I 
118TH CONGRESS 
2D SESSION 
H. R. 8371 
To make certain improvements in the laws administered by the Secretary 
of Veterans Affairs, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 14, 2024 
Mr. CISCOMANI (for himself, Mr. ELLZEY, Mr. CAREY, Mr. BAIRD, Mr. 
BERGMAN, Mr. LUTTRELL, Mr. BACON, Mr. MURPHY, Mr. BOST, Mrs. 
KIGGANS of Virginia, Mrs. MILLER-MEEKS, Mr. GIMENEZ, Mr. WIL-
LIAMS of New York, Mr. EDWARDS, and Mrs. STEEL) introduced the fol-
lowing bill; which was referred to the Committee on Veterans’ Affairs, 
and in addition to the Committees on Natural Resources, and Armed 
Services, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 
A BILL 
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, 
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’’. 
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(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. Finality of decisions by veteran and referring clinician under Vet-
erans Community Care Program. 
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. Standardized process to determine eligibility of covered veterans for 
participation in certain mental health treatment programs. 
Sec. 106. Improvements to Department of Veterans Affairs Mental Health Res-
idential Rehabilitation Treatment Program. 
Sec. 107. Pilot program to improve administration of care under Veterans 
Community Care Program. 
Sec. 108. Pilot program on consolidating approval process of Department of 
Veterans Affairs for covered dental care. 
Sec. 109. Strategic plan on value-based health care system for Veterans Health 
Administration; pilot program. 
Sec. 110. Plan on adoption of certain health information standards for Depart-
ment of Veterans Affairs and certain health care providers. 
Sec. 111. Report on use of value-based reimbursement models under Veterans 
Community Care Program. 
Sec. 112. Inspector General assessment of implementation of Veterans Commu-
nity Care Program. 
Sec. 113. 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. 
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. 
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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. 
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. 
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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. 
Sec. 304. Ensuring only licensed health care professionals perform medical dis-
ability examinations under certain Department of Veterans Af-
fairs pilot program. 
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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—ELECTRONIC HEALTH RECORD MATTERS 
Sec. 501. Short title. 
Sec. 502. Definitions. 
Subtitle A—Electronic Health Record System and Health Information 
Technology Modernization 
Sec. 511. Modernization of Department of Veterans Affairs electronic health 
record system and health information technology. 
Sec. 512. Responsibility for electronic health record program and health infor-
mation technology. 
Sec. 513. Protection of personal information. 
Subtitle B—Implementation Requirements 
Sec. 521. Veterans Health Administration workflow baseline. 
Sec. 522. Requirements for electronic health record system implementation. 
Sec. 523. Conditional restructuring of Electronic Health Record Modernization 
Program. 
Subtitle C—Reporting 
Sec. 531. Report on additional purposes. 
Sec. 532. Reports on baseline of clinical workflows. 
Sec. 533. Report on health care quality metrics. 
Sec. 534. Report on support strategy for existing sites. 
Sec. 535. Report on resources required for future sites. 
Sec. 536. Report on alternative modernization strategies. 
Sec. 537. Report on health information technology strategy and roadmap. 
Sec. 538. Annual report on efforts to maintain VistA electronic health record 
system. 
Sec. 539. Modification of quarterly reports. 
Sec. 540. Report on protection of personal information. 
Sec. 541. Report on organization and needs. 
Sec. 542. Report on governance, performance criteria, and readiness. 
TITLE VI—OVERSIGHT AND INVESTIGATIONS MATTERS 
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Sec. 601. Department of Veterans Affairs employee training regarding Office of 
Inspector General. 
Sec. 602. Annual review of security at covered facilities of the Department of 
Veterans Affairs. 
Sec. 603. Modification of certain housing loan fees. 
TITLE I—HEALTH CARE 
MATTERS 
Subtitle A—Veterans Community 
Care Program Matters 
SEC. 101. FINALITY OF DECISIONS BY VETERAN AND RE-
FERRING CLINICIAN UNDER VETERANS COM-
MUNITY CARE PROGRAM. 
(a) IN GENERAL.—During the period specified in 
subsection (c), and subject to subsection (b), an agreement 
under section 1703(d)(1)(E) of title 38, United States 
Code, between a covered veteran and the referring clini-
cian of such veteran regarding the best medical interest 
of the veteran is final and is not subject to review, ap-
proval, or change by the Department of Veterans Affairs 
unless a statutory or regulatory barrier prevents the De-
partment from providing the care or services required 
under such agreement. 
(b) CORRECTION OF ERRORS.—A covered veteran 
and the referring clinician of such veteran may correct any 
errors made with respect to an agreement described in 
subsection (a). 
(c) PERIOD SPECIFIED.—The period specified in this 
subsection is the two-year period beginning on the date 
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that is 180 days after the date of the enactment of this 
Act. 
(d) ANNUAL REPORT.—Not later than one year and 
not later than two years after the commencement of the 
period specified under subsection (c), the Secretary of Vet-
erans Affairs shall submit to Congress a report on the care 
provided 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) 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): 
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‘‘(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 
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) 
TRANSITIONAL
SERVICES.—Section 
1144(f)(1)(B)(i) of title 10, United States Code, is amend-
ed by inserting ‘‘, including how to enroll in the system 
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of annual patient enrollment established and operated 
under section 1705 of title 38 and the ability to seek care 
and services under sections 1703 and 1710 of such title’’ 
before the semicolon. 
(c) SOLID START PROGRAM.—Section 6320(a)(2)(A) 
of title 38, United States Code, is amended by inserting 
‘‘, including how to enroll in the system of annual patient 
enrollment established and operated under section 1705 
of this title and the ability to seek care and services under 
sections 1703 and 1710 of this title’’ before the semicolon. 
(d) COMPTROLLER GENERAL REPORT
ON 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 
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— 
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(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— 
‘‘(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 
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‘‘(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 
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)— 
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(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 clauses: 
‘‘(v) Equitable care. 
‘‘(vi) Outcomes relating to patient 
quality of life.’’; 
(C) in paragraph (4)— 
(i) by striking ‘‘and the Centers for 
Medicare & Medicaid Services’’ and insert-
ing ‘‘the Centers for Medicare & Medicaid 
Services, and the Indian Health Service’’; 
and 
(ii) by striking ‘‘and other nongovern-
mental entities’’ and inserting ‘‘and other 
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non-governmental entities including Third 
Party Administrators’’; and 
(D) by striking paragraph (5) and insert-
ing the following new paragraphs: 
‘‘(5) When collecting, considering, and applying data 
related to patient care for purposes of establishing stand-
ards for quality under paragraph (1), the Secretary shall 
ensure no metric is being over or under analyzed. 
‘‘(6) In establishing standards for quality under para-
graph (1), the Secretary shall— 
‘‘(A) utilize the most up-to-date practices for 
extracting and analyzing relevant data; 
‘‘(B) utilize all relevant data available to the 
Secretary; 
‘‘(C) ensure the most efficient use of time and 
resources related to the use of data scientists em-
ployed by the Department; and 
‘‘(D) collaborate, as appropriate, with entities 
specified in paragraph (4). 
‘‘(7)(A) Not less frequently than once every five 
years, the Secretary shall update the standards for quality 
established under paragraph (1) pursuant to the require-
ments for the establishment of such standards under this 
subsection. 
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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-
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 subsection (a). 
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(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. 
(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, 
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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— 
(i) comparable with industry stand-
ards; 
(ii) easily accessible to, and under-
stood by— 
(I) veterans; 
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(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— 
(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 
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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. STANDARDIZED PROCESS TO DETERMINE ELIGI-
BILITY OF COVERED VETERANS FOR PAR-
TICIPATION IN CERTAIN MENTAL HEALTH 
TREATMENT PROGRAMS. 
(a) STANDARDIZED
SCREENING
PROCESS.—Not 
later than one year after the date of the enactment of this 
Act, the Secretary of Veterans Affairs shall establish a 
standardized screening process to determine, based on 
clinical need, whether a covered veteran satisfies criteria 
for priority or routine admission to a covered treatment 
program. 
(b) ELIGIBILITY CRITERIA.— 
(1) IN
GENERAL.—Under the standardized 
screening process required by subsection (a), a cov-
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ered veteran shall be eligible for priority admission 
to a covered treatment program if the covered vet-
eran meets criteria that include, but are not limited 
to, the following: 
(A) Symptoms that— 
(i) significantly affect activities of 
daily life; and 
(ii) increase the risk of such veteran 
for adverse outcomes. 
(B) An unsafe living situation. 
(C) A high-risk flag for suicide. 
(D) A determination of being a high risk 
for suicide. 
(E) Risk factors for overdose. 
(F) Non-responsive, relapsed, or unable to 
find recovery from one other course of treat-
ment, such as outpatient or intensive outpatient 
treatment. 
(G) Other such criteria as the Secretary 
determines appropriate. 
(2) CONSIDERATION.—In making a determina-
tion under paragraph (1), the Secretary shall con-
sider any referral of a health care provider of a cov-
ered veteran for such covered veteran to be admitted 
to a covered treatment program. 
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(c) TIME FOR SCREENING AND ADMISSION.—Under 
the standardized screening process required by subsection 
(a), the Secretary shall ensure a covered veteran— 
(1) is screened not later than 48 hours after the 
date on which the covered veteran, or a relevant 
health care provider, makes a request for the cov-
ered veteran to be admitted to a covered treatment 
program. 
(2) determined eligible for priority admission to 
a covered treatment program is admitted to such 
covered treatment program not later than 48 hours 
after the date of such determination. 
(d) ACCESS
STANDARDS
FOR
ROUTINE
ADMIS-
SION.—The Secretary shall include the standardized 
screening process under this section in the wait time ac-
cess standards for eligibility for mental health care under 
section 1703(d) of such title established by the Secretary 
under section 1703B of such title. 
(e) CONDITIONS UNDER WHICH CARE SHALL BE 
FURNISHED THROUGH NON-DEPARTMENT PROVIDERS.— 
If the Secretary determines a covered veteran to be eligible 
for either priority or routine admission to a covered treat-
ment program pursuant to the standardized screening 
process required by subsection (a), and the Secretary is 
unable to admit such covered veteran to a clinically appro-
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priate covered treatment program at a facility of the De-
partment of Veterans Affairs within the State of residence 
of the covered veteran in a manner that complies with the 
applicable wait time standards established pursuant to 
this section, the Secretary shall offer the covered veteran 
the option to receive care— 
(1) at another facility of the Department; or 
(2) at a non-Department facility that— 
(A) can admit the covered veteran within 
the period required by the applicable standards 
of the Department; and 
(B) is party to a contract or agreement 
with the Department or enters into such a con-
tract or agreement under which the Department 
furnishes a program that is equivalent to a cov-
ered treatment program to a veteran through 
such non-Departmental facility. 
(f) SUNSET.— 
(1) IN GENERAL.—The authority of the Sec-
retary to make a determination under this section 
expires on the day that is two years after the date 
of the enactment of this Act. 
(2) RULE OF CONSTRUCTION.—Paragraph (1) 
shall not be construed to affect a covered veteran in 
a covered treatment program pursuant to a deter-
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mination made on or before the date in such para-
graph. 
(g) DEFINITIONS.—In this section: 
(1) The term ‘‘covered treatment program’’— 
(A) means a mental health residential re-
habilitation treatment program of the Depart-
ment of Veterans Affairs; 
(B) a program of the Department for resi-
dential care for mental health and substance 
abuse disorders; 
(C) includes— 
(i) the programs designated as of the 
date of the enactment of this section as 
domiciliary residential rehabilitation treat-
ment programs; and 
(ii) any programs designated as domi-
ciliary residential rehabilitation treatment 
programs on or after such date of enact-
ment; and 
(D) does not include Compensated Work 
Therapy Transition Residence programs of the 
Department. 
(2) The term ‘‘covered veteran’’ means a vet-
eran described in section 1703(b) of title 38, United 
States Code. 
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SEC. 106. IMPROVEMENTS TO DEPARTMENT OF VETERANS 
AFFAIRS MENTAL HEALTH RESIDENTIAL RE-
HABILITATION TREATMENT PROGRAM. 
(a) PERFORMANCE METRICS.— 
(1) IN GENERAL.—The Secretary shall develop 
metrics to track, and shall subsequently track, the 
performance of medical facilities and Veterans Inte-
grated Service Networks of the Department in meet-
ing the requirements for— 
(A) screening, under section 105 of this 
Act, for the Mental Health Residential Rehabili-
tation Treatment Program (in this section re-
ferred to as the ‘‘Program’’) ; and 
(B) timely admission, under such screen-
ing, to the Program. 
(2) ELEMENTS.—The metrics developed under 
paragraph (1) shall include metrics for tracking the 
performance of such medical facilities and Veterans 
Integrated Service Networks with respect to routine 
and priority admission under the Program. 
(b) PLACEMENT; TRANSPORTATION.— 
(1) LOCATIONS.—If the Secretary determines 
that a covered veteran is in need of residential care 
under the Program, the Secretary shall provide to 
the covered veteran a list of locations at which such 
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covered veteran can receive such residential care 
that meets— 
(A) the standards for screening under sec-
tion 105 of this Act; and 
(B) the care needs of the covered veteran, 
including applicable treatment tracks. 
(2) TRANSPORTATION
COVERAGE.—The Sec-
retary shall provide transportation or pay for or re-
imburse the costs of transportation for any covered 
veteran who is admitted into the Program and needs 
transportation assistance— 
(A) from the residence of the covered vet-
eran or a facility of the Department or author-
ized non-Department facility that does not pro-
vide such care to another such facility that pro-
vides residential care covered under the Pro-
gram; and 
(B) back to the residence of the covered 
veteran after the conclusion of the Program, if 
applicable. 
(c) CONSIDERATIONS.—In making placement deci-
sions under the Program, the Secretary shall consider the 
input of the covered veteran and the treating clinicians 
of the covered veteran, including with respect to program 
specialty, subtype, or treatment track offered to the cov-
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ered veteran, and the geographic placement of the covered 
veteran, including family- or occupation-related pref-
erences or circumstances. 
(d) APPEALS.— 
(1) IN GENERAL.—The Secretary shall develop 
a national policy and associated procedures under 
which a covered veteran, a representative of a cov-
ered veteran, or a provider who requests a covered 
veteran be admitted to the Program, including a 
provider of the Department or a non-Department 
provider, may file a clinical appeal pursuant to this 
subsection if the covered veteran is— 
(A) denied admission into the Program; or 
(B) accepted into the Program but is not 
offered bed placement in a timely manner. 
(2) TIMELINESS STANDARDS FOR REVIEW.— 
(A) IN GENERAL.—The national policy and 
procedures developed under paragraph (1) for 
appeals described in such paragraph shall in-
clude timeliness standards for the Department 
to review and make a decision on such an ap-
peal. 
(B) DECISION.—The Secretary shall re-
view and respond to any appeal under para-
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graph (1) not later than 72 hours after the Sec-
retary receives such appeal. 
(3) PUBLIC
GUIDANCE.—The Secretary shall 
develop, and make available to the public, guidance 
on how a covered veteran, a representative of the 
covered veteran, or a provider of the covered veteran 
can file a clinical appeal pursuant to this sub-
section— 
(A) if the covered veteran is denied admis-
sion into the Program; 
(B) if the first date on which the covered 
veteran may enter the Program does not comply 
with the standards established by the Depart-
ment under section 1703B of title 38, United 
States Code for purposes of determining eligi-
bility for mental health care under subsections 
(d) and (h) of section 1703 of such title; or 
(C) with respect to such other factors as 
the Secretary may specify. 
(4) RULE OF CONSTRUCTION.—Nothing in this 
subsection may be construed as granting a covered 
covered veteran the right to appeal a decision of the 
Secretary with respect to admission to the Program 
to the Board of Veterans’ Appeals under chapter 71 
of title 38, United States Code. 
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(e) TRACKING OF AVAILABILITY AND WAIT TIMES.— 
(1) IN GENERAL.—The Secretary shall, to the 
extent practicable, create a method for tracking 
availability and wait times under the Program across 
all facilities of the Department, Veterans Integrated 
Service Networks of the Department, and non-De-
partment providers throughout the United States. 
(2) AVAILABILITY OF INFORMATION.—The Sec-
retary shall, to the extent practicable, make the in-
formation tracked under paragraph (1) available in 
real time to— 
(A) the mental health treatment coordina-
tors at each facility of the Department; 
(B) the leadership of each medical center 
of the Department; 
(C) the leadership of each Veterans Inte-
grated Service Network; and 
(D) the Office of the Under Secretary for 
Health of the Department. 
(f) TRAINING AND OVERSIGHT.— 
(1) TRAINING.— 
(A) IN GENERAL.—The Secretary shall up-
date and implement training for staff of the 
Department directly involved in the Program 
regarding referrals, screening, admission, place-
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ment decisions, and appeals for the Program, 
including all changes to processes and guidance 
under the Program required by this section and 
under section 105 of this Act. 
(B) COVERED VETERANS AWAITING ADMIS-
SION.—The training under subparagraph (A) 
shall include procedures for the care of covered 
veterans awaiting admission into the Program 
and communication with such covered veterans 
and the providers of such covered veterans. 
(C) TIMING OF TRAINING.— 
(i) IN GENERAL.—The Secretary shall 
require the training under subparagraph 
(A) to be completed by staff required to 
complete such training— 
(I) not later than 60 days after 
beginning employment at the Depart-
ment in a position that includes work 
directly involving the Program; and 
(II) not less frequently than an-
nually. 
(ii) TRACKING.—The Secretary shall 
track completion of training required 
under clause (i) by staff required to com-
plete such training. 
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(2) OVERSIGHT
STANDARDS.—The Secretary 
shall review and revise oversight standards for the 
leadership of the Veterans Integrated Service Net-
works and the Veterans Health Administration to 
ensure that facilities and staff of the Department 
are adhering to the policy of the Program on access 
to care. 
(g) CARE COORDINATION AND FOLLOW-UP CARE.— 
(1) CONTINUITY OF CARE.—The Secretary shall 
ensure each covered veteran who is screened for ad-
mission to the Program is offered, and provided if 
agreed upon, care options during the period between 
screening of the covered veteran and admission of 
the covered veteran to the Program to ensure the 
covered veteran does not experience any lapse in 
care. 
(2) CARE COORDINATION FOR SUBSTANCE USE 
DISORDER.—For a covered veteran being treated for 
substance use disorder, the Secretary shall— 
(A) ensure there is a care plan in place 
during the period between any detoxification 
services or inpatient care received by the cov-
ered veteran and admission of the covered vet-
eran to the Program; and 
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(B) communicate that care plan to the cov-
ered veteran, the primary care provider of the 
covered veteran, and the facility of the Program 
where the covered veteran is or will be residing. 
(3) CARE PLANNING PRIOR TO DISCHARGE.— 
(A) IN GENERAL.—The Secretary, in con-
sultation with the covered veteran and the 
treating providers of the covered veteran in the 
Program, shall ensure the completion of a care 
plan prior to the covered veteran being dis-
charged from the Program. 
(B) MATTERS
TO
BE
INCLUDED.—The 
care plan required under subparagraph (A) for 
a covered veteran shall include details on the 
course of treatment for the covered veteran fol-
lowing completion of treatment under the Pro-
gram, including any necessary follow-up care. 
(C) SHARING OF CARE PLAN.—The care 
plan required under subparagraph (A) shall be 
shared with the covered veteran, the primary 
care provider of the covered veteran, and any 
other providers with which the covered veteran 
consents to sharing the plan. 
(D) DISCHARGE FROM NON-DEPARTMENT 
FACILITY.—Upon discharge of a covered vet-
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eran under the Program from a non-Depart-
ment facility, the facility shall share with the 
Department all care records maintained by the 
facility with respect to the covered veteran and 
shall work in consultation with the Department 
on the care plan of the covered veteran required 
under subparagraph (A). 
(h) REPORTS TO CONGRESS.— 
(1) REPORT
ON
MODIFICATIONS
TO
PRO-
GRAM.— 
(A) IN
GENERAL.—Not later than two 
years after the date of the enactment of this 
Act, the Secretary of Veterans Affairs shall 
submit to the Committees on Veterans’ Affairs 
of the House of Representatives and the Senate 
a report on modifications made to the guidance, 
operation, and oversight of the Program to ful-
fill the requirements of this section. 
(B) ELEMENTS.—The report required by 
subparagraph (A) shall include— 
(i) an assessment of whether costs of 
the Program, including for residential care 
provided through facilities of the Depart-
ment and non-Department facilities, serve 
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as a disincentive to placement in the Pro-
gram; 
(ii) a description of actions taken by 
the Department to address the findings 
and recommendations by the Secretary 
contained in the report under section 
503(c) of the STRONG Veterans Act of 
2022 (division V of Public Law 117–328), 
including such actions with respect to— 
(I) any new locations of the Pro-
gram added; 
(II) any beds added at existing 
facilities of the Program; and 
(III) any additional treatment 
tracks or sex-specific programs cre-
ated or added at facilities of the De-
partment; and 
(iii) such recommendations as the 
Secretary may have for legislative or ad-
ministrative action to address any funding 
constraints or disincentives for use of the 
Program. 
(2) ANNUAL REPORT ON OPERATION OF PRO-
GRAM.— 
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(A) IN GENERAL.—Not later than one year 
after the submission of the report under para-
graph (1)(A), and not less frequently than an-
nually thereafter during the duration of the 
Program, the Secretary shall submit to the 
Committees on Veterans’ Affairs of the House 
of Representatives and the Senate a report on 
the operation of the Program. 
(B) ELEMENTS.—Subject to subparagraph 
(C), each report required by subparagraph (A) 
shall include the following: 
(i) The number of covered veterans 
served by the Program, disaggregated by— 
(I) Veterans Integrated Service 
Network in which the covered veteran 
receives care; 
(II) facility, including facilities of 
the Department and non-Department 
facilities, at which the covered veteran 
receives care; 
(III) type of residential rehabili-
tation treatment care received by the 
covered veteran under the Program; 
(IV) sex of the covered veteran; 
and 
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(V) race or ethnicity of the cov-
ered veteran. 
(ii) Wait times under the Program for 
the most recent year data is available, 
disaggregated by— 
(I) treatment track or specificity 
of residential rehabilitation treatment 
care sought by the covered veteran; 
(II) sex of the covered veteran; 
(III) State or territory in which 
the covered veteran is located; 
(IV) Veterans Integrated Service 
Network in which the covered veteran 
is located; and 
(V) facility of the Department at 
which the covered veteran seeks care. 
(iii) A list of all locations of the Pro-
gram and number of bed spaces at each 
such location, disaggregated by residential 
rehabilitation treatment care or treatment 
track provided under the Program at such 
location. 
(iv) A list of any new Program loca-
tions added or removed and any bed spaces 
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added or removed during the one-year pe-
riod preceding the date of the report. 
(v) Average cost of a stay under the 
Program, including total stay average and 
daily average, at— 
(I) a facility of the Department; 
and 
(II) a non-Department facility. 
(vi) A review of staffing needs and 
gaps with respect to the Program. 
(vii) 
Any 
recommendations 
for 
changes to the operation of the Program, 
including any policy changes, guidance 
changes, 
training 
changes, 
or 
other 
changes. 
(C) ANONYMITY.—The Secretary shall pro-
vide the data under this paragraph pursuant to 
Federal laws and in a manner that is wholly 
consistent with applicable Federal privacy and 
confidentiality laws, including the Privacy Act 
(5 U.S.C. 552a), the Health Insurance Port-
ability and Accountability Act (Public Law 
104–191; 42 U.S.C. 201 note) and regulations 
(title 45, Code of Federal Regulations, parts 
160 and 164, or successor regulations), and 
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sections 5701, 5705, and 7332 of title 38, 
United States Code, to ensure that the provided 
data, or some portion of the data, will not un-
dermine the anonymity of a veteran. 
(i) REVISION OF GUIDANCE.—The Secretary shall 
update the guidance of the Department of Veterans Af-
fairs on the operation of the Mental Health Residential 
Rehabilitation Treatment Program to reflect each of the 
requirements under subsections (b) through (h). 
(j) DEADLINE.—The Secretary of Veterans Affairs 
shall carry out each requirement under this section by not 
later than one year after the date of the enactment of this 
Act, unless otherwise specified. 
(k) COMPTROLLER GENERAL REVIEW.— 
(1) IN
GENERAL.—Not later than two years 
after the date of the enactment of this Act, the 
Comptroller General of the United States shall re-
view access to care under the Program for covered 
veterans in need of residential mental health care 
and substance use disorder care. 
(2) ELEMENTS.—The review required by para-
graph (1) shall include the following: 
(A) A review of wait times under the Pro-
gram, disaggregated by— 
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(i) treatment track or specificity of 
residential rehabilitation treatment care 
needed; 
(ii) sex of the covered veteran; 
(iii) home State of the covered vet-
eran; 
(iv) home Veterans Integrated Service 
Network of the covered veteran; and 
(v) wait times for— 
(I) facilities of the Department; 
and 
(II) non-Department facilities. 
(B) A review of policy and training of the 
Department on screening, admission, and place-
ment under the Program. 
(C) A review of the rights of covered vet-
erans and providers to appeal admission deci-
sions under the Program and how the Depart-
ment adjudicates appeals. 
(D) When determining the facility at which 
a covered veteran admitted to the Program will 
be placed in the Program, a review of how the 
input of the covered veteran is taken into con-
sideration with respect to— 
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(i) program specialty, subtype, or 
treatment track offered to the covered vet-
eran; and 
(ii) the geographic placement of the 
covered veteran, including family- or occu-
pation-related 
preferences 
or 
cir-
cumstances. 
(E) A review of staffing and staffing needs 
and gaps of the Program, including with re-
spect to— 
(i) mental health providers and coor-
dinators at the facility level; 
(ii) staff of Program facilities; 
(iii) staff of Veterans Integrated Serv-
ice Networks; and 
(iv) overall administration of the Pro-
gram at the national level. 
(F) Recommendations for improvement of 
access by covered veterans to care under the 
Program, including with respect to— 
(i) any new sites or types of programs 
needed or in development; 
(ii) changes in training or policy; 
(iii) changes in communications with 
covered veterans; and 
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(iv) oversight of the Program by the 
Department. 
(l) DEFINITIONS.—In this section: 
(1) The term ‘‘covered veteran’’ means a vet-
eran described in section 1703(b) of title 38, United 
States Code. 
(2) The term ‘‘Mental Health Residential Reha-
bilitation Treatment Program’’— 
(A) means— 
(i) a mental health residential reha-
bilitation treatment program of the De-
partment under sections 103 and 104 of 
the Veterans Mental Health and Other 
Care Improvement Act of 2008 (Public 
Law 110–387); and 
(ii) the array of programs and serv-
ices of the Department that comprise resi-
dential care for mental health and sub-
stance use disorders; 
(B) includes— 
(i) the programs designated as of the 
date of the enactment of this Act as domi-
ciliary residential rehabilitation treatment 
programs; and 
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(ii) any programs designated as domi-
ciliary residential rehabilitation treatment 
programs on or after such date of enact-
ment; and 
(C) does not include compensated work 
therapy transition resident programs of the De-
partment. 
(3) The term ‘‘treatment track’’ means a spe-
cialized treatment program that is provided to a sub-
set of covered veterans in the Program who receive 
the same or similar intensive treatment and rehabili-
tative services. 
(m) SUNSET.—This section shall terminate on the 
day that is two years after that date on which the Sec-
retary completes carrying out each requirement pursuant 
to subsection (j). 
SEC. 107. 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 shall carry out a pilot program to seek to develop 
and implement a plan— 
(1) to provide monetary and non-monetary in-
centives to a covered health care provider— 
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(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-
mentation for care or services provided under 
the Veterans Community Care Program; 
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(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, annually thereafter during the term of the pilot pro-
gram, the Secretary of Veterans Affairs shall submit to 
the Committees on Veterans’ Affairs of the House of Rep-
resentatives and the Senate a report on the pilot program 
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-
scribed in subparagraph (D) of subsection 
(a)(1) has improved; 
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(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 
(B) that otherwise furnishes care or serv-
ices outside of Department facilities pursuant 
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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. 108. 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 shall carry out a pilot program to hire— 
(1) general dentists at medical facilities of the 
Department of Veterans Affairs to manage approval 
by the Department of treatment plans requested by 
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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; 
(B) a description of the implementation of 
such pilot program; 
(C) an identification of any barriers or 
challenges to implementing such pilot program; 
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(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 
subparagraphs (A) through (F) of such para-
graph; 
(B) includes recommendations of the Sec-
retary on whether the pilot program should 
be— 
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(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. 
SEC. 109. 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— 
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(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). 
(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). 
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(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 
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. 
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(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. 
(iii) Three individuals representing an 
organization recognized by the Secretary of 
Veterans Affairs under section 5902 of 
title 38, United States Code. 
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(3) 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. 
(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. 
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(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 
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, 
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(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; 
(G) equity; and 
(H) 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. 
(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 
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(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 
(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); 
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(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 
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. 
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(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 
shall commence a three-year pilot program to imple-
ment the elements of such strategic plan relating to 
the delivery, by the Veterans Health Administration, 
of primary care, inpatient and outpatient mental 
health treatment, inpatient and outpatient substance 
abuse treatment, spinal cord injury disorder care, 
and polytrauma care. 
(2) LOCATIONS.—The Secretary shall carry out 
such pilot program in four Veterans Integrated 
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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. 
(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, 
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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. 
SEC. 110. 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 
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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. 
(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 
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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— 
(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-
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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-
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; 
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(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 
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 
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(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 
(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. 111. 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 
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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 
(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. 
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SEC. 112. INSPECTOR GENERAL ASSESSMENT OF IMPLE-
MENTATION 
OF 
VETERANS 
COMMUNITY 
CARE PROGRAM. 
(a) IN GENERAL.—Not later than two years after the 
date of the enactment of this Act, and periodically there-
after, the Inspector General shall assess the performance 
of a representative sample of medical centers in each Vet-
erans Integrated Service Network 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 
(3) delivering such care and services in a timely 
manner. 
(b) BRIEFING ON ASSESSMENTS.—Upon the submis-
sion of the initial assessment required by subsection (a), 
the Inspector General of the Department of Veterans Af-
fairs shall provide to the Committees on Veterans Affairs 
of the House of Representatives and the Senate a briefing 
on the plans of such Inspector General with respect to the 
findings, frequency, and methodology relating to such as-
sessment. 
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SEC. 113. 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 
(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. 
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(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— 
(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 
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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. 
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 
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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): 
‘‘§ 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. 
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‘‘(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-
ing in rural areas, Native American, Native Hawai-
ian, or Alaska Native veterans, elderly veterans, 
women veterans, and veterans from other under-
served communities. 
‘‘(c) DISTRIBUTION.—The Secretary shall seek to en-
sure that grants and contracts awarded under this section 
are equitably distributed among entities located in States 
with varying levels of urbanization. 
‘‘(d) PRIORITY.—The Secretary shall prioritize 
awarding grants or contracts under this section that will 
serve the following areas: 
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‘‘(1) Areas with high rates of veterans enrolled 
in the family caregiver program. 
‘‘(2) Areas with high rates of— 
‘‘(A) suicide among veterans; or 
‘‘(B) referrals to the Veterans Crisis Line. 
‘‘(e) REQUIRED ACTIVITIES.—Any grant or contract 
awarded under this section shall be used— 
‘‘(1) to expand existing programs, activities, 
and services; 
‘‘(2) to establish new or additional programs, 
activities, and services; or 
‘‘(3) for travel and transportation to facilitate 
carrying out paragraph (1) or (2). 
‘‘(f) OUTCOME MEASURES.—(1) The Secretary shall 
develop and provide to each entity that receives a grant 
or contract under this section written guidance on the fol-
lowing: 
‘‘(A) Outcome measures. 
‘‘(B) Policies of the Department. 
‘‘(2) In developing outcome measures under para-
graph (1), the Secretary shall consider the following goals: 
‘‘(A) Increasing the utilization of mental health 
services among family caregivers of veterans partici-
pating in the family caregiver program. 
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‘‘(B) Reducing barriers to mental health serv-
ices among family caregivers of veterans partici-
pating in such program. 
‘‘(g) TRACKING REQUIREMENTS.—(1) The Secretary 
shall establish appropriate tracking requirements with re-
spect to the entities receiving a grant or contract under 
this section. 
‘‘(2) Not less frequently than annually, the Secretary 
shall submit to Congress a report on such tracking re-
quirements. 
‘‘(h) 
PERFORMANCE
REVIEW.—The 
Secretary 
shall— 
‘‘(1) review the performance of each entity that 
receives a grant or contract under this section; and 
‘‘(2) make information regarding such perform-
ance publicly available. 
‘‘(i) REMEDIATION PLAN.—(1) In the case of an enti-
ty that receives a grant or contract under this section and 
does not meet the outcome measures developed by the Sec-
retary under subsection (g), the Secretary shall require the 
entity to submit to the Secretary a remediation plan under 
which the entity shall describe how and when it plans to 
meet such outcome measures. 
‘‘(2) The Secretary may not award a subsequent 
grant or contract under this section to an entity described 
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in paragraph (1) unless the Secretary approves the reme-
diation plan submitted by the entity under such para-
graph. 
‘‘(j) MAXIMUM AMOUNT.—The amount of a grant or 
contract awarded under this section may not exceed 10 
percent of amounts made available for grants or contracts 
under this section for the fiscal year in which the grant 
or contract is awarded. 
‘‘(k) SUPPLEMENT, NOT SUPPLANT.—Any grant or 
contract awarded under this section shall be used to sup-
plement and not supplant funding that is otherwise avail-
able through the Department to provide mental health 
support among family caregivers of veterans participating 
in the family caregiver program. 
‘‘(l) OUTREACH TO FAMILY CAREGIVERS.—The Sec-
retary shall include, in the outreach materials regularly 
provided to a family caregiver who participates in the fam-
ily caregiver program, notice of mental health support pro-
vided by recipients of grants or contracts under this sec-
tion that are located in the relevant Veterans Integrated 
Service Network. 
‘‘(m) FUNDING.—(1) Amounts for the activities of 
the Department under this section shall be budgeted and 
appropriated through a separate appropriation account. 
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‘‘(2) In the budget justification materials submitted 
to Congress in support of the budget of the Department 
for any fiscal year (as submitted with the budget of the 
President under section 1105(a) of title 31), the Secretary 
shall include a separate statement of the amount re-
quested to be appropriated for that fiscal year for the ac-
count specified in paragraph (1). 
‘‘(n) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to the Secretary, for each 
of fiscal years 2025 and 2026, $10,000,000 to carry out 
this section. 
‘‘(o) DEFINITIONS.—In this section: 
‘‘(1) The terms ‘caregiver’ and ‘family care-
giver’ have the meanings given those terms in sec-
tion 1720G of this title. 
‘‘(2) The term ‘family caregiver program’ 
means the program of comprehensive assistance for 
family caregivers under section 1720G of this title. 
‘‘(3) The term ‘Veterans Crisis Line’ means the 
toll-free hotline for veterans established under sec-
tion 1720F of this title.’’. 
SEC. 123. HOME- AND COMMUNITY-BASED SERVICES: PRO-
GRAMS. 
(a) PROGRAMS.—Such subchapter is further amend-
ed by inserting after section 1720K (as added by section 
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122) the following new section (and conforming the table 
of sections at the beginning of such chapter accordingly): 
‘‘§ 1720L. Home- and community-based services: pro-
grams 
‘‘(a) IN GENERAL.—In furnishing noninstitutional al-
ternatives to nursing home care pursuant to the authority 
of section 1720C of this title (or any other authority under 
this chapter or other provision of law administered by the 
Secretary of Veterans Affairs), the Secretary shall carry 
out each of the programs specified in this section in ac-
cordance with such relevant authorities except as other-
wise provided in this section. 
‘‘(b) VETERAN-DIRECTED CARE PROGRAM.—(1) The 
Secretary of Veterans Affairs, in collaboration with the 
Secretary of Health and Human Services, shall carry out 
a program to be known as the ‘Veteran-Directed Care pro-
gram’. Under such program, the Secretary of Veterans Af-
fairs may enter into agreements with the providers de-
scribed in paragraph (2) to provide to eligible veterans 
funds, to the extent practicable, to obtain such in-home 
care services and related items that support clinical need 
and improve quality of life, as may be determined appro-
priate by the Secretary of Veterans Affairs and selected 
by the veteran, including through the veteran hiring indi-
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viduals to provide such services and items or directly pur-
chasing such services and items. 
‘‘(2) The providers described in this paragraph are 
the following: 
‘‘(A) An Aging and Disability Resource Center, 
an area agency on aging, or a State agency. 
‘‘(B) A center for independent living. 
‘‘(C) An Indian tribe or tribal organization re-
ceiving assistance under title VI of the Older Ameri-
cans Act of 1965 (42 U.S.C. 3057 et seq.). 
‘‘(D) Any other entity that the Secretary, in 
consultation with the Secretary of Health and 
Human Services, determines appropriate. 
‘‘(3) In carrying out the Veteran-Directed Care pro-
gram, the Secretary of Veterans Affairs shall— 
‘‘(A) administer such program through each 
medical center of the Department of Veterans Af-
fairs; 
‘‘(B) seek to ensure the availability of such pro-
gram in American Samoa, Guam, the Common-
wealth of the Northern Mariana Islands, the Com-
monwealth of Puerto Rico, the Virgin Islands of the 
United States, and any other territory or possession 
of the United States, to the extent practicable; and 
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‘‘(C) seek to ensure the availability of such pro-
gram for eligible veterans who are Native American 
veterans receiving care and services furnished by the 
Indian Health Service, a tribal health program, an 
Urban Indian organization, or (in the case of a Na-
tive Hawaiian veteran) a Native Hawaiian health 
care system, to the extent practicable. 
‘‘(4) If a veteran participating in the Veteran-Di-
rected Care program is hospitalized, the veteran may con-
tinue to use funds under the program during a period of 
hospitalization in the same manner that the veteran would 
be authorized to use such funds under the program if the 
veteran were not hospitalized. 
‘‘(c) HOMEMAKER AND HOME HEALTH AIDE PRO-
GRAM.—(1) The Secretary shall carry out a program to 
be known as the ‘Homemaker and Home Health Aide pro-
gram’ under which the Secretary may enter into agree-
ments with home health agencies to provide to eligible vet-
erans such home health aide services as may be deter-
mined appropriate by the Secretary. 
‘‘(2) In carrying out the Homemaker and Home 
Health Aide program, the Secretary shall— 
‘‘(A) administer such program in the locations 
specified in subparagraph (A) of subsection (b)(3); 
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‘‘(B) seek to ensure the availability of such pro-
gram in the locations specified in subparagraph (B) 
of subsection (b)(3); and 
‘‘(C) seek to ensure the availability of such pro-
gram for the veteran populations specified in sub-
paragraph (C) of subsection (b)(3). 
‘‘(d) HOME-BASED PRIMARY CARE PROGRAM.—The 
Secretary shall carry out a program to be known as the 
‘Home-Based Primary Care program’ under which the 
Secretary may furnish to eligible veterans in-home health 
care, the provision of which is overseen by a provider of 
the Department. 
‘‘(e) PURCHASED SKILLED HOME CARE PROGRAM.— 
The Secretary shall carry out a program to be known as 
the ‘Purchased Skilled Home Care program’ under which 
the Secretary may furnish to eligible veterans such in- 
home care services as may be determined appropriate and 
selected by the Secretary for the veteran. 
‘‘(f) CAREGIVER SUPPORT.—(1) With respect to a 
resident eligible caregiver of a veteran participating in a 
program under this section, the Secretary shall— 
‘‘(A) if the veteran meets the requirements of 
a covered veteran under section 1720G(b) of this 
title, provide to such caregiver the option of enroll-
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ing in the program of general caregiver support serv-
ices under such section; 
‘‘(B) provide to such caregiver covered respite 
care of not less than 30 days annually; and 
‘‘(C) conduct on an annual basis (and, to the 
extent practicable, in connection with in-person serv-
ices provided under the program in which the vet-
eran is participating), a wellness contact of such 
caregiver. 
‘‘(2) Covered respite care provided to a resident eligi-
ble caregiver of a veteran under paragraph (1) may exceed 
30 days annually if such extension is requested by the resi-
dent eligible caregiver or veteran and determined medi-
cally appropriate by the Secretary. 
‘‘(g) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to limit the authority of the Sec-
retary to carry out programs providing home- and commu-
nity-based services under any other provision of law. 
‘‘(h) DEFINITIONS.—In this section: 
‘‘(1) The terms ‘Aging and Disability Resource 
Center’, ‘area agency on aging’, and ‘State agency’ 
have the meanings given those terms in section 102 
of the Older Americans Act of 1965 (42 U.S.C. 
3002). 
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‘‘(2) The terms ‘caregiver’ and ‘family care-
giver’, with respect to a veteran, have the meanings 
given those terms, respectively, under subsection (e) 
of section 1720G of this title with respect to an eli-
gible veteran under subsection (a) of such section or 
a covered veteran under subsection (b) of such sec-
tion, as the case may be. 
‘‘(3) The term ‘center for independent living’ 
has the meaning given that term in section 702 of 
the Rehabilitation Act of 1973 (29 U.S.C. 796a). 
‘‘(4) The term ‘covered respite care’ has the 
meaning given such term in section 1720G(d) of this 
title. 
‘‘(5) The term ‘eligible veteran’ means any vet-
eran— 
‘‘(A) for whom the Secretary determines 
participation in a specific program under this 
section is medically necessary to promote, pre-
serve, or restore the health of the veteran; and 
‘‘(B) who absent such participation would 
be at increased risk for hospitalization, place-
ment in a nursing home, or emergency room 
care. 
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‘‘(6) The term ‘home health aide’ means an in-
dividual employed by a home health agency to pro-
vide in-home care services. 
‘‘(7) The term ‘in-home care service’ means any 
service, including a personal care service, provided to 
enable the recipient of such service to live at home. 
‘‘(8) The terms ‘Indian tribe’ and ‘tribal organi-
zation’ have the meanings given those terms in sec-
tion 4 of the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 5304). 
‘‘(9) The terms ‘Native American’ and ‘Native 
American veteran’ have the meanings given those 
terms in section 3765 of this title. 
‘‘(10) The terms ‘Native Hawaiian’ and ‘Native 
Hawaiian health care system’ have the meanings 
given those terms in section 12 of the Native Hawai-
ian Health Care Improvement Act (42 U.S.C. 
11711). 
‘‘(11) The terms ‘tribal health programs’ and 
‘Urban Indian organizations’ have the meanings 
given those terms in section 4 of the Indian Health 
Care Improvement Act (25 U.S.C. 1603). 
‘‘(12) The term ‘resident eligible caregiver’ 
means an individual who— 
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‘‘(A) is a caregiver, or a family caregiver, 
of a veteran and resides with that veteran; and 
‘‘(B) has not entered into a contract, 
agreement, or other arrangement for such indi-
vidual to act as a caregiver for that veteran un-
less such individual is a family member of the 
veteran or is furnishing caregiver services 
through a medical foster home.’’. 
(b) DEADLINE FOR IMPROVED ADMINISTRATION.— 
The Secretary of Veterans Affairs shall ensure that the 
Veteran-Directed Care program and the Homemaker and 
Home Health Aide program are administered through 
each medical center of the Department of Veterans Affairs 
in accordance with section 1720L of title 38, United 
States Code (as added by subsection (a)), by not later 
than two years after the date of the enactment of this Act. 
(c) ADMINISTRATION OF VETERAN-DIRECTED CARE 
PROGRAM.— 
(1) PROCEDURES.— 
(A) The Secretary shall establish proce-
dures to— 
(i) identify the staffing needs for the 
Veteran-Directed Care program of the De-
partment of Veterans Affairs under such 
section (as added by subsection (a)); and 
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(ii) define the roles and responsibil-
ities for personnel of the Department re-
sponsible for the administration of such 
program, including such personnel em-
ployed at the national, Veterans Integrated 
Service Network, or medical facility level. 
(B) The responsibilities described in clause 
(ii) of subparagraph (A) shall include respon-
sibilities for engagement with— 
(i) veterans participating in such pro-
gram; 
(ii) veterans interested in partici-
pating in such program; and 
(iii) providers described in section 
1720L(b)(2) (as added by subsection (a)). 
(2) STAFFING
MODEL; REPORT.—Not later 
than two years after enactment of this Act, the Sec-
retary of Veterans Affairs shall— 
(A) establish a staffing model for the ad-
ministration of such program at each medical 
facility of the Department of Veterans Affairs; 
and 
(B) submit to the Committees on Veterans’ 
Affairs of the House of Representatives and the 
Senate a report containing the following: 
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(i) A description of— 
(I) the staffing model described 
in subparagraph (A); and 
(II) the rationale for such staff-
ing model. 
(ii) An identification of the ratio of 
staff required to administer such program 
to the number of veterans served by such 
program, disaggregated by each medical 
facility of the Department of Veterans Af-
fairs. 
(iii) A description of budgetary re-
sources or other support, if any, required 
to accommodate an increase in staffing at 
medical facilities of the Department of 
Veterans Affairs pursuant to the require-
ments of the staffing model described in 
subparagraph (A). 
(iv) Such other matters as the Sec-
retary of Veterans Affairs determines ap-
propriate. 
SEC. 124. COORDINATION WITH ASSISTANCE AND SUPPORT 
SERVICES FOR CAREGIVERS. 
(a) COORDINATION WITH PROGRAM OF COMPREHEN-
SIVE ASSISTANCE FOR FAMILY CAREGIVERS.— 
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(1) COORDINATION.—Section 1720G(a) of title 
38, United States Code, is amended by adding at 
the end the following new paragraph: 
‘‘(14)(A) In the case of a veteran or caregiver who 
seeks services under this subsection and is denied such 
services, or a veteran or the family caregiver of a veteran 
who is discharged from the program under this subsection, 
the Secretary shall— 
‘‘(i) if the veteran meets the requirements of a 
covered veteran under subsection (b), provide to 
such caregiver the option of enrolling in the program 
of general caregiver support services under such sub-
section; 
‘‘(ii) assess the veteran or caregiver for partici-
pation in any other available program of the Depart-
ment for home- and community-based services (in-
cluding the programs specified in section 1720L of 
this title) for which the veteran or caregiver may be 
eligible and, with respect to the veteran, store (and 
make accessible to the veteran) the results of such 
assessment in the electronic medical record of the 
veteran; and 
‘‘(iii) provide to the veteran or caregiver written 
information on any such program identified pursu-
ant to the assessment under clause (ii), including in-
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formation about facilities, eligibility requirements, 
and relevant contact information for each such pro-
gram. 
‘‘(B) The Secretary shall, to the extent practicable, 
provide to a veteran or family caregiver the option of ob-
taining clinically appropriate services under any other 
available program of the Department for home- and com-
munity-based services (including the programs specified in 
section 1720L of this title) for which the veteran or family 
caregiver may be eligible prior to discharging the veteran 
or family caregiver from the program under this sub-
section. 
‘‘(C) For each veteran or family caregiver who is dis-
charged from the program under this subsection, a care-
giver support coordinator shall provide for a smooth and 
personalized transition from such program to an appro-
priate program of the Department for home- and commu-
nity-based services (including the programs specified in 
section 1720L of this title), including by integrating care-
giver support across programs.’’. 
(2) APPLICABILITY.—The amendments made 
by paragraph (1) shall apply with respect to denials 
and discharges occurring on or after the date that 
is 180 days after the date of the enactment of this 
Act. 
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(3) TECHNICAL
AND
CONFORMING
AMEND-
MENTS.—Section 1720G(d) of such title is amend-
ed— 
(A) by striking ‘‘or a covered veteran’’ 
each place it appears and inserting ‘‘, a veteran 
denied or discharged as specified in paragraph 
(14) of such subsection, or a covered veteran’’; 
and 
(B) by striking ‘‘under subsection (a), 
means’’ each place it appears and inserting 
‘‘under subsection (a) or a veteran denied or 
discharged as specified in paragraph (14) of 
such subsection, means’’. 
(b) CONFORMITY OF RESPITE CARE ACROSS PRO-
GRAMS.—Section 1720G of title 38, United States Code, 
as amended by subsection (a)(3), is further amended— 
(1) in subsection (a)(3)— 
(A) by amending subparagraph (A)(ii)(III) 
to read as follows: 
‘‘(III) covered respite care of not less than 
30 days annually;’’; and 
(B) by striking subparagraph (B) and re-
designating subparagraphs (C) and (D) as sub-
paragraphs (B) through (C), respectively; and 
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(2) by amending subsection (b)(3)(A)(iii) to 
read as follows: 
‘‘(iii) Covered respite care of not less than 30 
days annually.’’; and 
(3) in subsection (d)— 
(A) 
by 
redesignating 
paragraphs 
(2) 
through (4) as paragraphs (3) through (5), re-
spectively; and 
(B) by inserting after paragraph (1) the 
following new paragraph: 
‘‘(2) The term ‘covered respite care’ means, 
with respect to a caregiver of a veteran, respite care 
under section 1720B of this title that— 
‘‘(A) is medically and age appropriate for 
the veteran (including 24-hour per day care of 
the veteran commensurate with the care pro-
vided by the caregiver); and 
‘‘(B) includes in-home care.’’. 
(c) REVIEW RELATING TO CAREGIVER CONTACT.— 
The Secretary shall conduct a review of the capacity of 
the Department to establish a streamlined system for con-
tacting all caregivers enrolled in the program of general 
caregiver support services under section 1720G(b) of title 
38, United States Code, to provide to such caregivers pro-
gram updates and alerts relating to emerging services for 
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102 
(ii) re-evaluate payment rates annu-
ally to account for current economic condi-
tions and current costs of assisted living 
services. 
(e) CONTINUITY OF CARE.—Upon the termination of 
the pilot program under subsection (a)(1), the Secretary 
shall— 
(1) provide to all veterans participating in the 
pilot program at the time of such termination the 
option to continue to receive assisted living services 
at the site they were assigned to under the pilot pro-
gram, at the expense of the Department; and 
(2) for such veterans who do not opt to con-
tinue to receive such services— 
(A) ensure such veterans do not experience 
lapses in care; and 
(B) provide such veterans with information 
on, and furnish such veterans with, other ex-
tended care services based on their preferences 
and best medical interest. 
(f) DETERMINATION OF QUALITY.—The Secretary 
shall determine a method for assessment of quality of care 
provided to veterans participating in the pilot program 
under subsection (a)(1) and shall communicate that meth-
od to providers of services under the pilot program. 
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