II 117th CONGRESS 1st Session S. 3163 IN THE SENATE OF THE UNITED STATES November 4, 2021 Mr. Tester (for himself and Mr. Moran ) introduced the following bill; which was read twice and referred to the Committee on Veterans' Affairs A BILL To improve access to medical examinations required by veterans to obtain disability compensation or pension under laws administered by the Secretary of Veterans Affairs, and for other purposes.

1. Short title This Act may be cited as the Reform and Update Rural Access to Local Exams Act of 2021 or the RURAL Exams Act of 2021 . 2. Definitions In this Act: (1) Covered medical disability examination The term covered medical disability examination means a medical examination that the Secretary of Veterans Affairs determines necessary for the purposes of adjudicating a benefit under chapter 11 or 15 of title 38, United States Code, regardless of whether conducted by an employee or a contractor of the Department of Veterans Affairs. (2) Housebound The term housebound , with respect to a veteran, means— (A) the veteran meets the requirement of permanently housebound as described in section 1114(s) of title 38, United States Code; (B) the veteran meets the requirement of permanently housebound as described in section 1502(c) of such title; or (C) the Secretary has determined that the veteran faces significant difficulty in traveling to obtain a covered medical disability examination. (3) Rural area The term rural area means any non-urban area, within the meaning of the Rural-Urban Commuting Area Codes system of the Department of Agriculture and the Department of Health and Human Services, or successor system. (4) Rural veteran The term rural veteran means a veteran who resides in a rural area. 3. Improving data collection by Department of Veterans Affairs on covered medical disability examinations (a) Data collection required Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall begin collecting data to improve access of veterans to covered medical disability examinations. (b) Elements Data collected under subsection (a) shall include data regarding the following: (1) Timeliness, quality, and veteran satisfaction measurements of covered medical disability examinations. (2) Proportion of completed covered medical disability examinations determined to be inadequate for the adjudication of a claim for compensation or pension under chapter 11 or 15 of title 38, United States Code. (3) Every performance standard required for eligibility for financial incentives or disincentives in a contract between the Department of Veterans Affairs and any contractor for the provision of a covered medical disability examination. (c) Disaggregation of data The Secretary shall disaggregate data collected under subsection (a) by— (1) State; (2) county; and (3) as the case may be— (A) individual contractor with a Department of Veterans Affairs contract for the provision of a covered medical disability examination; or (B) individual Veterans Health Administration facility conducting a covered medical disability examination. (d) Publication Not later than one year after the date of the enactment of this Act, the Secretary shall make publicly available on an internet website, and updated not less frequently than quarterly, all data collected under subsection (a). 4. Study on improvements to Department of Veterans Affairs covered medical disability examinations in rural areas (a) Study required Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall complete a study on access by rural veterans to covered medical disability examinations. (b) Elements (1) In general The study conducted under subsection (a) shall include the following: (A) A comparison of the average number of days to complete covered medical disability examinations for rural veterans compared to the national non-rural average time to complete covered medical disability examinations, by either contractors or employees of the Department. (B) A root cause analysis of differences identified pursuant to subparagraph (A). (C) The plan of the Secretary for the following year to improve access described in subsection (a), which shall include a plan for the pursuit of a commercial or industry-standard solution or technology that could enable rural or housebound veterans to receive examinations without traveling long distances. (2) National non-rural average defined For purposes of paragraph (1)(A), the term national non-rural average means the national average of all periods in the previous calendar year— (A) beginning on the date on which a contractor received a request from the Secretary to conduct a covered medical disability examination for a veteran who is not a rural veteran; and (B) ending on the date on which the examination was completed. (c) Report on study Not later than one year after the date of the enactment of this Act, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the findings of the Secretary with respect to the study completed under subsection (a). (d) Annual report on plans Not later than two years after the date of the enactment of this Act and not less frequently than once each year thereafter, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report evaluating the conduct of the plans of the Secretary to improve access described in subsection (a) and a new or revised plan for such improvement in the following year. 5. Department of Veterans Affairs timeliness requirements for provision of covered medical disability examinations by contractors to rural and housebound veterans In each contract entered into by the Secretary of Veterans Affairs after the date of the enactment of this Act for the provision by a contractor of a covered medical disability examination, the Secretary shall include the following: (1) Such financial incentives as the Secretary considers appropriate to encourage a contractor to provide a covered medical disability examination to a rural veteran or a housebound veteran in a timely manner. (2) Such financial disincentives as the Secretary considers appropriate to discourage a contractor from failing to provide a covered medical disability examination to a rural veteran or a housebound veteran in a timely manner. (3) A requirement that the contractor cooperate with inspections conducted under the program required by section 6(a). 6. Annual inspections by Department of Veterans Affairs of facilities used by contractors for provision of covered medical disability examinations (a) Program required Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall establish a program of periodic inspections of sites, locations, and facilities where covered medical disability examinations are provided by contractors of the Department of Veterans Affairs. (b) Number and periodicity (1) In general Under the program required by subsection (a), the Secretary shall, each year, inspect not fewer than three percent of all sites, locations, and facilities used by a contractor of the Department to provide a covered medical disability examination during the previous one-year period. (2) Initial inspections Paragraph (1) shall apply with respect to the first one-year period beginning after the date of the establishment of the program pursuant to subsection (a) and each year thereafter. (c) Selection of sites, locations, and facilities for inspection Under the program required by subsection (a), the Secretary shall— (1) use both random and targeted methods of selecting sites, locations, and facilities for inspection; and (2) ensure that the number of inspections of sites, locations, and facilities in rural areas bears the same ratio to the total number of inspections as the number of covered medical disability examinations provided by contractors of the Department to rural veterans bears to the total number of covered medical disability examinations provided by contractors of the Department to all veterans. (d) Notice and timing Each inspection under the program required by subsection (a) shall be conducted during such business hours as the Secretary considers reasonable and the Secretary shall provide no more notice than the Secretary considers necessary to ensure the inspected facility is available for such inspection. (e) Elements Each inspection conducted under the program required by subsection (a) shall include inspection of a site, location, or facility for the following: (1) Compliance with the terms of any applicable contract. (2) Compliance with the Americans with Disabilities Act of 1990 ( 42 U.S.C. 12101 et seq. ). (3) Cleanliness. (4) General fitness for a covered medical disability examination. (5) Such other elements as the Secretary considers necessary to ensure that covered medical disability examinations provided on behalf of the Department are safe, clean, accessible, and dignified. (f) Annual reports Not later than one year after the date of the establishment of the program required by subsection (a), the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the findings of the Secretary with respect to the inspections conducted under the program during the one-year period ending on the date of the submittal of the report.