Notice of changes to Department of Veterans Affairs policies and 
guidance affecting the educational assistance programs of the 
Department. 
Sec. 214. Payment of VA educational assistance via electronic fund transfer to 
a foreign institution of higher education. 
Sec. 215. Improving transparency and accountability of educational institutions 
for purposes of veterans educational assistance. 
Subtitle B—Employment and Training 
Sec. 221. Improvements to reemployment rights of members of the Armed 
Forces. 
Sec. 222. Review of investigations manual of Veterans’ Employment and Train-
ing Service. 
Sec. 223. Warrior Training Advancement Course. 
Subtitle C—Home Loans 
Sec. 231. Improvements to program for direct housing loans made to Native 
American veterans by the Secretary of Veterans Affairs. 
Sec. 232. Native community development financial institution relending pro-
gram. 
TITLE III—DISABILITY AND MEMORIAL AFFAIRS MATTERS 
Sec. 301. Burial allowance for certain veterans who die at home while in receipt 
of hospice care furnished by Department of Veterans Affairs. 
Sec. 302. Authority for Secretary of Veterans Affairs to award grants to States 
and Indian Tribes to improve outreach to veterans. 
Sec. 303. Definition of surviving spouse. 
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Sec. 304. Ensuring only licensed health care professionals perform medical dis-
ability examinations under certain Department of Veterans Af-
fairs pilot program. 
Sec. 305. Provision of information regarding an agent or attorney to a licensed 
health care professional who performs a medical disability ex-
amination under certain Department of Veterans Affairs pilot 
program. 
Sec. 306. Modernization of Department of Veterans Affairs disability benefit 
questionnaires. 
Sec. 307. Department of Veterans Affairs automatic processing of certain 
claims for temporary disability ratings. 
TITLE IV—HOMELESSNESS MATTERS 
Sec. 401. Short title. 
Sec. 402. Per diem payments provided by the Secretary of Veterans Affairs for 
services furnished to homeless veterans. 
Sec. 403. Authorization for Secretary of Veterans Affairs to use of certain 
funds for improved flexibility in assistance to homeless vet-
erans. 
Sec. 404. Access to Department of Veterans Affairs telehealth services. 
TITLE V—OVERSIGHT AND INVESTIGATIONS MATTERS 
Sec. 501. Department of Veterans Affairs employee training regarding Office of 
Inspector General. 
Sec. 502. Annual review of security at covered facilities of the Department of 
Veterans Affairs. 
Sec. 503. Modification of certain housing loan fees. 
TITLE I—HEALTH CARE 
MATTERS 
Subtitle A—Veterans Community 
Care Program Matters 
SEC. 101. IMPLEMENTATION OF PROVISION OF CARE 
UNDER VETERANS COMMUNITY CARE PRO-
GRAM 
UPON 
DETERMINATION 
OF 
ELIGI-
BILITY BY VETERAN AND VETERAN’S REFER-
RING CLINICIAN. 
(a) IN GENERAL.—During the period specified in 
subsection (c), the Secretary of Veterans Affairs shall im-
plement section 1703(d)(1)(E) of title 38, United States 
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Code, in compliance with the implementing regulations for 
such section under section 17.4010(a)(5) of title 38, Code 
of Federal Regulations, such that the determination of eli-
gibility for care is final and shall be made by the veteran 
and the veteran’s referring clinician. 
(b) CORRECTION OF ERRORS.—A covered veteran 
and the referring clinician of such veteran may correct any 
errors made with respect to a determination described in 
subsection (a). 
(c) PERIOD SPECIFIED.—The period specified in this 
subsection is the two-year period beginning on the date 
that is 90 days after the date of the enactment of this 
Act. 
(d) REPORT.—Not later than one year and not later 
than two years after the commencement of the period 
specified by subsection (c), the Secretary of Veterans Af-
fairs shall submit to Congress a report on the care pro-
vided under section 1703(d)(1)(E) of title 38, United 
States Code, during the one-year period preceding the date 
of the report, including— 
(1) the number of instances of care provided; 
(2) the type of care provided; and 
(3) the cost of such care. 
(e) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to limit the Secretary’s authority 
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to prescribe, amend, or rescind regulations under section 
1703 of title 38, United States Code. 
(f) COVERED VETERAN DEFINED.—In this section, 
the term ‘‘covered veteran’’ has the meaning given that 
term in section 1703(b) of title 38, United States Code. 
SEC. 102. OUTREACH REGARDING CARE AND SERVICES 
UNDER VETERANS COMMUNITY CARE PRO-
GRAM. 
(a) REQUIREMENT.—Section 1703 of title 38, United 
States Code, is further amended— 
(1) by redesignating subsection (o) as sub-
section (p); and 
(2) by inserting after subsection (n) the fol-
lowing new subsection (o): 
‘‘(o) OUTREACH REGARDING AVAILABILITY OF CARE 
AND SERVICES.—(1) The Secretary shall conduct out-
reach 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 proc-
ess of the Veterans Health Administration. 
‘‘(2) Upon enrollment of a veteran in the system of 
annual patient enrollment established and operated under 
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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 de-
scribed in paragraph (1) is— 
‘‘(A) publicly displayed in each medical facility 
of the Department; 
‘‘(B) prominently displayed on a website of the 
Department; and 
‘‘(C) included in other outreach campaigns and 
activities conducted by the Secretary.’’. 
(b) SOLID START PROGRAM.—Section 6320(a)(2)(A) 
of title 38, United States Code, is amended by inserting 
‘‘, including how to enroll in the system of annual patient 
enrollment established and operated under section 1705 
of this title and the ability to seek care and services under 
sections 1703 and 1710 of this title’’ before the semicolon. 
(c) COMPTROLLER
GENERAL
REPORT
ON
OUT-
REACH.—Not later than two years after the date of the 
enactment of this Act, the Comptroller General of the 
United Stats shall submit to Congress a report on the ef-
forts of the Secretary of Veterans Affairs to ensure that 
veterans are informed of the conditions for eligibility for 
care and services under section 1703 of title 38, United 
States Code, including such efforts to conduct outreach 
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pursuant to subsection (q) of such section (as added by 
subsection (a)). 
SEC. 103. ANNUAL REVIEW AND REPORT ON WAIVERS OF 
CERTAIN PAYMENT RATES UNDER VETERANS 
COMMUNITY CARE PROGRAM. 
(a) IN GENERAL.—Section 1703 of title 38, United 
States Code, is further amended— 
(1) by redesignating subsection (p) as sub-
section (q); and 
(2) by inserting after subsection (p) the fol-
lowing new subsection (q): 
‘‘(q) ANNUAL REVIEW AND REPORT ON WAIVERS OF 
PAYMENT RATES.—(1) On an annual basis, the Secretary 
shall— 
‘‘(A) conduct a review of waivers of payment 
rates under subsection (i) for Third Party Adminis-
trators to identify whether such waivers help to al-
leviate community-specific challenges, including scar-
city of medical services associated with access to 
health care; and 
‘‘(B) submit to Congress a report on the results 
of such review. 
‘‘(2) Each report under paragraph (1)(B) shall in-
clude, with respect to the period covered by the report— 
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‘‘(A) a statement, disaggregated by region, of 
the total number of waivers described in subpara-
graph (A) of such paragraph requested by Third 
Party Administrators; 
‘‘(B) a statement of the total number of such 
waivers that were— 
‘‘(i) granted by the Secretary; 
‘‘(ii) denied by the Secretary; or 
‘‘(iii) withdrawn by a Third Party Admin-
istrator; 
‘‘(C) a description of the process for the review 
required under paragraph (1); 
‘‘(D) a statement, disaggregated by region, of 
the average time to process such waivers; 
‘‘(E) an assessment, disaggregated by region, of 
the extent to which such waivers that were granted 
by the Secretary improved access to health care for 
covered veterans; and 
‘‘(F) a description of trends, if any, identified 
by the Secretary with respect to such waivers. 
‘‘(3) In this subsection, the term ‘Third Party Ad-
ministrator’ has the meaning given such term in section 
1703B of this title.’’. 
(b) DEADLINE.—The Secretary shall submit the first 
report required under subsection (q) of section 1703 of 
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such title (as added by subsection (a)) not later than 180 
days after the date of the enactment of this Act. 
SEC. 104. MODIFICATION OF REQUIREMENTS FOR STAND-
ARDS FOR QUALITY OF CARE FROM DEPART-
MENT OF VETERANS AFFAIRS. 
(a) IN GENERAL.—Section 1703C of title 38, United 
States Code, is amended— 
(1) in subsection (a)— 
(A) in paragraph (2)— 
(i) by striking ‘‘In establishing’’ and 
inserting ‘‘(A) In establishing’’; and 
(ii) by adding at the end the following 
new subparagraph: 
‘‘(B) The Secretary shall ensure that the stand-
ards for quality established under paragraph (1) are 
comparable to industry standards to ensure there is 
adequate data transference between care furnished 
by the Department and care furnished by a non-De-
partment provider.’’; 
(B) in paragraph (3), by adding at the end 
the following new clause: 
‘‘(v) Outcomes relating to patient 
quality of life.’’; 
(C) in paragraph (4)— 
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(b) DEADLINE FOR UPDATE.—The Secretary, pursu-
ant to paragraph (7) of section 1703C(a) of title 38, 
United States Code (as added by subsection (a)), shall 
make the first update to the standards for quality estab-
lished under paragraph (1) of such section not later than 
the date that is five years after the date on which the Sec-
retary submits the report under paragraph (2) of sub-
section (d). 
(c) REPORT.—Not later than one year after the date 
of the enactment of this Act, the Secretary of Veterans 
Affairs shall submit to the appropriate committees of Con-
gress a report on how the Secretary— 
(1) has consulted with entities specified in para-
graph (4) of section 1703C(a) of title 38, United 
States Code, before the date of the enactment of this 
Act in establishing standards for quality under such 
section; 
(2) has continued to consult with those entities 
on and after such date of enactment; and 
(3) intends to leverage data sciences to improve 
standards for quality care furnished by the Depart-
ment of Veterans Affairs. 
(d) UPDATES TO QUALITY CARE METRICS.— 
(1) INITIAL REPORT.—Not later than one year 
after the date of the enactment of this Act, the Sec-
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retary of Veterans Affairs shall submit to the appro-
priate committees of Congress a report on how the 
Secretary plans to implement the amendments made 
by subsections (a). 
(2) DEADLINE; SUMMARY REPORT.—Not later 
than two years after the date of the enactment of 
this Act, the Secretary shall— 
(A) implement the amendments made by 
subsection (a), including by updating the stand-
ards for quality established under section 
1703C of title 38, United States Code; and 
(B) submit to the appropriate committees 
of Congress a report detailing the standards for 
quality updated pursuant to such amendments. 
(e) AUDIT OF QUALITY CARE METRICS.— 
(1) IN
GENERAL.—Not later than 180 days 
after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall enter into one or 
more contracts with a non-Department entity de-
scribed in paragraph (2) to conduct an audit on the 
quality of care from the Department of Veterans Af-
fairs, including through non-Department health care 
providers pursuant to section 1703 of title 38 
United States Code. 
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(2) NON-DEPARTMENT ENTITY DESCRIBED.—A 
non-Department entity described in this paragraph 
is an entity that— 
(A) specializes in analyzing large-scale or-
ganizational data collection and analysis efforts, 
especially with respect to the health care sector; 
and 
(B) has experience and proven outcomes in 
optimizing the accuracy and comprehensiveness 
of data collection and analysis related to the 
quality of health care services. 
(3) ELEMENTS.—The audit required under 
paragraph (1) shall include the following: 
(A) An assessment of the methodology 
used by the Department to collect and assess 
data on the quality of care furnished by the De-
partment, including any vulnerabilities in such 
methodology. 
(B) An assessment of the accuracy and re-
liability of the data sources used by the Depart-
ment to compile data on the quality of care fur-
nished by the Department. 
(C) The extent to which the standards the 
Department uses to assess the quality of care 
furnished by the Department are— 
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(i) comparable with industry stand-
ards; 
(ii) easily accessible to, and under-
stood by— 
(I) veterans; 
(II) employees of the Depart-
ment; and 
(III) other individuals, as the pri-
vate sector entity considers appro-
priate. 
(D) Any recommendations of such private 
sector entity with respect to improvements that 
the Secretary could administer to more accu-
rately capture the quality of care furnished by 
the Department. 
(4) REPORTS ON AUDIT.— 
(A) REPORT
ON
FINDINGS
AND
REC-
OMMENDATIONS.—Not later than 60 days after 
any date on which a private sector entity de-
scribed in paragraph (2) completes an audit 
under paragraph (1), such private sector entity 
shall submit to the Secretary, the Committee on 
Veterans’ Affairs of the Senate, and the Com-
mittee on Veterans’ Affairs of the House of 
Representatives a report that includes— 
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(i) the findings of such audit; and 
(ii) recommendations of such private 
sector entity with respect to such audit. 
(B) REPORT
ON
PLANNED
IMPROVE-
MENTS.—Not later than 60 days after any date 
on which the Secretary receives a report under 
subparagraph (A), the Secretary shall submit to 
the Committee on Veterans’ Affairs of the Sen-
ate and the Committee on Veterans’ Affairs of 
the House of Representatives a report on how 
the Secretary plans to improve the standards 
for quality of care of the Department. 
(f) APPROPRIATE COMMITTEES OF CONGRESS DE-
FINED.—In this section, the term ‘‘appropriate commit-
tees of Congress’’ has the meaning given such term in sec-
tion 1703C of title 38, United States Code. 
SEC. 105. PILOT PROGRAM TO IMPROVE ADMINISTRATION 
OF CARE UNDER VETERANS COMMUNITY 
CARE PROGRAM. 
(a) ESTABLISHMENT.—Pursuant to section 1703E of 
title 38, United States Code, the Secretary of Veterans 
Affairs, acting through the Center for Innovation for Care 
and Payment established under such section, shall carry 
out a pilot program to seek to develop and implement a 
plan— 
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(1) to provide monetary and non-monetary in-
centives to a covered health care provider— 
(A) to allow the Secretary to see the sched-
uling system of the provider, to assess the avail-
ability of, and to assist in scheduling appoint-
ments for, veterans under the Veterans Com-
munity Care Program under section 1703 of 
such title, including through synchronous, asyn-
chronous, and asynchronous assisted digital 
scheduling; 
(B) to complete continuing professional 
educational training available through the VHA 
TRAIN program (or any successor program or 
initiative) regarding veteran cultural com-
petency, the opioid safety initiative (or any suc-
cessor program or initiative), and other subjects 
determined appropriate by the Secretary; 
(C) to improve methods of accounting for 
non-Department training that is equivalent or 
substantially similar to the continuing profes-
sional educational training described in sub-
paragraph (B); 
(D) to improve the rate of the timely re-
turn to the Secretary of medical record docu-
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mentation for care or services provided under 
the Veterans Community Care Program; 
(E) to improve the timeliness and quality 
of the delivery of care and services to veterans 
under such program; and 
(F) to achieve other objectives determined 
appropriate by the Secretary; and 
(2) to decrease the rate of no-show appoint-
ments under such program. 
(b) REPORT.—Not later than one year after the date 
of the establishment of the pilot program under this sec-
tion, and annually thereafter during the term of the pilot 
program, the Secretary of Veterans Affairs shall submit 
to the Committees on Veterans’ Affairs of the House of 
Representatives and the Senate a report on the pilot pro-
gram that includes, with respect to the period covered by 
the report— 
(1) an assessment of the extent to which— 
(A) the system of the Department of Vet-
erans Affairs for scheduling appointments for 
veterans under the Veterans Community Care 
Program has improved; 
(B) the rate of timely return to the Sec-
retary of medical record documentation de-
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scribed in subparagraph (D) of subsection 
(a)(1) has improved; 
(C) the timeliness and quality of the deliv-
ery of care and services described in subpara-
graph (E) of such subsection has improved; and 
(D) the frequency of no-show appointments 
described in paragraph (2) of such subsection 
decreased; 
(2) a list of the continuing professional edu-
cational training courses under subparagraph (B) of 
such subsection available to covered health care pro-
viders; 
(3) the rate of participation in such continuing 
professional education training courses; and 
(4) any other matter the Secretary determines 
appropriate. 
(c) DEFINITIONS.—In this section: 
(1) The term ‘‘covered health care provider’’ 
means a health care provider— 
(A) described in subsection (c) of section 
1703 of title 38, United States Code, that fur-
nishes care or services under the Veterans Com-
munity Care Program pursuant to a contract or 
agreement with a Third Party Administrator; 
or 
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(B) that otherwise furnishes care or serv-
ices outside of Department facilities pursuant 
to a contract or agreement with the Secretary 
of Veterans Affairs. 
(2) The term ‘‘opioid safety initiative’’ means 
the programs, processes, and guidelines of the Vet-
erans Health Administration of the Department of 
Veterans Affairs relating to the management of 
opioid therapy and chronic pain. 
(3) The term ‘‘Third Party Administrator’’ 
means an entity that manages a network of health 
care providers and performs administrative services 
related to such network under section 1703 of such 
title. 
(4) The term ‘‘VHA TRAIN program’’ means 
the free program of the Veterans Health Adminis-
tration that offers veteran-specific continuing med-
ical education courses. 
SEC. 106. PILOT PROGRAM ON CONSOLIDATING APPROVAL 
PROCESS OF DEPARTMENT OF VETERANS AF-
FAIRS FOR COVERED DENTAL CARE. 
(a) IN GENERAL.—Not later than 180 days after the 
date of the enactment of this Act, the Secretary of Vet-
erans Affairs, acting through the Center for Innovation 
for Care and Payment established under section 1703E 
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of title 38, United States Code, shall carry out a pilot pro-
gram under which the Secretary shall hire— 
(1) general dentists at medical facilities of the 
Department of Veterans Affairs to manage approval 
by the Department of treatment plans requested by 
dental providers in providing covered dental care; 
and 
(2) dental specialists at Veterans Integrated 
Service Networks of the Department to manage ap-
proval by the Department of treatment plans for 
specialty dental care requested by dental providers 
in providing covered dental care. 
(b) LOCATIONS.—The Secretary shall carry out the 
pilot program in not fewer than two Veterans Integrated 
Service Networks of the Department. 
(c) REPORTS.— 
(1) INITIAL REPORT.—Not later than one year 
after the date of the commencement of such pilot 
program, the Secretary shall submit to the Commit-
tees on Veterans’ Affairs of the Senate and the 
House of Representatives a report on the pilot pro-
gram, that includes— 
(A) an identification of the Veterans Inte-
grated Service Networks participating in such 
pilot program; 
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(B) a description of the implementation of 
such pilot program; 
(C) an identification of any barriers or 
challenges to implementing such pilot program; 
(D) an assessment of the efficacy of hiring 
general dentists and dental specialists pursuant 
to such pilot program; 
(E) aggregated feedback with respect to 
such pilot program from dentists of the Depart-
ment in Veterans Integrated Service Networks 
participating in such pilot program; and 
(F) aggregated feedback from dental pro-
viders providing covered dental care within such 
Veterans Integrated Service Networks regard-
ing any changes in the timeliness of treatment 
plan approvals by the Department. 
(2) FINAL REPORT.—Not later than 90 days 
before the date of the completion of such pilot pro-
gram, the Secretary shall submit to the Committees 
on Veterans’ Affairs of the Senate and the House of 
Representatives a report on the pilot program that— 
(A) includes, with respect to the period 
covered by the report, each element of the re-
port required under paragraph (1) described in 
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subparagraphs (A) through (F) of such para-
graph; 
(B) includes recommendations of the Sec-
retary on whether the pilot program should 
be— 
(i) extended; 
(ii) expanded; or 
(iii) adopted throughout the Depart-
ment; and 
(C) indicates whether the Secretary re-
quests action by Congress to make the pilot 
program permanent. 
(d) SUNSET.—The authority to carry out the pilot 
program under this section shall terminate on the date 
that is two years after the date of the enactment of this 
Act. 
(e) COVERED DENTAL CARE DEFINED.—In this sec-
tion, the term ‘‘covered dental care’’ means dental care 
provided— 
(1) under section 1703 of title 38, United 
States Code; or 
(2) pursuant to a Veterans Care Agreement 
under section 1703A of such title. 
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SEC. 107. STRATEGIC PLAN ON VALUE-BASED HEALTH 
CARE SYSTEM FOR VETERANS HEALTH AD-
MINISTRATION; PILOT PROGRAM. 
(a) ESTABLISHMENT OF WORKING GROUP.— 
(1) IN
GENERAL.—Not later than one year 
after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall— 
(A) establish a working group on value- 
based care; and 
(B) submit to the Committees on Veterans’ 
Affairs of the House of Representatives and the 
Senate the strategic plan developed by the 
working group pursuant to subsection (b). 
(2) MEMBERSHIP.— 
(A) REQUIRED
MEMBERS.—The working 
group shall include, at a minimum, the fol-
lowing members: 
(i) The Under Secretary for Health of 
the Department of Veterans Affairs. 
(ii) The Director of the Office of Men-
tal Health and Suicide Prevention of the 
Department of Veterans Affairs (or any 
successor office). 
(iii) The Director of the Office of In-
tegrated Veteran Care of the Department 
(or any successor office). 
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(iv) The Director of the Office of 
Rural Health of the Department (or any 
successor office). 
(v) The Director of the Office of Con-
nected Care of the Department (or any 
successor office). 
(vi) The Assistant Secretary for the 
Office of Information Technology (or any 
successor office). 
(vii) The Chief Officer of the Office of 
Healthcare Innovation and Learning of the 
Office of Discovery, Education, and Affil-
iate Networks of the Veterans Health Ad-
ministration (or any successor office). 
(viii) An individual designated by the 
Secretary from the Center for Innovation 
for Care and Payment of the Department 
under section 1703E of title 38, United 
States Code. 
(ix) An individual designated by the 
Administrator of the Centers for Medicare 
& Medicaid Services from the Center for 
Medicare and Medicaid Innovation. 
(x) An individual designated by the 
Secretary of Health and Human Services 
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from the Federal Office of Rural Health 
Policy of the Health Resources and Serv-
ices Administration. 
(xi) The Chief of Human Capital 
Management for the Veterans Health Ad-
ministration. 
(xii) An individual designated by the 
Secretary of Defense that is a representa-
tive of the Defense Health Agency. 
(xiii) An individual selected by the 
Secretary of Veterans Affairs from the spe-
cial medical advisory group established 
under section 7312 of title 38, United 
States Code. 
(B) OPTIONAL MEMBERS.—The Secretary 
of Veterans Affairs may appoint any of the fol-
lowing individuals as members of the working 
group: 
(i) An individual representing the 
Health and Medicine Division of the Na-
tional Academies of Sciences, Engineering, 
and Medicine. 
(ii) Three individuals representing a 
private health care system that has made 
the transition to value-based care. 
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(iii) Three individuals representing an 
organization recognized by the Secretary of 
Veterans Affairs under section 5902 of 
title 38, United States Code. 
(3) PUBLIC AVAILABILITY.—All meetings delib-
erations, and products of the working group shall be 
made publicly available throughout the duration of 
the working group, including to individuals rep-
resenting organizations recognized by the Secretary 
of Veterans Affairs under section 5902 of title 38, 
United States Code. 
(4) EXEMPTION FROM FACA.—Chapter 10 of 
title 5, United States Code, shall not apply to the 
working group established under paragraph (1). 
(b) DEVELOPMENT
OF
STRATEGIC
PLAN.—The 
working group shall develop a strategic plan to implement 
value-based care into the Veterans Health Administration 
that includes the following: 
(1) An identification of the state of the Vet-
erans Health Administration as of the date of the 
enactment of this Act, including an assessment of 
the current model of health care delivery used by the 
Veterans Health Administration in medical facilities 
of the Department of Veterans Affairs. 
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(2) An assessment of the capacity needs of the 
Veterans Health Administration during the five-year 
period beginning on the date of the enactment of 
this Act. 
(3) An analysis of the leadership of the Vet-
erans Health Administration, including an assess-
ment of leadership acumen and ability to implement 
a clear, shared vision and effective change manage-
ment and care coordination. 
(4) An identification of goals for the future of 
the Veterans Health Administration. 
(5) An identification and classification of the 
current capabilities, capacity, and gaps in access and 
quality of the health care system of the Department 
of Veterans Affairs. 
(6) An analysis of value-based care models, in-
cluding— 
(A) a selection of potential models that 
would best work for the Veterans Health Ad-
ministration; 
(B) the capacity and capabilities of each 
such model; and 
(C) a thorough justification of the selection 
of each selected model, including an summary 
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of the ability of such model to improve the 
metrics described under paragraph (9). 
(7) A definition of what quality means with re-
spect to— 
(A) access to health care under the laws 
administered by the Secretary of Veterans Af-
fairs; and 
(B) delivery of such health care. 
(8) A definition of what value means with re-
spect to care furnished by the Veterans Health Ad-
ministration, 
(9) A system for measuring value within the 
Veterans 
Health 
Administration 
that 
includes 
metrics for— 
(A) outcomes; 
(B) safety; 
(C) service; 
(D) access; 
(E) productivity; 
(F) capacity; and 
(G) total cost of patient care. 
(10) With respect to the system described in 
subparagraph (H), an analysis of variable value with 
respect to patient outcomes across different health 
care types and specialties. 
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(11) An assessment of— 
(A) previous or ongoing assessments of the 
current information technology infrastructure of 
the Veterans Health Administration, includ-
ing— 
(i) such assessments conducted pursu-
ant to the Electronic Health Record Mod-
ernization program of the Department of 
Veterans Affairs; and 
(ii) any other ongoing information 
technology modernization programs of such 
Department and any unimplemented rel-
evant recommendations from such assess-
ments; 
(B) the information technology infrastruc-
ture of the Veterans Health Administration in 
effect as of the date of the enactment of this 
Act; 
(C) the value-driven framework of the De-
partment, in effect as of the date of the enact-
ment of this Act, for evaluating health care in-
novations, and how improvements in such 
framework could be used to encourage innova-
tion; and 
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(D) workforce challenges and needs of the 
Veterans Health Administration based on— 
(i) reviews of workforce assessment 
data available as of the date of the enact-
ment of this Act; and 
(ii) the findings of— 
(I) the report required by section 
301(d) 
of 
the 
Veterans 
Access, 
Choice, and Accountability Act of 
2014 (Public Law 113–146); 
(II) the reports required by sec-
tion 505 of the John S. McCain III, 
Daniel K. Akaka and Samuel R. 
Johnson VA Maintaining Internal 
Systems 
and 
Strengthening 
Inte-
grated Outside Networks Act of 2018 
(Public Law 115–182); 
(III) the report required by sec-
tion 301 of the VA Choice and Qual-
ity Employment Act of 2017 (Public 
Law 115–46); and 
(IV) any comprehensive health 
care inspection conducted by the In-
spector General of the Department of 
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Veterans Affairs as of the date of the 
enactment of this Act. 
(12) Any recommendations of the working 
group with respect to improving the information 
technology infrastructure described in clause (i) of 
subparagraph (J). 
(13) An analysis of how the value-driven frame-
work described in clause (iii) of such subparagraph 
could be used to improve the model of care delivery 
by the Department. 
(14) A description of how a value-based care 
system would apply to primary care, inpatient and 
outpatient mental health care, and inpatient and 
outpatient substance use treatment, spinal cord in-
jury disorder care, and polytrauma care furnished by 
the Veterans Health Administration. 
(15) With respect to legislative or administra-
tive action necessary to incorporate value-based care 
models into the Veterans Health Administration, a 
description of the estimated timelines, effect on 
workforce, and costs. 
(c) PILOT PROGRAM.— 
(1) IN
GENERAL.—Not later than 180 days 
after the submission of the strategic plan pursuant 
to subsection (b), the Secretary of Veterans Affairs, 
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acting through the Center for Innovation for Care 
and Payment established under section 1703E of 
title 38, United States Code, shall commence a 
three-year pilot program under which the Secretary 
shall implement the elements of such strategic plan 
relating to the delivery, by the Veterans Health Ad-
ministration, of primary care, inpatient and out-
patient mental health treatment, inpatient and out-
patient substance abuse treatment, spinal cord in-
jury disorder care, and polytrauma care. 
(2) LOCATIONS.—The Secretary shall carry out 
such pilot program in four Veterans Integrated 
Service Networks that are geographically dispersed 
and shall include the following: 
(A) A Veterans Integrated Service Net-
work that predominately serves veterans in 
rural and highly rural areas. 
(B) A Veterans Integrated Service Net-
work that predominately serves veterans in 
urban areas. 
(C) A Veterans Integrated Service Net-
work that has a high rate of suicide among vet-
erans. 
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(D) A Veterans Integrated Service Net-
work that has a high rate of substance use dis-
order among veterans. 
(E) A Veterans Integrated Service Net-
work that has access or productivity challenges. 
(3) REPORTS TO CONGRESS.— 
(A) ANNUAL REPORT.—Not later than one 
year after the commencement of the pilot pro-
gram, and annually thereafter during the dura-
tion of the pilot program, the Secretary shall 
submit to Congress a report on the pilot pro-
gram. 
(B) FINAL REPORT.—Not later than 90 
days before the conclusion of the pilot program, 
the Secretary shall submit to Congress a final 
report on the pilot program that includes— 
(i) lessons learned during the adminis-
tration of such pilot program; and 
(ii) specific health outcomes in veteran 
patient care compared to the Veterans 
Health Administration system of care in 
effect as of the date of the enactment of 
this Act. 
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SEC. 108. PLAN ON ADOPTION OF CERTAIN HEALTH INFOR-
MATION STANDARDS FOR DEPARTMENT OF 
VETERANS AFFAIRS AND CERTAIN HEALTH 
CARE PROVIDERS. 
(a) PLAN
FOR CERTAIN HEALTH INFORMATION 
STANDARDS.— 
(1) IN GENERAL.—The Secretary of Veterans 
Affairs, in consultation with the Secretary of Health 
and Human Services, the Administrator of the Cen-
ters for Medicare & Medicaid Services, and the Na-
tional Coordinator for Health Information Tech-
nology of the Department of Health and Human 
Services, shall create and implement a plan to adopt, 
as rapidly and to the most comprehensive extent fea-
sible, national health information interoperability 
standards for the Department of Veterans Affairs 
and community care providers with respect to— 
(A) coordination of— 
(i) care; and 
(ii) benefits; 
(B) patient identity matching; 
(C) measurement and reporting of quality; 
(D) population health; and 
(E) public health. 
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(2) CONSIDERATION.—In developing the plan 
under paragraph (1), the Secretary of Veterans Af-
fairs shall consider challenges faced by— 
(A) small community care providers; and 
(B) community care providers located in 
rural areas. 
(b) PLAN ON ELECTRONIC HEALTH RECORD EX-
CHANGE.— 
(1) IN
GENERAL.—Not later than one year 
after the date of enactment of this Act, the Sec-
retary shall submit to the Committees on Veterans’ 
Affairs of the Senate and the House of Representa-
tives a plan to provide, at no cost, to community 
care providers of the Department, through Third 
Party Administrators, a capability to facilitate the 
electronic direct exchange, between such providers 
and the Department, of— 
(A) the health records of veterans; and 
(B) documents relating to health care of 
veterans, clinical notes, and any other informa-
tion the Secretary determines necessary. 
(2) PRIORITIZATION.—In developing the plan 
required under paragraph (1), the Secretary shall 
prioritize providing the capability described in such 
paragraph to community care providers that— 
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(A) provide care under the laws adminis-
tered by the Secretary to— 
(i) a lower volume of veterans; and 
(ii) veterans who are located in rural 
areas; and 
(B) are unable or unwilling to exchange 
the records and documents described in sub-
paragraphs (A) and (B) of such paragraph with 
the Department through standards-based or di-
rect exchange mechanisms in effect as of the 
date of the enactment of this Act. 
(c) REPORTS
ON PLAN
FOR INTEROPERABILITY 
STANDARDS.— 
(1) INITIAL REPORT.—Not later than one year 
after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall submit to the Com-
mittees on Veterans’ Affairs of the Senate and the 
House of Representatives— 
(A) the plan required by subsection (a); 
and 
(B) a report that includes— 
(i) an analysis of gaps, if any, be-
tween the use, by the Department and 
other agencies, health information ex-
changes, and technology companies, of na-
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tional health information interoperability 
standards and the potential, or optimal, 
use of such national health information 
interoperability standards; 
(ii) an analysis and description of the 
participation by the Department, commu-
nity care providers, and other relevant en-
tities in the Trusted Exchange Framework 
and Common Agreement program of the 
Department of Health and Human Serv-
ices as of the date of the enactment of this 
Act; 
(iii) recommendations of the Secretary 
with respect to development of health in-
formation interoperability standards; 
(iv) timelines or schedules to imple-
ment the plan required by subsection (a); 
and 
(v) an identification of any legislative 
authorities or resources the Secretary re-
quires to implement such plan. 
(2) RECURRING REPORT REQUIREMENT.— 
(A) IN
GENERAL.—Not later than 18 
months after the date of the enactment of this 
Act, and every 180 days thereafter for four 
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years, the Secretary of Veterans Affairs shall 
submit to Committees on Veterans’ Affairs of 
the Senate and the House of Representatives a 
report on the status of implementation of the 
plan required under subsection (a). 
(B) ELEMENTS
OF
SUBSEQUENT
RE-
PORTS.—Each report under subparagraph (A) 
submitted after the date on which the first re-
port required by such subparagraph is sub-
mitted shall include a description of any revi-
sions to— 
(i) the plan required by subsection (a) 
made during the period covered by the re-
port; and 
(ii) the analysis, recommendations, 
timelines, and legislative authorities re-
ported pursuant to paragraph (1). 
(d) DEFINITIONS.—In this section: 
(1) The term ‘‘community care provider’’ means 
a non-Department health care provider providing 
care (including dental care)— 
(A) under section 1703 of title 38, United 
States Code; 
(B) pursuant to a Veterans Care Agree-
ment under section 1703A of such title; or 
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(C) under any other law administered by 
the Secretary of Veterans Affairs. 
(2) The term ‘‘Third Party Administrator’’ 
means an entity that manages a provider network 
and performs administrative services related to such 
network under section 1703 of title 38, United 
States Code. 
SEC. 109. REPORT ON USE OF VALUE-BASED REIMBURSE-
MENT MODELS UNDER VETERANS COMMU-
NITY CARE PROGRAM. 
(a) REPORT
ON VALUE-BASED REIMBURSEMENT 
MODELS.—Not later than one year after the date of the 
enactment of this Act, the Secretary of Veterans Affairs, 
in consultation with the Center for Innovation for Care 
and Payment of the Department of Veterans Affairs under 
section 1703E of title 38 United States Code, the Office 
of Integrated Veteran Care of the Department, or suc-
cessor office, and Third Party Administrators, shall sub-
mit to the Committees on Veterans’ Affairs of the House 
of Representatives and the Senate a report containing— 
(1) an assessment of the efforts of the Depart-
ment pursuant to section 1703(i)(5) of such title, to 
incorporate value-based reimbursement models under 
the Veterans Community Care Program to promote 
the provision of high-quality care to veterans; and 
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(2) such recommendations for legislative or ad-
ministrative action as the Secretary considers appro-
priate regarding the use of value-based reimburse-
ment models throughout the Veterans Community 
Care Program under section 1703 of such title. 
(b) RULE OF CONSTRUCTION.—This section shall not 
be construed to be a pilot program subject to the require-
ments of section 1703E of title 38, United States Code. 
(c) THIRD PARTY ADMINISTRATOR DEFINED.—In 
this section, the term ‘‘Third Party Administrator’’ means 
an entity that manages a provider network and performs 
administrative services related to such network under sec-
tion 1703 of title 38, United States Code. 
SEC. 110. INSPECTOR GENERAL ASSESSMENT OF IMPLE-
MENTATION 
OF 
VETERANS 
COMMUNITY 
CARE PROGRAM. 
(a) IN GENERAL.—Not later than 18 months after 
the date of the enactment of this Act, and periodically 
thereafter, the Inspector General shall assess the perform-
ance of the Department of Veterans Affairs in— 
(1) appropriately identifying veterans eligible 
for care and services under section 1703 of title 38, 
United States Code; 
(2) informing veterans of their eligibility for 
such care and services; and 
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(3) delivering such care and services in a timely 
manner. 
(b) BRIEFING ON ASSESSMENTS.—Upon the submis-
sion of the assessment required by subsection (a), the In-
spector General of the Department of Veterans Affairs 
shall provide to the Committees on Veterans Affairs of the 
House of Representatives and the Senate a briefing on the 
results of such assessment. 
SEC. 111. COMPTROLLER GENERAL REPORT ON DENTISTRY 
UNDER VETERANS COMMUNITY CARE PRO-
GRAM. 
(a) IN GENERAL.—Not later than one year after the 
date of the enactment of this Act, the Comptroller General 
of the United States shall submit to the Committees on 
Veterans’ Affairs of the Senate and the House of Rep-
resentatives a report on dental care furnished by the Sec-
retary of Veterans Affairs under the Veterans Community 
Care Program under section 1703 of title 38, United 
States Code, that includes a review of— 
(1) the impact current reimbursement rates 
provided by the Department of Veterans Affairs to 
dental providers under such program have on— 
(A) the availability of dental care for vet-
erans; and 
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(B) the ability of Third Party Administra-
tors to meet their contractual obligations for 
network adequacy; 
(2) the satisfaction of dental providers pro-
viding dental care under such program with the 
processes of the Department for approving dental 
care under such program; and 
(3) the current processes of the Department for 
approving emergent dental care under such program. 
(b) 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 sec-
tion 1703 of title 38, United States Code. 
Subtitle B—Matters Relating to 
Nursing Home and Other Long 
Term Care and Family Care-
givers 
SEC. 120. INCREASE OF EXPENDITURE CAP FOR NON-
INSTITUTIONAL 
CARE 
ALTERNATIVES 
TO 
NURSING HOME CARE. 
(a) INCREASE
OF
EXPENDITURE
CAP.—Section 
1720C(d) of title 38, United States Code, is amended— 
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(1) by striking ‘‘The total cost’’ and inserting 
‘‘(1) Except as provided in paragraph (2), the total 
cost’’; 
(2) by striking ‘‘65 percent’’ and inserting ‘‘100 
percent’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(2)(A) The total cost of providing services or in-kind 
assistance in the case of any veteran described in subpara-
graph (B) for any fiscal year under the program may ex-
ceed 100 percent of the cost that would otherwise have 
been incurred as specified in paragraph (1) if the Sec-
retary determines, based on a consideration of clinical 
need, geographic market factors, and such other matters 
as the Secretary may prescribe through regulation, that 
such higher total cost is in the best interest of the veteran. 
‘‘(B) A veteran described in this subparagraph is a 
veteran with amyotrophic lateral sclerosis, a spinal cord 
injury, or a condition the Secretary determines to be simi-
lar to such conditions.’’. 
(b) APPLICABILITY.—The amendments made by sub-
section (a) shall apply with respect to fiscal years begin-
ning on or after the date of the enactment of this Act. 
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SEC. 121. COORDINATION WITH PROGRAM OF ALL-INCLU-
SIVE CARE FOR THE ELDERLY. 
Section 1720C of title 38, United States Code, as 
amended by section 120, is further amended by adding 
at the end the following new subsection: 
‘‘(f) In furnishing services to a veteran under the pro-
gram conducted pursuant to subsection (a), if a medical 
center of the Department through which such program is 
administered is located in a geographic area in which serv-
ices are available to the veteran under a PACE program 
(as such term is defined in sections 1894(a)(2) and 
1934(a)(2) of the Social Security Act (42 U.S.C. 
1395eee(a)(2); 1396u–4(a)(2))), the Secretary shall seek 
to enter into an agreement with the PACE program oper-
ating in that area for the furnishing of such services.’’. 
SEC. 122. AUTHORITY FOR SECRETARY OF VETERANS AF-
FAIRS TO AWARD GRANTS OR CONTRACTS TO 
ENTITIES TO IMPROVE PROVISION OF MEN-
TAL HEALTH SUPPORT TO FAMILY CARE-
GIVERS OF VETERANS. 
Subchapter II of chapter 17 of title 38, United States 
Code, is amended by adding at the end the following new 
section (and conforming the table of sections at the begin-
ning of such chapter accordingly): 
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‘‘§ 1720K. Grants or contracts to provide mental 
health support to family caregivers of 
veterans 
‘‘(a) AUTHORITY.—The Secretary may award grants 
to carry out, coordinate, improve, or otherwise enhance 
mental health counseling, treatment, or support to the 
family caregivers of veterans participating in the family 
caregiver program. 
‘‘(b) APPLICATION.—(1) To be eligible for a grant or 
contract under this section, an entity shall submit to the 
Secretary an application therefor at such time, in such 
manner, and containing such information as the Secretary 
may require. 
‘‘(2) Each application submitted under paragraph (1) 
shall include the following: 
‘‘(A) A detailed plan for the use of the grant 
or contract. 
‘‘(B) A description of the programs or efforts 
through which the entity will meet the outcome 
measures developed by the Secretary under sub-
section (g). 
‘‘(C) A description of how the entity will dis-
tribute grant or contract amounts equitably among 
areas with varying levels of urbanization. 
‘‘(D) A plan for how the grant or contract will 
be used to meet the unique needs of veterans resid-
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program under paragraph (1), the Secretary shall 
submit to the Committees on Veterans’ Affairs of 
the House of Representatives and the Senate a re-
port that includes— 
(A) a statement of the results of such pilot 
program; and 
(B) an assessment of the feasibility and 
advisability of— 
(i) extending such pilot program; or 
(ii) making such pilot program a per-
manent program of the Department of 
Veterans Affairs. 
(b) REPORT ON USE OF FUNDS.—Not later than one 
year after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall submit to the Committees 
on Veterans’ Affairs of the House of Representatives and 
the Senate a report containing, with respect to the period 
beginning in fiscal year 2012 and ending in fiscal year 
2024, the following: 
(1) An identification of the amount of funds 
that were included in a budget of the Department of 
Veterans Affairs during such period for the provision 
of in-home care to veterans under the Homemaker 
and Home Health Aide program but were not ex-
pended for such provision, disaggregated by medical 
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