Senator Elizabeth Dole 21st Century Veterans Healthcare and

Senator Elizabeth Do th Congress

Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act

Source: Congress.gov · 42,064 words in original text

What This Bill Does

This law makes changes to programs that help veterans get health care, education, housing, and other support. It updates rules for community care (getting care outside VA hospitals), improves services for veterans' family caregivers, and changes how the VA handles dental care, educational benefits, and disability claims. ##

Who It Affects

- Veterans enrolled in VA health care programs - Family members and caregivers of veterans - Veterans receiving educational benefits - Native American veterans applying for home loans - Homeless veterans - Health care providers working with the VA - State homes caring for veterans - Educational institutions receiving VA education benefits ##

Key Provisions

- The VA must allow veterans and their doctors to make final decisions about whether community care (non-VA medical services) is needed, for a two-year test period starting 90 days after this law passes (Sec. 101) - The VA must tell veterans about community care options through mail, websites, and medical facilities at least every two years (Sec. 102) - The VA must increase the spending cap for non-nursing home care alternatives from 65 percent to 100 percent of what nursing home care would cost (Sec. 120) - The VA must create programs allowing veterans to direct their own in-home care services and to hire caregivers directly (Sec. 123) - Educational institutions approved for VA benefits must provide digital transcripts to veterans (Sec. 207) ##

What Changes

If this law passes: - Veterans will have more say in choosing community care providers instead of waiting for VA approval - Family members of veterans will have better access to mental health support through new grants to community organizations - Home-based care services expand as an alternative to nursing homes - The VA must regularly report to Congress on community care waivers (payment rate adjustments) by region - Quality standards for VA care must be updated every five years and compared to industry standards - Veterans can pay VA educational benefits directly to foreign colleges electronically - Dental care approval processes will be tested with VA dentists managing treatment plans - Veterans denied family caregiver program services must be offered other home-care options before discharge ##

Important Definitions

- **Community Care Program**: Services provided by health care providers outside the VA system to eligible veterans (Sec. 1703) - **Covered Veteran**: A veteran who qualifies for community care services (Sec. 1703(b)) - **Third Party Administrator**: A company that manages networks of health care providers and handles administrative work for community care (Sec. 1703) - **Family Caregiver**: A family member providing care to a veteran (Sec. 1720G) - **Resident Eligible Caregiver**: A caregiver who lives with the veteran they care for (Sec. 1720L) ##

Effective Date

Most provisions take effect upon enactment (when signed into law). Specific provisions have these timelines: - Eligibility determination pilot period: Two years beginning 90 days after enactment (Sec. 101) - Community care outreach report deadline: Two years after enactment (Sec. 102) - First payment waiver report: 180 days after enactment (Sec. 103) - Dental care pilot program: Ends two years after enactment (Sec. 106) - Veteran-Directed Care and Homemaker programs administration: Must be operational within two years (Sec. 123) - New caregiver protections: 180 days after enactment (Sec. 124)

PUBLIC LAW 118–210—JAN. 2, 2025 SENATOR ELIZABETH DOLE 21ST CENTURY VETERANS HEALTHCARE AND BENEFITS IMPROVEMENT ACT 138 STAT. 2706 PUBLIC LAW 118–210—JAN. 2, 2025 Public Law 118–210 118th Congress An Act To amend title 38, United States Code, to improve certain programs of the Depart- ment of Veterans Affairs for home and community based services for veterans, and for other purposes. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE; TABLE OF CONTENTS. (a) SHORT TITLE.—This Act may be cited as the ‘‘Senator Eliza- beth Dole 21st Century Veterans Healthcare and Benefits Improve- ment Act’’. (b) TABLE OF CONTENTS.—The table of contents for this Act is as follows: Sec. 1. Short title; table of contents. TITLE I—HEALTH CARE MATTERS Subtitle A—Veterans Community Care Program Matters Sec. 101. Implementation of provision of care under Veterans Community Care Pro- gram upon determination of eligibility by veteran and veteran’s refer- ring clinician. Sec. 102. Outreach regarding care and services under Veterans Community Care Program. Sec. 103. Annual review and report on waivers of certain payment rates under Vet- erans Community Care Program. Sec. 104. Modification of requirements for standards for quality of care from De- partment of Veterans Affairs. Sec. 105. Pilot program to improve administration of care under Veterans Commu- nity Care Program. Sec. 106. Pilot program on consolidating approval process of Department of Vet- erans Affairs for covered dental care. Sec. 107. Strategic plan on value-based health care system for Veterans Health Ad- ministration; pilot program. Sec. 108. Plan on adoption of certain health information standards for Department of Veterans Affairs and certain health care providers. Sec. 109. Report on use of value-based reimbursement models under Veterans Com- munity Care Program. Sec. 110. Inspector General assessment of implementation of Veterans Community Care Program. Sec. 111. Comptroller General report on dentistry under Veterans Community Care Program. Subtitle B—Matters Relating to Nursing Home and Other Long Term Care and Family Caregivers Sec. 120. Increase of expenditure cap for noninstitutional care alternatives to nurs- ing home care. Sec. 121. Coordination with Program of All-Inclusive Care for the Elderly. Sec. 122. Authority for Secretary of Veterans Affairs to award grants or contracts to entities to improve provision of mental health support to family care- givers of veterans. Sec. 123. Home- and community-based services: programs. Sec. 124. Coordination with assistance and support services for caregivers. 38 USC 101 note. Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act. Jan. 2, 2025 [S. 141] 138 STAT. 2707 PUBLIC LAW 118–210—JAN. 2, 2025 Sec. 125. Improvements to program of comprehensive assistance for family care- givers. Sec. 126. Improvements relating to Homemaker and Home Health Aide program. Sec. 127. Pilot program to furnish assisted living services to certain veterans. Sec. 128. Provision of medicine, equipment, and supplies available to Department of Veterans Affairs to State homes. Sec. 129. Recognition of organizations and individuals to assist veterans, family members, and caregivers navigating programs and services of Veterans Health Administration. Sec. 130. Reviews and other improvements relating to home- and community-based services. Sec. 131. GAO report on mental health support for caregivers. Sec. 132. Development of centralized website for program information. Sec. 133. Definitions. Subtitle C—Medical Treatment and Other Matters Sec. 140. Quarterly report on referrals for non-Department of Veterans Affairs health care. Sec. 141. Elimination of certain requirements for certain Department of Veterans Affairs Assistant Under Secretaries. Sec. 142. Modification of pay limitation for physicians, podiatrists, optometrists, and dentists of Department of Veterans Affairs. Sec. 143. Reimbursement of ambulance cost for care for certain rural veterans. Sec. 144. Pilot program to furnish dental care from the Department of Veterans Af- fairs to certain veterans diagnosed with ischemic heart disease. Sec. 145. Documentation of preferences of veterans for scheduling of appointments for health care under laws administered by Secretary of Veterans Af- fairs. Sec. 146. Staffing model and performance metrics for certain employees of the De- partment of Veterans Affairs. Sec. 147. Online health education portal for veterans enrolled in patient enrollment system of Department of Veterans Affairs. Sec. 148. Limitation on detail of directors of medical centers of Department of Vet- erans Affairs to different positions. Sec. 149. National Veteran Suicide Prevention Annual Report. Sec. 150. Report on physical infrastructure required by medical facilities of Depart- ment of Veterans Affairs to provide dental care services. Sec. 151. Comptroller General report on certain oral health care programs under laws administered by Secretary of Veterans Affairs. Sec. 152. Review of workflows associated with processing referrals between facili- ties of the Veterans Health Administration. Sec. 153. Plan for timely scheduling of appointments at medical facilities of Depart- ment of Veterans Affairs. Sec. 154. Authorization of appropriations to support initiatives for mobile mammog- raphy services for veterans. TITLE II—ECONOMIC OPPORTUNITY MATTERS Subtitle A—Educational Assistance Sec. 201. Temporary expansion of eligibility for Marine Gunnery Sergeant John David Fry Scholarship. Sec. 202. Removal of expiration on entitlement to Marine Gunnery Sergeant John David Fry Scholarship for surviving spouses. Sec. 203. Sole liability for transferred educational assistance by an individual who fails to complete a service agreement. Sec. 204. Notice to educational institutions of risk-based surveys. Sec. 205. Relationship of participation by an educational institution in certain Fed- eral student financial aid programs to approval of such institution for purposes of Department of Veterans Affairs educational assistance pro- grams. Sec. 206. Expansion of Department of Veterans Affairs oversight of certain edu- cational institutions. Sec. 207. Requirement that educational institutions approved for purposes of De- partment of Veterans Affairs educational assistance programs provide digital official transcripts. Sec. 208. Payment of full monthly housing stipend for veterans enrolled in final se- mester using educational assistance under Post-9/11 Educational Assist- ance Program. Sec. 209. Modification of rules for approval of commercial driver education pro- grams for purposes of educational assistance programs of the Depart- ment of Veterans Affairs. 138 STAT. 2708 PUBLIC LAW 118–210—JAN. 2, 2025 Sec. 210. Provision of certificates of eligibility and award letters using electronic means. Sec. 211. Retroactive effective date of law regarding charge to entitlement to edu- cational assistance for individuals who do not transfer credits from cer- tain closed or disapproved programs of education. Sec. 212. Department of Veterans Affairs high technology program. Sec. 213. Notice of changes to Department of Veterans Affairs policies and guidance affecting the educational assistance programs of the Department. Sec. 214. Payment of VA educational assistance via electronic fund transfer to a foreign institution of higher education. Sec. 215. Improving transparency and accountability of educational institutions for purposes of veterans educational assistance. Subtitle B—Employment and Training Sec. 221. Improvements to reemployment rights of members of the Armed Forces. Sec. 222. Review of investigations manual of Veterans’ Employment and Training Service. Sec. 223. Warrior Training Advancement Course. Subtitle C—Home Loans Sec. 231. Improvements to program for direct housing loans made to Native Amer- ican veterans by the Secretary of Veterans Affairs. Sec. 232. Native community development financial institution relending program. TITLE III—DISABILITY AND MEMORIAL AFFAIRS MATTERS Sec. 301. Burial allowance for certain veterans who die at home while in receipt of hospice care furnished by Department of Veterans Affairs. Sec. 302. Authority for Secretary of Veterans Affairs to award grants to States and Indian Tribes to improve outreach to veterans. Sec. 303. Definition of surviving spouse. Sec. 304. Ensuring only licensed health care professionals perform medical dis- ability examinations under certain Department of Veterans Affairs pilot program. Sec. 305. Provision of information regarding an agent or attorney to a licensed health care professional who performs a medical disability examination under certain Department of Veterans Affairs pilot program. Sec. 306. Modernization of Department of Veterans Affairs disability benefit ques- tionnaires. Sec. 307. Department of Veterans Affairs automatic processing of certain claims for temporary disability ratings. TITLE IV—HOMELESSNESS MATTERS Sec. 401. Short title. Sec. 402. Per diem payments provided by the Secretary of Veterans Affairs for serv- ices furnished to homeless veterans. Sec. 403. Authorization for Secretary of Veterans Affairs to use certain funds for improved flexibility in assistance to homeless veterans. Sec. 404. Access to Department of Veterans Affairs telehealth services. TITLE V—OVERSIGHT AND INVESTIGATIONS MATTERS Sec. 501. Department of Veterans Affairs employee training regarding Office of In- spector General. Sec. 502. Annual review of security at covered facilities of the Department of Vet- erans Affairs. Sec. 503. Modification of certain housing loan fees. TITLE I—HEALTH CARE MATTERS Subtitle A—Veterans Community Care Program Matters SEC. 101. IMPLEMENTATION OF PROVISION OF CARE UNDER VET- ERANS COMMUNITY CARE PROGRAM UPON DETERMINA- TION OF ELIGIBILITY BY VETERAN AND VETERAN’S REFER- RING CLINICIAN. (a) IN GENERAL.—During the period specified in subsection (c), the Secretary of Veterans Affairs shall implement section 38 USC 1703 note. 138 STAT. 2709 PUBLIC LAW 118–210—JAN. 2, 2025 1703(d)(1)(E) of title 38, United States Code, in compliance with the implementing regulations for such section under section 17.4010(a)(5) of title 38, Code of Federal Regulations, such that the determination of eligibility for care is final and shall be made by the veteran and the veteran’s referring clinician. (b) CORRECTION OF ERRORS.—A covered veteran and the refer- ring clinician of such veteran may correct any errors made with respect to a determination described in subsection (a). (c) PERIOD SPECIFIED.—The period specified in this subsection is the two-year period beginning on the date that is 90 days after the date of the enactment of this Act. (d) REPORT.—Not later than one year and not later than two years after the commencement of the period specified by subsection (c), the Secretary of Veterans Affairs shall submit to Congress a report on the care provided under section 1703(d)(1)(E) of title 38, United States Code, during the one-year period preceding the date of the report, including— (1) the number of instances of care provided; (2) the type of care provided; and (3) the cost of such care. (e) RULE OF CONSTRUCTION.—Nothing in this section shall be construed to limit the Secretary’s authority to prescribe, amend, or rescind regulations under section 1703 of title 38, United States Code. (f) COVERED VETERAN DEFINED.—In this section, the term ‘‘cov- ered veteran’’ has the meaning given that term in section 1703(b) of title 38, United States Code. SEC. 102. OUTREACH REGARDING CARE AND SERVICES UNDER VET- ERANS COMMUNITY CARE PROGRAM. (a) REQUIREMENT.—Section 1703 of title 38, United States Code, is amended— (1) by redesignating subsection (o) as subsection (p); and (2) by inserting after subsection (n) the following new sub- section (o): ‘‘(o) OUTREACH REGARDING AVAILABILITY OF CARE AND SERV- ICES.—(1) The Secretary shall conduct outreach to inform veterans of the following: ‘‘(A) The conditions for care or services under subsections (d) and (e). ‘‘(B) How to request such care or services. ‘‘(C) How to appeal a denial of a request for such care or services using the clinical appeals process of the Veterans Health Administration. ‘‘(2) Upon enrollment of a veteran in the system of annual patient enrollment established and operated under section 1705 of this title, and not less frequently than every two years thereafter, the Secretary shall inform the veteran of information described in paragraph (1). ‘‘(3) The Secretary shall ensure that information described in paragraph (1) is— ‘‘(A) publicly displayed in each medical facility of the Department; ‘‘(B) prominently displayed on a website of the Department; and ‘‘(C) included in other outreach campaigns and activities conducted by the Secretary.’’. Web posting. Public information. Time period. Notification. Time period. Effective date. 138 STAT. 2710 PUBLIC LAW 118–210—JAN. 2, 2025 (b) SOLID START PROGRAM.—Section 6320(a)(2)(A) of title 38, United States Code, is amended by inserting ‘‘, including how to enroll in the system of annual patient enrollment established and operated under section 1705 of this title and the ability to seek care and services under sections 1703 and 1710 of this title’’ before the semicolon. (c) COMPTROLLER GENERAL REPORT ON OUTREACH.—Not later than two years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the efforts of the Secretary of Veterans Affairs to ensure that veterans are informed of the conditions for eligibility for care and services under section 1703 of title 38, United States Code, including such efforts to conduct outreach pursuant to sub- section (o) of such section (as added by subsection (a)). SEC. 103. ANNUAL REVIEW AND REPORT ON WAIVERS OF CERTAIN PAYMENT RATES UNDER VETERANS COMMUNITY CARE PROGRAM. (a) IN GENERAL.—Section 1703 of title 38, United States Code, is further amended— (1) by redesignating subsection (p) as subsection (q); and (2) by inserting after subsection (o) the following new sub- section (p): ‘‘(p) ANNUAL REVIEW AND REPORT ON WAIVERS OF PAYMENT RATES.—(1) On an annual basis, the Secretary shall— ‘‘(A) conduct a review of waivers of payment rates under subsection (i) for Third Party Administrators to identify whether such waivers help to alleviate community-specific chal- lenges, including scarcity of medical services associated with access to health care; and ‘‘(B) submit to Congress a report on the results of such review. ‘‘(2) Each report under paragraph (1)(B) shall include, with respect to t [Text truncated for display. Full text available on Congress.gov.]

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