I 
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 Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Veteran Care Improve-
ment Act of 2023’’. 
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SEC. 2. CODIFICATION OF ACCESS STANDARDS FOR COM-
MUNITY CARE FURNISHED BY THE DEPART-
MENT 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 Sec-
retary cannot schedule an in-person appointment for 
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‘‘(A) Federal entities (including the De-
partment of Defense, the Department of Health 
and Human Services, and the Centers for Medi-
care & 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 partici-
pating 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 re-
garding such access standards.’’; 
(2) by striking subsection (g); 
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(3) by redesignating subsections (f), (h), and (i) 
as subsections (d), (e), and (f), respectively; 
(4) in subsection (d), as redesignated by para-
graph (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 REGARD-
ING ELIGIBILITY.—(1) Consistent with’’; 
and 
(ii) by striking ‘‘designated access 
standards established under this section’’ 
and inserting ‘‘access standards under sub-
section (a)’’; and 
(B) in paragraph (2)(B), by striking ‘‘des-
ignated access standards established under this 
section’’ and inserting ‘‘access standards under 
subsection (a)’’; and 
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(6) in subsection (f), as redesignated by para-
graph (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 ‘‘des-
ignated access standards developed by the Secretary 
under section 1703B of this title’’ and inserting ‘‘ac-
cess 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’’. 
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SEC. 3. REQUIREMENT THAT SECRETARY NOTIFY VET-
ERANS OF ELIGIBILITY FOR CARE UNDER 
VETERANS COMMUNITY CARE PROGRAM. 
Section 1703 of title 38, United States Code, is fur-
ther 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 serv-
ices 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 cov-
ered 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 AT-
TENDANT. 
Section 1703 of title 38, United States Code, is fur-
ther amended, in subsection (d)(2), by adding at the end 
the following new subparagraphs: 
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‘‘(F) The preference of the covered veteran re-
garding 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 ex-
tended care services.’’. 
SEC. 5. NOTIFICATION OF DENIAL OF REQUEST FOR CARE 
UNDER VETERANS COMMUNITY CARE PRO-
GRAM. 
Section 1703 of title 38, United States Code, is fur-
ther amended— 
(1) by redesignating subsection (o) as sub-
section (p); and 
(2) by inserting after subsection (n) the fol-
lowing new subsection (o): 
‘‘(o) NOTIFICATION OF DENIAL OF REQUEST FOR 
CARE AND HOW TO APPEAL.—(1) If a request by a vet-
eran 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 
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‘‘(B) with instructions on how to appeal such 
denial using the clinical appeals process of the Vet-
erans 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 para-
graph 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 COM-
MUNITY CARE PROGRAM. 
Section 1703 of title 38, United States Code, is fur-
ther amended— 
(1) by redesignating subsection (p) as sub-
section (q); and 
(2) by inserting after subsection (o) the fol-
lowing new subsection (p): 
‘‘(p) PROVISION OF INFORMATION REGARDING OP-
TION 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 tele-
health, either through a medical facility of the Department 
or under this section, if— 
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‘‘(1) a health care provider described in sub-
section (c) provides such care or services via tele-
health; and 
‘‘(2) the Secretary determines telehealth is ap-
propriate for the type of care or services the veteran 
seeks; and’’. 
SEC. 7. FINALITY OF DECISION BY VETERAN AND VET-
ERAN’S REFERRING PROVIDER. 
(a) IN GENERAL.—Section 1703 of title 38, United 
States Code, is further amended— 
(1) by redesignating subsection (q) as sub-
section (r); and 
(2) by inserting after subsection (p) the fol-
lowing 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 refer-
ring provider in writing that the Secretary may not pro-
vide 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’’. 
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SEC. 8. 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 (r) as sub-
section (s); and 
(2) by inserting after subsection (q) the fol-
lowing new subsection (r): 
‘‘(r) 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 
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— 
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‘‘(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 PRO-
GRAM. 
(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 Vet-
erans Affairs shall negotiate with third party administra-
tors 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 
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under subsection (b) terms to establish the use of value- 
based reimbursement models under the Veterans Commu-
nity 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 sec-
tion 1703E of title 38, United States Code, and the Office 
of Integrated Veteran Care of the Department, or suc-
cessor office, shall submit to the Committee on Veterans’ 
Affairs of the Senate and the Committee on Veterans’ Af-
fairs of the House of Representatives a report con-
taining— 
(1) an assessment of the efforts of the Depart-
ment pursuant to section 1703(i)(5) of such title, as 
amended by subsection (a), to incorporate value- 
based reimbursement models to promote the provi-
sion of high-quality care to veterans; and 
(2) such recommendations for legislative or ad-
ministrative action as the Secretary considers appro-
priate to increase the use of value-based reimburse-
ment 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 require-
ments of section 1703E of title 38, United States Code. 
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(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 sec-
tion 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 DE-
PENDENCY. 
Section 1720A of title 38, United States Code, is 
amended by adding at the end the following new sub-
section: 
‘‘(e) The Secretary shall determine whether a veteran 
who requests residential treatment and rehabilitative serv-
ices for alcohol or drug dependence under this section re-
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quires 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 sys-
tem 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, in-
cluding through synchronous, asynchronous, 
and asynchronous assisted digital scheduling; 
(B) to complete continuing professional 
educational training regarding veteran cultural 
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competency and other subjects determined ap-
propriate by the Secretary; 
(C) to improve the rate of the timely re-
turn to the Secretary of medical record docu-
mentation 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 appoint-
ments under such program and consider the feasi-
bility 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 reim-
bursement models under section 1703(i)(5) of such title, 
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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 Vet-
erans’ Affairs of the Senate and House of Rep-
resentatives 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 Rep-
resentatives 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 Rep-
resentatives 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 sub-
mitted under paragraph (3)— 
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(A) a complete list of the value-based reim-
bursement 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 descrip-
tion of the reasons such model was not imple-
mented. 
(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 en-
actment 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 adminis-
trator. 
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(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 IMPLEMEN-
TATION 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 cen-
ter 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. 
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(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 assess-
ment required by subsection (a). 
Æ 
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