Protecting Veteran Community Care Act

II 118TH CONGRESS 1ST SESSION S. 1745 To amend title 38, United States Code, to expand access to the Veterans Community Care Program of the Department of Veterans Affairs to include certain veterans seeking mental health or substance-use services, and for other purposes. IN THE SENATE OF THE UNITED STATES MAY 18, 2023 Mr. DAINES (for himself, Mr. TILLIS, Ms. LUMMIS, Mr. SCOTT of Florida, and Mr. GRASSLEY) introduced the following bill; which was read twice and referred to the Committee on Veterans’ Affairs A BILL To amend title 38, United States Code, to expand access to the Veterans Community Care Program of the Depart- ment of Veterans Affairs to include certain veterans seeking mental health or substance-use services, 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. 3 This Act may be cited as the ‘‘Protecting Veteran 4 Community Care Act’’. 5 SEC. 2. FINDINGS. 6 Congress finds the following: 7 VerDate Sep 11 2014 06:23 Jun 13, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1745.IS S1745 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •S 1745 IS (1) On June 6, 2018, the John S. McCain III, 1 Daniel K. Akaka, and Samuel R. Johnson VA Main- 2 taining Internal Systems and Strengthening Inte- 3 grated Outside Networks Act of 2018 (Public Law 4 115–182) (in this section referred to as the ‘‘VA 5 MISSION Act’’) became law. 6 (2) Congressional intent with the VA MISSION 7 Act was to reform and replace the program under 8 section 101 of the Veterans Access, Choice, and Ac- 9 countability Act of 2014 (Public Law 113–146; 38 10 U.S.C. 1701 note) to ensure access of veterans to 11 community health care providers. 12 (3) The eligibility standards established by the 13 VA MISSION Act were not meant to be used to 14 limit health care options for veterans or to be ap- 15 plied to community providers, which would result in 16 reduced health care options. 17 (4) Many veterans do not have access to a med- 18 ical facility of the Department of Veterans Affairs in 19 their community and each medical facility of the De- 20 partment may not be able to adequately address the 21 specific health care needs of a particular veteran. 22 (5) It was the intent of Congress in the VA 23 MISSION Act that all medical services, including 24 mental health treatments and institutional extended 25 VerDate Sep 11 2014 06:23 Jun 13, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1745.IS S1745 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •S 1745 IS care services for mental health, were to be available 1 to veterans in the community. 2 (6) The Department is limiting access of vet- 3 erans to community care for mental health treat- 4 ments. 5 (7) Despite the best efforts of the Department, 6 veteran suicide remains at significant levels through- 7 out the United States. 8 (8) No veteran should have to wait 30 days for 9 mental health services to be approved by the Depart- 10 ment. 11 (9) Telehealth appointments represent a valu- 12 able complementary health care option for under- 13 served veterans, but do not offer the same quality of 14 care as in-person visits to facilities of the Depart- 15 ment or in the community for veterans in crisis. 16 SEC. 3. EXPANSION OF VETERANS COMMUNITY CARE PRO- 17 GRAM TO INCLUDE ACCESS TO MENTAL 18 HEALTH OR SUBSTANCE-USE SERVICES FOR 19 VETERANS UNABLE TO TIMELY ACCESS MEN- 20 TAL HEALTH RESIDENTIAL TREATMENT PRO- 21 GRAMS. 22 (a) IN GENERAL.—Section 1703 of title 38, United 23 States Code, is amended— 24 (1) in subsection (d)— 25 VerDate Sep 11 2014 06:23 Jun 13, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1745.IS S1745 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •S 1745 IS (A) in paragraph (1) 1 (i) in subparagraph (D), by striking 2 ‘‘; or’’ and inserting a semicolon; 3 (ii) in subparagraph (E), by striking 4 the period at the end and inserting ‘‘; or’’; 5 and 6 (iii) by adding at the end the fol- 7 lowing new subparagraph: 8 ‘‘(F) in the case of residential mental health or 9 substance-use services, the covered veteran— 10 ‘‘(i) meets the criteria of the Department 11 for priority admission to a Mental Health Resi- 12 dential Rehabilitation Treatment Program of 13 the Department and the Department is unable 14 to accommodate such priority admission; or 15 ‘‘(ii) has contacted the Department to re- 16 quest such services from a Mental Health Resi- 17 dential Rehabilitation Treatment Program of 18 the Department and the Department is not able 19 to furnish such services in a manner than com- 20 plies with the access standards of the Depart- 21 ment for specialty care provided under this sec- 22 tion by a health care provider specified in sub- 23 section (c).’’; and 24 VerDate Sep 11 2014 06:23 Jun 13, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1745.IS S1745 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •S 1745 IS (B) by adding at the end the following new 1 paragraph (4): 2 ‘‘(4) In the case of a covered veteran entitled to men- 3 tal health or substance-use services under paragraph 4 (1)(F), the Secretary shall ensure that referral of a vet- 5 eran to an alternate Mental Health Residential Rehabilita- 6 tion Treatment Program of the Department does not take 7 precedence over timely access to such services under this 8 section pursuant to such paragraph unless such referral 9 is requested by the covered veteran.’’; 10 (2) by redesignating subsection (o) as sub- 11 section (p); and 12 (3) by inserting after subsection (n) the fol- 13 lowing new subsection (o): 14 ‘‘(o) MINIMUM STANDARDS FOR RESIDENTIAL MEN- 15 TAL HEALTH OR SUBSTANCE-USE SERVICES.—(1) Sub- 16 ject to paragraph (2), in furnishing residential mental 17 health or substance-use services to covered veterans pursu- 18 ant to subsection (d)(1)(F), the Secretary shall ensure 19 that programs or facilities providing such services under 20 this section meet the following standards: 21 ‘‘(A) A treatment program or facility must be 22 licensed and accredited by a State for the provision 23 of the services provided. 24 VerDate Sep 11 2014 06:23 Jun 13, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1745.IS S1745 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •S 1745 IS ‘‘(B) A treatment program must be accredited 1 under either the Joint Commission Behavioral 2 Health Standards or the Behavioral Health Stand- 3 ards manual (residential treatment) of the Commis- 4 sion on Accreditation of Rehabilitation Facilities, or 5 any successor standards or manual. 6 ‘‘(2) If a program or facility to which a covered vet- 7 eran is to be referred pursuant to subsection (d)(1)(F) 8 does not meet the standards specified under paragraph 9 (1), the Secretary, acting through the director of the facil- 10 ity of the Department carrying out the referral— 11 ‘‘(A) shall consider an alternate program or fa- 12 cility; and 13 ‘‘(B) may waive such standards on an indi- 14 vidual basis if no other alternate program or facility 15 is available or such waiver is in the best interest of 16 the veteran.’’. 17 (b) MODIFICATION OF ACCESS STANDARDS.—Not 18 later than 90 days after the date of the enactment of this 19 Act, the Secretary of Veterans Affairs shall develop or 20 amend existing access standards of the Department of 21 Veterans Affairs to ensure that access to mental health 22 care under the Veterans Community Care Program under 23 section 1703 of title 38, United States Code, as amended 24 VerDate Sep 11 2014 06:23 Jun 13, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1745.IS S1745 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •S 1745 IS by subsection (a), is not more restrictive than the access 1 standards for specialty care under such section. 2 SEC. 4. PROHIBITION ON CERTAIN LIMITATIONS ON AC- 3 CESS OF VETERANS TO CARE. 4 Section 1703(n) of title 38, United States Code, is 5 amended by adding at the end the following new para- 6 graphs: 7 ‘‘(3) In applying wait times or access standards 8 under this section for purposes of determining eligibility 9 of a covered veteran for care or services under this section, 10 the Secretary may not determine that the veteran is ineli- 11 gible for such care or services due solely to the fact that 12 health care providers specified in subsection (c) are unable 13 to provide such care or services in compliance with such 14 wait times or access standards. 15 ‘‘(4) If multiple options are available to a covered vet- 16 eran for care or services under this section, the Secretary 17 shall permit the veteran to elect the option that the vet- 18 eran prefers.’’. 19 SEC. 5. DEVELOPMENT OF COMMUNITY CARE METRICS. 20 (a) IN GENERAL.—Section 1703(m)(1) of title 38, 21 United States Code, is amended by adding at the end the 22 following new subparagraph: 23 VerDate Sep 11 2014 06:23 Jun 13, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1745.IS S1745 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •S 1745 IS ‘‘(C) The review submitted under subparagraph (A) 1 shall include, for the year covered by the review, the fol- 2 lowing: 3 ‘‘(i) The number of instances of care or services 4 requested. 5 ‘‘(ii) The number of such requests that were ap- 6 proved. 7 ‘‘(iii) The number of such requests that were 8 denied. 9 ‘‘(iv) The number of appeals under subsection 10 (f) of such requests that were denied, including the 11 final decision of such appeal. 12 ‘‘(v) The eligibility criteria under which each el- 13 igible veteran has qualified for care or services under 14 this section. 15 ‘‘(vi) Data with respect to the following: 16 ‘‘(I) Requests for care or services relating 17 to mental health. 18 ‘‘(II) Authorizations for emergency care, 19 including whether transportation for such care 20 was required or whether further care or a hos- 21 pital stay was required.’’. 22 (b) APPLICATION.—The amendment made by sub- 23 section (a) shall apply to each review conducted under sub- 24 VerDate Sep 11 2014 06:23 Jun 13, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1745.IS S1745 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •S 1745 IS paragraph (A) of such section after the date of the enact- 1 ment of this Act. 2 SEC. 6. LIMITATION ON MODIFICATION OF COMMUNITY 3 CARE ACCESS STANDARDS. 4 Any modification on or after the date of the enact- 5 ment of this Act by the Secretary of Veterans Affairs of 6 the conditions under which care is required to be provided 7 under section 1703(d) of title 38, United States Code, ei- 8 ther through a modification of the designated access 9 standards under paragraph (1)(D) of such section, a 10 modification of the criteria developed by the Secretary 11 under paragraph (1)(E) of such section, or otherwise 12 through regulation, shall not take effect until a joint reso- 13 lution is enacted approving such modification to the condi- 14 tions under which care is required to be provided under 15 such section. 16 Æ VerDate Sep 11 2014 06:23 Jun 13, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6301 E:\BILLS\S1745.IS S1745 pbinns on DSKJLVW7X2PROD with $$_JOB