II 118TH CONGRESS 1ST SESSION S. 1315 To improve the provision of care and services under the Veterans Community Care Program of the Department of Veterans Affairs, and for other purposes. 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. 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 ‘‘Veterans’ Health Empowerment, Access, Leadership, 5 and Transparency for our Heroes (HEALTH) Act of 6 2023’’. 7 (b) TABLE OF CONTENTS.—The table of contents for 8 this Act is as follows: 9 Sec. 1. Short title; table of contents. VerDate Sep 11 2014 02:39 May 03, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\S1315.IS S1315 DMWilson on DSKJM0X7X2PROD with BILLS 2 •S 1315 IS 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 Commu- nity 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 appoint- ments 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 require- ment for pilot program. Sec. 207. Online health education portal for veterans enrolled in patient enroll- ment system of Department of Veterans Affairs. Sec. 208. Reports. VerDate Sep 11 2014 02:39 May 03, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\S1315.IS S1315 DMWilson on DSKJM0X7X2PROD with BILLS 3 •S 1315 IS TITLE I—IMPROVEMENT OF VET- 1 ERANS COMMUNITY CARE 2 PROGRAM 3 SEC. 101. CODIFICATION OF REQUIREMENTS FOR ELIGI- 4 BILITY STANDARDS FOR ACCESS TO COMMU- 5 NITY CARE FROM DEPARTMENT OF VET- 6 ERANS AFFAIRS. 7 (a) ELIGIBILITY ACCESS STANDARDS.—Section 8 1703B of title 38, United States Code, is amended— 9 (1) by striking subsections (a) through (e) and 10 inserting the following: 11 ‘‘(a) ELIGIBILITY STANDARDS FOR ACCESS TO COM- 12 MUNITY CARE.—(1) A covered veteran shall be eligible to 13 elect to receive non-Department hospital care, medical 14 services, or extended care services, excluding nursing home 15 care, through the Veterans Community Care Program 16 under section 1703 of this title pursuant to subsection 17 (d)(1)(D) of such section using the following eligibility ac- 18 cess standards: 19 ‘‘(A) With respect to primary care, mental 20 health care, or extended care services, excluding 21 nursing home care, if the Department cannot sched- 22 ule an appointment for the covered veteran with a 23 health care provider of the Department who can pro- 24 vide the needed service— 25 VerDate Sep 11 2014 02:39 May 03, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1315.IS S1315 DMWilson on DSKJM0X7X2PROD with BILLS 4 •S 1315 IS ‘‘(i) within 30 minutes average driving 1 time (or such shorter average driving time as 2 the Secretary may prescribe) from the residence 3 of the veteran unless a longer average driving 4 time has been agreed to by the veteran in con- 5 sultation with a health care provider of the vet- 6 eran; and 7 ‘‘(ii) within 20 days (or such shorter pe- 8 riod as the Secretary may prescribe) of the date 9 of request for such an appointment unless a 10 later date has been agreed to by the veteran in 11 consultation with a health care provider of the 12 veteran. 13 ‘‘(B) With respect to specialty care, if the De- 14 partment cannot schedule an appointment for the 15 covered veteran with a health care provider of the 16 Department who can provide the needed service— 17 ‘‘(i) within 60 minutes average driving 18 time (or such shorter average driving time as 19 the Secretary may prescribe) from the residence 20 of the veteran unless a longer average driving 21 time has been agreed to by the veteran in con- 22 sultation with a health care provider of the vet- 23 eran; and 24 VerDate Sep 11 2014 02:39 May 03, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1315.IS S1315 DMWilson on DSKJM0X7X2PROD with BILLS 5 •S 1315 IS ‘‘(ii) within 28 days (or such shorter pe- 1 riod as the Secretary may prescribe) of the date 2 of request for such an appointment unless a 3 later date has been agreed to by the veteran in 4 consultation with a health care provider of the 5 veteran. 6 ‘‘(2) For the purposes of determining the eligibility 7 of a covered veteran for care or services under paragraph 8 (1), the Secretary shall not take into consideration the 9 availability of telehealth appointments from the Depart- 10 ment when determining whether the Department is able 11 to furnish such care or services in a manner that complies 12 with the eligibility access standards under such paragraph. 13 ‘‘(3) In the case of a covered veteran who has had 14 an appointment with a health care provider of the Depart- 15 ment canceled by the Department for a reason other than 16 the request of the veteran, in calculating a wait time for 17 a subsequent appointment under paragraph (1), the Sec- 18 retary shall calculate such wait time from the date of the 19 request for the original, canceled appointment. 20 ‘‘(4) If a veteran agrees to a longer average drive 21 time or a later date under subparagraph (A) or (B) of 22 paragraph (1), the Secretary shall document the agree- 23 ment to such longer average drive time or later date in 24 the electronic health record of the veteran and provide the 25 VerDate Sep 11 2014 02:39 May 03, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1315.IS S1315 DMWilson on DSKJM0X7X2PROD with BILLS 6 •S 1315 IS veteran a copy of such documentation. Such copy may be 1 provided electronically. 2 ‘‘(b) APPLICATION.—The Secretary shall ensure that 3 the eligibility access standards established under sub- 4 section (a) apply— 5 ‘‘(1) to all care and services within the medical 6 benefits package of the Department to which a cov- 7 ered veteran is eligible under section 1703 of this 8 title, excluding nursing home care; and 9 ‘‘(2) to all covered veterans, regardless of 10 whether a veteran is a new or established patient. 11 ‘‘(c) PERIODIC REVIEW OF ACCESS STANDARDS.— 12 Not later than three years after the date of the enactment 13 of the Veterans’ Health Empowerment, Access, Leader- 14 ship, and Transparency for our Heroes (HEALTH) Act 15 of 2023, and not less frequently than once every three 16 years thereafter, the Secretary shall— 17 ‘‘(1) conduct a review of the eligibility access 18 standards under subsection (a) in consultation 19 with— 20 ‘‘(A) such Federal entities as the Secretary 21 considers appropriate, including the Depart- 22 ment of Defense, the Department of Health and 23 Human Services, and the Centers for Medicare 24 & Medicaid Services; 25 VerDate Sep 11 2014 02:39 May 03, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1315.IS S1315 DMWilson on DSKJM0X7X2PROD with BILLS 7 •S 1315 IS ‘‘(B) entities and individuals in the private 1 sector, including— 2 ‘‘(i) veteran patients; 3 ‘‘(ii) veterans service organizations; 4 and 5 ‘‘(iii) health care providers partici- 6 pating in the Veterans Community Care 7 Program under section 1703 of this title; 8 and 9 ‘‘(C) other entities that are not part of the 10 Federal Government; and 11 ‘‘(2) submit to the appropriate committees of 12 Congress a report on— 13 ‘‘(A) the findings of the Secretary with re- 14 spect to the review conducted under paragraph 15 (1); and 16 ‘‘(B) such recommendations as the Sec- 17 retary may have with respect to the eligibility 18 access standards under subsection (a).’’; 19 (2) by striking subsection (g); 20 (3) by redesignating subsections (f), (h), and (i) 21 as subsections (d), (e), and (f), respectively; 22 (4) in subsection (d), as redesignated by para- 23 graph (3)— 24 VerDate Sep 11 2014 02:39 May 03, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1315.IS S1315 DMWilson on DSKJM0X7X2PROD with BILLS 8 •S 1315 IS (A) by striking ‘‘established’’ each place it 1 appears; and 2 (B) in paragraph (1), by striking ‘‘(1) 3 Subject to’’ and inserting ‘‘COMPLIANCE BY 4 COMMUNITY CARE PROVIDERS WITH ACCESS 5 STANDARDS.—(1) Subject to’’; 6 (5) in subsection (e), as so redesignated— 7 (A) in paragraph (1)— 8 (i) by striking ‘‘(1) Consistent with’’ 9 and inserting ‘‘DETERMINATION REGARD- 10 ING ELIGIBILITY.—(1) Consistent with’’; 11 and 12 (ii) by striking ‘‘designated access 13 standards established under this section’’ 14 and inserting ‘‘eligibility access standards 15 under subsection (a)’’; and 16 (B) in paragraph (2)(B), by striking ‘‘des- 17 ignated access standards established under this 18 section’’ and inserting ‘‘eligibility access stand- 19 ards under subsection (a)’’; and 20 (6) in subsection (f), as redesignated by para- 21 graph (2)— 22 (A) in the matter preceding paragraph (1), 23 by striking ‘‘In this section’’ and inserting 24 ‘‘DEFINITIONS.—In this section’’; and 25 VerDate Sep 11 2014 02:39 May 03, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1315.IS S1315 DMWilson on DSKJM0X7X2PROD with BILLS 9 •S 1315 IS (B) in paragraph (2)— 1 (i) by striking ‘‘covered veterans’’ and 2 inserting ‘‘covered veteran’’; and 3 (ii) by striking ‘‘veterans described’’ 4 and inserting ‘‘a veteran described’’. 5 (b) CONFORMING AMENDMENTS.—Section 1703(d) 6 of such title is amended— 7 (1) in paragraph (1)(D), by striking ‘‘des- 8 ignated access standards developed by the Secretary 9 under section 1703B of this title’’ and inserting ‘‘eli- 10 gibility access standards under section 1703B(a) of 11 this title’’; and 12 (2) in paragraph (3), by striking ‘‘designated 13 access standards developed by the Secretary under 14 section 1703B of this title’’ and inserting ‘‘eligibility 15 access standards under section 1703B(a) of this 16 title’’. 17 SEC. 102. REQUIREMENT THAT SECRETARY NOTIFY VET- 18 ERANS OF ELIGIBILITY FOR CARE UNDER 19 VETERANS COMMUNITY CARE PROGRAM. 20 Section 1703(a) of title 38, United States Code, is 21 amended by adding at the end the following new para- 22 graph: 23 ‘‘(5)(A) The Secretary shall notify each covered vet- 24 eran in writing of the eligibility of such veteran for care 25 VerDate Sep 11 2014 02:39 May 03, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1315.IS S1315 DMWilson on DSKJM0X7X2PROD with BILLS 10 •S 1315 IS or services under this section as soon as possible, but not 1 later than two business days, after the date on which the 2 Secretary is aware that the veteran is seeking care or serv- 3 ices and is eligible for such care or services under this 4 section. 5 ‘‘(B) With respect to each covered veteran eligible for 6 care or services under subsection (d), the Secretary shall 7 provide such veteran periodic reminders, as the Secretary 8 determines appropriate, of their ongoing eligibility under 9 such subsection. 10 ‘‘(C) Any notification or reminder under this para- 11 graph may be provided electronically.’’. 12 SEC. 103. CONSIDERATION UNDER VETERANS COMMUNITY 13 CARE PROGRAM OF VETERAN PREFERENCE 14 FOR CARE AND NEED FOR CAREGIVER OR AT- 15 TENDANT. 16 Section 1703(d)(2) of title 38, United States Code, 17 is amended by adding at the end the following new sub- 18 paragraphs: 19 ‘‘(F) The preference of the covered veteran for 20 where, when, and how to seek hospital care, medical 21 services, or extended care services. 22 ‘‘(G) Whether the covered veteran requests or 23 requires the assistance of a caregiver or attendant 24 VerDate Sep 11 2014 02:39 May 03, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1315.IS S1315 DMWilson on DSKJM0X7X2PROD with BILLS 11 •S 1315 IS when seeking hospital care, medical services, or ex- 1 tended care services.’’. 2 SEC. 104. NOTIFICATION OF DENIAL OF REQUEST FOR 3 CARE UNDER VETERANS COMMUNITY CARE 4 PROGRAM. 5 Section 1703 of title 38, United States Code, is 6 amended— 7 (1) by redesignating subsection (o) as sub- 8 section (p); and 9 (2) by inserting after subsection (n) the fol- 10 lowing new subsection (o): 11 ‘‘(o) NOTIFICATION OF DENIAL OF REQUEST FOR 12 CARE AND HOW TO APPEAL.—(1) If a request by a vet- 13 eran for care or services under this section is denied, the 14 Secretary shall notify the veteran in writing as soon as 15 possible, but not later than two business days, after the 16 denial is made— 17 ‘‘(A) of the reason for the denial; and 18 ‘‘(B) with instructions on how to appeal such 19 denial using the clinical appeals process of the Vet- 20 erans Health Administration. 21 ‘‘(2) If a denial under paragraph (1) is due to not 22 meeting the eligibility access standards under section 23 1703B(a) of this title, notice under such paragraph shall 24 VerDate Sep 11 2014 02:39 May 03, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1315.IS S1315 DMWilson on DSKJM0X7X2PROD with BILLS 12 •S 1315 IS include an explanation for why the Secretary does not con- 1 sider the veteran to have met such standards. 2 ‘‘(3) Any notif [Text truncated for display. 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