I 118th CONGRESS 1st Session H. R. 3520 IN THE HOUSE OF REPRESENTATIVES May 18, 2023 Mrs. Miller-Meeks (for herself, Mr. Bost , Mr. Bergman , Mrs. Radewagen , Mrs. Kiggans of Virginia , Ms. Mace , Mr. Murphy , and Mr. Van Orden ) introduced the following bill; which was referred to the Committee on Veterans' Affairs A BILL To improve the provision of care and services under the Veterans Community Care Program of the Department of Veterans Affairs, and for other purposes.

1. Short title This Act may be cited as the Veteran Care Improvement Act of 2023 . 2. Codification of access standards for community care furnished by the Department of Veterans Affairs (a) Access standards Section 1703B of title 38, United States Code, is amended— (1) by striking subsections (a) through (e) and inserting the following: (a) Access standards for community care (1) A covered veteran may receive hospital care, medical services, or extended care services under section 1703(d)(1)(D) of this title if the Secretary determines the following: (A) With respect to primary care, mental health care, or extended care services, the Secretary cannot schedule an in-person appointment for the covered veteran with a health care provider of the Department for such care or services— (i) at a facility of the Department that is located less than a 30-minute drive from the residence of the covered veteran; or (ii) during the 20-day period after the date on which the covered veteran requests such appointment. (B) With respect to specialty care, the Secretary cannot schedule an in-person appointment for the covered veteran with a health care provider of the Department who can provide such care— (i) at a facility of the Department that is located less than a 60-minute drive from the residence of the covered veteran; or (ii) during the 28-day period after the date on which the covered veteran requests such appointment. (C) With respect to residential treatment and rehabilitative services for alcohol or drug dependence, the Secretary cannot provide the covered veteran such services at a facility of the Department— (i) that is located less than a 30-minute drive from the residence of the covered veteran; or (ii) during the 10-day period after the date on which the covered veteran requests such services. (2) (A) The Secretary may prescribe regulations that establish a shorter drive or time period than those established by paragraph (1). (B) A covered veteran may consent to a longer drive or time period than established by paragraph (1) (or pursuant to regulations prescribed under paragraph (2)). If a covered veteran so consents, the Secretary shall document such consent in the electronic health record of the covered veteran and provide the covered veteran with a copy of such documentation in writing or through electronic means. (3) In making any determination under paragraph (1), the Secretary may not consider— (A) a telehealth appointment; or (B) the cancellation of an appointment unless such cancellation was at the request of the covered veteran. (b) Applicability The Secretary shall ensure that the access standards established under subsection (a) apply— (1) to all care and services (except nursing home care) within the medical benefits package of the Department to which a covered veteran is eligible under section 1703 of this title; and (2) to all covered veterans. (c) Periodic review of access standards Not later than three years after the date of the enactment of the Veteran Care Improvement Act of 2023 , and not less frequently than once every three years thereafter, the Secretary shall— (1) conduct a review of the access standards under subsection (a) in consultation with— (A) Federal entities (including the Department of Defense, the Department of Health and Human Services, and the Centers for Medicare & Medicaid Services) that the Secretary determines appropriate; (B) entities and individuals in the private sector, including— (i) veterans who receive hospital care, medical services, and extended care services furnished by the Secretary; (ii) veterans service organizations; and (iii) health care providers participating in the Veterans Community Care Program under section 1703 of this title; and (C) other entities that are not part of the Federal Government; and (2) submit to the appropriate committees of Congress a report on— (A) the findings of the Secretary under such review; and (B) recommendations of the Secretary regarding such access standards. ; (2) by striking subsection (g); (3) by redesignating subsections (f), (h), and (i) as subsections (d), (e), and (f), respectively; (4) in subsection (d), as redesignated by paragraph (3)— (A) by striking established each place it appears; and (B) in paragraph (1), by striking (1) Subject to and inserting Compliance by community care providers with access standards .—(1) Subject to ; (5) in subsection (e), as so redesignated— (A) in paragraph (1)— (i) by striking (1) Consistent with and inserting Determination regarding eligibility .—(1) Consistent with ; and (ii) by striking designated access standards established under this section and inserting access standards under subsection (a) ; and (B) in paragraph (2)(B), by striking designated access standards established under this section and inserting access standards under subsection (a) ; and (6) in subsection (f), as redesignated by paragraph (2)— (A) in the matter preceding paragraph (1), by striking In this section and inserting Definitions .—In this section ; and (B) in paragraph (2)— (i) by striking covered veterans and inserting covered veteran ; and (ii) by striking veterans described and inserting a veteran described . (b) Conforming amendments Subsection (d) of section 1703 of such title is amended— (1) in paragraph (1)(D), by striking designated access standards developed by the Secretary under section 1703B of this title and inserting access standards under section 1703B(a) of this title ; and (2) in paragraph (3), by striking designated access standards developed by the Secretary under section 1703B of this title and inserting access standards under section 1703B(a) of this title . 3. Requirement that Secretary notify veterans of eligibility for care under Veterans Community Care Program Section 1703 of title 38, United States Code, is further amended, in subsection (a), by adding at the end the following new paragraph: (5) (A) The Secretary shall notify a covered veteran in writing of the eligibility of such veteran for care or services under this section not later than two business days after the date on which— (i) the veteran seeks care or services under this chapter; and (ii) the Secretary determines that the veteran is a covered veteran. (B) The Secretary may provide a covered veteran with a periodic notification of the eligibility of such covered veteran for care under subsection (d). (C) Any notification under this paragraph may be provided through electronic means. . 4. Consideration under Veterans Community Care Program of veteran preference for care and need for caregiver or attendant Section 1703 of title 38, United States Code, is further amended, in subsection (d)(2), by adding at the end the following new subparagraphs: (F) The preference of the covered veteran regarding where, when, and how to seek hospital care, medical services, or extended care services. (G) Whether the covered veteran requests or requires the assistance of a caregiver or attendant when seeking hospital care, medical services, or extended care services. . 5. Notification of denial of request for care under Veterans Community Care Program Section 1703 of title 38, United States Code, is further amended— (1) by redesignating subsection (o) as subsection (p); and (2) by inserting after subsection (n) the following new subsection (o): (o) Notification of denial of request for care and how To appeal (1) If a request by a veteran for care or services under this section is denied, the Secretary shall notify the veteran in writing as soon as possible, but not later than two business days, after the denial is made— (A) of the reason for the denial; and (B) with instructions on how to appeal such denial using the clinical appeals process of the Veterans Health Administration. (2) If a denial under paragraph (1) is because the Secretary determines that access standards under section 1703B(a) of this title are not met, notice under such paragraph shall include an explanation of such determination. (3) Any notification under this subsection may be provided electronically. . 6. Provision of information regarding option for telehealth under Veterans Community Care Program Section 1703 of title 38, United States Code, is further amended— (1) by redesignating subsection (p) as subsection (q); and (2) by inserting after subsection (o) the following new subsection (p): (p) Provision of information regarding option for telehealth With regards to options for care or services for a covered veteran under this section, the Secretary shall ensure that the veteran is informed that the veteran may elect to seek care or services via telehealth, either through a medical facility of the Department or under this section, if— (1) a health care provider described in subsection (c) provides such care or services via telehealth; and (2) the Secretary determines telehealth is appropriate for the type of care or services the veteran seeks; and . 7. Finality of decision by veteran and veteran’s referring provider (a) In general Section 1703 of title 38, United States Code, is further amended— (1) by redesignating subsection (q) as subsection (r); and (2) by inserting after subsection (p) the following new subsection (q): (q) Finality of agreement between covered veteran and referring provider The Secretary may not override an agreement under subsection (d)(1)(E) unless the Secretary notifies the covered veteran and referring provider in writing that the Secretary may not provide the care or services described in such agreement. . (b) Conforming amendment Subsection (d)(1)(E) such section is amended by striking referring clinician and inserting referring provider . 8. Outreach regarding care and services under Veterans Community Care Program (a) Requirement Section 1703 of title 38, United States Code, is further amended— (1) by redesignating subsection (r) as subsection (s); and (2) by inserting after subsection (q) the following new subsection (r): (r) Outreach regarding availability of care and services (1) The Secretary shall conduct outreach to inform veterans of the following: (A) The conditions for care or services under subsections (d) and (e). (B) How to request such care or services. (C) How to appeal a denial of a request for such care or services using the clinical appeals process of the Veterans Health Administration. (2) Upon enrollment of a veteran in the system of annual patient enrollment established and operated under section 1705 of this title, and not less frequently than every two years thereafter, the Secretary shall inform the veteran of information described in paragraph (1). (3) The Secretary shall ensure that information described in paragraph (1) is— (A) publicly displayed in each medical facility of the Department; (B) prominently displayed on a website of the Department; and (C) included in other outreach campaigns and activities conducted by the Secretary. . (b) Solid Start program Section 6320(a)(2)(A) of title 38, United States Code, is amended by inserting , including how to enroll in the system of annual patient enrollment established and operated under section 1705 of this title and the ability to seek care and services under sections 1703 and 1710 of this title before the semicolon. 9. Use of value-based reimbursement models under Veterans Community Care Program (a) Mandatory use Section 1703 of title 38, United States Code, is further amended, in paragraph (5) of subsection (i), by striking may and inserting shall . (b) Negotiation of terms The Secretary of Veterans Affairs shall negotiate with third party administrators to establish the use of value-based reimbursement models under the Veterans Community Care Program under such paragraph, as amended by this section. (c) Report on value-Based reimbursement models Not later than one year after negotiating under subsection (b) terms to establish the use of value-based reimbursement models under the Veterans Community Care Program under such section, the Secretary, in consultation with the Center for Innovation for Care and Payment of the Department of Veterans Affairs under section 1703E of title 38, United States Code, and the Office of Integrated Veteran Care of the Department, or successor office, shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report containing— (1) an assessment of the efforts of the Department pursuant to section 1703(i)(5) of such title, as amended by subsection (a), to incorporate value-based reimbursement models to promote the provision of high-quality care to veterans; and (2) such recommendations for legislative or administrative action as the Secretary considers appropriate to increase the use of value-based reimbursement models throughout the Veterans Community Care Program under section 1703 of such title. (d) Rule of construction This section shall not be construed to be a pilot program subject to the requirements of section 1703E of title 38, United States Code. (e) Third Party Administrator defined In this section, the term third party administrator means an entity that manages a provider network and performs administrative services related to such network under section 1703 of title 38, United States Code. 10. Extension of deadline for submission of claims by health care entities and providers under prompt payment standard Subsection (b) of section 1703D of title 38, United States Code, is amended— (1) by striking 180 days and inserting one year ; and (2) in the heading, by striking submittal and inserting submission . 11. Treatment and rehabilitative services for veterans with drug or alcohol dependency Section 1720A of title 38, United States Code, is amended by adding at the end the following new subsection: (e) The Secretary shall determine whether a veteran who requests residential treatment and rehabilitative services for alcohol or drug dependence under this section requires such services not later than 72 hours after receipt of such request. . 12. Pilot program to improve administration of care under Veterans Community Care Program (a) Establishment Pursuant to section 1703E of title 38, United States Code, the Secretary of Veterans Affairs, acting through the Center for Innovation for Care and Payment of the Department of Veterans Affairs, shall seek to develop and implement a plan with a third party administrator— (1) to provide incentives to a covered health care provider, pursuant to an agreement with such third party administrator— (A) to allow the Secretary and the third party administrator to see the scheduling system of the provider, to assess the availability of, and to assist in scheduling appointments for, veterans under the Veterans Community Care Program under section 1703 of such title, including through synchronous, asynchronous, and asynchronous assisted digital scheduling; (B) to complete continuing professional educational training regarding veteran cultural competency and other subjects determined appropriate by the Secretary; (C) to improve the rate of the timely return to the Secretary of medical record documentation for care or services provided under such program; (D) to improve the timeliness and quality of the delivery of care and services to veterans under such program; and (E) to achieve other objectives determined appropriate by the Secretary in consultation with third party administrators; (2) to decrease the rate of no-show appointments under such program and consider the feasibility and advisability of appropriately compensating such health care providers for no-show appointments under such program; and (3) within each region in which such program is carried out, to assess needed specialties and to provide incentives to community providers in such specialties to participate in such program. (b) Value-Based reimbursement models In developing a plan under subsection (a), the Secretary and third party administrators shall consider value-based reimbursement models under section 1703(i)(5) of such title, as amended by section 9, to achieve the goals under such subsection. (c) Reporting (1) Progress report Not later than 180 days after the date of the enactment of this Act, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives a report on progress in developing the plan under subsection (a). (2) Submission Not later than 90 days after completing development of a plan under subsection (a), the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives a copy of such plan. (3) Quarterly update Not less frequently than quarterly during the term of the pilot program, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives a report containing any updates on the implementation of such plan. (4) Use of value-based reimbursement models The Secretary shall include with a plan submitted under paragraph (2) and any report submitted under paragraph (3)— (A) a complete list of the value-based reimbursement models considered under the plan; (B) an indication of whether any such model has been implemented; and (C) with respect to any such model that was considered but not implemented, a description of the reasons such model was not implemented. (d) No penalty for not meeting objectives No health care provider or third party administrator may be penalized for not carrying out any part of a plan under subsection (a). (e) Termination The pilot program under this section shall terminate five years after the date of the enactment of this Act. (f) Definitions In this section: (1) The term covered health care provider means a health care provider— (A) described in subsection (c) of section 1703 of such title; (B) that furnishes care or services under the Veterans Community Care Program under such section; and (C) that is served by third party administrator. (2) The term third party administrator means an entity that manages a network of health care providers and performs administrative services related to such network under section 1703 of such title. 13. Inspector General assessment of implementation of Veterans Community Care Program (a) In general Not later than three years after the date of the enactment of this Act, and periodically thereafter as the Inspector General of the Department of Veterans Affairs determines appropriate, the Inspector General shall assess the performance of each medical center of the Department of Veterans Affairs in— (1) appropriately identifying veterans eligible for care and services under section 1703 of title 38, United States Code; (2) informing veterans of their eligibility for such care and services, including, if appropriate and applicable, the availability of such care and services via telehealth; (3) delivering such care and services in a timely manner; and (4) appropriately coordinating such care and services. (b) Commencement of assessment Not later than one year after the date of the enactment of this Act, the Inspector General shall commence the initial assessment required by subsection (a).