[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 141 Enrolled Bill (ENR)]
S.141
One Hundred Eighteenth Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Wednesday,
the third day of January, two thousand and twenty four
An Act
To amend title 38, United States Code, to improve certain programs of
the Department 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,

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(a) Short Title.--This Act may be cited as the ``Senator Elizabeth
Dole 21st Century Veterans Healthcare and Benefits Improvement Act''.
(b) Table of Contents.--The table of contents for this Act is as
follows:

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Subtitle A--Veterans Community Care Program Matters

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Care Program upon determination of eligibility by veteran and
veteran's referring clinician.

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TITLE I

-HEALTH CARE MATTERS

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of Veterans Affairs for covered dental care.

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Department of Veterans Affairs and certain health care
providers.

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Community Care Program.
Subtitle B--Matters Relating to Nursing Home and Other Long Term Care
and Family Caregivers

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contracts to entities to improve provision of mental health
support to family caregivers of veterans.

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Department of Veterans Affairs to State homes.

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veterans, family members, and caregivers navigating programs
and services of Veterans Health Administration.

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Subtitle C--Medical Treatment and Other Matters

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Veterans Affairs Assistant Under Secretaries.

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optometrists, and dentists of Department of Veterans Affairs.

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Veterans Affairs to certain veterans diagnosed with ischemic
heart disease.

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appointments for health care under laws administered by
Secretary of Veterans Affairs.

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patient enrollment system of Department of Veterans Affairs.

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Department of Veterans Affairs to different positions.

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facilities of Department of Veterans Affairs to provide dental
care services.

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programs under laws administered by Secretary of Veterans
Affairs.

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between facilities of the Veterans Health Administration.

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facilities of Department of Veterans Affairs.

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mobile mammography services for veterans.
Subtitle A--Educational Assistance

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TITLE II

-ECONOMIC OPPORTUNITY MATTERS

Sergeant John David Fry Scholarship for surviving spouses.

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individual who fails to complete a service agreement.

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certain Federal student financial aid programs to approval of
such institution for purposes of Department of Veterans
Affairs educational assistance programs.

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purposes of Department of Veterans Affairs educational
assistance programs provide digital official transcripts.

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in final semester using educational assistance under Post-9/11
Educational Assistance Program.

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education programs for purposes of educational assistance
programs of the Department of Veterans Affairs.

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entitlement to educational assistance for individuals who do
not transfer credits from certain closed or disapproved
programs of education.

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and guidance affecting the educational assistance programs of
the Department.

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transfer to a foreign institution of higher education.

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institutions for purposes of veterans educational assistance.
Subtitle B--Employment and Training

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Native American veterans by the Secretary of Veterans Affairs.

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receipt of hospice care furnished by Department of Veterans
Affairs.

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TITLE III

-DISABILITY AND MEMORIAL AFFAIRS MATTERS

States and Indian Tribes to improve outreach to veterans.

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medical disability examinations under certain Department of
Veterans Affairs pilot program.

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licensed health care professional who performs a medical
disability examination under certain Department of Veterans
Affairs pilot program.

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Affairs for services furnished to homeless veterans.

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TITLE IV

-HOMELESSNESS MATTERS

funds for improved flexibility in assistance to homeless
veterans.

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TITLE V

-OVERSIGHT AND INVESTIGATIONS MATTERS

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COMMUNITY CARE PROGRAM UPON DETERMINATION OF ELIGIBILITY BY
VETERAN AND VETERAN'S REFERRING CLINICIAN.
(a) In General.--During the period specified in subsection (c), the
Secretary of Veterans Affairs shall implement section 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 referring
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 ``covered
veteran'' has the meaning given that term in section 1703(b) of title
38, United States Code.

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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
subsection (o):
``(o) Outreach Regarding Availability of Care and Services.--(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.''.
(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 subsection (o) of such section
(as added by subsection (a)).

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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
subsection (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 challenges,
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 the period covered by the report--
``(A) a statement, disaggregated by region, of the total number
of waivers described in subparagraph (A) of such paragraph
requested by Third Party Administrators;
``(B) a statement of the total number of such waivers that
were--
``(i) granted by the Secretary;
``(ii) denied by the Secretary; or
``(iii) withdrawn by a Third Party Administrator;
``(C) a description of the process for the review required
under paragraph (1);
``(D) a statement, disaggregated by region, of the average time
to process such waivers;
``(E) an assessment, disaggregated by region, of the extent to
which such waivers that were granted by the Secretary improved
access to health care for covered veterans; and
``(F) a description of trends, if any, identified by the
Secretary with respect to such waivers.
``(3) In this subsection, the term `Third Party Administrator' has
the meaning given such term in section 1703B of this title.''.
(b) Deadline.--The Secretary shall submit the first report required
under subsection (p) of section 1703 of such title (as added by
subsection (a)) not later than 180 days after the date of the enactment
of this Act.

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CARE FROM DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Section 1703C of title 38, United States Code, is
amended--
(1) in subsection (a)--
(A) in paragraph (2)--
(i) by striking ``In establishing'' and inserting ``(A)
In establishing''; and
(ii) by adding at the end the following new
subparagraph:
``(B) The Secretary shall ensure that the standards for quality
established under paragraph (1) are comparable to industry
standards to ensure there is adequate data transference between
care furnished by the Department and care furnished by a non-
Department provider.'';
(B) in paragraph (3)(B), by adding at the end the following
new clause:
``(v) Outcomes relating to patient quality of life.'';
(C) in paragraph (4)--
(i) by striking ``and the Centers for Medicare &
Medicaid Services'' and inserting ``the Centers for
Medicare & Medicaid Services, and the Indian Health
Service''; and
(ii) by striking ``and other nongovernmental entities''
and inserting ``and other non-governmental entities
including Third Party Administrators''; and
(D) by striking paragraph (5) and inserting the following
new paragraphs:
``(5) When collecting, considering, and applying data related to
patient care for purposes of establishing standards for quality under
paragraph (1), the Secretary shall ensure no metric is being over or
under analyzed.
``(6) In establishing standards for quality under paragraph (1),
the Secretary shall--
``(A) utilize the most up-to-date practices for extracting and
analyzing relevant data;
``(B) utilize all relevant data available to the Secretary;
``(C) ensure the most efficient use of time and resources
related to the use of data scientists employed by the Department;
and
``(D) collaborate, as appropriate, with entities specified in
paragraph (4).
``(7)(A) Not less frequently than once every five years, the
Secretary shall update the standards for quality established under
paragraph (1) pursuant to the requirements for the establishment of
such standards under this subsection.
``(B) Not later than 30 days after any date on which the Secretary
updates, pursuant to subparagraph (A), the standards for quality under
paragraph (1), the Secretary shall submit to the appropriate committees
of Congress a report on such updated standards for quality.''; and
(2) in subsection (b)--
(A) in paragraph (1)--
(i) by striking ``Not later than 1 year after the date
on which the Secretary establishes standards for quality
under subsection (a)'' and inserting ``Not less frequently
than once every three years''; and
(ii) by inserting ``pursuant to standards for quality
under subsection (a)'' after ``medical facilities of the
Department''; and
(B) in paragraph (2), by inserting ``or updates'' after
``establishes''.
(b) Deadline for Update.--The Secretary, pursuant to paragraph (7)
of section 1703C(a) of title 38, United States Code (as added by
subsection (a)), shall make the first update to the standards for
quality established under paragraph (1) of such section not later than
the date that is five years after the date on which the Secretary
submits the report under paragraph (2) of subsection (d).
(c) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit
to the appropriate committees of Congress a report on how the
Secretary--
(1) has consulted with entities specified in paragraph (4) of
section 1703C(a) of title 38, United States Code, before the date
of the enactment of this Act in establishing standards for quality
under such section;
(2) has continued to consult with those entities on and after
such date of enactment; and
(3) intends to leverage data sciences to improve standards for
quality care furnished by the Department of Veterans Affairs.
(d) Updates to Quality Care Metrics.--
(1) Initial report.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs shall
submit to the appropriate committees of Congress a report on how
the Secretary plans to implement the amendments made by subsections
(a).
(2) Deadline; summary report.--Not later than two years after
the date of the enactment of this Act, the Secretary shall--
(A) implement the amendments made by subsection (a),
including by updating the standards for quality established
under section 1703C of title 38, United States Code; and
(B) submit to the appropriate committees of Congress a
report detailing the standards for quality updated pursuant to
such amendments.
(e) Audit of Quality Care Metrics.--
(1) In general.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
enter into one or more contracts with a non-Department entity
described in paragraph (2) to conduct an audit on the quality of
care from the Department of Veterans Affairs, including through
non-Department health care providers pursuant to section 1703 of
title 38 United States Code.
(2) Non-department entity described.--A non-Department entity
described in this paragraph is an entity that--
(A) specializes in analyzing large-scale organizational
data collection and analysis efforts, especially with respect
to the health care sector; and
(B) has experience and proven outcomes in optimizing the
accuracy and comprehensiveness of data collection and analysis
related to the quality of health care services.
(3) Elements.--The audit required under paragraph (1) shall
include the following:
(A) An assessment of the methodology used by the Department
to collect and assess data on the quality of care furnished by
the Department, including any vulnerabilities in such
methodology.
(B) An assessment of the accuracy and reliability of the
data sources used by the Department to compile data on the
quality of care furnished by the Department.
(C) The extent to which the standards the Department uses
to assess the quality of care furnished by the Department are--
(i) comparable with industry standards;
(ii) easily accessible to, and understood by--
(I) veterans;
(II) employees of the Department; and
(III) other individuals, as the private sector
entity considers appropriate.
(D) Any recommendations of such private sector entity with
respect to improvements that the Secretary could administer to
more accurately capture the quality of care furnished by the
Department.
(4) Reports on audit.--
(A) Report on findings and recommendations.--Not later than
60 days after any date on which a private sector entity
described in paragraph (2) completes an audit under paragraph
(1), such private sector entity shall submit to the Secretary,
the Committee on Veterans' Affairs of the Senate, and the
Committee on Veterans' Affairs of the House of Representatives
a report that includes--
(i) the findings of such audit; and
(ii) recommendations of such private sector entity with
respect to such audit.
(B) Report on planned improvements.--Not later than 60 days
after any date on which the Secretary receives a report under
subparagraph (A), the Secretary shall submit to the Committee
on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report on
how the Secretary plans to improve the standards for quality of
care of the Department.
(f) Appropriate Committees of Congress Defined.--In this section,
the term ``appropriate committees of Congress'' has the meaning given
such term in section 1703C of title 38, United States Code.

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VETERANS COMMUNITY CARE PROGRAM.
(a) Establishment.--Pursuant to section 1703E of title 38, United
States Code, the Secretary of Veterans Affairs, acting through the
Center for Innovation for Care and Payment established under such
section, shall carry out a pilot program to seek to develop and
implement a plan--
(1) to provide monetary and non-monetary incentives to a
covered health care provider--
(A) to allow the Secretary to see the scheduling system of
the provider, to assess the availability of, and to assist in
scheduling appointments for, veterans under the Veterans
Community Care Program under section 1703 of such title,
including through synchronous, asynchronous, and asynchronous
assisted digital scheduling;
(B) to complete continuing professional educational
training available through the VHA TRAIN program (or any
successor program or initiative) regarding veteran cultural
competency, the opioid safety initiative (or any successor
program or initiative), and other subjects determined
appropriate by the Secretary;
(C) to improve methods of accounting for non-Department
training that is equivalent or substantially similar to the
continuing professional educational training described in
subparagraph (B);
(D) to improve the rate of the timely return to the
Secretary of medical record documentation for care or services
provided under the Veterans Community Care Program;
(E) to improve the timeliness and quality of the delivery
of care and services to veterans under such program; and
(F) to achieve other objectives determined appropriate by
the Secretary; and
(2) to decrease the rate of no-show appointments under such
program.
(b) Report.--Not later than one year after the date of the
establishment of the pilot program under this section, and annually
thereafter during the term of the pilot program, the Secretary of
Veterans Affairs shall submit to the Committees on Veterans' Affairs of
the House of Representatives and the Senate a report on the pilot
program that includes, with respect to the period covered by the
report--
(1) an assessment of the extent to which--
(A) the system of the Department of Veterans Affairs for
scheduling appointments for veterans under the Veterans
Community Care Program has improved;
(B) the rate of timely return to the Secretary of medical
record documentation described in subparagraph (D) of
subsection (a)(1) has improved;
(C) the timeliness and quality of the delivery of care and
services described in subparagraph (E) of such subsection has
improved; and
(D) the frequency of no-show appointments described in
paragraph (2) of such subsection decreased;
(2) a list of the continuing professional educational training
courses under subparagraph (B) of such subsection available to
covered health care providers;
(3) the rate of participation in such continuing professional
education training courses; and
(4) any other matter the Secretary determines appropriate.
(c) Definitions.--In this section:
(1) The term ``covered health care provider'' means a health
care provider--
(A) described in subsection (c) of section 1703 of title
38, United States Code, that furnishes care or services under
the Veterans Community Care Program pursuant to a contract or
agreement with a Third Party Administrator; or
(B) that otherwise furnishes care or services outside of
Department facilities pursuant to a contract or agreement with
the Secretary of Veterans Affairs.
(2) The term ``opioid safety initiative'' means the programs,
processes, and guidelines of the Veterans Health Administration of
the Department of Veterans Affairs relating to the management of
opioid therapy and chronic pain.
(3) The term ``Third Party Administrator'' means an entity that
manages a network of health care providers and performs
administrative services related to such network under section 1703
of such title.
(4) The term ``VHA TRAIN program'' means the free program of
the Veterans Health Administration that offers veteran-specific
continuing medical education courses.

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DEPARTMENT OF VETERANS AFFAIRS FOR COVERED DENTAL CARE.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs, acting
through the Center for Innovation for Care and Payment established
under section 1703E of title 38, United States Code, shall carry out a
pilot program under which the Secretary shall hire--
(1) general dentists at medical facilities of the Department of
Veterans Affairs to manage approval by the Department of treatment
plans requested by dental providers in providing covered dental
care; and
(2) dental specialists at Veterans Integrated Service Networks
of the Department to manage approval by the Department of treatment
plans for specialty dental care requested by dental providers in
providing covered dental care.
(b) Locations.--The Secretary shall carry out the pilot program in
not fewer than two Veterans Integrated Service Networks of the
Department.
(c) Reports.--
(1) Initial report.--Not later than one year after the date of
the commencement of such pilot program, the Secretary shall submit
to the Committees on Veterans' Affairs of the Senate and the House
of Representatives a report on the pilot program, that includes--
(A) an identification of the Veterans Integrated Service
Networks participating in such pilot program;
(B) a description of the implementation of such pilot
program;
(C) an identification of any barriers or challenges to
implementing such pilot program;
(D) an assessment of the efficacy of hiring general
dentists and dental specialists pursuant to such pilot program;
(E) aggregated feedback with respect to such pilot program
from dentists of the Department in Veterans Integrated Service
Networks participating in such pilot program; and
(F) aggregated feedback from dental providers providing
covered dental care within such Veterans Integrated Service
Networks regarding any changes in the timeliness of treatment
plan approvals by the Department.
(2) Final report.--Not later than 90 days before the date of
the completion of such pilot program, the Secretary shall submit to
the Committees on Veterans' Affairs of the Senate and the House of
Representatives a report on the pilot program that--
(A) includes, with respect to the period covered by the
report, each element of the report required under paragraph (1)
described in subparagraphs (A) through (F) of such paragraph;
(B) includes recommendations of the Secretary on whether
the pilot program should be--
(i) extended;
(ii) expanded; or
(iii) adopted throughout the Department; and
(C) indicates whether the Secretary requests action by
Congress to make the pilot program permanent.
(d) Sunset.--The authority to carry out the pilot program under
this section shall terminate on the date that is two years after the
date of the enactment of this Act.
(e) Covered Dental Care Defined.--In this section, the term
``covered dental care'' means dental care provided--
(1) under section 1703 of title 38, United States Code; or
(2) pursuant to a Veterans Care Agreement under section 1703A
of such title.

93a9a692fb43ecfe2017b5a5ff437a2757f19acca405544c7df5f533902c241a

VETERANS HEALTH ADMINISTRATION; PILOT PROGRAM.
(a) Establishment of Working Group.--
(1) In general.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall--
(A) establish a working group on value-based care; and
(B) submit to the Committees on Veterans' Affairs of the
House of Representatives and the Senate the strategic plan
developed by the working group pursuant to subsection (b).
(2) Membership.--
(A) Required members.--The working group shall include, at
a minimum, the following members:
(i) The Under Secretary for Health of the Department of
Veterans Affairs.
(ii) The Director of the Office of Mental Health and
Suicide Prevention of the Department of Veterans Affairs
(or any successor office).
(iii) The Director of the Office of Integrated Veteran
Care of the Department (or any successor office).
(iv) The Director of the Office of Rural Health of the
Department (or any successor office).
(v) The Director of the Office of Connected Care of the
Department (or any successor office).
(vi) The Assistant Secretary for the Office of
Information Technology (or any successor office).
(vii) The Chief Officer of the Office of Healthcare
Innovation and Learning of the Office of Discovery,
Education, and Affiliate Networks of the Veterans Health
Administration (or any successor office).
(viii) An individual designated by the Secretary from
the Center for Innovation for Care and Payment of the
Department under section 1703E of title 38, United States
Code.
(ix) An individual designated by the Administrator of
the Centers for Medicare & Medicaid Services from the
Center for Medicare and Medicaid Innovation.
(x) An individual designated by the Secretary of Health
and Human Services from the Federal Office of Rural Health
Policy of the Health Resources and Services Administration.
(xi) The Chief of Human Capital Management for the
Veterans Health Administration.
(xii) An individual designated by the Secretary of
Defense that is a representative of the Defense Health
Agency.
(xiii) An individual selected by the Secretary of
Veterans Affairs from the special medical advisory group
established under section 7312 of title 38, United States
Code.
(B) Optional members.--The Secretary of Veterans Affairs
may appoint any of the following individuals as members of the
working group:
(i) An individual representing the Health and Medicine
Division of the National Academies of Sciences,
Engineering, and Medicine.
(ii) Three individuals representing a private health
care system that has made the transition to value-based
care.
(iii) Three individuals representing an organization
recognized by the Secretary of Veterans Affairs under
section 5902 of title 38, United States Code.
(3) Public availability.--All meetings deliberations, and
products of the working group shall be made publicly available
throughout the duration of the working group, including to
individuals representing organizations recognized by the Secretary
of Veterans Affairs under section 5902 of title 38, United States
Code.
(4) Exemption from faca.--Chapter 10 of title 5, United States
Code, shall not apply to the working group established under
paragraph (1).
(b) Development of Strategic Plan.--The working group shall develop
a strategic plan to implement value-based care into the Veterans Health
Administration that includes the following:
(1) An identification of the state of the Veterans Health
Administration as of the date of the enactment of this Act,
including an assessment of the current model of health care
delivery used by the Veterans Health Administration in medical
facilities of the Department of Veterans Affairs.
(2) An assessment of the capacity needs of the Veterans Health
Administration during the five-year period beginning on the date of
the enactment of this Act.
(3) An analysis of the leadership of the Veterans Health
Administration, including an assessment of leadership acumen and
ability to implement a clear, shared vision and effective change
management and care coordination.
(4) An identification of goals for the future of the Veterans
Health Administration.
(5) An identification and classification of the current
capabilities, capacity, and gaps in access and quality of the
health care system of the Department of Veterans Affairs.
(6) An analysis of value-based care models, including--
(A) a selection of potential models that would best work
for the Veterans Health Administration;
(B) the capacity and capabilities of each such model; and
(C) a thorough justification of the selection of each
selected model, including a summary of the ability of such
model to improve the metrics described under paragraph (9).
(7) A definition of what quality means with respect to--
(A) access to health care under the laws administered by
the Secretary of Veterans Affairs; and
(B) delivery of such health care.
(8) A definition of what value means with respect to care
furnished by the Veterans Health Administration,
(9) A system for measuring value within the Veterans Health
Administration that includes metrics for--
(A) outcomes;
(B) safety;
(C) service;
(D) access;
(E) productivity;
(F) capacity; and
(G) total cost of patient care.
(10) With respect to the system described in subparagraph (H),
an analysis of variable value with respect to patient outcomes
across different health care types and specialties.
(11) An assessment of--
(A) previous or ongoing assessments of the current
information technology infrastructure of the Veterans Health
Administration, including--
(i) such assessments conducted pursuant to the
Electronic Health Record Modernization program of the
Department of Veterans Affairs; and
(ii) any other ongoing information technology
modernization programs of such Department and any
unimplemented relevant recommendations from such
assessments;
(B) the information technology infrastructure of the
Veterans Health Administration in effect as of the date of the
enactment of this Act;
(C) the value-driven framework of the Department, in effect
as of the date of the enactment of this Act, for evaluating
health care innovations, and how improvements in such framework
could be used to encourage innovation; and
(D) workforce challenges and needs of the Veterans Health
Administration based on--
(i) reviews of workforce assessment data available as
of the date of the enactment of this Act; and
(ii) the findings of--
(I) the report required by section 301(d) of the
Veterans Access, Choice, and Accountability Act of 2014
(Public Law 113-146);
(II) the reports required by section 505 of the
John S. McCain III, Daniel K. Akaka and Samuel R.
Johnson VA Maintaining Internal Systems and
Strengthening Integrated Outside Networks Act of 2018
(Public Law 115-182);
(III) the report required by section 301 of the VA
Choice and Quality Employment Act of 2017 (Public Law
115-46); and
(IV) any comprehensive health care inspection
conducted by the Inspector General of the Department of
Veterans Affairs as of the date of the enactment of
this Act.
(12) Any recommendations of the working group with respect to
improving the information technology infrastructure described in
clause (i) of subparagraph (J).
(13) An analysis of how the value-driven framework described in
clause (iii) of such subparagraph could be used to improve the
model of care delivery by the Department.
(14) A description of how a value-based care system would apply
to primary care, inpatient and outpatient mental health care, and
inpatient and outpatient substance use treatment, spinal cord
injury disorder care, and polytrauma care furnished by the Veterans
Health Administration.
(15) With respect to legislative or administrative action
necessary to incorporate value-based care models into the Veterans
Health Administration, a description of the estimated timelines,
effect on workforce, and costs.
(c) Pilot Program.--
(1) In general.--Not later than 180 days after the submission
of the strategic plan pursuant to subsection (b), the Secretary of
Veterans Affairs, acting through the Center for Innovation for Care
and Payment established under section 1703E of title 38, United
States Code, shall commence a three-year pilot program under which
the Secretary shall implement the elements of such strategic plan
relating to the delivery, by the Veterans Health Administration, of
primary care, inpatient and outpatient mental health treatment,
inpatient and outpatient substance abuse treatment, spinal cord
injury disorder care, and polytrauma care.
(2) Locations.--The Secretary shall carry out such pilot
program in four Veterans Integrated Service Networks that are
geographically dispersed and shall include the following:
(A) A Veterans Integrated Service Network that
predominately serves veterans in rural and highly rural areas.
(B) A Veterans Integrated Service Network that
predominately serves veterans in urban areas.
(C) A Veterans Integrated Service Network that has a high
rate of suicide among veterans.
(D) A Veterans Integrated Service Network that has a high
rate of substance use disorder among veterans.
(E) A Veterans Integrated Service Network that has access
or productivity challenges.
(3) Reports to congress.--
(A) Annual report.--Not later than one year after the
commencement of the pilot program, and annually thereafter
during the duration of the pilot program, the Secretary shall
submit to Congress a report on the pilot program.
(B) Final report.--Not later than 90 days before the
conclusion of the pilot program, the Secretary shall submit to
Congress a final report on the pilot program that includes--
(i) lessons learned during the administration of such
pilot program; and
(ii) specific health outcomes in veteran patient care
compared to the Veterans Health Administration system of
care in effect as of the date of the enactment of this Act.

c6d084b922aeaeb91a2c3e6b78b020d1e434dbac0a9005d3c473da47cd6c5a05

FOR DEPARTMENT OF VETERANS AFFAIRS AND CERTAIN HEALTH CARE
PROVIDERS.
(a) Plan for Certain Health Information Standards.--
(1) In general.--The Secretary of Veterans Affairs, in
consultation with the Secretary of Health and Human Services, the
Administrator of the Centers for Medicare & Medicaid Services, and
the National Coordinator for Health Information Technology of the
Department of Health and Human Services, shall create and implement
a plan to adopt, as rapidly and to the most comprehensive extent
feasible, national health information interoperability standards
for the Department of Veterans Affairs and community care providers
with respect to--
(A) coordination of--
(i) care; and
(ii) benefits;
(B) patient identity matching;
(C) measurement and reporting of quality;
(D) population health; and
(E) public health.
(2) Consideration.--In developing the plan under paragraph (1),
the Secretary of Veterans Affairs shall consider challenges faced
by--
(A) small community care providers; and
(B) community care providers located in rural areas.
(b) Plan on Electronic Health Record Exchange.--
(1) In general.--Not later than one year after the date of
enactment of this Act, the Secretary shall submit to the Committees
on Veterans' Affairs of the Senate and the House of Representatives
a plan to provide, at no cost, to community care providers of the
Department, through Third Party Administrators, a capability to
facilitate the electronic direct exchange, between such providers
and the Department, of--
(A) the health records of veterans; and
(B) documents relating to health care of veterans, clinical
notes, and any other information the Secretary determines
necessary.
(2) Prioritization.--In developing the plan required under
paragraph (1), the Secretary shall prioritize providing the
capability described in such paragraph to community care providers
that--
(A) provide care under the laws administered by the
Secretary to--
(i) a lower volume of veterans; and
(ii) veterans who are located in rural areas; and
(B) are unable or unwilling to exchange the records and
documents described in subparagraphs (A) and (B) of such
paragraph with the Department through standards-based or direct
exchange mechanisms in effect as of the date of the enactment
of this Act.
(c) Reports on Plan for Interoperability Standards.--
(1) Initial report.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs shall
submit to the Committees on Veterans' Affairs of the Senate and the
House of Representatives--
(A) the plan required by subsection (a); and
(B) a report that includes--
(i) an analysis of gaps, if any, between the use, by
the Department and other agencies, health information
exchanges, and technology companies, of national health
information interoperability standards and the potential,
or optimal, use of such national health information
interoperability standards;
(ii) an analysis and description of the participation
by the Department, community care providers, and other
relevant entities in the Trusted Exchange Framework and
Common Agreement program of the Department of Health and
Human Services as of the date of the enactment of this Act;
(iii) recommendations of the Secretary with respect to
development of health information interoperability
standards;
(iv) timelines or schedules to implement the plan
required by subsection (a); and
(v) an identification of any legislative authorities or
resources the Secretary requires to implement such plan.
(2) Recurring report requirement.--
(A) In general.--Not later than 18 months after the date of
the enactment of this Act, and every 180 days thereafter for
four years, the Secretary of Veterans Affairs shall submit to
Committees on Veterans' Affairs of the Senate and the House of
Representatives a report on the status of implementation of the
plan required under subsection (a).
(B) Elements of subsequent reports.--Each report under
subparagraph (A) submitted after the date on which the first
report required by such subparagraph is submitted shall include
a description of any revisions to--
(i) the plan required by subsection (a) made during the
period covered by the report; and
(ii) the analysis, recommendations, timelines, and
legislative authorities reported pursuant to paragraph (1).
(d) Definitions.--In this section:
(1) The term ``community care provider'' means a non-Department
health care provider providing care (including dental care)--
(A) under section 1703 of title 38, United States Code;
(B) pursuant to a Veterans Care Agreement under section
1703A of such title; or
(C) under any other law administered by the Secretary of
Veterans Affairs.
(2) The term ``Third Party Administrator'' means an entity that
manages a provider network and performs administrative services
related to such network under section 1703 of title 38, United
States Code.

cd7b1daf997af216d4a8e16345c481efaac6f053c2c5699cbd7534710a0c486b

VETERANS COMMUNITY CARE PROGRAM.
(a) Report on Value-based Reimbursement Models.--Not later than one
year after the date of the enactment of this Act, the Secretary of
Veterans Affairs, in consultation with the Center for Innovation for
Care and Payment of the Department of Veterans Affairs under section
1703E of title 38 United States Code, the Office of Integrated Veteran
Care of the Department, or successor office, and Third Party
Administrators, shall submit to the Committees on Veterans' Affairs of
the House of Representatives and the Senate a report containing--
(1) an assessment of the efforts of the Department pursuant to
section 1703(i)(5) of such title, to incorporate value-based
reimbursement models under the Veterans Community Care Program to
promote the provision of high-quality care to veterans; and
(2) such recommendations for legislative or administrative
action as the Secretary considers appropriate regarding the use of
value-based reimbursement models throughout the Veterans Community
Care Program under section 1703 of such title.
(b) Rule of Construction.--This section shall not be construed to
be a pilot program subject to the requirements of section 1703E of
title 38, United States Code.
(c) Third Party Administrator Defined.--In this section, the term
``Third Party Administrator'' means an entity that manages a provider
network and performs administrative services related to such network
under section 1703 of title 38, United States Code.

8bbeb49d20e6d51d2f43a08307c04d1b7c4896a51c6649069d455bdde01f0494

VETERANS COMMUNITY CARE PROGRAM.
(a) In General.--Not later than 18 months after the date of the
enactment of this Act, and periodically thereafter, the Inspector
General shall assess the performance of the Department of Veterans
Affairs in--
(1) appropriately identifying veterans eligible for care and
services under section 1703 of title 38, United States Code;
(2) informing veterans of their eligibility for such care and
services; and
(3) delivering such care and services in a timely manner.
(b) Briefing on Assessments.--Upon the submission of the assessment
required by subsection (a), the Inspector General of the Department of
Veterans Affairs shall provide to the Committees on Veterans Affairs of
the House of Representatives and the Senate a briefing on the results
of such assessment.

89d14b24cfeddefbdb9cc745152bb4fb17c99b5c9c6ca29ba56c04559b3e5a46

COMMUNITY CARE PROGRAM.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to the Committees on Veterans' Affairs of the Senate and
the House of Representatives a report on dental care furnished by the
Secretary of Veterans Affairs under the Veterans Community Care Program
under section 1703 of title 38, United States Code, that includes a
review of--
(1) the impact current reimbursement rates provided by the
Department of Veterans Affairs to dental providers under such
program have on--
(A) the availability of dental care for veterans; and
(B) the ability of Third Party Administrators to meet their
contractual obligations for network adequacy;
(2) the satisfaction of dental providers providing dental care
under such program with the processes of the Department for
approving dental care under such program; and
(3) the current processes of the Department for approving
emergent dental care under such program.
(b) Third Party Administrator Defined.--In this section, the term
``Third Party Administrator'' means an entity that manages a provider
network and performs administrative services related to such network
under section 1703 of title 38, United States Code.
Subtitle B--Matters Relating to Nursing Home and Other Long Term Care
and Family Caregivers

3e1cffed846366349120f9a4c9679943469a197d44ed09e0327ad43c320ec408

ALTERNATIVES TO NURSING HOME CARE.
(a) Increase of Expenditure Cap.--Section 1720C(d) of title 38,
United States Code, is amended--
(1) by striking ``The total cost'' and inserting ``(1) Except
as provided in paragraph (2), the total cost'';
(2) by striking ``65 percent'' and inserting ``100 percent'';
and
(3) by adding at the end the following new paragraph:
``(2)(A) The total cost of providing services or in-kind assistance
in the case of any veteran described in subparagraph (B) for any fiscal
year under the program may exceed 100 percent of the cost that would
otherwise have been incurred as specified in paragraph (1) if the
Secretary determines, based on a consideration of clinical need,
geographic market factors, and such other matters as the Secretary may
prescribe through regulation, that such higher total cost is in the
best interest of the veteran.
``(B) A veteran described in this subparagraph is a veteran with
amyotrophic lateral sclerosis, a spinal cord injury, or a condition the
Secretary determines to be similar to such conditions.''.
(b) Applicability.--The amendments made by subsection (a) shall
apply with respect to fiscal years beginning on or after the date of
the enactment of this Act.

d827a69d450126f8b477a517bce498053656c1f1cfce10bc0981d1d8c490b57a

ELDERLY.
Section 1720C of title 38, United States Code, as amended by
section 120, is further amended by adding at the end the following new
subsection:
``(f) In furnishing services to a veteran under the program
conducted pursuant to subsection (a), if a medical center of the
Department through which such program is administered is located in a
geographic area in which services are available to the veteran under a
PACE program (as such term is defined in sections 1894(a)(2) and
1934(a)(2) of the Social Security Act (42 U.S.C. 1395eee(a)(2); 1396u-
4(a)(2))), the Secretary shall seek to enter into an agreement with the
PACE program operating in that area for the furnishing of such
services.''.

9e5e37baf19e35b867fd412593baf5e0763767b278b2799ab6d94869e56f955e

GRANTS OR CONTRACTS TO ENTITIES TO IMPROVE PROVISION OF MENTAL
HEALTH SUPPORT TO FAMILY CAREGIVERS OF VETERANS.
Subchapter II of chapter 17 of title 38, United States Code, is
amended by adding at the end the following new section (and conforming
the table of sections at the beginning of such chapter accordingly):
``Sec. 1720K. Grants or contracts to provide mental health support to
family caregivers of veterans
``(a) Authority.--The Secretary may award grants or contracts to
carry out, coordinate, improve, or otherwise enhance mental health
counseling, treatment, or support to the family caregivers of veterans
participating in the family caregiver program.
``(b) Application.--(1) To be eligible for a grant or contract
under this section, an entity shall submit to the Secretary an
application therefor at such time, in such manner, and containing such
information as the Secretary may require.
``(2) Each application submitted under paragraph (1) shall include
the following:
``(A) A detailed plan for the use of the grant or contract.
``(B) A description of the programs or efforts through which
the entity will meet the outcome measures developed by the
Secretary under subsection (f).
``(C) A description of how the entity will distribute grant or
contract amounts equitably among areas with varying levels of
urbanization.
``(D) A plan for how the grant or contract will be used to meet
the unique needs of veterans residing in rural areas, Native
American, Native Hawaiian, or Alaska Native veterans, elderly
veterans, women veterans, and veterans from other underserved
communities.
``(c) Distribution.--The Secretary shall seek to ensure that grants
and contracts awarded under this section are equitably distributed
among entities located in States with varying levels of urbanization.
``(d) Priority.--The Secretary shall prioritize awarding grants or
contracts under this section that will serve the following areas:
``(1) Areas with high rates of veterans enrolled in the family
caregiver program.
``(2) Areas with high rates of--
``(A) suicide among veterans; or
``(B) referrals to the Veterans Crisis Line.
``(e) Required Activities.--Any grant or contract awarded under
this section shall be used--
``(1) to expand existing programs, activities, and services;
``(2) to establish new or additional programs, activities, and
services; or
``(3) for travel and transportation to facilitate carrying out
paragraph (1) or (2).
``(f) Outcome Measures.--(1) The Secretary shall develop and
provide to each entity that receives a grant or contract under this
section written guidance on the following:
``(A) Outcome measures.
``(B) Policies of the Department.
``(2) In developing outcome measures under paragraph (1), the
Secretary shall consider the following goals:
``(A) Increasing the utilization of mental health services
among family caregivers of veterans participating in the family
caregiver program.
``(B) Reducing barriers to mental health services among family
caregivers of veterans participating in such program.
``(g) Tracking Requirements.--(1) The Secretary shall establish
appropriate tracking requirements with respect to the entities
receiving a grant or contract under this section.
``(2) Not less frequently than annually, the Secretary shall submit
to Congress a report on such tracking requirements.
``(h) Performance Review.--The Secretary shall--
``(1) review the performance of each entity that receives a
grant or contract under this section; and
``(2) make information regarding such performance publicly
available.
``(i) Remediation Plan.--(1) In the case of an entity that receives
a grant or contract under this section and does not meet the outcome
measures developed by the Secretary under subsection (f), the Secretary
shall require the entity to submit to the Secretary a remediation plan
under which the entity shall describe how and when it plans to meet
such outcome measures.
``(2) The Secretary may not award a subsequent grant or contract
under this section to an entity described in paragraph (1) unless the
Secretary approves the remediation plan submitted by the entity under
such paragraph.
``(j) Maximum Amount.--The amount of a grant or contract awarded
under this section may not exceed 10 percent of amounts made available
for grants or contracts under this section for the fiscal year in which
the grant or contract is awarded.
``(k) Supplement, Not Supplant.--Any grant or contract awarded
under this section shall be used to supplement and not supplant funding
that is otherwise available through the Department to provide mental
health support among family caregivers of veterans participating in the
family caregiver program.
``(l) Outreach to Family Caregivers.--The Secretary shall include,
in the outreach materials regularly provided to a family caregiver who
participates in the family caregiver program, notice of mental health
support provided by recipients of grants or contracts under this
section that are located in the relevant Veterans Integrated Service
Network.
``(m) Funding.--(1) Amounts for the activities of the Department
under this section shall be budgeted and appropriated through a
separate appropriation account.
``(2) In the budget justification materials submitted to Congress
in support of the budget of the Department for any fiscal year (as
submitted with the budget of the President under section 1105(a) of
title 31), the Secretary shall include a separate statement of the
amount requested to be appropriated for that fiscal year for the
account specified in paragraph (1).
``(n) Authorization of Appropriations.--There is authorized to be
appropriated to the Secretary, for each of fiscal years 2025 and 2026,
$10,000,000 to carry out this section.
``(o) Definitions.--In this section:
``(1) The terms `caregiver' and `family caregiver' have the
meanings given those terms in section 1720G of this title.
``(2) The term `family caregiver program' means the program of
comprehensive assistance for family caregivers under section 1720G
of this title.
``(3) The term `Veterans Crisis Line' means the toll-free
hotline for veterans established under section 1720F of this
title.''.

5a87c96b4baec0659e8503a0a76f9e359ea468c3c54987cadec9d0f2a484ba8a

(a) Programs.--Such subchapter is further amended by inserting
after section 1720K (as added by section 122) the following new section
(and conforming the table of sections at the beginning of such chapter
accordingly):
``Sec. 1720L. Home- and community-based services: programs
``(a) In General.--In furnishing noninstitutional alternatives to
nursing home care pursuant to the authority of section 1720C of this
title (or any other authority under this chapter or other provision of
law administered by the Secretary of Veterans Affairs), the Secretary
shall carry out each of the programs specified in this section in
accordance with such relevant authorities except as otherwise provided
in this section.
``(b) Veteran-Directed Care Program.--(1) The Secretary of Veterans
Affairs, in collaboration with the Secretary of Health and Human
Services, shall carry out a program to be known as the `Veteran-
Directed Care program'. Under such program, the Secretary of Veterans
Affairs may enter into agreements with the providers described in
paragraph (2) to provide to eligible veterans funds, to the extent
practicable, to obtain such in-home care services and related items
that support clinical need and improve quality of life, as may be
determined appropriate by the Secretary of Veterans Affairs and
selected by the veteran, including through the veteran hiring
individuals to provide such services and items or directly purchasing
such services and items.
``(2) The providers described in this paragraph are the following:
``(A) An Aging and Disability Resource Center, an area agency
on aging, or a State agency.
``(B) A center for independent living.
``(C) An Indian tribe or tribal organization receiving
assistance under title VI of the Older Americans Act of 1965 (42
U.S.C. 3057 et seq.).
``(D) Any other entity that the Secretary, in consultation with
the Secretary of Health and Human Services, determines appropriate.
``(3) In carrying out the Veteran-Directed Care program, the
Secretary of Veterans Affairs shall--
``(A) administer such program through each medical center of
the Department of Veterans Affairs;
``(B) seek to ensure the availability of such program in
American Samoa, Guam, the Commonwealth of the Northern Mariana
Islands, the Commonwealth of Puerto Rico, the Virgin Islands of the
United States, and any other territory or possession of the United
States, to the extent practicable; and
``(C) seek to ensure the availability of such program for
eligible veterans who are Native American veterans receiving care
and services furnished by the Indian Health Service, a tribal
health program, an Urban Indian organization, or (in the case of a
Native Hawaiian veteran) a Native Hawaiian health care system, to
the extent practicable.
``(4) If a veteran participating in the Veteran-Directed Care
program is hospitalized, the veteran may continue to use funds under
the program during a period of hospitalization in the same manner that
the veteran would be authorized to use such funds under the program if
the veteran were not hospitalized.
``(c) Homemaker and Home Health Aide Program.--(1) The Secretary
shall carry out a program to be known as the `Homemaker and Home Health
Aide program' under which the Secretary may enter into agreements with
home health agencies to provide to eligible veterans such home health
aide services as may be determined appropriate by the Secretary.
``(2) In carrying out the Homemaker and Home Health Aide program,
the Secretary shall--
``(A) administer such program in the locations specified in
subparagraph (A) of subsection (b)(3);
``(B) seek to ensure the availability of such program in the
locations specified in subparagraph (B) of subsection (b)(3); and
``(C) seek to ensure the availability of such program for the
veteran populations specified in subparagraph (C) of subsection
(b)(3).
``(d) Home-Based Primary Care Program.--The Secretary shall carry
out a program to be known as the `Home-Based Primary Care program'
under which the Secretary may furnish to eligible veterans in-home
health care, the provision of which is overseen by a provider of the
Department.
``(e) Purchased Skilled Home Care Program.--The Secretary shall
carry out a program to be known as the `Purchased Skilled Home Care
program' under which the Secretary may furnish to eligible veterans
such in-home care services as may be determined appropriate and
selected by the Secretary for the veteran.
``(f) Caregiver Support.--(1) With respect to a resident eligible
caregiver of a veteran participating in a program under this section,
the Secretary shall--
``(A) if the veteran meets the requirements of a covered
veteran under section 1720G(b) of this title, provide to such
caregiver the option of enrolling in the program of general
caregiver support services under such section;
``(B) provide to such caregiver covered respite care of not
less than 30 days annually; and
``(C) conduct on an annual basis (and, to the extent
practicable, in connection with in-person services provided under
the program in which the veteran is participating), a wellness
contact of such caregiver.
``(2) Covered respite care provided to a resident eligible
caregiver of a veteran under paragraph (1) may exceed 30 days annually
if such extension is requested by the resident eligible caregiver or
veteran and determined medically appropriate by the Secretary.
``(g) Rule of Construction.--Nothing in this section shall be
construed to limit the authority of the Secretary to carry out programs
providing home- and community-based services under any other provision
of law.
``(h) Definitions.--In this section:
``(1) The terms `Aging and Disability Resource Center', `area
agency on aging', and `State agency' have the meanings given those
terms in section 102 of the Older Americans Act of 1965 (42 U.S.C.
3002).
``(2) The terms `caregiver' and `family caregiver', with
respect to a veteran, have the meanings given those terms,
respectively, under subsection (e) of section 1720G of this title
with respect to an eligible veteran under subsection (a) of such
section or a covered veteran under subsection (b) of such section,
as the case may be.
``(3) The term `center for independent living' has the meaning
given that term in section 702 of the Rehabilitation Act of 1973
(29 U.S.C. 796a).
``(4) The term `covered respite care' has the meaning given
such term in section 1720G(d) of this title.
``(5) The term `eligible veteran' means any veteran--
``(A) for whom the Secretary determines participation in a
specific program under this section is medically necessary to
promote, preserve, or restore the health of the veteran; and
``(B) who absent such participation would be at increased
risk for hospitalization, placement in a nursing home, or
emergency room care.
``(6) The term `home health aide' means an individual employed
by a home health agency to provide in-home care services.
``(7) The term `in-home care service' means any service,
including a personal care service, provided to enable the recipient
of such service to live at home.
``(8) The terms `Indian tribe' and `tribal organization' have
the meanings given those terms in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 5304).
``(9) The terms `Native American' and `Native American veteran'
have the meanings given those terms in section 3765 of this title.
``(10) The terms `Native Hawaiian' and `Native Hawaiian health
care system' have the meanings given those terms in section 12 of
the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11711).
``(11) The terms `tribal health programs' and `Urban Indian
organizations' have the meanings given those terms in section 4 of
the Indian Health Care Improvement Act (25 U.S.C. 1603).
``(12) The term `resident eligible caregiver' means an
individual who--
``(A) is a caregiver, or a family caregiver, of a veteran
and resides with that veteran; and
``(B) has not entered into a contract, agreement, or other
arrangement for such individual to act as a caregiver for that
veteran unless such individual is a family member of the
veteran or is furnishing caregiver services through a medical
foster home.''.
(b) Deadline for Improved Administration.--The Secretary of
Veterans Affairs shall ensure that the Veteran-Directed Care program
and the Homemaker and Home Health Aide program are administered through
each medical center of the Department of Veterans Affairs in accordance
with section 1720L of title 38, United States Code (as added by
subsection (a)), by not later than two years after the date of the
enactment of this Act.
(c) Administration of Veteran-Directed Care Program.--
(1) Procedures.--
(A) The Secretary shall establish procedures to--
(i) identify the staffing needs for the Veteran-
Directed Care program of the Department of Veterans Affairs
under such section (as added by subsection (a)); and
(ii) define the roles and responsibilities for
personnel of the Department responsible for the
administration of such program, including such personnel
employed at the national, Veterans Integrated Service
Network, or medical facility level.
(B) The responsibilities described in clause (ii) of
subparagraph (A) shall include responsibilities for engagement
with--
(i) veterans participating in such program;
(ii) veterans interested in participating in such
program; and
(iii) providers described in section 1720L(b)(2) (as
added by subsection (a)).
(2) Staffing model; report.--Not later than two years after
enactment of this Act, the Secretary of Veterans Affairs shall--
(A) establish a staffing model for the administration of
such program at each medical facility of the Department of
Veterans Affairs; and
(B) submit to the Committees on Veterans' Affairs of the
House of Representatives and the Senate a report containing the
following:
(i) A description of--
(I) the staffing model described in subparagraph
(A); and
(II) the rationale for such staffing model.
(ii) An identification of the ratio of staff required
to administer such program to the number of veterans served
by such program, disaggregated by each medical facility of
the Department of Veterans Affairs.
(iii) A description of budgetary resources or other
support, if any, required to accommodate an increase in
staffing at medical facilities of the Department of
Veterans Affairs pursuant to the requirements of the
staffing model described in subparagraph (A).
(iv) Such other matters as the Secretary of Veterans
Affairs determines appropriate.

460b2b66c0b5a8f75a44116205665e5ec410ec9a1d1f3b6902ab8dd85bf268e8

CAREGIVERS.
(a) Coordination With Program of Comprehensive Assistance for
Family Caregivers.--
(1) Coordination.--Section 1720G(a) of title 38, United States
Code, is amended by adding at the end the following new paragraph:
``(14)(A) In the case of a veteran or caregiver who seeks services
under this subsection and is denied such services, or a veteran or the
family caregiver of a veteran who is discharged from the program under
this subsection, the Secretary shall--
``(i) if the veteran meets the requirements of a covered
veteran under subsection (b), provide to such caregiver the option
of enrolling in the program of general caregiver support services
under such subsection;
``(ii) assess the veteran or caregiver for participation in any
other available program of the Department for home- and community-
based services (including the programs specified in section 1720L
of this title) for which the veteran or caregiver may be eligible
and, with respect to the veteran, store (and make accessible to the
veteran) the results of such assessment in the electronic medical
record of the veteran; and
``(iii) provide to the veteran or caregiver written information
on any such program identified pursuant to the assessment under
clause (ii), including information about facilities, eligibility
requirements, and relevant contact information for each such
program.
``(B) The Secretary shall, to the extent practicable, provide to a
veteran or family caregiver the option of obtaining clinically
appropriate services under any other available program of the
Department for home- and community-based services (including the
programs specified in section 1720L of this title) for which the
veteran or family caregiver may be eligible prior to discharging the
veteran or family caregiver from the program under this subsection.
``(C) For each veteran or family caregiver who is discharged from
the program under this subsection, a caregiver support coordinator
shall provide for a smooth and personalized transition from such
program to an appropriate program of the Department for home- and
community-based services (including the programs specified in section
1720L of this title), including by integrating caregiver support across
programs.''.
(2) Applicability.--The amendments made by paragraph (1) shall
apply with respect to denials and discharges occurring on or after
the date that is 180 days after the date of the enactment of this
Act.
(3) Technical and conforming amendments.--Section 1720G(d) of
such title is amended--
(A) by striking ``or a covered veteran'' each place it
appears and inserting ``, a veteran denied or discharged as
specified in paragraph (14) of such subsection, or a covered
veteran''; and
(B) by striking ``under subsection (a), means'' each place
it appears and inserting ``under subsection (a) or a veteran
denied or discharged as specified in paragraph (14) of such
subsection, means''.
(b) Conformity of Respite Care Across Programs.--Section 1720G of
title 38, United States Code, as amended by subsection (a)(3), is
further amended--
(1) in subsection (a)(3)--
(A) by amending subparagraph (A)(ii)(III) to read as
follows:
``(III) covered respite care of not less than 30 days
annually;''; and
(B) by striking subparagraph (B) and redesignating
subparagraphs (C) and (D) as subparagraphs (B) through (C),
respectively; and
(2) by amending subsection (b)(3)(A)(iii) to read as follows:
``(iii) Covered respite care of not less than 30 days
annually.''; and
(3) in subsection (d)--
(A) by redesignating paragraphs (2) through (4) as
paragraphs (3) through (5), respectively; and
(B) by inserting after paragraph (1) the following new
paragraph:
``(2) The term `covered respite care' means, with respect to a
caregiver of a veteran, respite care under section 1720B of this
title that--
``(A) is medically and age appropriate for the veteran
(including 24-hour per day care of the veteran commensurate
with the care provided by the caregiver); and
``(B) includes in-home care.''.
(c) Review Relating to Caregiver Contact.--The Secretary shall
conduct a review of the capacity of the Department to establish a
streamlined system for contacting all caregivers enrolled in the
program of general caregiver support services under section 1720G(b) of
title 38, United States Code, to provide to such caregivers program
updates and alerts relating to emerging services for which such
caregivers or the veterans for which they provide care may be eligible.

b3b9f98703d4b6829185f9ffb815405a87b56af97481abb69ccc04e870412f86

FAMILY CAREGIVERS.
Section 1720G(a) of title 38, United States Code, as amended by
section 124, is further amended--
(1) in paragraph (12)--
(A) in subparagraph (A), by inserting ``, which shall
include all criteria used to determine eligibility for such
assistance and, in the case of a completed evaluation, how such
criteria were used to evaluate information provided in
assessments to determine such eligibility'' before the period
at the end; and
(B) in subparagraph (C)(i), by striking ``who submits'' and
all that follows through the end of the clause and inserting
the following: ``who--
``(I) submits an application for the program established
under paragraph (1); or
``(II) is being reassessed for eligibility to continue in
such program.''; and
(2) by adding at the end the following new paragraph:
``(15)(A) Not less frequently than annually, the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate and the
House of Representatives a comprehensive report on the program required
by paragraph (1) that includes, with respect to the one-year period
preceding the date of the submission of such report, the following:
``(i) The number of applications received for such program.
``(ii) The number, disaggregated by race, sex, and era and
branch of service in the Armed Forces of the applicant, of--
``(I) approvals of such applications; and
``(II) denials of such applications.
``(iii) The number of reassessments conducted for such program.
``(iv) An identification of each decision made with respect to
a reassessment conducted for such program, disaggregated by
decisions resulting in--
``(I) disenrollment, including removal, discharge, or
voluntary withdrawal;
``(II) tier reduction; and
``(III) tier continuation.
``(v) The number of appeals of decisions made with respect to
such program, disaggregated by type of appeal.
``(vi) With respect to each appeal described in clause (v), the
decision rendered, if any.
``(vii) A description of all tools used in assessments
conducted for such program, including an explanation of how and by
whom such tools are administered.
``(viii) A description of procedures used under such program
for reviewing and integrating clinical records from health care
providers that includes an explanation of how such records are used
in determinations of eligibility for such program.
``(ix) A description of procedures available under such program
for health care providers to communicate medical opinions to the
teams conducting assessments to determine eligibility for such
program, including health care providers in the private sector and
health care providers specified in subsection (c) of section 1703
of this title.
``(x) A description of information technology systems and
processes used under such program to upload and integrate all
clinical records from all non-Department providers, including
providers in the private sector and providers under the Veterans
Community Care Program established under such section.
``(B) The Secretary shall ensure that all data included in a report
under subparagraph (A)--
``(i) relating to a decision made under the program required by
paragraph (1), are disaggregated by the specific reason for the
decision;
``(ii) relating to a veteran, include comprehensive demographic
information of the veteran, including the time period of the
injuries, if any, of the veteran and the Veterans Integrated
Service Network in which the veteran is located; and
``(iii) with respect to eligibility determinations relating to
a serious injury of a veteran, specify--
``(I) how many such determinations relate to the ability of
the veteran to perform activities of daily living; and
``(II) how many such determinations relate to the need of a
veteran for supervision and protection.
``(C) The Secretary shall provide the data under paragraph (B)
pursuant to Federal laws and in a manner that is wholly consistent with
applicable Federal privacy and confidentiality laws, including the
Privacy Act (5 U.S.C. 552a), the Health Insurance Portability and
Accountability Act (Public Law 104-191; 42 U.S.C. 201 note) and
regulations (title 45, Code of Federal Regulations, parts 160 and 164,
or successor regulations), and sections 5701, 5705, and 7332 of this
title to ensure that the provided data, or some portion of the data,
will not undermine the anonymity of a veteran.''.

80ca4372b7b9414be04312d88fb48df7182ae13f9c6b60d4464c7ba30c235676

PROGRAM.
(a) Pilot Program for Communities With Shortage of Home Health
Aides.--
(1) Program.--Beginning not later than 18 months after the date
of the enactment of this Act, the Secretary shall carry out a
three-year pilot program under which the Secretary shall provide
homemaker and home health aide services to veterans who reside in
communities with a shortage of home health aides.
(2) Locations.--The Secretary shall select not fewer than five
geographic locations in which the Secretary determines there is a
shortage of home health aides at which to carry out the pilot
program under paragraph (1).
(3) Nursing assistants.--
(A) In general.--In carrying out the pilot program under
paragraph (1), the Secretary may hire nursing assistants as new
employees of the Department of Veterans Affairs, or reassign
nursing assistants who are existing employees of the
Department, to provide to veterans in-home care services
(including basic tasks authorized by the State certification of
the nursing assistant) under the pilot program, in lieu of or
in addition to the provision of such services through non-
Department home health aides.
(B) Relationship to home-based primary care program.--
Nursing assistants hired or reassigned under subparagraph (A)
may provide services to a veteran under the pilot program under
paragraph (1) while serving as part of a health care team for
the veteran under the Home-Based Primary Care program.
(4) Report to congress.--Not later than one year before the
date of the termination of the pilot program under paragraph (1),
the Secretary shall submit to the Committees on Veterans' Affairs
of the House of Representatives and the Senate a report that
includes--
(A) a statement of the results of such pilot program; and
(B) an assessment of the feasibility and advisability of--
(i) extending such pilot program; or
(ii) making such pilot program a permanent program of
the Department of Veterans Affairs.
(b) Report on Use of Funds.--Not later than one year after the date
of the enactment of this Act, the Secretary of Veterans Affairs shall
submit to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a report containing, with respect to the
period beginning in fiscal year 2012 and ending in fiscal year 2024,
the following:
(1) An identification of the amount of funds that were included
in a budget of the Department of Veterans Affairs during such
period for the provision of in-home care to veterans under the
Homemaker and Home Health Aide program but were not expended for
such provision, disaggregated by medical center of the Department
for which such unexpended funds were budgeted (if such
disaggregation is possible).
(2) To the extent practicable, an identification of the number
of veterans for whom, during such period, the hours during which a
home health aide was authorized to provide services to the veteran
under the Homemaker and Home Health Aide program were reduced for a
reason other than a change in the health care needs of the veteran,
and a detailed description of the reasons why any such reductions
may have occurred.
(c) Updated Guidance on Program.--Not later than one year after the
date of the enactment of this Act, the Secretary shall issue updated
guidance for the Homemaker and Home Health Aide program. Such updated
guidance shall include the following:
(1) A process for the transition of veterans from the Homemaker
and Home Health Aide program to other covered programs.
(2) A requirement for the directors of the medical facilities
of the Department to complete such process whenever a veteran with
care needs has been denied services from home health agencies under
the Homemaker and Home Health Aide program as a result of the
clinical needs or behavioral issues of the veteran.

27f3afd6cd59b2233b205523fbd63e5fb5e5c6e28e6754ce8c3c8140d194c3ed

CERTAIN VETERANS.
(a) Establishment.--Beginning not later than two years after the
date of the enactment of this Act, the Secretary of Veterans Affairs
shall carry out a pilot program to assess--
(1) the effectiveness of providing assisted living services to
eligible veterans, at the election of such veterans; and
(2) the satisfaction with the pilot program of veterans
participating in such pilot program.
(b) Program Locations.--
(1) Veterans integrated service networks.--The Secretary shall
select two Veterans Integrated Service Networks of the Department
of Veterans Affairs at which to carry out the pilot program under
subsection (a).
(2) Facilities.--
(A) In general.--Within the Veterans Integrated Service
Networks selected under paragraph (1), the Secretary shall
select facilities at which to carry out the pilot program under
subsection (a)(1).
(B) Selection criteria.--In selecting facilities under
subparagraph (A) at which to carry out the pilot program under
subsection (a)(1), the Secretary shall ensure that--
(i) the locations of such facilities are in
geographically diverse areas;
(ii) not fewer than one such facility serves veterans
in rural or highly rural areas (as determined through the
use of the Rural-Urban Commuting Areas coding system of the
Department of Agriculture);
(iii) not fewer than one such facility is located in
each Veterans Integrated Service Network selected under
paragraph (1); and
(iv) not fewer than one such facility is a State home.
(c) Program Participants.--Not more than 60 eligible veterans may
participate in the pilot program under subsection (a)(1) in each
Veterans Integrated Service Network selected under subsection (b)(1).
(d) Provision of Assisted Living Services.--
(1) Agreements.--In carrying out the pilot program under
subsection (a)(1), the Secretary may enter into agreements for the
provision of assisted living services on behalf of eligible
veterans with--
(A) a provider participating under a State plan or waiver
under title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.); or
(B) a State home recognized and certified under subpart B
of part 51 of title 38, Code of Federal Regulations, or
successor regulations.
(2) Standards.--The Secretary may not place, transfer, or admit
a veteran to any facility for assisted living services under the
pilot program under subsection (a)(1) unless the Secretary
determines that--
(A) the facility meets the standards for community
residential care established under sections 17.61 through 17.72
of title 38, Code of Federal Regulations, or successor
regulations, and any additional standards of care as the
Secretary may specify; or
(B) in the case of a facility that is a State home, the
State home meets such standards of care as the Secretary may
specify.
(3) Inspection.--The Secretary shall inspect facilities at
which veterans are placed under the pilot program under subsection
(a)(1)--
(A) with respect to a facility that is a State home, not
less frequently than annually and in the same manner as the
Secretary conducts inspection of State homes under section 1742
of title 38, United States Code; and
(B) with respect to any other facility, not less frequently
than annually and in the same manner as the Secretary conducts
inspection of facilities under section 1730 of such title.
(4) Payment to certain facilities.--
(A) State homes.--In the case of a facility participating
in the pilot program under subsection (a)(1) that is a State
home, the Secretary shall pay to the State home a per diem for
each veteran participating in the pilot program at a rate
agreed to by the Secretary and the State home.
(B) Community assisted living facilities.--In the case of a
facility participating in the pilot program under subsection
(a)(1) that is a community assisted living facility, the
Secretary shall--
(i) pay to the facility an amount that is less than the
average rate paid by the Department for placement in a
community nursing home in the same Veterans Integrated
Service Network; and
(ii) re-evaluate payment rates annually to account for
current economic conditions and current costs of assisted
living services.
(e) Continuity of Care.--Upon the termination of the pilot program
under subsection (a)(1), the Secretary shall--
(1) provide to all veterans participating in the pilot program
at the time of such termination the option to continue to receive
assisted living services at the site they were assigned to under
the pilot program, at the expense of the Department; and
(2) for such veterans who do not opt to continue to receive
such services--
(A) ensure such veterans do not experience lapses in care;
and
(B) provide such veterans with information on, and furnish
such veterans with, other extended care services based on their
preferences and best medical interest.
(f) Determination of Quality.--The Secretary shall determine a
method for assessment of quality of care provided to veterans
participating in the pilot program under subsection (a)(1) and shall
communicate that method to providers of services under the pilot
program.
(g) Annual Report.--Not later than one year after the initiation of
the pilot program under subsection (a)(1), and annually thereafter for
the duration of such pilot program, the Secretary shall submit to the
Committees on Veterans' Affairs of the House of Representatives and the
Senate a report on the pilot program that includes--
(1) an identification of Veterans Integrated Services Networks
and facilities of the Department participating in the pilot program
and assisted living facilities and State homes at which veterans
are placed under the pilot program;
(2) the number of participants in the pilot program,
disaggregated by facility;
(3) general demographic information of participants in the
pilot program, including average age, sex, and race or ethnicity;
(4) disability status of participants in the pilot program;
(5) an identification of any barriers or challenges to
furnishing care to veterans under the pilot program, conducting
oversight of the pilot program, or any other barriers or
challenges;
(6) the cost of care at each assisted living facility and State
home participating in the pilot program, including an analysis of
any cost savings by the Department when comparing that cost to the
cost of nursing home care;
(7) aggregated feedback from participants in the pilot program,
including from veteran resident surveys and interviews; and
(8) such other matters the Secretary considers appropriate.
(h) Final Report.--Not later than one year after the pilot program
terminates under subsection (j), the Secretary shall submit to the
Committees on Veterans' Affairs of the House of Representatives and the
Senate a report on the pilot program that--
(1) includes the matters required under paragraphs (1) through
(8) of subsection (g);
(2) includes recommendations on whether the model studied in
the pilot program should be continued or adopted throughout the
Department; and
(3) indicates whether the Secretary requests action by Congress
to make the pilot program permanent.
(i) Inspector General Report.--
(1) In general.--Not later than three years after the
initiation of the pilot program under subsection (a)(1), the
Inspector General of the Department of Veterans Affairs shall
submit to the Secretary of Veterans Affairs and the Committees on
Veterans' Affairs of House of Representatives and the Senate a
report on the pilot program.
(2) Elements.--The report required by paragraph (1) shall
include an assessment of--
(A) the quality of care provided to veterans at facilities
participating in the pilot program, measured pursuant to the
method determined under subsection (f);
(B) the oversight of such facilities, as conducted by the
Department, the Centers for Medicare & Medicaid Services, State
agencies, and other relevant entities; and
(C) such other matters as the Inspector General considers
appropriate.
(3) Plan required.--Not later than 90 days after the submission
of the report under paragraph (1), the Secretary shall submit to
the Committees on Veterans' Affairs of the House of Representatives
and the Senate a plan to address the deficiencies identified in the
report, if any.
(j) Termination.--
(1) In general.--Subject to paragraph (2), the pilot program
under subsection (a)(1) shall terminate on September 30, 2028.
(2) Extension.--The Secretary may extend the duration of the
pilot program for an additional two-year period if the Secretary,
based on the results of the reports submitted under subsection (g),
determines such an extension is appropriate.
(k) Definitions.--In this section:
(1) The term ``assisted living services'' means services of a
facility in providing room, board, and personal care for and
supervision of residents for their health, safety, and welfare.
(2) The term ``eligible veteran'' means a veteran who is--
(A) receiving nursing home care paid for by the Department
of Veterans Affairs, eligible to receive such care pursuant to
section 1710A of title 38, United States Code, or requires a
higher level of care than the domiciliary care provided by the
Department of Veterans Affairs, but does not meet the
requirements for nursing home level care provided by the
Department pursuant to such section; and
(B) eligible for assisted living services, as determined by
the Secretary or meets such additional criteria for eligibility
for the pilot program under subsection (a)(1) as the Secretary
may establish.
(3) The term ``State home'' has the meaning given that term in
section 101 of title 38, United States Code.

f7865898861baba0a1800191a018858021926ee4fda117c0c5395cb663b54f46

TO DEPARTMENT OF VETERANS AFFAIRS TO STATE HOMES.
(a) Provision Authorized.--The Secretary of Veterans Affairs may
provide to State homes medicine, personal protective equipment, medical
supplies, and any other equipment, supplies, and assistance available
to the Department of Veterans Affairs.
(b) Definition.--In this section:
(1) The term ``personal protective equipment'' means any
protective equipment required to prevent the wearer from
contracting an infectious disease, including gloves, N-95
respirator masks, gowns, goggles, face shields, or other equipment
required for safety.
(2) The term ``State home'' has the meaning given such term in
section 101 of title 38, United States Code.

b21cfdfaa790a68c564bc9d1e35170bea3698070c384f85a66522be86024ffcb

VETERANS, FAMILY MEMBERS, AND CAREGIVERS NAVIGATING PROGRAMS AND
SERVICES OF VETERANS HEALTH ADMINISTRATION.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
establish a process through which the Department of Veterans Affairs
may recognize organizations and individuals to assist a veteran, a
family member of a veteran, or a caregiver of a veteran (as defined in
section 1720G(d) of title 38, United States Code) in navigating the
programs and services of the Veterans Health Administration.
(b) Solicitation of Feedback.--The Secretary shall solicit feedback
and recommendations in the creation of the process under subsection (a)
from such organizations as the Secretary may consider relevant.
(c) Limitation.--The Secretary may not recognize an organization or
individual pursuant to the process established under subsection (a)
unless the organization or individual has certified to the Secretary
that no fee or compensation of any nature will be charged to any
individual for services rendered in providing assistance pursuant to
such subsection.

dffc4e8ec7fe8d1cb872c0711d0c51f86ea15362cd73b47ed91ad28edee3d157

COMMUNITY-BASED SERVICES.
(a) Office of Geriatric and Extended Care.--
(1) Review of programs.--The Under Secretary for Health of the
Department of Veterans Affairs shall conduct a review of each
program administered through the Office of Geriatric and Extended
Care of the Department and the Caregiver Support Program Office of
the Department, or any successor offices, to--
(A) eliminate service gaps at the medical center level; and
(B) ensure--
(i) the clinical needs of veterans are met;
(ii) consistency in program management;
(iii) the availability of, and the access by veterans
to, home- and community-based services, including for
veterans living in rural areas; and
(iv) proper coordination between covered programs.
(2) Assessment of staffing needs.--The Secretary of Veterans
Affairs shall conduct an assessment of the staffing needs of the
Office of Geriatric and Extended Care of the Department and the
Caregiver Support Program Office of the Department, or any
successor offices.
(3) Goals for geographic alignment of care.--
(A) Establishment of goals.--The Director of the Office of
Geriatric and Extended Care, or successor office, shall
establish quantitative goals to enable aging or disabled
veterans who are not located near medical centers of the
Department to access extended care services (including by
improving access to home- and community-based services for such
veterans).
(B) Implementation timeline.--Each goal established under
subparagraph (A) shall include a timeline for the
implementation of the goal at each medical center of the
Department.
(4) Goals for in-home specialty care.--The Director of the
Office of Geriatric and Extended Care, or successor office, shall
establish quantitative goals to address the specialty care needs of
veterans through in-home care, including by ensuring the education
of home health aides and caregivers of veterans in the following
areas:
(A) Dementia care.
(B) Care for spinal cord injuries and diseases.
(C) Ventilator care.
(D) Other speciality care areas as determined by the
Secretary.
(5) Input on goals.--To the extent practicable, the head of the
Caregiver Support Program Office, or successor office, shall
provide to the Director of the Office of Geriatric and Extended
Care, or successor office, input with respect to the establishment
of the goals under paragraphs (3) and (4).
(6) Report to congress.--Not later than one year after the date
of the enactment of this Act, the Secretary shall submit to the
Committees on Veterans' Affairs of the House of Representatives and
the Senate a report containing the findings of the review under
paragraph (1), the results of the assessment under paragraph (2),
and the goals established under paragraphs (3) and (4).
(b) Review of Incentives and Efforts Relating to Home- and
Community-based Services.--
(1) Review.--The Secretary of Veterans Affairs shall conduct a
review of the following:
(A) The financial and organizational incentives or
disincentives for the directors of medical centers of the
Department to establish or expand covered programs at such
medical centers.
(B) Any incentives or disincentives for such directors to
provide to veterans home- and community-based services in lieu
of institutional care.
(C) The efforts taken by the Secretary to enhance spending
of the Department for extended care by balancing spending
between institutional care and home- and community-based
services consistent with the demand for such services.
(D) The plan of the Under Secretary for Health of the
Department to accelerate efforts to enhance spending as
specified in subparagraph (C), to match the progress of similar
efforts taken by the Administrator of the Centers for Medicare
& Medicaid Services with respect to spending of the Centers for
Medicare & Medicaid Services for extended care.
(2) Report to congress.--Not later than one year after the date
of the enactment of this Act, the Secretary shall submit to the
Committees on Veterans' Affairs of the House of Representatives and
the Senate a report on the findings of the review under paragraph
(1).
(c) Review of Respite Care Services.--Not later than two years
after the date of the enactment of this Act, the Secretary of Veterans
Affairs shall conduct a review of the use, availability, cost, and
effectiveness, of the respite care services furnished by the Secretary
under chapter 17 of title 38, United States Code, including--
(1) the frequency at which the Department of Veterans Affairs
is unable to meet demand for such services;
(2) a detailed description of--
(A) the reasons the Department of Veterans Affairs is
unable to meet the demand for such services; and
(B) any actions, or planned actions, of the Secretary of
Veterans Affairs to ensure such demand is met.
(d) Collaboration to Improve Home- and Community-based Services.--
(1) Recommendations.--
(A) Development.--The Secretary of Veterans Affairs shall
develop recommendations as follows:
(i) With respect to home- and community-based services
for veterans, the Secretary of Veterans Affairs shall
develop recommendations regarding new services (in addition
to those furnished as of the date of enactment of this Act)
in collaboration with the Secretary of Health and Human
Services.
(ii) With respect to the national shortage of home
health aides, the Secretary of Veterans Affairs shall
develop recommendations regarding methods to address such
shortage in collaboration with the Secretary of Health and
Human Services and the Secretary of Labor.
(B) Submission to congress.--The Secretary of Veterans
Affairs shall submit to the Committees on Veterans' Affairs of
the House of Representatives and the Senate a report containing
the recommendations developed under subparagraph (A) and an
identification of any changes in existing law or new statutory
authority necessary to implement the recommendations, as
determined by the Secretary.
(C) Consultation with secretary of labor.--In carrying out
this paragraph, the Secretary of Veterans Affairs shall consult
with the Secretary of Labor.
(2) Feedback and recommendations on caregiver support.--
(A) Feedback and recommendations.--The Secretary of
Veterans Affairs shall solicit from the entities described in
subparagraph (B) feedback and recommendations regarding
opportunities for the Secretary to enhance home- and community-
based services for veterans and the caregivers of veterans,
including through the potential provision by the entity of care
and respite services to veterans and caregivers who may not be
eligible for any program under section 1720G of title 38,
United States Code, or section 1720L of such title (as added by
section 123), but have a need for assistance.
(B) Covered entities.--The entities described in this
subparagraph are veterans service organizations and nonprofit
organizations with a focus on caregiver support or long term
care (as determined by the Secretary).
(3) Collaboration for certain veterans.--The Secretary of
Veterans Affairs shall collaborate with the Director of the Indian
Health Service and representatives from tribal health programs and
Urban Indian organizations to ensure the availability of home- and
community-based services for--
(A) Native American veterans, including Native American
veterans receiving health care and medical services under
multiple health care systems; and
(B) Native Hawaiian veterans, including Native Hawaiian
veterans receiving health care and medical services under the
Native Hawaiian health care system.

8c7bfcd1a2205ec13019a2da5bc1fe7439e9cab6b694188fb1df97f59d6fbd8a

(a) Report Required.--Not later than one year after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of Representatives a
report on the provision of mental health support to caregivers of
veterans.
(b) Contents.--The report submitted under subsection (a) shall
include the following:
(1) An assessment of the need for mental health support among
caregivers participating in the caregiver programs.
(2) An assessment of options for mental health support in
facilities of the Department of Veterans Affairs and in the
community for caregivers participating in the caregiver programs.
(3) An assessment of the availability and accessibility of
mental health support in facilities of the Department and in the
community for caregivers participating in the caregiver programs.
(4) An assessment of the awareness among caregivers of the
availability of mental health support in facilities of the
Department and in the community for caregivers participating in the
caregiver programs.
(5) An assessment of barriers to mental health support in
facilities of the Department and in the community for caregivers
participating in the caregiver programs.
(c) Definitions.--In this section:
(1) The term ``caregiver'' has the meaning given that term in
section 1720G of title 38, United States Code.
(2) The term ``caregiver programs'' means--
(A) the program of comprehensive assistance for family
caregivers under subsection (a) of section 1720G of title 38,
United States Code; and
(B) the program of support services for caregivers under
subsection (b) of such section.

067c8a6e9739b87e248c5365956c8f5db81576e946f43f1d4addde61a9507ad2

INFORMATION.
(a) Centralized Website.--The Secretary shall develop and maintain
a centralized and publically accessible internet website of the
Department as a clearinghouse for information and resources relating to
covered programs.
(b) Contents.--The website under subsection (a) shall contain the
following:
(1) A description of each covered program.
(2) An informational assessment tool that--
(A) explains the administrative eligibility, if applicable,
of a veteran, or a caregiver of a veteran, for any covered
program; and
(B) provides information, as a result of such explanation,
on any covered program for which the veteran or caregiver (as
the case may be) may be eligible.
(3) A list of required procedures for the directors of the
medical facilities of the Department to follow in determining the
eligibility and suitability of veterans for participation in a
covered program, including procedures applicable to instances in
which the resource constraints of a facility (or of a community in
which a facility is located) may result in the inability to address
the health needs of a veteran under a covered program in a timely
manner.
(c) Updates.--The Secretary shall ensure the website under
subsection (a) is updated on a periodic basis.

5849ac7877ad31e12f50eac596b74c2539aabec238e6efd23afc23bac91bbbfd

In this subtitle:
(1) The terms ``caregiver'' and ``family caregiver'' have the
meanings given those terms under section 1720L(h) of title 38,
United States Code (as added by section 123).
(2) The term ``covered program''--
(A) means any program of the Department of Veterans Affairs
for home- and community-based services; and
(B) includes the programs specified in section 1720L of
title 38, United States Code (as added by section 123).
(3) The term ``home- and community-based services''--
(A) means the services referred to in section 1701(6)(E) of
title 38, United States Code; and
(B) includes services furnished under a program specified
in section 1720L of such title (as added by section 123).
(4) The terms ``Home-Based Primary Care program'', ``Homemaker
and Home Health Aide program'', and ``Veteran-Directed Care
program'' mean the programs of the Department of Veterans Affairs
specified in subsection (d), (c), and (b) of such section 1720L,
respectively.
(5) The terms ``home health aide'', ``Native American'',
``Native American veteran'', ``tribal health programs'', and
``Urban Indian organizations'' have the meanings given those terms
in subsection (h) of such section 1720L.
(6) The term ``veterans service organization'' means any
organization recognized by the Secretary under section 5902 of such
title.
Subtitle C--Medical Treatment and Other Matters

8f6dacf25f4b073c8bdf67df3b0855849cacc4fd76b4c0e3770f5f36824ceb19

VETERANS AFFAIRS HEALTH CARE.
(a) In General.--Subchapter I of chapter 17 of title 38, United
States Code, is amended by inserting after section 1703F the following
new section (and amending the table of sections at the beginning of
such chapter accordingly):
``Sec. 1703G. Quarterly report on referrals for non-Department health
care
``The Secretary shall submit to the Committees on Veterans' Affairs
of the Senate and the House of Representatives a quarterly report
containing, with respect to referrals for non-Department health care
originating from a medical facility of the Department during the
quarter preceding the date of the submission of the report, a
measurement of, for each such medical facility--
``(1) the period of time between--
``(A) the date on which a clinician employed by the
Department determines that a veteran requires care, or a
veteran presents to the Department requesting care, and the
date on which the referral for care is sent to a non-Department
health care provider;
``(B) the date on which such referral is sent to a non-
Department health care provider and the date on which such non-
Department health care provider accepts such referral;
``(C) the date on which such non-Department health care
provider accepts such referral and the date on which such
referral is completed;
``(D) the date on which such referral is completed and the
date on which an appointment with a non-Department health care
provider is made; and
``(E) the date on which such an appointment is made and the
date on which such appointment occurs; and
``(2) any other period of time that the Secretary determines
necessary.''.
(b) Effective Date.--The first report under section 1703G, as added
by this section, shall be due not later than 180 days after the date of
the enactment of this section.

0dc5d02424bc91d9ded9474245fec9ac55e20eb2209ece45f6d95f6ba7ac56b5

DEPARTMENT OF VETERANS AFFAIRS ASSISTANT UNDER SECRETARIES.
Section 7306 of title 38, United States Code, is amended--
(1) by striking subsection (b);
(2) by redesignating subsections (c) through (g) as subsections
(b) through (f), respectively; and
(3) in subsection (c) (as so redesignated), by striking
``subsection (e)'' and inserting ``subsection (d)''.

edcc45dfe5d0e9a1aa4ae4de55431feee77cba8d11335b0297c754508c8f6302

PODIATRISTS, OPTOMETRISTS, AND DENTISTS OF DEPARTMENT OF VETERANS
AFFAIRS.
(a) Pay.--
(1) In general.--Section 7431 of title 38, United States Code,
is amended--
(A) by inserting ``optometrists,'' after ``podiatrists,''
each place it appears;
(B) by inserting ``optometrist'' after ``podiatrist,'' each
place it appears;
(C) in subsection (c)--
(i) in paragraph (5), by adding at the end the
following new sentence: ``Such a notice shall include a
statement of whether the market pay will increase,
decrease, or remain unchanged following such evaluation.'';
and
(ii) by adding at the end the following new paragraphs:
``(7) The Secretary shall ensure that each physician,
podiatrist, optometrist, and dentist in the Veterans Health
Administration is--
``(A) advised, on an annual basis, of the criteria
described in subparagraph (F) of paragraph (4);
``(B) evaluated in accordance with such criteria; and
``(C) compensated in accordance with--
``(i) applicable assignment and pay levels, subject to
relevant pay limitations; and
``(ii) the extent to which such criteria are met.
``(8) Not later than 120 days after the end of each fiscal
year, the Secretary shall submit to the Committees on Veterans'
Affairs of the Senate and the House of Representatives a report
that includes the following:
``(A) A list of each facility and specialty that conducted
an evaluation of pay during the period covered by the report.
``(B) For each evaluation described in subparagraph (A)--
``(i) a list of occupations for which pay was
evaluated, disaggregated by medical specialty, number of
authorized full-time employees, and onsite full-time
employees as of the date of the evaluation;
``(ii) the date such evaluation was completed;
``(iii) whether a market pay adjustment was made
following the evaluation per each occupation and specialty
evaluated;
``(iv) whether applicable employees were notified of
such evaluation;
``(v) whether local labor partners were notified of
such evaluation; and
``(vi) in the case of an evaluation that resulted in an
adjustment of pay--
``(I) the date such adjustment--
``(aa) was implemented; and
``(bb) became effective; and
``(II) the percentage of employees of each
occupation and specialty for which pay was adjusted
pursuant to such evaluation.
``(C) A list of facilities of the Department that have not
conducted an evaluation of market pay, pursuant to paragraph
(5), during the 18-month-period that precedes the date of the
submission of such report.''; and
(D) in subsection (e), by adding at the end the following
new paragraphs:
``(5) Notwithstanding any compensation or pay limitations under
this title or title 5, the Secretary may authorize the Under
Secretary for Health to pay physicians, podiatrists, optometrists,
and dentists--
``(A) awards authorized under this title;
``(B) advance payments, recruitment or relocation bonuses,
and retention allowances authorized under section 7410(a) of
this title or as otherwise provided by law;
``(C) incentives or bonuses under section 706 of this title
or as otherwise provided by law; and
``(D) earnings from fee-basis appointments under section
7405(a)(2) of this title.
``(6)(A) The Secretary may waive any pay limitation described
in this section (including tier limitations) that the Secretary
determines necessary for the recruitment or retention of critical
health care personnel whom the Secretary determines would provide
direct patient care.
``(B) Priority for such waivers shall be given for positions,
locations, and care provided through agreements that are costly to
the Department.
``(C) The Chief Human Capital Officer of the Department, the
Chief Financial Officer of the Department, and the Office of the
General Counsel of the Department shall review any waiver issued
under subparagraph (A).
``(D) During the period the authority under subparagraph (A) is
effective, the Secretary may not issue more than 300 waivers under
such subparagraph.
``(E) The Secretary may prescribe requirements, limitations,
and other considerations for waivers under such subparagraph.
``(F) Not later than 180 days after the date of the enactment
of the Senator Elizabeth Dole 21st Century Veterans Healthcare and
Benefits Improvement Act, and annually thereafter, the Secretary
shall submit to the Committees on Veterans' Affairs of the Senate
and the House of Representatives a report that includes--
``(i) any updates to the requirements, limitations, and
considerations prescribed under subparagraph (B) during the
period covered by the report;
``(ii) a description of the findings of each review, if
any, conducted pursuant to subparagraph (C);
``(iii) a description of each waiver under subparagraph (A)
in effect as of the date of the submission of the report,
including the--
``(I) duty location, position, specialty, market and
performance considerations for the waiver; and
``(II) impact, if any, of the waiver on care furnished
by the Department pursuant to an agreement regarding the
geographic area; and
``(iv) a list of any separation actions during the period
covered by the report with respect to a position for which a
waiver under subparagraph (A) is in effect.
``(G) The authority of the Secretary under subparagraph (A)
shall terminate on the last day of the third full fiscal year
following the date of the enactment of the Senator Elizabeth Dole
21st Century Veterans Healthcare and Benefits Improvement Act.''.
(2) Report on waiver authority.--Not later than 180 days after
the date of the enactment of this Act, the Secretary of Veterans
Affairs shall submit to the Committees on Veterans' Affairs of the
Senate and the House of Representatives a report that includes a
description of the requirements, limitations, and other
considerations prescribed under section 7431(b)(6)(D) of title 38,
United States Code, as added by paragraph (1).
(3) Conforming amendments.--
(A) Pay of under secretary for health.--Section 7432(b)(1)
of such title is amended by inserting ``, podiatrist,
optometrist,'' after ``physician''.
(B) Administrative matters.--Section 7433 of such title is
amended by inserting ``optometrists,'' after ``physicians,''
each place it appears.
(C) Competitive pay.--Section 7451(a)(2)(C) of such title
is amended by inserting ``optometrist,'' after ``physician,''.
(4) Clerical amendments.--
(A) Subchapter heading.--Subchapter III of chapter 74 of
such title is amended in the heading by inserting
``Optometrists,'' after ``PODIATRISTS,''.
(B) Table of sections.--The table of sections for such
chapter is amended by striking the item relating to subchapter
III and inserting the following:
``subchapter iii--pay for physicians and other health-care personnel''.
(5) Applicability dates.--The amendments made by this
subsection shall apply to any pay period of the Department of
Veterans Affairs beginning on or after the date that is 180 days
after the date of the enactment of this Act.
(b) Modification and Clarification of Pay Grade for Optometrists.--
Section 7404 of title 38, United States Code, is amended--
(1) in subsection (a)(2)(A), by striking ``podiatrists, and
dentists'' and inserting ``podiatrists, optometrists, and
dentists''; and
(2) in subsection (b)--
(A) by striking ``podiatrist (dpm), and dentist'' and
inserting ``podiatrist (dpm), optometrist (od), and dentist'';
(B) by striking ``clinical chiropractor and optometrist
schedule,'' and inserting ``clinical chiropractor schedule'';
and
(C) by inserting ``optometrist grade'' after ``Podiatrist
grade''.
(c) Retroactive Authority for Compensation.--
(1) In general.--The Secretary of Veterans Affairs may pay
retroactive compensation to a covered employee in an amount that
equals the amount of compensation that was authorized to be paid to
such covered employee during the period specified in paragraph (2),
but was deferred and paid to such employee in the calendar year
following the calender year in which such compensation was
authorized because the payment such compensation would have
exceeded an applicable cap on annual compensation.
(2) Period specified.--The period specified in this paragraph
is the period beginning on January 8, 2006, and ending on December
31, 2017.
(3) Exclusion.--Compensation authorized under this subsection
shall not be included in the calculation of any aggregate limit on
compensation for a covered employee for the year in which it is
paid.
(4) Charging of compensation.--Compensation authorized under
this subsection shall be charged to the appropriate medical care
appropriation account of the Department of Veterans Affairs for the
fiscal year in which the work was performed except as follows:
(A) In the case of an account that has closed pursuant to
section 1552 of title 31, United States Code, the compensation
shall be charged to a current appropriation account in
accordance with section 1553 of such title.
(B) In the case of an expired account that has not closed,
if charging the compensation to the expired account would cause
such account to have a negative unliquidated or unexpended
balance, the compensation may be charged to a current
appropriation account available for the same purpose.
(5) Definitions.--In this subsection:
(A) The term ``compensation'' means any pay, including
salary, awards, and incentives.
(B) The term ``covered employee'' means a physician,
podiatrist, or dentist subject to market pay under section 7431
of title 38, United States Code.

e8064e15d2a3c16ac5af9dd207267a321c7e0615a21935065d6d0e5eb28a9503

RURAL VETERANS.
(a) In General.--The Secretary of Veterans Affairs shall pay, or
reimburse a covered veteran for, the cost of transporting the veteran
by ambulance, including air ambulance, from a covered location to a
provider of the Department of Veterans Affairs, a non-Department
provider, or the nearest hospital that can meet the needs of the
veteran (including a hospital that compacts with the Indian Health
Service) for covered care.
(b) Amount Covered.--The maximum cumulative amount covered under
this section for a covered veteran is $46,000.
(c) Sunset.--This section shall cease to be effective on September
30, 2026.
(d) Definitions.--In this section:
(1) The term ``covered care'' means care for a veteran eligible
for care provided by the Department of Veterans Affairs under title
38, United States Code, or any other law administered by the
Secretary of Veterans Affairs, even if the care associated with the
transport described in subsection (a) is not authorized by the
Department.
(2) The term ``covered location'' means a location that is--
(A) in a State that is 100 miles or more from the nearest
medical center of the Department of Veterans Affairs; and
(B) in an area rated as a 10 or higher under the rural-
urban commuting areas coding system of the Department of
Agriculture.
(3) The term ``covered veteran'' means a veteran who--
(A) has a service-connected disability rated by the
Secretary as between 0 and 30 percent disabling;
(B) is not eligible for payments or reimbursements for
beneficiary travel or other transportation under the laws
administered by the Secretary of Veterans Affairs, other than
under this section; and
(C) is not entitled to care or services under a non-
Department of Veterans Affairs health-plan contract.
(4) The term ``health-plan contract'' has the meaning given
that term in section 1725 of title 38, United States Code.
(5) The term ``service-connected'' has the meaning given that
term in section 101 of such title.

7eb54b0520283a0a5d9b1abd413ba451a81619225ef5ad0d92700d14586ad043

OF VETERANS AFFAIRS TO CERTAIN VETERANS DIAGNOSED WITH ISCHEMIC
HEART DISEASE.
(a) In General.--Beginning not later than one year after the date
of the enactment of this Act, the Secretary of Veterans Affairs shall
carry out a two-year pilot program (in this section referred to as the
``pilot program'') under which the Secretary shall furnish covered care
to covered veterans through means that include the use of community
care.
(b) Locations.--
(1) In general.--The Secretary shall select not more than four
States in which to carry out the pilot program.
(2) Selection criteria.--In selecting States under paragraph
(1), the Secretary shall prioritize States in which--
(A) the Department of Veterans Affairs serves a high
proportion, as determined by the Secretary, of veterans
residing in rural or highly rural areas (as determined through
the use of the Rural-Urban Commuting Areas coding system of the
Department of Agriculture);
(B) dental clinics operated by the Department of Veterans
Affairs currently utilize teledentistry;
(C) the Department of Veterans Affairs does not currently
operate a dental clinic; or
(D) the Secretary determines a large percentage of veterans
enrolled in the system of annual patient enrollment of the
Department of Veterans Affairs established and operated under
paragraphs (1) or (2) of section 1705(a) of title 38, United
States Code, visit emergency rooms for dental emergencies at
high rates.
(c) Participation Limitation.--Participation in a pilot program
established pursuant to this section shall be limited to a covered
veteran who receives health care in a facility of the Department
located in a State selected under subsection (b).
(d) Use of Certain Methods to Provide Care.--
(1) Mobile dental clinics.--In carrying out the pilot program,
the Secretary shall test the efficacy of mobile dental clinics to
service rural areas that do not have a population base to warrant a
full-time clinic but where there are covered veterans in need of
dental care.
(2) Home-based dental care.--In carrying out the pilot program,
the Secretary shall test the efficacy of portable dental care units
to service rural veterans in their homes, as the Secretary
considers medically appropriate.
(e) Administration.--
(1) Community care network review.--
(A) In general.--Before commencing the pilot program, the
Secretary shall work with third party administrators to conduct
a review of dental providers who are part of the community care
network of the Department in each State selected under
subsection (b)(1) to ensure--
(i) dental providers who are no longer accepting
patients from the Department--
(I) are not still listed as providers accepting
referrals from the Department; and
(II) are not sent referrals from the Department;
and
(ii) dental providers participating in each such
network are capable of receiving an influx of patients from
the Department under the pilot program.
(B) Expansion of network.--If, pursuant to a review under
subparagraph (A), the Secretary determines the community care
network in a State selected under subsection (b)(1) is not
capable of receiving an influx of patients under the pilot
program, the Secretary shall coordinate with the Third Party
Administrator for such State to ensure the dental provider
network of such community care network is sufficiently expanded
before the initiation of the pilot program.
(2) Notice to covered veterans.--In carrying out the pilot
program, the Secretary shall inform all covered veterans in States
selected under subsection (b)(1) of the covered care available
under the pilot program.
(3) Loss of eligibility.--Any veteran participating in the
pilot program who ceases to be a covered veteran shall be removed
from the pilot program on the date that is 90 days after the
Secretary determines the participant is no longer a covered
veteran.
(4) Continuity of care.--
(A) In general.--Upon the termination of the pilot program,
the Secretary shall provide to all veterans participating in
the pilot program at the time of such termination--
(i) information on how to enroll in the dental
insurance plan of the Department of Veterans Affairs under
section 1712C of title 38, United States Code;
(ii) if appropriate, information on the VETSmile
program of the Department of Veterans Affairs, or any
successor program; and
(iii) contact information for dental providers in the
surrounding community who provide low- or no-cost dental
care and whom the Secretary has confirmed are available to
take on new patients.
(B) Continuation of treatment plan.--Any veteran
participating in the pilot program may continue to receive
services under the pilot program after the termination of the
pilot program to complete a treatment plan commenced under the
pilot program, as determined necessary by the Secretary.
(f) Reports.--
(1) Annual report.--Not later than one year after the
commencement of the pilot program, and annually thereafter for the
duration of the pilot program, the Secretary of Veterans Affairs
shall submit to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a report on the pilot program that
includes--
(A) an identification of the States participating in the
pilot program;
(B) a description of the implementation and operation of
the pilot program;
(C) the number of participants in the pilot program,
disaggregated by--
(i) State; and
(ii) disability rating;
(D) an identification of any barriers or challenges to
implementing the pilot program;
(E) aggregated feedback from participants in the pilot
program, including from interviews and surveys;
(F) the average annual cost of providing covered care to a
participant in the pilot program, disaggregated by--
(i) State;
(ii) disability rating; and
(iii) whether the care was provided through the
community care network or through a provider of the
Department;
(G) an analysis of the communication and collaboration of
the Department with Third Party Administrators and community
care dental providers, disaggregated by State;
(H) an analysis of any cost savings by the Department with
respect to the treatment of ischemic heart disease;
(I) an assessment of the impact of the pilot program on
appointments for care, prescriptions, hospitalizations,
emergency room visits, wellness, employability, satisfaction,
and perceived quality of life of covered veterans related to
their diagnosis of ischemic heart disease;
(J) an analysis and assessment of the efficacy of mobile
clinics and portable dental care units, to the extent such
modalities are used, to service the needs of covered veterans
under the pilot program;
(K) an analysis and assessment of the usage of
teledentistry to service the needs of covered veterans under
the pilot program, to include a cost benefit analysis of such
services; and
(L) such other matters as the Secretary considers
appropriate.
(2) Final report.--Not later than 90 days before the completion
of the pilot program, the Secretary shall submit to the Committees
on Veterans' Affairs of the House of Representatives and the Senate
a report on the pilot program that--
(A) includes the matters required under paragraph (1);
(B) includes recommendations on whether the pilot program
should be continued, expanded, or adopted throughout the
Department; and
(C) indicates whether the Secretary requests action by
Congress to make the pilot program permanent.
(g) Impact on Community Care.--Participants in the pilot program
shall be able to access covered care in the community under section
1703 of title 38, United States Code.
(h) Definitions.--In this section:
(1) The term ``covered care'' means dental care that is
consistent with the dental services and treatment furnished by the
Secretary of Veterans Affairs to veterans pursuant to section
1712(a)(1)(G) of title 38, United States Code.
(2) The term ``covered veteran'' means a veteran who--
(A) is enrolled in the system of annual patient enrollment
of the Department established and operated under paragraphs (1)
or (2) of section 1705(a) of title 38, United States Code;
(B) is not eligible for dental services and treatment and
related dental appliances under the laws administered by the
Secretary as of the date of the enactment of this Act; and
(C) has a diagnosis of ischemic heart disease.
(3) The term ``Third Party Administrator'' has the meaning
given such term in section 1703F of such title.

c80bc98c3197d1c2de4d86e7e268a4b2a90f85062e51dd80bdf7cce387e1dab0

OF APPOINTMENTS FOR HEALTH CARE UNDER LAWS ADMINISTERED BY
SECRETARY OF VETERANS AFFAIRS.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall develop
a mechanism to solicit information regarding the preference of veterans
enrolled in the system of annual patient enrollment of the Department
of Veterans Affairs established and operated under section 1705(a) of
title 38, United States Code, for scheduling of appointments for health
care and related services under the laws administered by the Secretary,
including through non-Department providers.
(b) Documentation of Preference.--Preferences provided voluntarily
by a veteran pursuant to subsection (a) shall be documented on My
HealtheVet or another system designated by the Secretary that allows
the veteran to view and change such preferences at any time.
(c) Inclusion in Preference.--Preferences solicited under
subsection (a) shall include the following:
(1) How and when the veteran prefers to be contacted about an
appointment for health care.
(2) Whether the veteran prefers to schedule appointments
without the assistance of the Department, if able.
(3) Whether the veteran prefers to select a provider without
the assistance of the Department, if able.
(4) Whether the veteran prefers appointments to be scheduled
during certain days or times.
(d) Use of Preference.--The Secretary shall make the preferences
provided under subsection (a) easily accessible to medical support
assistants and other staff of the Department, or non-Department staff,
as the Secretary determines appropriate, who assist in the appointment
scheduling process.
(e) Deployment of Mechanism.--
(1) In general.--Beginning after the date on which the
Secretary develops the mechanism required under subsection (a), the
Secretary shall--
(A) test the mechanism in not fewer than three
geographically diverse Veterans Integrated Service Networks;
and
(B) gather feedback about the effectiveness of such
mechanism from veterans, medical support assistants, staff and
other stakeholders as the Secretary determines appropriate.
(2) Limitation.--The Secretary may not implement such mechanism
across the Veterans Health Administration of the Department before
the Secretary addresses the feedback described in paragraph (1)(B).

6fad5185f9b8dbb05ba74d5ca65f05dc62839b3ee51cc6e550527c10b04dcade

EMPLOYEES OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Staffing Model.--
(1) In general.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall--
(A) develop, validate, and implement a staffing model for
the Office of Integrated Veteran Care of the Department of
Veterans Affairs, or successor office, Veterans Integrated
Services Networks, and medical centers of the Department that
includes appropriate target staffing levels nationally,
regionally, and locally to ensure timely access to care and
effectively oversee the provision of care by the Department,
whether at a facility of the Department or through a non-
Department provider; and
(B) provide to Congress a briefing on such staffing model,
which shall include--
(i) the metrics and measures used by the Secretary in
developing such staffing model;
(ii) an analysis of how such staffing model compares to
the staffing models of other relevant Government-owned and
private sector health care systems; and
(iii) an estimate of the portion of the roles in such
staffing model that will be filled by contracted staff at
any given time.
(2) Report on implementation of staffing model.--Not later than
one year after the date on which the Secretary implements the
staffing model required under paragraph (1), the Secretary shall
submit to Congress and the Comptroller General of the United States
a report containing--
(A) an update on such implementation; and
(B) information on the outcomes yielded by such staffing
model in terms of improved access to care for veterans and
improved compliance with relevant laws, regulations, policy
directives, and guidance governing access to care.
(b) Performance Metrics.--
(1) In general.--Not later than one year after the date of the
enactment of this Act, the Secretary shall develop and implement a
plan, with an appropriate tracking system, to incorporate
appropriate standardized performance metrics and oversight measures
within the performance appraisal systems for employees of the
Department specified in paragraph (2).
(2) Employees of the department specified.--Employees of the
Department specified in this paragraph are employees who are
responsible for ensuring timely access to care from the Department,
compliance with relevant statutes and regulations relating to the
provision of care, including section 1703 of title 38, United
States Code, and overseeing the provision of care, whether at a
facility of the Department or through a non-Department provider,
including employees within the Office of Integrated Veteran Care of
the Department, or successor office, employees of a Veterans
Integrated Service Network, and employees of a medical center of
the Department.
(3) Report on implementation of performance metrics.--Not later
than one year after implementing the performance metrics required
under paragraph (1), the Secretary shall submit to Congress and the
Comptroller General of the United States a report containing--
(A) an update on such implementation; and
(B) information on the outcomes yielded by such performance
metrics in terms of improved access to care for veterans and
improved compliance with relevant laws, policy directives, and
guidance governing access to care.
(c) GAO Report.--Not later than two years after the later of the
date on which the Comptroller General receives the report under
subsection (a)(2) or the report under subsection (b)(3), the
Comptroller General shall submit to Congress a report that includes--
(1) an assessment of the performance of the Office of
Integrated Veteran Care of the Department, or successor office, in
improving access to care for veterans in facilities of the
Department and pursuant to section 1703 of title 38, United States
Code; and
(2) such recommendations as the Comptroller General considers
appropriate with respect to improving access to the care described
in paragraph (1) for veterans.

15ce58348d7781a6537c7fdafae36bf65e5150656c1315b22d0aa52add775c63

Housing our Military Veterans Effectively Act of 2024 — S. 141

Other Sections

TITLE I

TITLE II

TITLE III

TITLE IV

TITLE V

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