I 118th CONGRESS 2d Session H. R. 10267 IN THE HOUSE OF REPRESENTATIVES December 3, 2024 Mr. Bost (for himself and Mr. Bilirakis ) 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; table of contents (a) Short title This Act may be cited as the Complete the Mission Act of 2024 . (b) Table of contents The table of contents for this Act is as follows: Sec. 1. Short title; table of contents. Title I—Improvement of Veterans Community Care Program Sec. 101. Codification of requirements for eligibility standards for access to community care from Department of Veterans Affairs. Sec. 102. Requirement that Secretary notify veterans of eligibility for care under Veterans Community Care Program. Sec. 103. Consideration under Veterans Community Care Program of veteran preference for care and need for caregiver or attendant. Sec. 104. Notification of denial of request for care under Veterans Community Care Program. Sec. 105. Discussion of telehealth options under Veterans Community Care Program. Sec. 106. Use of value-based reimbursement models under Veterans Community Care Program. Sec. 107. Extension of deadline for submittal of claims by health care entities and providers under prompt payment standard. Title II—Other Health Care Matters Sec. 201. Plan on establishment of interactive, online self-service module for care. Sec. 202. Publication of wait times for care at medical centers of Department of Veterans Affairs. Sec. 203. Modification of requirements for Center for Innovation for Care and Payment of the Department of Veterans Affairs and requirement for pilot program. Sec. 204. Standardized process to determine eligibility of covered veterans for participation in certain mental health treatment programs. Sec. 205. Reports. I Improvement of Veterans Community Care Program 101. Codification of requirements for eligibility standards for access to community care from Department of Veterans Affairs (a) Eligibility access standards Section 1703B of title 38, United States Code, is amended— (1) by striking subsections (a) through (e) and inserting the following: (a) Eligibility standards for access to community care (1) A covered veteran shall be eligible to elect to receive non-Department hospital care, medical services, or extended care services, excluding nursing home care, through the Veterans Community Care Program under section 1703 of this title pursuant to subsection (d)(1)(D) of such section using the following eligibility access standards: (A) With respect to primary care, mental health care, or extended care services, excluding nursing home care, if the Department cannot schedule an in-person appointment for the covered veteran with a health care provider of the Department who can provide the needed service— (i) within 30 minutes average driving time (or such shorter average driving time as the Secretary may prescribe) from the residence of the veteran unless a longer average driving time has been agreed to by the veteran in consultation with a health care provider of the veteran; and (ii) within 20 days (or such shorter period as the Secretary may prescribe) of the date of request for such an appointment unless a later date has been agreed to by the veteran in consultation with a health care provider of the veteran. (B) With respect to specialty care, if the Department cannot schedule an in-person appointment for the covered veteran with a health care provider of the Department who can provide the needed service— (i) within 60 minutes average driving time (or such shorter average driving time as the Secretary may prescribe) from the residence of the veteran unless a longer average driving time has been agreed to by the veteran in consultation with a health care provider of the veteran; and (ii) within 28 days (or such shorter period as the Secretary may prescribe) of the date of request for such an appointment unless a later date has been agreed to by the veteran in consultation with a health care provider of the veteran. (2) For the purposes of determining the eligibility of a covered veteran for care or services under paragraph (1), the Secretary shall not take into consideration the availability of telehealth appointments from the Department when determining whether the Department is able to furnish such care or services in a manner that complies with the eligibility access standards under such paragraph. (3) In the case of a covered veteran who has had an appointment with a health care provider of the Department canceled by the Department for a reason other than the request of the veteran, in calculating a wait time for a subsequent appointment under paragraph (1), the Secretary shall calculate such wait time from the date of the request for the original, canceled appointment. (4) If a veteran agrees to a longer average drive time or a later date under subparagraph (A) or (B) of paragraph (1), the Secretary shall document the agreement to such longer average drive time or later date in the electronic health record of the veteran and provide the veteran a copy of such documentation. Such copy may be provided electronically. (b) Application The Secretary shall ensure that the eligibility access standards established under subsection (a) apply— (1) to all care and services within the medical benefits package of the Department to which a covered veteran is eligible under section 1703 of this title, excluding nursing home care; and (2) to all covered veterans, regardless of whether a veteran is a new or established patient. (c) Periodic review of access standards Not later than three years after the date of the enactment of the Complete the Mission Act of 2024 , and not less frequently than once every three years thereafter, the Secretary shall— (1) conduct a review of the eligibility access standards under subsection (a) in consultation with— (A) such Federal entities as the Secretary considers appropriate, including the Department of Defense, the Department of Health and Human Services, and the Centers for Medicare & Medicaid Services; (B) entities and individuals in the private sector, including— (i) veteran patients; (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 with respect to the review conducted under paragraph (1); and (B) such recommendations as the Secretary may have with respect to the eligibility access standards under subsection (a). ; (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 eligibility access standards under subsection (a) ; and (B) in paragraph (2)(B), by striking designated access standards established under this section and inserting eligibility 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 Section 1703(d) 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 eligibility 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 eligibility access standards under section 1703B(a) of this title . 102. Requirement that Secretary notify veterans of eligibility for care under Veterans Community Care Program Section 1703(a) of title 38, United States Code, is amended by adding at the end the following new paragraph: (5) (A) The Secretary shall notify each covered veteran in writing of the eligibility of such veteran for care or services under this section as soon as possible, but not later than two business days, after the date on which a veteran eligible for such care or services under this section seeks care or services. (B) With respect to each covered veteran eligible for care or services under subsection (d), the Secretary shall provide such veteran periodic reminders, as the Secretary determines appropriate, of their ongoing eligibility under such subsection. (C) Any notification or reminder under this paragraph may be provided electronically. . 103. Consideration under Veterans Community Care Program of veteran preference for care and need for caregiver or attendant Section 1703(d)(2) of title 38, United States Code, is amended by adding at the end the following new subparagraphs: (F) The preference of the covered veteran for 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. . 104. Notification of denial of request for care under Veterans Community Care Program Section 1703 of title 38, United States Code, is 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 due to not meeting the eligibility access standards under section 1703B(a) of this title, notice under such paragraph shall include an explanation for why the Secretary does not consider the veteran to have met such standards. (3) Any notification under this subsection may be provided electronically. . 105. Discussion of telehealth options under Veterans Community Care Program Section 1703 of title 38, United States Code, as amended by section 104, is further amended— (1) by redesignating subsection (p) as subsection (q); and (2) by inserting after subsection (o) the following new subsection (p): (p) Discussion of options for telehealth When discussing options for care or services for a covered veteran under this section, the Secretary shall ensure that the veteran is informed of the ability of the veteran to seek care or services via telehealth, either through a medical facility of the Department or under this section, if telehealth— (1) is available to the veteran; (2) is appropriate for the type of care or services the veteran is seeking, as determined by the Secretary; and (3) is acceptable to the veteran. . 106. Use of value-based reimbursement models under Veterans Community Care Program (a) In general Section 1703(i)(5) of title 38, United States Code, is amended 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 section 1703 of title 38, United States Code, pursuant to the amendment made by subsection (a). (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 section 1703 of title 38, United States Code, 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. 107. Extension of deadline for submittal of claims by health care entities and providers under prompt payment standard Section 1703D(b) of title 38, United States Code, is amended by striking 180 days and inserting one year . II Other Health Care Matters 201. Plan on establishment of interactive, online self-service module for care (a) In general The Secretary of Veterans Affairs, working with Third Party Administrators and acting through the Center for Innovation for Care and Payment of the Department of Veterans Affairs under section 1703E of title 38, United States Code, shall develop and implement a plan to establish an interactive, online self-service module— (1) to allow veterans to request appointments, track referrals for health care under the laws administered by the Secretary, whether at a facility of the Department or through a non-Department provider, and receive appointment reminders; (2) to allow veterans to appeal and track decisions relating to— (A) denials of requests for care or services under section 1703 of title 38, United States Code; or (B) denials of requests for care or services at facilities of the Department, including under section 1710 of such title; and (3) to implement such other matters as determined appropriate by the Secretary in consultation with Third Party Administrators. (b) Submittal of plan (1) Initial plan Not later than 180 days 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 the plan developed under subsection (a). (2) Quarterly update Not less frequently than quarterly following the submittal of the plan under paragraph (1) and for two years 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 containing any updates on the implementation of such plan. (c) 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. (d) 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. 202. Publication of wait times for care at medical centers of Department of Veterans Affairs (a) In general Subchapter I of chapter 17 of title 38, United States Code, is amended by inserting after section 1703F the following new section: 1703G. Publication of wait times for care at medical centers (a) In general The Secretary shall publish on a publicly available internet website of the Department the average wait time for a veteran to schedule an appointment at each medical center of the Department for the receipt of primary care, specialty care, and mental health care measured from the date of request for the appointment to the date on which the care was provided. (b) Update The Secretary shall update the wait times published under subsection (a) not less frequently than monthly. . (b) Clerical amendment The table of sections at the beginning of such subchapter is amended by inserting after the item relating to section 1703F the following new item: 1703G. Publication of wait times for care at medical centers. . 203. Modification of requirements for Center for Innovation for Care and Payment of the Department of Veterans Affairs and requirement for pilot program (a) In general Section 1703E of title 38, United States Code, is amended— (1) in subsection (a)— (A) in paragraph (1), by striking within the Department and inserting within the Office of the Secretary ; (B) in paragraph (2), by striking may and inserting shall ; and (C) in paragraph (3)— (i) in subparagraph (A), by striking ; and and inserting a semicolon; (ii) in subparagraph (B), by striking the period at the end and inserting ; or ; and (iii) by adding at the end the following new subparagraph: (C) increase productivity, efficiency, and modernization throughout the Department. ; (2) by striking subsection (d) and inserting the following new subsection (d): (d) Budgetary line item The Secretary shall include in the budget justification materials submitted to Congress in support of the budget of the Department of Veterans Affairs for a fiscal year (as submitted with the budget of the President under section 1105(a) of title 31) specific identification, as a budgetary line item, of the amounts required to carry out this section. ; (3) in subsection (f)— (A) in paragraph (1), by striking in subchapters I, II, and III of this chapter and inserting of this title, of title 38, Code of Federal Regulations, and of any handbooks, directives, or policy documents of the Department ; and (B) in paragraph (2), in the matter preceding subparagraph (A), by striking waiving any authority and inserting waiving any provision of this title ; (4) in subsection (g)(1), by inserting fewer than three or before more than 10 ; (5) in subsection (i)— (A) in paragraph (1), by striking the Under Secretary for Health and the Special Medical Advisory Group established pursuant to section 7312 of this title and inserting the Under Secretary for Health, the Special Medical Advisory Group established pursuant to section 7312 of this title, the Office of Integrated Veteran Care (or successor office), the Office of Finance (or successor office), the Veteran Experience Office (or successor office), the Office of Enterprise Integration (or successor office), and the Office of Information and Technology (or successor office) ; and (B) in paragraph (2), by striking representatives of relevant Federal agencies, and clinical and analytical experts with expertise in medicine and health care management and inserting representatives of relevant Federal agencies, nonprofit organizations, and other public and private sector entities, including those with clinical and analytical experts with expertise in medicine and health care management ; and (6) by adding at the end the following new subsection: (k) Report on activities of Center for Innovation for Care and Payment Not less frequently than annually, the Secretary shall submit to Congress a report that contains, for the one-year period preceding the date of the report— (1) a full accounting of the activities, staff, budget, and other resources and efforts of the Center; and (2) an assessment of the outcomes of the efforts of the Center. . (b) Comptroller General Report Not later than 18 months after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report— (1) on the efforts of the Center for Innovation for Care and Payment of the Department of Veterans Affairs in fulfilling the objectives and requirements under section 1703E of title 38, United States Code, as amended by subsection (a); and (2) containing such recommendations as the Comptroller General considers appropriate. (c) Pilot program (1) In general Not later than one year after the date of the enactment of this Act, the Center for Innovation for Care and Payment of the Department of Veterans Affairs under section 1703E of title 38, United States Code, shall establish a three-year pilot program in not fewer than five locations to allow veterans enrolled in the system of annual patient enrollment of the Department established and operated under section 1705(a) of such title to access outpatient mental health and substance use services through health care providers specified under section 1703(c) of such title without referral or pre-authorization. (2) Priority In selecting sites for the pilot program under paragraph (1), the Secretary shall prioritize sites in the following areas: (A) Areas with varying degrees of urbanization, including urban, rural, and highly rural areas. (B) Areas with high rates of suicide among veterans. (C) Areas with high rates of overdose deaths among veterans. (D) Areas with high rates of calls to the Veterans Crisis Line. (E) Areas with long wait times for mental health and substance use services at facilities of the Department. (F) Areas with outpatient mental health and substance use programs that utilize a value-based care model, to the extent practicable. (3) Elements The Secretary, in implementing the pilot program under paragraph (1), shall ensure the Department has a care coordination system in place that includes— (A) knowledge sharing, including the timely exchange of medical documentation; (B) assistance with transitions of care, including the potential need for inpatient or residential psychiatric services, substance use detoxification services, post-detoxification step-down services, and residential rehabilitation programs; (C) continuous assessment of patient needs and goals; and (D) creating personalized, proactive care plans. (4) Oversight and outcomes The Secretary shall develop appropriate metrics and measures— (A) to track and oversee sites at which the pilot program under paragraph (1) is carried out; (B) to monitor patient safety and outcomes under the pilot program; and (C) to assess and mitigate any barriers to extending the pilot program across the entire Veterans Health Administration. (5) Annual report (A) In general Not later than one year after the commencement of the pilot program under paragraph (1), and not less frequently than annually thereafter during the duration of the pilot program, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and Committee on Veterans’ Affairs of the House of Representatives a report on the pilot program, which shall include the following: (i) The number of unique veterans who participated in the pilot program. (ii) The number of health care providers who participated in the pilot program. (iii) An assessment of the effectiveness of the pilot program in increasing access to, and improving outcomes for, mental health and substance use treatment services. (iv) The cost of the pilot program. (v) Such other matters as the Secretary considers appropriate. (B) Final report The Secretary shall include in the final report submitted under subparagraph (A), in addition to the requirements under such subparagraph, the assessment by the Secretary of the feasibility and advisability of extending the pilot program across the entire Veterans Health Administration, including a plan, timeline, and required resources for such an extension. (6) Veterans crisis line defined In this subsection, the term Veterans Crisis Line means the toll-free hotline for veterans established under section 1720F(h) of title 38, United States Code. 204. Standardized process to determine eligibility of covered veterans for participation 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 covered veteran shall be eligible for priority admission to a covered treatment program if the covered veteran 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 treatment, such as outpatient or intensive outpatient treatment. (G) Other such criteria as the Secretary determines appropriate. (2) Consideration In making a determination under paragraph (1), the Secretary shall consider any referral of a health care provider of a covered veteran for such covered veteran to be admitted to a covered treatment program. (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 covered veteran to be admitted to a covered treatment program; and (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 admission The Secretary shall include the standardized screening process under this section in the wait time access 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 treatment program pursuant to the standardized screening process required by subsection (a), and the Secretary is unable to admit such covered veteran to a clinically necessary covered treatment program at a facility of the Department of Veterans Affairs within 30 minutes average driving time (or such shorter period as the Secretary may prescribe) of the veteran’s residence; and within 20 days (or such shorter period as the Secretary may prescribe) of the date of request for veterans eligible for routine admission, or within 48 hours (or such shorter period as the Secretary may prescribe) for veterans deemed eligible for priority admission unless a later date has been agreed to by the veteran in consultation with their Department health care provider. (f) Definitions In this section: (1) The term covered treatment program — (A) means a mental health residential rehabilitation treatment program of the Department of Veterans Affairs; (B) a program of the Department for residential 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 treatment programs; and (ii) any programs designated as domiciliary residential rehabilitation treatment programs on or after such date of enactment; and (D) does not include Compensated Work Therapy Transition Residence programs of the Department. (2) The term covered veteran means a veteran described in section 1703(b) of title 38, United States Code. 205. Reports (a) Report on improvements to clinical appeals process Not later than one year after the date of the enactment of this Act, and not less frequently than once every three years thereafter, the Secretary of Veterans Affairs, in consultation with veterans service organizations, veterans, caregivers of veterans, employees of the Department of Veterans Affairs, and other stakeholders as determined by the Secretary, shall submit to the Committee on Veterans’ Affairs of the Senate and Committee on Veterans’ Affairs of the House of Representatives a report containing recommendations for legislative or administrative action to improve the clinical appeals process of the Department with respect to timeliness, transparency, objectivity, consistency, and fairness. (b) Report on required care and services under community care program Not later than one year after the date of the enactment of this Act, and not less frequently than annually thereafter, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and Committee on Veterans’ Affairs of the House of Representatives a report that contains, for the one-year period preceding the date of the report, the following: (1) The number of veterans eligible for care or services under section 1703 of title 38, United States Code, and the reasons for such eligibility, including multiple such reasons for veterans eligible under more than one eligibility criteria. (2) The number of veterans who opt to seek care or services under such section. (3) The number of veterans who do not opt to seek care or services under such section. (4) An assessment of the timeliness of referrals for care or services under such section. (5) The number of times a veteran did not show for an appointment for care or services under such section. (6) The number of requests for an appeal of a denial of care or services under such section using the clinical appeals process of the Veterans Health Administration. (7) The timeliness of each such appeal. (8) The outcome of each such appeal. (c) Veterans service organization defined In this section, the term veterans service organization means any organization recognized by the Secretary under section 5902 of title 38, United States Code.