II 118th CONGRESS 1st Session S. 1315 IN THE SENATE OF THE UNITED STATES April 26, 2023 Mr. Moran (for himself and Ms. Sinema ) introduced the following bill; which was read twice and 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 Veterans' Health Empowerment, Access, Leadership, and Transparency for our Heroes (HEALTH) Act of 2023 . (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. Finality of decision by veteran and veteran’s referring provider. Sec. 107. Outreach regarding care and services under Veterans Community Care Program. Sec. 108. Plan to improve administration of care under Veterans Community Care Program. Sec. 109. Use of value-based reimbursement models under Veterans Community Care Program. Sec. 110. Extension of deadline for submittal of claims by health care entities and providers under prompt payment standard. Sec. 111. Inspector General assessment of implementation of Veterans Community Care Program. TITLE II—Other health care matters Sec. 201. Strategic plan on transition of Veterans Health Administration to value-based health care model. Sec. 202. Plan on establishment of interactive, online self-service module for care. Sec. 203. Publication of wait times for care at medical centers of Department of Veterans Affairs. Sec. 204. Documentation of preferences of veterans for scheduling of appointments for care. Sec. 205. Staffing model and performance metrics for certain employees of the Department of Veterans Affairs. Sec. 206. Modification of requirements for Center for Innovation for Care and Payment of the Department of Veterans Affairs and requirement for pilot program. Sec. 207. Online health education portal for veterans enrolled in patient enrollment system of Department of Veterans Affairs. Sec. 208. 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 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 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 Veterans' Health Empowerment, Access, Leadership, and Transparency for our Heroes (HEALTH) Act of 2023 , 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 the Secretary is aware that the veteran is seeking care or services and is eligible for such care or services under this section. (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. Finality of decision by veteran and veteran’s referring provider (a) In general Section 1703 of title 38, United States Code, as amended by sections 104 and 105, 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 decision by veteran and referring provider An agreement by a covered veteran and the covered veteran’s referring provider under this section regarding the best medical interest of the covered veteran or regarding eligibility for care or services under this section, including an agreement under subsection (d)(1)(E), is final and may not be changed by the Department without the knowledge and consent, documented in writing, of the covered veteran and the provider unless there is a statutory or regulatory barrier preventing the Department from providing the care or services in question. . (b) Conforming amendment Section 1703(d)(1)(E) of title 38, United States Code, is amended by striking referring clinician and inserting referring provider . 107. Outreach regarding care and services under Veterans Community Care Program (a) In general Section 1703 of title 38, United States Code, as amended by sections 104, 105, and 106, 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— (A) conduct public outreach to inform veterans of— (i) the conditions for eligibility for care or services under subsections (d) and (e); (ii) how to request such care or services; and (iii) how to appeal a denial of a request for such care or services using the clinical appeals process of the Veterans Health Administration; and (B) ensure that information about eligibility for care or services under subsections (d) and (e) is prominently displayed on the website of the Department and included in other outreach campaigns and activities conducted by the Secretary. (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 directly inform the veteran of— (A) the conditions for eligibility for care or services under subsections (d) and (e); (B) how to request such care or services; and (C) how to appeal a denial of a request for such care or services using the clinical appeals process of the Veterans Health Administration. (3) The Secretary shall ensure that each medical facility of the Department publicly displays information regarding— (A) the conditions for eligibility of veterans for care or services under subsections (d) and (e); (B) how to request such care or services; and (C) how to appeal a denial of a request for such care or services using the clinical appeals process of the Veterans Health Administration. . (b) Transitional services upon separation from armed forces Section 1144(f)(1)(B)(i) of title 10, 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 title 38, 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 outreach Not later than two years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the efforts of the Department 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 outreach conducted under subsection (r) of such section, as added by subsection (a) of this section. 108. Plan to improve administration of care under Veterans Community Care Program (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— (1) to provide monetary and non-monetary incentives to health care providers specified in subsection (c) of section 1703 of title 38, United States Code, furnishing care or services under the Veterans Community Care Program under such section pursuant to an agreement with a Third Party Administrator— (A) to allow the Secretary and Third Party Administrators to see the scheduling system of the provider for purposes of assessing availability and assisting with scheduling appointments for veterans under such program, including through synchronous, asynchronous, and asynchronous assisted digital scheduling; (B) to complete training for continuing professional education credit regarding veteran cultural competency and other subjects as determined appropriate by the Secretary and to better account for equivalent or similar non-Department training; (C) to improve the rate of the timely return to the Department 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 such other objectives as 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 incentivize community providers in those specialties to participate in such program. (b) Value-Based reimbursement models In developing the plan under subsection (a), the Secretary and Third Party Administrators shall explore value-based reimbursement models authorized to be used under section 1703(i)(5) of title 38, United States Code, to achieve the goals under such subsection. (c) 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 during the five-year period following the submittal of the plan under paragraph (1), 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. (3) Use of value-based reimbursement models The Secretary shall include with the plan submitted under paragraph (1) and any report submitted under paragraph (2)— (A) a complete list of the value-based reimbursement models considered under the plan; (B) an indication of whether any such model has been put into practice; and (C) with respect to any such model that was considered but not put into practice, a description of the reasons such model was not put into practice. (d) No penalty for not meeting objectives Health care providers specified in section 1703(c) of title 38, United States Code, shall not be penalized for not meeting an objective under paragraph (1) of subsection (a) included in the plan required under such subsection. (e) 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. (f) 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. 109. 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. 110. 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 . 111. 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 considers 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 of the Department shall commence the initial assessment required by subsection (a). II Other health care matters 201. Strategic plan on transition of Veterans Health Administration to value-based health care model (a) Findings Congress makes the following findings: (1) The final report of the Creating Options for Veterans’ Expedited Recovery Commission (commonly referred to as the COVER Commission ) established under section 931 of the Jason Simcakoski Memorial and Promise Act (title IX of Public Law 114–198 ; 38 U.S.C. 1701 note) submitted under subsection (e)(2) of such section made a key recommendation to transform the current health care delivery model of the Department of Veterans Affairs into one that is person-centered, relationship-based, and recovery-focused, and to support that transformation with a system that is value-based and incentivized for continuous innovation and quality improvement. (2) The consensus study report of the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine dated February 2022 and entitled, Achieving Whole Health: A New Approach for Veterans and the Nation recommends the Veterans Health Administration adopt a value-based model to align with delivering whole health care. (3) The consensus study report of the National Academy of Medicine dated October 2020 found that a value-based care model helps reduce physician burnout. (4) The National Academy of Medicine has developed a widely accepted approach that describes high-value health care as safe, timely, effective, efficient, equitable, and patient-centered (STEEEP). Further, the Institute for Healthcare Improvement has translated that approach into a framework for action known as the Quadruple Aim . The Quadruple Aim is made up of better patient outcomes, improved patient satisfaction, lower costs, and physician and health care professional well-being. (5) Health care systems that have made the transition to value-based care have seen a significant decrease in suicides among their patient population, and the top clinical priority of the Veterans Health Administration is suicide prevention. (6) Value-based care programs can encourage providers to work together to deliver coordinated, person-centered care, which will improve the overall quality of care. (7) A critical component of a successful transition to a value-based care delivery model is an operational electronic health record system in place as a foundation. (b) Establishment of working group (1) In general Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall establish a working group on the shift of the Veterans Health Administration to a value-based care system. (2) Membership (A) Required members The working group shall include, at a minimum, the following members: (i) The Under Secretary of Veterans Affairs for Health. (ii) The Director of the Office of Mental Health and Suicide Prevention of the Department of Veterans Affairs, or successor office. (iii) The Director of the Office of Integrated Veteran Care of the Department, or successor office. (iv) The Director of the Office of Rural Health of the Department, or successor office. (v) The Director of the Office of Connected Care of the Department, or successor office. (vi) The Director of the Office of Information and Technology of the Department, or successor office. (vii) The Chief Officer of the Office of Healthcare Innovation and Learning of the Office of Discovery, Education, and Affiliate Networks of the Veterans Health Administration, or 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 Services Administration. (B) Optional members The Secretary of Veterans Affairs may appoint any of the following individuals as members of the working group: (i) An individual representing the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine. (ii) An individual designated by the Chairman of the Veterans’ Expedited Recovery Commission (commonly referred to as the COVER Commission ) established under section 931 of the Jason Simcakoski Memorial and Promise Act (title IX of Public Law 114–198 ; 38 U.S.C. 1701 note). (iii) Three individuals representing a private health care system that has made the transition to value-based care. (iv) Three individuals representing a health care provider participating in the Veterans Community Care Program under section 1703 of title 38, United States Code, that operates under a value-based care model. (v) An individual representing an organization recognized by the Secretary of Veterans Affairs under section 5902 of title 38, United States Code. (3) Exemption from application of FACA Chapter 10 of title 5, United States Code, shall not apply to the working group established under paragraph (1). (c) Development of strategic plan (1) In general Not later than one year after the establishment of the working group under subsection (b), the working group shall develop a strategic plan to shift the Veterans Health Administration to a value-based care system. (2) Elements The strategic plan required under paragraph (1) shall contain the following elements: (A) An identification of the current state of the Veterans Health Administration, 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 and through the Veterans Community Care Program under section 1703 of title 38, United States Code, in comparison to a value-based care system. (B) An analysis of the leadership of the Veterans Health Administration, including an assessment of leadership acumen and ability to implement a shift with a clear, shared vision and effective change management and care coordination. (C) An identification of goals for the future of the Veterans Health Administration. (D) An identification and classification of the current capabilities and gaps of the health care system of the Department of Veterans Affairs. (E) An analysis of the four main types of value-based care models, including— (i) a selection of the model that best fits a successful transition for the Veterans Health Administration; and (ii) a thorough justification of the selection of such model. (F) A definition of what quality means with respect to access to health care and delivery of health care. (G) A definition of what value means with respect to care furnished by the Veterans Health Administration, a system, with metrics, for measuring value within the Veterans Health Administration that includes outcomes, safety, service, access, and total cost of patient care, and an analysis of variable value with respect to patient outcomes across different health care types and specialities. (H) An assessment of the current information technology infrastructure of the Veterans Health Administration and any recommendations to make such infrastructure more robust. (I) An assessment of the workforce challenges and needs of the Veterans Health Administration, including with respect to recruitment and retention and the effectiveness of the ability of the performance appraisal system of the Veterans Health Administration to appropriately incentivize and reward employees and ensure adherence to relevant statutes, regulations, policy directives, and treatment guidelines. (J) An assessment of the current value-driven framework of the Department for evaluating health care innovations and how that framework could be used to propel a shift in the model of care delivery by the Department. (K) A focus on value-based care for primary care, inpatient and outpatient mental health care, and inpatient and outpatient substance use treatment. (L) A description of the timeline, costs, and legislative or administrative action necessary to transition the Veterans Health Administration to a value-based care system. (d) Submittal of strategic plan to Congress Not later than 30 days after the completion by the working group established under subsection (b) of the strategic plan required under subsection (c), the Secretary of Veterans Affairs shall submit the strategic plan to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives. (e) Pilot program implementation of strategic plan (1) In general Not later than 180 days after the submittal under subsection (d) of the strategic plan required under subsection (c), the Secretary of Veterans Affairs shall commence a five-year pilot program to implement the strategic plan. (2) Care included The pilot program under paragraph (1) shall include the implementation of the strategic plan for the delivery by the Veterans Health Administration of primary care, inpatient and outpatient mental health treatment, and inpatient and outpatient substance use treatment. (3) Locations The Secretary shall carry out the pilot program under paragraph (1) in four Veterans Integrated Service Networks that are geographically dispersed and shall include the following: (A) A Veterans Integrated Service Network that predominately serves veterans in rural and highly rural areas. (B) A Veterans Integrated Service Network that predominately serves veterans in urban areas. (C) A Veterans Integrated Service Network that has a high rate of suicide among veterans. (D) A Veterans Integrated Service Network that has a high rate of substance use disorder among veterans. (E) A Veterans Integrated Service Network with a documented issue with workforce recruitment and retention. (4) Reports to Congress (A) Annual report Not later than one year after the commencement of the pilot program, and annually thereafter during the duration of the pilot program, the Secretary shall submit to Congress a report on the pilot program. (B) Final report Not later than 180 days before the conclusion of the pilot program, the Secretary shall submit to Congress a final report on the pilot program that includes a plan and timeline for full implementation of the strategic plan required under subsection (c) across the entire Veterans Health Administration. 202. 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. 203. 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. . 204. Documentation of preferences of veterans for scheduling of appointments for care (a) In general Upon enrollment of a veteran in the system of annual patient enrollment of the Department of Veterans Affairs established and operated under section 1705(a) of title 38, United States Code, and not less frequently than annually thereafter, the Secretary of Veterans Affairs shall solicit from the veteran the preference of the veteran for scheduling of appointments for health care and related services furnished by the Department, including through non-Department providers. (b) Documentation of preference Preferences provided by a veteran pursuant to subsection (a) shall be documented on My HealtheVet or another system designated by the Secretary that allows the veteran to change such preferences at any time. (c) Inclusion in preference Preferences solicited under subsection (a) shall include the following: (1) How and when the veteran prefers to be contacted by the Department about an appointment for health care. (2) Whether the veteran prefers to schedule their own appointments, if able. (3) Whether the veteran prefers to select their own provider, if able. (4) Whether the veteran prefers appointments to be scheduled during certain days or times. (5) Whether the veteran is willing to consider telehealth appointments. (d) Use of preference The Secretary shall make the preferences provided under subsection (a) easily accessible to medical support assistants and other staff of the Department assisting in the appointment scheduling process to use to improve the timeliness of the scheduling of appointments for health care and related services furnished by the Department, including through non-Department providers. 205. Staffing model and performance metrics for certain employees of the Department of Veterans Affairs (a) Staffing model (1) In general Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall— (A) develop, validate, and implement a staffing model for the Office of Integrated Veteran Care of the Department of Veterans Affairs, or successor office, Veterans Integrated Services Networks, and medical centers of the Department that includes appropriate target staffing levels nationally, regionally, and locally to ensure timely access to care and effectively oversee the provision of care by the Department, whether at a facility of the Department or through a non-Department provider; and (B) provide to Congress a briefing on such staffing model, which shall include— (i) the metrics and measures used by the Secretary in developing such staffing model; and (ii) an analysis of how such staffing model compares to the staffing models of other relevant government and private sector health care systems. (2) Report on implementation of staffing model Not later than one year after implementing the staffing model required under paragraph (1), the Secretary shall submit to Congress and the Comptroller General of the United States a report containing— (A) an update on such implementation; and (B) information on the outcomes yielded by such staffing model in terms of improved access to care for veterans and improved compliance with relevant laws, regulations, policy directives, and guidance governing access to care. (b) Performance metrics (1) In general Not later than one year after the date of the enactment of this Act, the Secretary shall develop and implement a plan to incorporate appropriate performance metrics and accountability measures within the performance appraisal systems for employees of the Department specified in paragraph (2). (2) Employees of the Department specified Employees of the Department specified in this paragraph are employees who are responsible for ensuring timely access to care from the Department, compliance with relevant statutes and regulations relating to the provision of care, including section 1703 of title 38, United States Code, and overseeing the provision of care, whether at a facility of the Department or through a non-Department provider, including employees within the Office of Integrated Veteran Care of the Department, or successor office, employees of a Veterans Integrated Service Network, and employees of a medical center of the Department. (3) Report on implementation of performance metrics Not later than one year after implementing the performance metrics required under paragraph (1), the Secretary shall submit to Congress and the Comptroller General of the United States a report containing— (A) an update on such implementation; and (B) information on the outcomes yielded by such performance metrics in terms of improved access to care for veterans and improved compliance with relevant laws, policy directives, and guidance governing access to care. (c) Comptroller General report Not later than two years after receiving the report under subsection (a)(2) or the report under subsection (b)(3), whichever occurs later, the Comptroller General of the United States shall submit to Congress a report— (1) assessing the performance of the Office of Integrated Veteran Care of the Department, or successor office, in improving access to care for veterans in facilities of the Department and pursuant to section 1703 of title 38, United States Code; and (2) containing such recommendations as the Comptroller General considers appropriate relating to improving access to such care. 206. 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. 207. Online health education portal for veterans enrolled in patient enrollment system of Department of Veterans Affairs Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall establish an online health education portal that includes interactive online educational modules to ensure veterans enrolled in the patient enrollment system of the Department of Veterans Affairs established and operated under section 1705(a) of title 38, United States Code, understand their basic health care eligibilities and entitlements under the laws administered by the Secretary, including under the Veterans Community Care Program under section 1703 of such title. 208. 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.