COFA Veterans Review Act of 2019

II 116TH CONGRESS 1ST SESSION S. 1222 To require the Secretary of Veterans Affairs to carry out a pilot program to provide hospital care and medical services to veterans in the Freely Associated States of the Republic of Palau, the Republic of the Marshall Islands, and the Federated States of Micronesia, and to conduct a study on the feasibility and advisability of establishing regional offices, suboffices, contact units, or other subordinate offices of the Department of Veterans Affairs in the Freely Associated States to provide such care and services, and for other purposes. IN THE SENATE OF THE UNITED STATES APRIL 29, 2019 Mr. SCHATZ introduced the following bill; which was read twice and referred to the Committee on Veterans’ Affairs A BILL To require the Secretary of Veterans Affairs to carry out a pilot program to provide hospital care and medical services to veterans in the Freely Associated States of the Republic of Palau, the Republic of the Marshall Islands, and the Federated States of Micronesia, and to conduct a study on the feasibility and advisability of establishing regional offices, suboffices, contact units, or other subordinate offices of the Department of Vet- erans Affairs in the Freely Associated States to provide such care and services, and for other purposes. VerDate Sep 11 2014 01:16 May 01, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\S1222.IS S1222 SSpencer on DSKBBXCHB2PROD with BILLS 2 •S 1222 IS 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. 3 This Act may be cited as the ‘‘Compact of Free Asso- 4 ciation Veterans Review Act of 2019’’ or the ‘‘COFA Vet- 5 erans Review Act of 2019’’. 6 SEC. 2. DEFINITIONS. 7 In this Act: 8 (1) APPROPRIATE COMMITTEES OF CON- 9 GRESS.—The term ‘‘appropriate committees of Con- 10 gress’’ means— 11 (A) the Committee on Veterans’ Affairs 12 and the Committee on Appropriations of the 13 Senate; and 14 (B) the Committee on Veterans’ Affairs 15 and the Committee on Appropriations of the 16 House of Representatives. 17 (2) DEPARTMENT.—The term ‘‘Department’’ 18 means the Department of Veterans Affairs. 19 (3) FREELY ASSOCIATED STATES.—The term 20 ‘‘Freely Associated States’’ means the Republic of 21 Palau, the Republic of the Marshall Islands, and the 22 Federated States of Micronesia, which have each en- 23 tered into a Compact of Free Association with the 24 United States. 25 VerDate Sep 11 2014 04:43 Apr 30, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1222.IS S1222 SSpencer on DSKBBXCHB2PROD with BILLS 3 •S 1222 IS (4) HOSPITAL CARE; MEDICAL SERVICES.—The 1 terms ‘‘hospital care’’ and ‘‘medical services’’ have 2 the meanings given those terms in section 1701 of 3 title 38, United States Code. 4 (5) PATIENT ALIGNED CARE TEAM.—The term 5 ‘‘patient aligned care team’’ means a team of health 6 care professionals of the Department that provides 7 comprehensive primary care in partnership with the 8 patient and manages and coordinates comprehensive 9 health care services consistent with agreed-upon 10 goals of care. 11 (6) PROJECT ECHO EDUCATION AND TRAIN- 12 ING.—The term ‘‘Project ECHO education and 13 training’’ means education and training provided 14 under the Project Extension for Community Health 15 Outcomes. 16 (7) SECRETARY.—The term ‘‘Secretary’’ means 17 the Secretary of Veterans Affairs. 18 (8) SERVICE-CONNECTED; NON-SERVICE-CON- 19 NECTED.—The terms ‘‘service-connected’’ and ‘‘non- 20 service-connected’’ have the meanings given those 21 terms in section 101 of title 38, United States Code. 22 (9) VETERANS SERVICE ORGANIZATION.—The 23 term ‘‘veterans service organization’’ means any or- 24 ganization recognized by the Secretary for the rep- 25 VerDate Sep 11 2014 04:43 Apr 30, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1222.IS S1222 SSpencer on DSKBBXCHB2PROD with BILLS 4 •S 1222 IS resentation of veterans under section 5902 of title 1 38, United States Code. 2 SEC. 3. PILOT PROGRAM ON PROVIDING HOSPITAL CARE 3 AND MEDICAL SERVICES TO VETERANS RE- 4 SIDING IN THE FREELY ASSOCIATED STATES. 5 (a) PILOT PROGRAM REQUIRED.—Commencing not 6 later than January 1, 2020, the Secretary shall carry out 7 a pilot program to provide hospital care, medical services, 8 and other related services to veterans residing in the Free- 9 ly Associated States. 10 (b) DURATION.—The Secretary shall carry out the 11 pilot program required by subsection (a) during the three- 12 year period beginning on the date of the commencement 13 of the pilot program. 14 (c) SERVICES PROVIDED.—In carrying out the pilot 15 program required by subsection (a), the Secretary shall 16 ensure that the pilot program— 17 (1) emphasizes the use of telehealth; 18 (2) provides Project ECHO education and 19 training to employees of the Department responsible 20 for carrying out the pilot program; 21 (3) includes the use of primary and specialty 22 care provided by patient aligned care teams and spe- 23 cialty care providers; and 24 VerDate Sep 11 2014 04:43 Apr 30, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1222.IS S1222 SSpencer on DSKBBXCHB2PROD with BILLS 5 •S 1222 IS (4) includes the provision of compensation and 1 pension medical examinations. 2 (d) OUTREACH PROGRAM.—As part of the pilot pro- 3 gram required by subsection (a), the Secretary shall con- 4 duct a program of outreach to inform veterans in the 5 Freely Associated States about the pilot program and the 6 services available under the pilot program. 7 (e) AUTHORIZATION OF APPROPRIATIONS.—There 8 are authorized to be appropriated to the Secretary such 9 funds as may be necessary to carry out the pilot program. 10 SEC. 4. STUDY ON PROVIDING HOSPITAL CARE AND MED- 11 ICAL SERVICES TO VETERANS RESIDING IN 12 THE FREELY ASSOCIATED STATES. 13 (a) STUDY REQUIRED.— 14 (1) IN GENERAL.—The Secretary shall conduct 15 a study on the feasibility and advisability of estab- 16 lishing one or more regional offices, suboffices, con- 17 tact units, or other subordinate offices of the De- 18 partment in the remote Pacific islands, including the 19 Freely Associated States, to provide hospital care 20 and medical services to veterans residing in the re- 21 mote Pacific islands, including the Freely Associated 22 States. 23 VerDate Sep 11 2014 04:43 Apr 30, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1222.IS S1222 SSpencer on DSKBBXCHB2PROD with BILLS 6 •S 1222 IS (2) CONSIDERATIONS AND ANALYSIS.—In con- 1 ducting the study required by paragraph (1), the 2 Secretary shall consider and analyze the following: 3 (A) The results of the pilot program re- 4 quired by section 3(a). 5 (B) The ability of the Department to pro- 6 vide hospital care and medical services to vet- 7 erans residing or traveling outside the United 8 States, including veterans residing in the Freely 9 Associated States. 10 (C) The feasibility, efficacy, and advis- 11 ability of building clinics or leasing space on 12 embassy compounds or in consulate facilities of 13 the United States in the Freely Associated 14 States or insular areas for the purposes of pro- 15 viding hospital care and medical services to vet- 16 erans residing or traveling outside the United 17 States, including veterans residing in the Freely 18 Associated States. 19 (D) The feasibility and advisability of pro- 20 viding services, such as telehealth, Project 21 ECHO education and training, primary and 22 specialty care provided by patient aligned care 23 teams and specialty care providers, and com- 24 pensation and pension medical examinations, to 25 VerDate Sep 11 2014 04:43 Apr 30, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1222.IS S1222 SSpencer on DSKBBXCHB2PROD with BILLS 7 •S 1222 IS veterans residing in the Freely Associated 1 States. 2 (E) Updates to census data of the Depart- 3 ment on the number of veterans residing in the 4 Freely Associated States to determine whether 5 such data supports the establishment of a per- 6 manent patient aligned care team of the De- 7 partment based in the Freely Associated States. 8 (F) With respect to the United States and 9 the Freely Associated States, the data stand- 10 ards for— 11 (i) patient medical record information; 12 and 13 (ii) the electronic interchange of such 14 information. 15 (G) The feasibility and advisability of pro- 16 viding hospital care and medical services to vet- 17 erans residing in the Freely Associated States 18 for non-service-connected disabilities. 19 (H) The feasibility and advisability of pro- 20 viding continuity of care to veterans for service- 21 connected disabilities that cannot be treated by 22 the Department within a regional office, sub- 23 office, contact unit, or other subordinate office 24 VerDate Sep 11 2014 04:43 Apr 30, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1222.IS S1222 SSpencer on DSKBBXCHB2PROD with BILLS 8 •S 1222 IS of the Department in the remote Pacific is- 1 lands, including the Freely Associated States. 2 (I) Such other matters as the Secretary 3 considers appropriate. 4 (3) COOPERATION AND CONSULTATION.—The 5 Secretary shall conduct the study required by para- 6 graph (1)— 7 (A) in cooperation with— 8 (i) the Secretary of Defense; 9 (ii) the Secretary of Health and 10 Human Services; 11 (iii) the Secretary of the Interior; 12 (iv) the Secretary of State; and 13 (v) such other heads of Federal agen- 14 cies as may be interested in the study; and 15 (B) in consultation with— 16 (i) such representatives of State and 17 local governments as the Secretary deter- 18 mines may be interested in the study; 19 (ii) each government of the Freely As- 20 sociated States; 21 (iii) veterans service organizations; 22 (iv) such nongovernmental organiza- 23 tions as the Secretary considers appro- 24 priate; and 25 VerDate Sep 11 2014 04:43 Apr 30, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1222.IS S1222 SSpencer on DSKBBXCHB2PROD with BILLS 9 •S 1222 IS (v) the public. 1 (b) REPORT REQUIRED.— 2 (1) IN GENERAL.—Not later than 270 days 3 after the date on which the pilot program required 4 by section 3(a) terminates, the Secretary shall sub- 5 mit to the appropriate committees of Congress a re- 6 port on the findings of the Secretary with respect to 7 the study required by subsection (a)(1). 8 (2) CONTENTS.—The report submitted under 9 paragraph (1) shall include the following: 10 (A) A description of the processes required 11 for the Secretary to establish one or more re- 12 gional offices, suboffices, contact units, or other 13 subordinate offices in the Freely Associated 14 States. 15 (B) The number of veterans expected to 16 receive hospital care and medical services pro- 17 vided under laws administered by the Secretary 18 in the Freely Associated States. 19 (C) A resource management plan for the 20 Department to provide hospital care and med- 21 ical services in the Freely Associated States, in- 22 cluding an assessment of the effect that such 23 provision would have on the Department of Vet- 24 VerDate Sep 11 2014 04:43 Apr 30, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1222.IS S1222 SSpencer on DSKBBXCHB2PROD with BILLS 10 •S 1222 IS erans Affairs Pacific Islands Health Care Sys- 1 tem. 2 (D) An explanation of the guidelines that 3 the Department will use to provide hospital care 4 and medical services under laws administered 5 by the Secretary in the Freely Associated 6 States, including an explanation of benefits for 7 service-connected and non-service-connected dis- 8 abilities. 9 (E) An explanation of how the Department 10 expects to provide continuity of care to veterans 11 for service-connected disabilities that cannot be 12 treated within a regional office, suboffice, con- 13 tact unit, or other subordinate office in the 14 Freely Associated States, including how the De- 15 partment plans to communicate with such vet- 16 erans regarding their continuity of care. 17 (F) An assessment of the budgetary re- 18 sources required to establish and provide hos- 19 pital care and medical services to veterans in 20 the Freely Associated States during the 10-year 21 period beginning on the date of the submittal of 22 the report. 23 Æ VerDate Sep 11 2014 04:43 Apr 30, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\S1222.IS S1222 SSpencer on DSKBBXCHB2PROD with BILLS