Veteran Care Improvement Act of 2023

I 118TH CONGRESS 1ST SESSION H. R. 3520 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 HOUSE OF REPRESENTATIVES MAY 18, 2023 Mrs. MILLER-MEEKS (for herself, Mr. BOST, Mr. BERGMAN, Mrs. RADEWAGEN, Mrs. KIGGANS of Virginia, Ms. MACE, Mr. MURPHY, and Mr. VAN ORDEN) introduced the following bill; which was 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. 3 This Act may be cited as the ‘‘Veteran Care Improve- 4 ment Act of 2023’’. 5 VerDate Sep 11 2014 04:37 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3520.IH H3520 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 3520 IH SEC. 2. CODIFICATION OF ACCESS STANDARDS FOR COM- 1 MUNITY CARE FURNISHED BY THE DEPART- 2 MENT OF VETERANS AFFAIRS. 3 (a) ACCESS STANDARDS.—Section 1703B of title 38, 4 United States Code, is amended— 5 (1) by striking subsections (a) through (e) and 6 inserting the following: 7 ‘‘(a) ACCESS STANDARDS FOR COMMUNITY CARE.— 8 (1) A covered veteran may receive hospital care, medical 9 services, or extended care services under section 10 1703(d)(1)(D) of this title if the Secretary determines the 11 following: 12 ‘‘(A) With respect to primary care, mental 13 health care, or extended care services, the Secretary 14 cannot schedule an in-person appointment for the 15 covered veteran with a health care provider of the 16 Department for such care or services— 17 ‘‘(i) at a facility of the Department that is 18 located less than a 30-minute drive from the 19 residence of the covered veteran; or 20 ‘‘(ii) during the 20-day period after the 21 date on which the covered veteran requests such 22 appointment. 23 ‘‘(B) With respect to specialty care, the Sec- 24 retary cannot schedule an in-person appointment for 25 VerDate Sep 11 2014 04:37 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3520.IH H3520 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 3520 IH the covered veteran with a health care provider of 1 the Department who can provide such care— 2 ‘‘(i) at a facility of the Department that is 3 located less than a 60-minute drive from the 4 residence of the covered veteran; or 5 ‘‘(ii) during the 28-day period after the 6 date on which the covered veteran requests such 7 appointment. 8 ‘‘(C) With respect to residential treatment and 9 rehabilitative services for alcohol or drug depend- 10 ence, the Secretary cannot provide the covered vet- 11 eran such services at a facility of the Department— 12 ‘‘(i) that is located less than a 30-minute 13 drive from the residence of the covered veteran; 14 or 15 ‘‘(ii) during the 10-day period after the 16 date on which the covered veteran requests such 17 services. 18 ‘‘(2)(A) The Secretary may prescribe regulations that 19 establish a shorter drive or time period than those estab- 20 lished by paragraph (1). 21 ‘‘(B) A covered veteran may consent to a longer drive 22 or time period than established by paragraph (1) (or pur- 23 suant to regulations prescribed under paragraph (2)). If 24 a covered veteran so consents, the Secretary shall docu- 25 VerDate Sep 11 2014 04:37 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3520.IH H3520 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 3520 IH ment such consent in the electronic health record of the 1 covered veteran and provide the covered veteran with a 2 copy of such documentation in writing or through elec- 3 tronic means. 4 ‘‘(3) In making any determination under paragraph 5 (1), the Secretary may not consider— 6 ‘‘(A) a telehealth appointment; or 7 ‘‘(B) the cancellation of an appointment unless 8 such cancellation was at the request of the covered 9 veteran. 10 ‘‘(b) APPLICABILITY.—The Secretary shall ensure 11 that the access standards established under subsection (a) 12 apply— 13 ‘‘(1) to all care and services (except nursing 14 home care) within the medical benefits package of 15 the Department to which a covered veteran is eligi- 16 ble under section 1703 of this title; and 17 ‘‘(2) to all covered veterans. 18 ‘‘(c) PERIODIC REVIEW OF ACCESS STANDARDS.— 19 Not later than three years after the date of the enactment 20 of the Veteran Care Improvement Act of 2023, and not 21 less frequently than once every three years thereafter, the 22 Secretary shall— 23 ‘‘(1) conduct a review of the access standards 24 under subsection (a) in consultation with— 25 VerDate Sep 11 2014 04:37 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3520.IH H3520 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 3520 IH ‘‘(A) Federal entities (including the De- 1 partment of Defense, the Department of Health 2 and Human Services, and the Centers for Medi- 3 care & Medicaid Services) that the Secretary 4 determines appropriate; 5 ‘‘(B) entities and individuals in the private 6 sector, including— 7 ‘‘(i) veterans who receive hospital 8 care, medical services, and extended care 9 services furnished by the Secretary; 10 ‘‘(ii) veterans service organizations; 11 and 12 ‘‘(iii) health care providers partici- 13 pating in the Veterans Community Care 14 Program under section 1703 of this title; 15 and 16 ‘‘(C) other entities that are not part of the 17 Federal Government; and 18 ‘‘(2) submit to the appropriate committees of 19 Congress a report on— 20 ‘‘(A) the findings of the Secretary under 21 such review; and 22 ‘‘(B) recommendations of the Secretary re- 23 garding such access standards.’’; 24 (2) by striking subsection (g); 25 VerDate Sep 11 2014 04:37 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3520.IH H3520 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 3520 IH (3) by redesignating subsections (f), (h), and (i) 1 as subsections (d), (e), and (f), respectively; 2 (4) in subsection (d), as redesignated by para- 3 graph (3)— 4 (A) by striking ‘‘established’’ each place it 5 appears; and 6 (B) in paragraph (1), by striking ‘‘(1) 7 Subject to’’ and inserting ‘‘COMPLIANCE BY 8 COMMUNITY CARE PROVIDERS WITH ACCESS 9 STANDARDS.—(1) Subject to’’; 10 (5) in subsection (e), as so redesignated— 11 (A) in paragraph (1)— 12 (i) by striking ‘‘(1) Consistent with’’ 13 and inserting ‘‘DETERMINATION REGARD- 14 ING ELIGIBILITY.—(1) Consistent with’’; 15 and 16 (ii) by striking ‘‘designated access 17 standards established under this section’’ 18 and inserting ‘‘access standards under sub- 19 section (a)’’; and 20 (B) in paragraph (2)(B), by striking ‘‘des- 21 ignated access standards established under this 22 section’’ and inserting ‘‘access standards under 23 subsection (a)’’; and 24 VerDate Sep 11 2014 04:37 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3520.IH H3520 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 3520 IH (6) in subsection (f), as redesignated by para- 1 graph (2)— 2 (A) in the matter preceding paragraph (1), 3 by striking ‘‘In this section’’ and inserting 4 ‘‘DEFINITIONS.—In this section’’; and 5 (B) in paragraph (2)— 6 (i) by striking ‘‘covered veterans’’ and 7 inserting ‘‘covered veteran’’; and 8 (ii) by striking ‘‘veterans described’’ 9 and inserting ‘‘a veteran described’’. 10 (b) CONFORMING AMENDMENTS.—Subsection (d) of 11 section 1703 of such title is amended— 12 (1) in paragraph (1)(D), by striking ‘‘des- 13 ignated access standards developed by the Secretary 14 under section 1703B of this title’’ and inserting ‘‘ac- 15 cess standards under section 1703B(a) of this title’’; 16 and 17 (2) in paragraph (3), by striking ‘‘designated 18 access standards developed by the Secretary under 19 section 1703B of this title’’ and inserting ‘‘access 20 standards under section 1703B(a) of this title’’. 21 VerDate Sep 11 2014 04:37 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3520.IH H3520 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 3520 IH SEC. 3. REQUIREMENT THAT SECRETARY NOTIFY VET- 1 ERANS OF ELIGIBILITY FOR CARE UNDER 2 VETERANS COMMUNITY CARE PROGRAM. 3 Section 1703 of title 38, United States Code, is fur- 4 ther amended, in subsection (a), by adding at the end the 5 following new paragraph: 6 ‘‘(5)(A) The Secretary shall notify a covered veteran 7 in writing of the eligibility of such veteran for care or serv- 8 ices under this section not later than two business days 9 after the date on which— 10 ‘‘(i) the veteran seeks care or services under 11 this chapter; and 12 ‘‘(ii) the Secretary determines that the veteran 13 is a covered veteran. 14 ‘‘(B) The Secretary may provide a covered veteran 15 with a periodic notification of the eligibility of such cov- 16 ered veteran for care under subsection (d). 17 ‘‘(C) Any notification under this paragraph may be 18 provided through electronic means.’’. 19 SEC. 4. CONSIDERATION UNDER VETERANS COMMUNITY 20 CARE PROGRAM OF VETERAN PREFERENCE 21 FOR CARE AND NEED FOR CAREGIVER OR AT- 22 TENDANT. 23 Section 1703 of title 38, United States Code, is fur- 24 ther amended, in subsection (d)(2), by adding at the end 25 the following new subparagraphs: 26 VerDate Sep 11 2014 04:37 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3520.IH H3520 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 3520 IH ‘‘(F) The preference of the covered veteran re- 1 garding where, when, and how to seek hospital care, 2 medical services, or extended care services. 3 ‘‘(G) Whether the covered veteran requests or 4 requires the assistance of a caregiver or attendant 5 when seeking hospital care, medical services, or ex- 6 tended care services.’’. 7 SEC. 5. NOTIFICATION OF DENIAL OF REQUEST FOR CARE 8 UNDER VETERANS COMMUNITY CARE PRO- 9 GRAM. 10 Section 1703 of title 38, United States Code, is fur- 11 ther amended— 12 (1) by redesignating subsection (o) as sub- 13 section (p); and 14 (2) by inserting after subsection (n) the fol- 15 lowing new subsection (o): 16 ‘‘(o) NOTIFICATION OF DENIAL OF REQUEST FOR 17 CARE AND HOW TO APPEAL.—(1) If a request by a vet- 18 eran for care or services under this section is denied, the 19 Secretary shall notify the veteran in writing as soon as 20 possible, but not later than two business days, after the 21 denial is made— 22 ‘‘(A) of the reason for the denial; and 23 VerDate Sep 11 2014 04:37 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3520.IH H3520 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 3520 IH ‘‘(B) with instructions on how to appeal such 1 denial using the clinical appeals process of the Vet- 2 erans Health Administration. 3 ‘‘(2) If a denial under paragraph (1) is because the 4 Secretary determines that access standards under section 5 1703B(a) of this title are not met, notice under such para- 6 graph shall include an explanation of such determination. 7 ‘‘(3) Any notification under this subsection may be 8 provided electronically.’’. 9 SEC. 6. PROVISION OF INFORMATION REGARDING OPTION 10 FOR TELEHEALTH UNDER VETERANS COM- 11 MUNITY CARE PROGRAM. 12 Section 1703 of title 38, United States Code, is fur- 13 ther amended— 14 (1) by redesignating subsection (p) as sub- 15 section (q); and 16 (2) by inserting after subsection (o) the fol- 17 lowing new subsection (p): 18 ‘‘(p) PROVISION OF INFORMATION REGARDING OP- 19 TION FOR TELEHEALTH.—With regards to options for 20 care or services for a covered veteran under this section, 21 the Secretary shall ensure that the veteran is informed 22 that the veteran may elect to seek care or services via tele- 23 health, either through a medical facility of the Department 24 or under this section, if— 25 VerDate Sep 11 2014 04:37 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3520.IH H3520 kjohnson on DSK79L0C42PROD with BILLS 11 •HR 3520 IH ‘‘(1) a health care provider described in sub- 1 section (c) provides such care or services via tele- 2 health; and 3 ‘‘(2) the Secretary determines telehealth is ap- 4 propriate for the type of care or services the veteran 5 seeks; and’’. 6 SEC. 7. FINALITY OF DECISION BY VETERAN AND VET- 7 ERAN’S REFERRING PROVIDER. 8 (a) IN GENERAL.—Section 1703 of title 38, United 9 States Code, is further amended— 10 (1) by redesignating subsection (q) as sub- 11 section (r); and 12 (2) by inserting after subsection (p) the fol- 13 lowing new subsection (q): 14 ‘‘(q) FINALITY OF AGREEMENT BETWEEN COVERED 15 VETERAN AND REFERRING PROVIDER.—The Secretary 16 may not override an agreement under subsection (d)(1)(E) 17 unless the Secretary notifies the covered veteran and refer- 18 ring provider in writing that the Secretary may not pro- 19 vide the care or services described in such agreement.’’. 20 (b) CONFORMING AMENDMENT.—Subsection 21 (d)(1)(E) such section is amended by striking ‘‘referring 22 clinician’’ and inserting ‘‘referring provider’’. 23 VerDate Sep 11 2014 04:37 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3520.IH H3520 kjohnson on DSK79L0C42PROD with BILLS 12 •HR 3520 IH SEC. 8. OUTREACH REGARDING CARE AND SERVICES 1 UNDER VETERANS COMMUNITY CARE PRO- 2 GRAM. 3 (a) REQUIREMENT.—Section 1703 of title 38, United 4 States Code, is further amended— 5 (1) by redesignating subsection (r) as sub- 6 section (s); and 7 (2) by inserting after subsection (q) the fol- 8 lowing new subsection (r): 9 ‘‘(r) OUTREACH REGARDING AVAILABILITY OF CARE 10 AND SERVICES.—(1) The Secretary shall conduct out- 11 reach to inform veterans of the following: 12 ‘‘(A) The conditions for care or services under 13 subsections (d) and (e). 14 ‘‘(B) How to request such care or services. 15 ‘‘(C) How to appeal a denial of a request for 16 such care or services using the clinical appeals proc- 17 ess of the Veterans Health Administration. 18 ‘‘(2) Upon enrollment of a veteran in the system of 19 annual patient enrollment established and operated under 20 section 1705 of this title, and not less frequently than 21 every two years thereafter, the Secretary shall inform the 22 veteran of information described in paragraph (1). 23 ‘‘(3) The Secretary shall ensure that information de- 24 scribed in paragraph (1) is— 25 VerDate Sep 11 2014 04:37 Jun 06, 2023 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H3520.IH H3520 kjohnson on DSK79L0C42PROD with BILLS 13 •HR 3520 IH ‘‘(A) publicly displayed in each medical facility 1 of the Department; 2 ‘‘(B) prominently displayed on a website of the 3 Department; and 4 ‘‘(C) included in other outreach campaigns and 5 activities conducted by the Secretary.’’. 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