II 117TH CONGRESS 1ST SESSION S. 1863 To amend title 38, United States Code, to improve access to health care for veterans, and for other purposes. IN THE SENATE OF THE UNITED STATES MAY 26, 2021 Mr. MORAN (for himself, Mr. BOOZMAN, Mr. CASSIDY, Mr. TILLIS, Mr. SUL- LIVAN, Mrs. BLACKBURN, Mr. CRAMER, and Mr. TUBERVILLE) intro- duced the following bill; which was read twice and referred to the Com- mittee on Veterans’ Affairs A BILL To amend title 38, United States Code, to improve access to health care for veterans, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘Guaranteeing Healthcare Access to Personnel Who 5 Served Act’’. 6 (b) TABLE OF CONTENTS.—The table of contents for 7 this Act is as follows: 8 Sec. 1. Short title; table of contents. TITLE I—MISSION ACT PROTECTION VerDate Sep 11 2014 04:20 Jun 02, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\S1863.IS S1863 kjohnson on DSK79L0C42PROD with BILLS 2 •S 1863 IS Subtitle A—Access to Community Care Sec. 101. Modifications to access standards for care furnished through Commu- nity Care Program of Department of Veterans Affairs. Sec. 102. Strategic plan to ensure continuity of care in the case of the realign- ment of a medical facility of the Department. Subtitle B—Community Care Self-scheduling Pilot Program Sec. 111. Definitions. Sec. 112. Pilot program establishing a community care self-scheduling appoint- ment system. Sec. 113. Capabilities of self-scheduling appointment system. Sec. 114. Report. Subtitle C—Non-Department of Veterans Affairs Providers Sec. 121. Credentialing verification requirements for providers of non-Depart- ment of Veterans Affairs health care services. Sec. 122. Inapplicability of certain providers to provide non-Department of Vet- erans Affairs care. TITLE II—IMPROVEMENT OF RURAL HEALTH AND TELEHEALTH Sec. 201. Establishment of strategic plan requirement for Office of Connected Care of Department of Veterans Affairs. Sec. 202. Comptroller General report on transportation services by third parties for rural veterans. Sec. 203. Comptroller General report on telehealth services of the Department of Veterans Affairs. TITLE III—FOREIGN MEDICAL PROGRAM Sec. 301. Analysis of feasibility and advisability of expanding assistance and support to caregivers to include caregivers of veterans in the Republic of the Philippines. Sec. 302. Comptroller General report on Foreign Medical Program of Depart- ment of Veterans Affairs. TITLE IV—MENTAL HEALTH CARE Sec. 401. Analysis of feasibility and advisability of Department of Veterans Af- fairs providing evidence-based treatments for the diagnosis of treatment-resistant depression. Sec. 402. Modification of resource allocation system to include peer specialists. Sec. 403. Gap analysis of psychotherapeutic interventions of the Department of Veterans Affairs. TITLE V—OTHER MATTERS Sec. 501. Online health care education portal. Sec. 502. Exclusion of application of Paperwork Reduction Act to research ac- tivities of the Veterans Health Administration. VerDate Sep 11 2014 04:20 Jun 02, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\S1863.IS S1863 kjohnson on DSK79L0C42PROD with BILLS 3 •S 1863 IS TITLE I—MISSION ACT 1 PROTECTION 2 Subtitle A—Access to Community 3 Care 4 SEC. 101. MODIFICATIONS TO ACCESS STANDARDS FOR 5 CARE FURNISHED THROUGH COMMUNITY 6 CARE PROGRAM OF DEPARTMENT OF VET- 7 ERANS AFFAIRS. 8 (a) ACCESS STANDARDS.— 9 (1) IN GENERAL.—Section 1703B of title 38, 10 United States Code, is amended— 11 (A) by striking subsections (a) through (g) 12 and inserting the following: 13 ‘‘(a) THRESHOLD ELIGIBILITY STANDARDS FOR AC- 14 CESS TO COMMUNITY CARE.—(1) A covered veteran shall 15 receive non-Department hospital care, medical services, or 16 extended care services through the Veterans Community 17 Care Program under section 1703 of this title pursuant 18 to subsection (d)(1)(D) of such section using the following 19 eligibility access standards: 20 ‘‘(A) With respect to primary care, mental 21 health care, or non-institutional extended care serv- 22 ices, if the Department cannot schedule an appoint- 23 ment for the covered veteran with a health care pro- 24 vider of the Department— 25 VerDate Sep 11 2014 04:20 Jun 02, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1863.IS S1863 kjohnson on DSK79L0C42PROD with BILLS 4 •S 1863 IS ‘‘(i) within 30 minutes average driving 1 time from the residence of the veteran; and 2 ‘‘(ii) within 20 days of the date of request 3 for such an appointment unless a later date has 4 been agreed to by the veteran in consultation 5 with the health care provider. 6 ‘‘(B) With respect to specialty care or specialty 7 services, if the Department cannot schedule an ap- 8 pointment for the covered veteran with a health care 9 provider of the Department— 10 ‘‘(i) within 60 minutes average driving 11 time from the residence of the veteran; and 12 ‘‘(ii) within 28 days of the date of request 13 for such an appointment, unless a later date 14 has been agreed to by the veteran in consulta- 15 tion with the health care provider. 16 ‘‘(2) For the purposes of determining the eligibility 17 of a covered veteran for care or services under paragraph 18 (1), the Secretary shall not take into consideration the 19 availability of telehealth appointments from the Depart- 20 ment when determining whether the Department is able 21 to furnish such care or services in a manner that complies 22 with the eligibility access standards under such paragraph. 23 ‘‘(b) ACCESS TO CARE STANDARDS FOR COMMUNITY 24 CARE.—(1) Subject to subsection (c), the Secretary shall 25 VerDate Sep 11 2014 04:20 Jun 02, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1863.IS S1863 kjohnson on DSK79L0C42PROD with BILLS 5 •S 1863 IS meet the following access to care standards when fur- 1 nishing non-Department hospital care, medical services, or 2 extended care services to a covered veteran through the 3 Veterans Community Care Program under section 1703 4 of this title: 5 ‘‘(A) With respect to an appointment for pri- 6 mary care, mental health care, or non-institutional 7 extended care services— 8 ‘‘(i) within 30 minutes average driving 9 time from the residence of the veteran unless a 10 longer driving time has been agreed to by the 11 veteran; and 12 ‘‘(ii) within 20 days of the date of request 13 for such an appointment unless a later date has 14 been agreed to by the veteran. 15 ‘‘(B) With respect to an appointment for spe- 16 cialty care or specialty services— 17 ‘‘(i) within 60 minutes average driving 18 time from the residence of the veteran unless a 19 longer driving time has been agreed to by the 20 veteran; and 21 ‘‘(ii) within 28 days of the date of request 22 for such an appointment unless a later date has 23 been agreed to by the veteran. 24 VerDate Sep 11 2014 04:20 Jun 02, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1863.IS S1863 kjohnson on DSK79L0C42PROD with BILLS 6 •S 1863 IS ‘‘(2) The Secretary shall ensure that health care pro- 1 viders specified under section 1703(c) of this title are able 2 to comply with the applicable access to care standards 3 under paragraph (1) for such providers. 4 ‘‘(c) WAIVERS TO ACCESS TO CARE STANDARDS FOR 5 COMMUNITY CARE PROVIDERS.—(1) A Third Party Ad- 6 ministrator may request a waiver to the access to care 7 standards under subsection (b) if— 8 ‘‘(A)(i) the scarcity of available providers or fa- 9 cilities in the region precludes the Third Party Ad- 10 ministrator from meeting those access to care stand- 11 ards; or 12 ‘‘(ii) the landscape of providers or facilities has 13 changed, and certain providers or facilities are not 14 available such that the Third Party Administrator is 15 not able to meet those access to care standards; and 16 ‘‘(B) to address the scarcity of available pro- 17 viders or the change in the provider or facility land- 18 scape, as the case may be, the Third Party Adminis- 19 trator has contracted with other providers or facili- 20 ties that may not meet those access to care stand- 21 ards but are the currently available providers or fa- 22 cilities most accessible to veterans within the region 23 of responsibility of the Third Party Administrator. 24 VerDate Sep 11 2014 04:20 Jun 02, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1863.IS S1863 kjohnson on DSK79L0C42PROD with BILLS 7 •S 1863 IS ‘‘(2) Any waiver requested by a Third Party Adminis- 1 trator under paragraph (1) must be requested in writing 2 and submitted to the Office of Community Care of the 3 Department for approval by that office. 4 ‘‘(3) As part of any waiver request under paragraph 5 (1), a Third Party Administrator must include conclusive 6 evidence and documentation that the access to care stand- 7 ards under subsection (b) cannot be met because of scar- 8 city of available providers or changes to the landscape of 9 providers or facilities. 10 ‘‘(4) In evaluating a waiver request under paragraph 11 (1), the Secretary shall consider the following: 12 ‘‘(A) The number and geographic distribution 13 of eligible health care providers available within the 14 geographic area and specialty referenced in the waiv- 15 er request. 16 ‘‘(B) The prevailing market conditions within 17 the geographic area and specialty referenced in the 18 waiver request, which shall include the number and 19 distribution of health care providers contracting with 20 other health care plans (including commercial plans 21 and the Medicare program under title XVIII of the 22 Social Security Act (42 U.S.C. 1395 et seq.)) oper- 23 ating in the geographic area and specialty referenced 24 in the waiver request. 25 VerDate Sep 11 2014 04:20 Jun 02, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1863.IS S1863 kjohnson on DSK79L0C42PROD with BILLS 8 •S 1863 IS ‘‘(C) Whether the service area is comprised of 1 highly rural, rural, or urban areas or some combina- 2 tion of such areas. 3 ‘‘(D) How significantly the waiver request dif- 4 fers from the relevant access to care standards 5 under subsection (b). 6 ‘‘(5) The Secretary shall not consider inability to con- 7 tract as a valid sole rationale for granting a waiver under 8 paragraph (1). 9 ‘‘(d) CALCULATION OF DRIVING TIME.—For pur- 10 poses of calculating average driving time from the resi- 11 dence of the veteran under subsections (a) and (b), the 12 Secretary shall use geographic information system soft- 13 ware. 14 ‘‘(e) PERIODIC REVIEW OF ACCESS STANDARDS.— 15 Not later than three years after the date of the enactment 16 of the Guaranteeing Healthcare Access to Personnel Who 17 Served Act, and not less frequently than once every three 18 years thereafter, the Secretary shall— 19 ‘‘(1) conduct a review of the eligibility access 20 standards under subsection (a) and the access to 21 care standards under subsection (b), in consultation 22 with— 23 ‘‘(A) such Federal entities as the Secretary 24 considers appropriate, including the Depart- 25 VerDate Sep 11 2014 04:20 Jun 02, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1863.IS S1863 kjohnson on DSK79L0C42PROD with BILLS 9 •S 1863 IS ment of Defense, the Department of Health and 1 Human Services, and the Centers for Medicare 2 & Medicaid Services; 3 ‘‘(B) entities in the private sector; and 4 ‘‘(C) other entities that are not part of the 5 Federal Government; and 6 ‘‘(2) submit to the appropriate committees of 7 Congress a report on— 8 ‘‘(A) the findings of the Secretary with re- 9 spect to the review conducted under paragraph 10 (1); and 11 ‘‘(B) such recommendations as the Sec- 12 retary may have with respect to the eligibility 13 access standards under subsection (a) and the 14 access to care standards under subsection (b). 15 ‘‘(f) PUBLICATION OF ELIGIBILITY ACCESS STAND- 16 ARDS AND WAIT TIMES.—(1) The Secretary shall publish 17 on a publicly available internet website of the Department 18 the eligibility access standards under subsection (a). 19 ‘‘(2)(A) The Secretary shall publish on a publicly 20 available internet website of the Department the average 21 wait time for a veteran to schedule an appointment at each 22 medical center of the Department for the receipt of pri- 23 mary care and specialty care, measured from the date of 24 VerDate Sep 11 2014 04:20 Jun 02, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1863.IS S1863 kjohnson on DSK79L0C42PROD with BILLS 10 •S 1863 IS request for the appointment to the date on which the care 1 was provided. 2 ‘‘(B) The Secretary shall update the wait times pub- 3 lished under subparagraph (A) not less frequently than 4 monthly.’’; 5 (B) by redesignating subsections (h) and 6 (i) as subsections (g) and (h), respectively; 7 (C) in subsection (g), as redesignated by 8 subparagraph (B)— 9 (i) in paragraph (1), by striking ‘‘des- 10 ignated access standards established under 11 this section’’ and inserting ‘‘eligibility ac- 12 cess standards under subsection (a)’’; and 13 (ii) in paragraph (2)(B), by striking 14 ‘‘designated access standards established 15 under this section’’ and inserting ‘‘eligi- 16 bility access standards under subsection 17 (a)’’; and 18 (D) in subsection (h), as so redesignated, 19 by adding at the end the following new para- 20 graphs: 21 ‘‘(3) The term ‘inability to contract’, with re- 22 spect to a Third Party Administrator, means the in- 23 ability of the Third Party Administrator to success- 24 VerDate Sep 11 2014 04:20 Jun 02, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1863.IS S1863 kjohnson on DSK79L0C42PROD with BILLS 11 •S 1863 IS fully negotiate and establish a community care net- 1 work contract with a provider or facility. 2 ‘‘(4) The term ‘Third Party Administrator’ 3 means an entity that manages a provider network 4 and performs administrative services related to such 5 network within the Veterans Community Care Pro- 6 gram under section 1703 of this title.’’. 7 (2) CONFORMING AMENDMENTS.—Section 8 1703(d) of such title is amended— 9 (A) in paragraph (1)(D), by striking ‘‘des- 10 ignated access standards developed by the Sec- 11 retary under section 1703B of this title’’ and 12 inserting ‘‘eligibility access standards under sec- 13 tion 1703B(a) of this title’’; and 14 (B) in paragraph (3), by striking ‘‘des- 15 ignated access standards developed by the Sec- 16 retary under section 1703B of this title’’ and 17 inserting ‘‘eligibility access standards under sec- 18 tion 1703B(a) of this title’’. 19 (b) PREVENTION OF SUSPENSION OF VETERANS 2 [Text truncated for display. Full text available on Congress.gov.]