II
119THCONGRESS
1
STSESSION S. 275
To improve the provision of care and services under the Veterans Community
Care Program of the Department of Veterans Affairs, and for other purposes.
IN THE SENATE OF THE UNITED STATES
JANUARY28, 2025
Mr. M
ORANintroduced the following bill; which was read twice and referred
to the Committee on Veterans’ Affairs
A BILL
To improve the provision of care and services under the
Veterans Community Care Program of the Department
of Veterans Affairs, and for other purposes.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3
(a) S
HORTTITLE.—This Act may be cited as the 4
‘‘Veterans’ Assuring Critical Care Expansions to Support 5
Servicemembers (ACCESS) Act of 2025’’. 6
(b) T
ABLE OFCONTENTS.—The table of contents for 7
this Act is as follows: 8
Sec. 1. Short title; table of contents.
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TITLE I—IMPROVEMENT OF VETERANS COMMUNITY CARE
PROGRAM
Sec. 101. Codification of requirements for eligibility standards for access to
community care from Department of Veterans Affairs.
Sec. 102. Requirement that Secretary notify veterans of eligibility for care
under Veterans Community Care Program.
Sec. 103. Consideration under Veterans Community Care Program of veteran
preference for care, continuity of care, and need for caregiver
or attendant.
Sec. 104. Notification of denial of request for care under Veterans Community
Care Program.
Sec. 105. Discussion of telehealth options under Veterans Community Care
Program.
Sec. 106. Extension of deadline for submittal of claims by health care entities
and providers under prompt payment standard.
TITLE II—MENTAL HEALTH TREATMENT PROGRAMS
Sec. 201. Definitions.
Sec. 202. Standardized process to determine eligibility of covered veterans for
participation in certain mental health treatment programs.
Sec. 203. Improvements to Department of Veterans Affairs Mental Health Res-
idential Rehabilitation Treatment Program.
TITLE III—OTHER HEALTH CARE MATTERS
Sec. 301. Plan on establishment of interactive, online self-service module for
care.
Sec. 302. Modification of requirements for Center for Innovation for Care and
Payment of the Department of Veterans Affairs and require-
ment for pilot program.
Sec. 303. Reports.
TITLE I—IMPROVEMENT OF VET-1
ERANS COMMUNITY CARE 2
PROGRAM 3
SEC. 101. CODIFICATION OF REQUIREMENTS FOR ELIGI-4
BILITY STANDARDS FOR ACCESS TO COMMU-5
NITY CARE FROM DEPARTMENT OF VET-6
ERANS AFFAIRS. 7
(a) E
LIGIBILITYACCESSSTANDARDS.—Section 8
1703B of title 38, United States Code, is amended— 9
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(1) by striking subsections (a) through (e) and 1
inserting the following: 2
‘‘(a) E
LIGIBILITYSTANDARDS FORACCESS TOCOM-3
MUNITYCARE.—(1) A covered veteran shall be eligible to 4
elect to receive non-Department hospital care, medical 5
services, or extended care services, excluding nursing home 6
care, through the Veterans Community Care Program 7
under section 1703 of this title pursuant to subsection 8
(d)(1)(D) of such section using the following eligibility ac-9
cess standards: 10
‘‘(A) With respect to primary care, mental 11
health care, or extended care services, excluding 12
nursing home care, if the Department cannot sched-13
ule an appointment for the covered veteran with a 14
health care provider of the Department who can pro-15
vide the needed service— 16
‘‘(i) within 30 minutes average driving 17
time (or such shorter average driving time as 18
the Secretary may prescribe) from the residence 19
of the veteran unless a longer average driving 20
time has been agreed to by the veteran in con-21
sultation with a health care provider of the vet-22
eran; and 23
‘‘(ii) within 20 days (or such shorter pe-24
riod as the Secretary may prescribe) of the date 25
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of request for such an appointment unless a 1
later date has been agreed to by the veteran in 2
consultation with a health care provider of the 3
veteran. 4
‘‘(B) With respect to specialty care, if the De-5
partment cannot schedule an appointment for the 6
covered veteran with a health care provider of the 7
Department who can provide the needed service— 8
‘‘(i) within 60 minutes average driving 9
time (or such shorter average driving time as 10
the Secretary may prescribe) from the residence 11
of the veteran unless a longer average driving 12
time has been agreed to by the veteran in con-13
sultation with a health care provider of the vet-14
eran; and 15
‘‘(ii) within 28 days (or such shorter pe-16
riod as the Secretary may prescribe) of the date 17
of request for such an appointment unless a 18
later date has been agreed to by the veteran in 19
consultation with a health care provider of the 20
veteran. 21
‘‘(2) For the purposes of determining the eligibility 22
of a covered veteran for care or services under paragraph 23
(1), the Secretary shall not take into consideration the 24
availability of telehealth appointments from the Depart-25
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ment when determining whether the Department is able 1
to furnish such care or services in a manner that complies 2
with the eligibility access standards under such paragraph. 3
‘‘(3) In the case of a covered veteran who has had 4
an appointment with a health care provider of the Depart-5
ment canceled by the Department for a reason other than 6
the request of the veteran, in calculating a wait time for 7
a subsequent appointment under paragraph (1), the Sec-8
retary shall calculate such wait time from the date of the 9
request for the original, canceled appointment. 10
‘‘(4) If a veteran agrees to a longer average drive 11
time or a later date under subparagraph (A) or (B) of 12
paragraph (1), the Secretary shall document the agree-13
ment to such longer average drive time or later date in 14
the electronic health record of the veteran and provide the 15
veteran a copy of such documentation. Such copy may be 16
provided electronically. 17
‘‘(b) A
PPLICATION.—The Secretary shall ensure that 18
the eligibility access standards established under sub-19
section (a) apply— 20
‘‘(1) to all care and services within the medical 21
benefits package of the Department to which a cov-22
ered veteran is eligible under section 1703 of this 23
title, excluding nursing home care; and 24
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‘‘(2) to all covered veterans, regardless of 1
whether a veteran is a new or established patient. 2
‘‘(c) P
ERIODICREVIEW OFACCESSSTANDARDS.— 3
Not later than three years after the date of the enactment 4
of the Veterans’ Assuring Critical Care Expansions to 5
Support Servicemembers (ACCESS) Act of 2025, and not 6
less frequently than once every three years thereafter, the 7
Secretary shall— 8
‘‘(1) conduct a review of the eligibility access 9
standards under subsection (a) in consultation 10
with— 11
‘‘(A) such Federal entities as the Secretary 12
considers appropriate, including the Depart-13
ment of Defense, the Department of Health and 14
Human Services, and the Centers for Medicare 15
& Medicaid Services; 16
‘‘(B) entities and individuals in the private 17
sector, including— 18
‘‘(i) veteran patients; 19
‘‘(ii) veterans service organizations; 20
and 21
‘‘(iii) health care providers partici-22
pating in the Veterans Community Care 23
Program under section 1703 of this title; 24
and 25
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‘‘(C) other entities that are not part of the 1
Federal Government; and 2
‘‘(2) submit to the appropriate committees of 3
Congress a report on— 4
‘‘(A) the findings of the Secretary with re-5
spect to the review conducted under paragraph 6
(1); and 7
‘‘(B) such recommendations as the Sec-8
retary may have with respect to the eligibility 9
access standards under subsection (a).’’; 10
(2) by striking subsection (g); 11
(3) by redesignating subsections (f), (h), and (i) 12
as subsections (d), (e), and (f), respectively; 13
(4) in subsection (d), as redesignated by para-14
graph (3)— 15
(A) by striking ‘‘established’’ each place it 16
appears; and 17
(B) in paragraph (1), by striking ‘‘(1) 18
Subject to’’ and inserting ‘‘C
OMPLIANCE BY 19
C
OMMUNITYCAREPROVIDERSWITHACCESS 20
S
TANDARDS.—(1) Subject to’’; 21
(5) in subsection (e), as so redesignated— 22
(A) in paragraph (1)— 23
(i) by striking ‘‘(1) Consistent with’’ 24
and inserting ‘‘D
ETERMINATIONREGARD-25
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INGELIGIBILITY.—(1) Consistent with’’; 1
and 2
(ii) by striking ‘‘designated access 3
standards established under this section’’ 4
and inserting ‘‘eligibility access standards 5
under subsection (a)’’; and 6
(B) in paragraph (2)(B), by striking ‘‘des-7
ignated access standards established under this 8
section’’ and inserting ‘‘eligibility access stand-9
ards under subsection (a)’’; and 10
(6) in subsection (f), as redesignated by para-11
graph (2)— 12
(A) in the matter preceding paragraph (1), 13
by striking ‘‘In this section’’ and inserting 14
‘‘D
EFINITIONS.—In this section’’; and 15
(B) in paragraph (2)— 16
(i) by striking ‘‘covered veterans’’ and 17
inserting ‘‘covered veteran’’; and 18
(ii) by striking ‘‘veterans described’’ 19
and inserting ‘‘a veteran described’’. 20
(b) C
ONFORMINGAMENDMENTS.—Section 1703(d) 21
of such title is amended— 22
(1) in paragraph (1)(D), by striking ‘‘des-23
ignated access standards developed by the Secretary 24
under section 1703B of this title’’ and inserting ‘‘eli-25
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gibility access standards under section 1703B(a) of 1
this title’’; and 2
(2) in paragraph (3), by striking ‘‘designated 3
access standards developed by the Secretary under 4
section 1703B of this title’’ and inserting ‘‘eligibility 5
access standards under section 1703B(a) of this 6
title’’. 7
SEC. 102. REQUIREMENT THAT SECRETARY NOTIFY VET-8
ERANS OF ELIGIBILITY FOR CARE UNDER 9
VETERANS COMMUNITY CARE PROGRAM. 10
Section 1703(a) of title 38, United States Code, is 11
amended by adding at the end the following new para-12
graph: 13
‘‘(5)(A) The Secretary shall notify each covered vet-14
eran in writing of the eligibility of such veteran for care 15
or services under this section as soon as possible, but not 16
later than two business days, after the date on which the 17
Secretary is aware that the veteran is seeking care or serv-18
ices and is eligible for such care or services under this 19
section. 20
‘‘(B) With respect to each covered veteran eligible for 21
care or services under subsection (d), the Secretary shall 22
provide such veteran periodic reminders, as the Secretary 23
determines appropriate, of their ongoing eligibility under 24
such subsection. 25
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‘‘(C) Any notification or reminder under this para-1
graph may be provided electronically.’’. 2
SEC. 103. CONSIDERATION UNDER VETERANS COMMUNITY 3
CARE PROGRAM OF VETERAN PREFERENCE 4
FOR CARE, CONTINUITY OF CARE, AND NEED 5
FOR CAREGIVER OR ATTENDANT. 6
Section 1703(d)(2) of title 38, United States Code, 7
is amended by adding at the end the following new sub-8
paragraphs: 9
‘‘(F) The preference of the covered veteran for 10
where, when, and how to seek hospital care, medical 11
services, or extended care services. 12
‘‘(G) Continuity of care. 13
‘‘(H) Whether the covered veteran requests or 14
requires the assistance of a caregiver or attendant 15
when seeking hospital care, medical services, or ex-16
tended care services.’’. 17
SEC. 104. NOTIFICATION OF DENIAL OF REQUEST FOR 18
CARE UNDER VETERANS COMMUNITY CARE 19
PROGRAM. 20
Section 1703 of title 38, United States Code, is 21
amended— 22
(1) by redesignating subsection (o) as sub-23
section (p); and 24
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(2) by inserting after subsection (n) the fol-1
lowing new subsection (o): 2
‘‘(o) N
OTIFICATION OFDENIAL OFREQUEST FOR 3
C
ARE ANDHOWTOAPPEAL.—(1) If a request by a vet-4
eran for care or services under this section is denied, the 5
Secretary shall notify the veteran in writing as soon as 6
possible, but not later than two business days, after the 7
denial is made— 8
‘‘(A) of the reason for the denial; and 9
‘‘(B) with instructions on how to appeal such 10
denial using the clinical appeals process of the Vet-11
erans Health Administration. 12
‘‘(2) If a denial under paragraph (1) is due to not 13
meeting the eligibility access standards under section 14
1703B(a) of this title, notice under such paragraph shall 15
include an explanation for why the Secretary does not con-16
sider the veteran to have met such standards. 17
‘‘(3) Any notification under this subsection may be 18
provided electronically.’’. 19
SEC. 105. DISCUSSION OF TELEHEALTH OPTIONS UNDER 20
VETERANS COMMUNITY CARE PROGRAM. 21
Section 1703 of title 38, United States Code, as 22
amended by section 104, is further amended— 23
(1) by redesignating subsection (p) as sub-24
section (q); and 25
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(2) by inserting after subsection (o) the fol-1
lowing new subsection (p): 2
‘‘(p) D
ISCUSSION OFOPTIONS FORTELEHEALTH.— 3
When discussing options for care or services for a covered 4
veteran under this section, the Secretary shall ensure that 5
the veteran is informed of the ability of the veteran to 6
seek care or services via telehealth, either through a med-7
ical facility of the Department or under this section, if 8
telehealth— 9
‘‘(1) is available to the veteran; 10
‘‘(2) is appropriate for the type of care or serv-11
ices the veteran is seeking, as determined by the 12
Secretary; and 13
‘‘(3) is acceptable to the veteran.’’. 14
SEC. 106. EXTENSION OF DEADLINE FOR SUBMITTAL OF 15
CLAIMS BY HEALTH CARE ENTITIES AND 16
PROVIDERS UNDER PROMPT PAYMENT 17
STANDARD. 18
Section 1703D(b) of title 38, United States Code, is 19
amended by striking ‘‘180 days’’ and inserting ‘‘one year’’. 20
TITLE II—MENTAL HEALTH 21
TREATMENT PROGRAMS 22
SEC. 201. DEFINITIONS. 23
In this title: 24
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(1) COVERED TREATMENT PROGRAM .—The 1
term ‘‘covered treatment program’’— 2
(A) means— 3
(i) a mental health residential reha-4
bilitation treatment program of the De-5
partment of Veterans Affairs; or 6
(ii) a program of the Department for 7
residential care for mental health and sub-8
stance abuse disorders; 9
(B) includes— 10
(i) the programs designated as of the 11
date of the enactment of this Act as domi-12
ciliary residential rehabilitation treatment 13
programs; and 14
(ii) any programs designated as domi-15
ciliary residential rehabilitation treatment 16
programs on or after such date of enact-17
ment; and 18
(C) does not include Compensated Work 19
Therapy Transition Residence programs of the 20
Department. 21
(2) C
OVERED VETERAN .—The term ‘‘covered 22
veteran’’ means a veteran described in section 23
1703(b) of title 38, United States Code. 24
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(3) SOCIAL SUPPORT SYSTEMS .—The term ‘‘so-1
cial support systems’’, with respect to a covered vet-2
eran— 3
(A) means— 4
(i) a member of the family of the cov-5
ered veteran, including a parent, spouse, 6
child, step-family member, or extended 7
family member; or 8
(ii) an individual who lives with the 9
veteran but is not a member of the family 10
of the veteran; and 11
(B) does not include a facility-organized 12
peer support program. 13
(4) T
REATMENT TRACK.—The term ‘‘treatment 14
track’’ means a specialized treatment program that 15
is provided to a subset of covered veterans in a cov-16
ered treatment program who receive the same or 17
similar intensive treatment and rehabilitative serv-18
ices. 19
SEC. 202. STANDARDIZED PROCESS TO DETERMINE ELIGI-20
BILITY OF COVERED VETERANS FOR PAR-21
TICIPATION IN CERTAIN MENTAL HEALTH 22
TREATMENT PROGRAMS. 23
(a) S
TANDARDIZED SCREENING PROCESS.—Not 24
later than one year after the date of the enactment of this 25
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Act, the Secretary of Veterans Affairs shall establish a 1
standardized screening process to determine, based on 2
clinical need, whether a covered veteran satisfies criteria 3
for priority or routine admission to a covered treatment 4
program. 5
(b) E
LIGIBILITYCRITERIA FORPRIORITYADMIS-6
SION.— 7
(1) I
N GENERAL.—Under the standardized 8
screening process required by subsection (a), a cov-9
ered veteran shall be eligible for priority admission 10
to a covered treatment program if the covered vet-11
eran meets criteria established by the Secretary that 12
include any of the following: 13
(A) Symptoms that— 14
(i) significantly affect activities of 15
daily life; and 16
(ii) increase the risk of such veteran 17
for adverse outcomes. 18
(B) An unsafe living situation. 19
(C) A high-risk flag for suicide. 20
(D) A determination of being a high risk 21
for suicide. 22
(E) Risk factors for overdose. 23
(F) Non-responsive, relapsed, or unable to 24
find recovery from one other course of treat-25
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ment, such as outpatient or intensive outpatient 1
treatment. 2
(G) Such other criteria as the Secretary 3
determines appropriate. 4
(2) C
ONSIDERATION.—In making a determina-5
tion that a covered veteran meets criteria established 6
by the Secretary under paragraph (1) for priority 7
admission to a covered treatment program, the Sec-8
retary shall consider any referral of a health care 9
provider of a covered veteran. 10
(c) T
IME FORSCREENING ANDADMISSION.—Under 11
the standardized screening process required by subsection 12
(a), the Secretary shall ensure a covered veteran— 13
(1) is screened not later than 48 hours after the 14
date on which the covered veteran, or a relevant 15
health care provider, makes a request for the cov-16
ered veteran to be admitted to a covered treatment 17
program; 18
(2) if determined eligible for priority admission 19
to a covered treatment program, is admitted to such 20
covered treatment program not later than 48 hours 21
after the date of such determination; and 22
(3) is screened at an appropriate time for po-23
tential mild, moderate, or severe traumatic brain in-24
jury. 25
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(d) CONSIDERATIONS.—In making placement deci-1
sions in a covered treatment program for veterans who 2
meet criteria for priority admission, the Secretary shall— 3
(1) consider the input of the covered veteran 4
with respect to the— 5
(A) program specialty, subtype, and treat-6
ment track offered to the covered veteran; and 7
(B) geographic placement of the covered 8
veteran; and 9
(2) maximize the proximity of the covered vet-10
eran to social support systems. 11
(e) C
ONDITIONSUNDERWHICHCARESHALLBE 12
F
URNISHEDTHROUGHNON-DEPARTMENTPROVIDERS.— 13
(1) P
RIORITY ADMISSION.—If the Secretary de-14
termines a covered veteran is eligible for priority ad-15
mission to a covered treatment program pursuant to 16
the standardized screening process required by sub-17
section (a) and the Secretary is unable to admit 18
such covered veteran to a covered treatment pro-19
gram at a facility of the Department of Veterans Af-20
fairs in a manner that complies with the require-21
ments under subsections (c) and (d), the Secretary 22
shall offer the covered veteran the option to receive 23
care at a non-Department facility that— 24
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(A) can admit the covered veteran within 1
the period required by subsection (c); 2
(B) is party to a contract or agreement 3
with the Department or enters into such a con-4
tract or agreement under which the Department 5
furnishes a program that is equivalent to a cov-6
ered treatment program to a veteran through 7
such non-Department facility; 8
(C) is licensed by a State; and 9
(D) is accredited by the Commission on 10
Accreditation of Rehabilitation Facilities or the 11
Joint Commission. 12
(2) R
OUTINE ADMISSION.—If the Secretary de-13
termines a covered veteran is eligible for routine ad-14
mission to a covered treatment program pursuant to 15
the standardized screening process required by sub-16
section (a) and the Secretary is unable to admit 17
such covered veteran to a covered treatment pro-18
gram at a facility of the Department of Veterans Af-19
fairs in a manner that complies with the access 20
standards for mental health care established pursu-21
ant to section 1703B of title 38, United States 22
Code, the Secretary shall offer the covered veteran 23
the option to receive care at a non-Department facil-24
ity that— 25
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(A) is party to a contract or agreement 1
with the Department or enters into such a con-2
tract or agreement under which the Department 3
furnishes a program that is equivalent to a cov-4
ered treatment program to a veteran through 5
such non-Department facility; 6
(B) is licensed by a State; and 7
(C) is accredited by the Commission on Ac-8
creditation of Rehabilitation Facilities or the 9
Joint Commission. 10
(3) R
ULE OF CONSTRUCTION .—This subsection 11
shall not be construed to affect a covered veteran in 12
a covered treatment program pursuant to a deter-13
mination made on or before the date of the enact-14
ment of this Act. 15
SEC. 203. IMPROVEMENTS TO DEPARTMENT OF VETERANS 16
AFFAIRS MENTAL HEALTH RESIDENTIAL RE-17
HABILITATION TREATMENT PROGRAM. 18
(a) P
ERFORMANCEMETRICS.— 19
(1) I
N GENERAL.—The Secretary of Veterans 20
Affairs shall develop metrics to track, and shall sub-21
sequently track, the performance of medical facilities 22
and Veterans Integrated Service Networks of the 23
Department of Veterans Affairs in meeting the re-24
quirements for— 25
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(A) screening, under section 202, for a 1
covered treatment program; and 2
(B) timely admission to a covered treat-3
ment program under such screening. 4
(2) E
LEMENTS.—The metrics developed under 5
paragraph (1) shall include metrics for tracking the 6
performance of medical facilities and Veterans Inte-7
grated Service Networks with respect to routine and 8
priority admission under a covered treatment pro-9
gram. 10
(b) O
VERSIGHT.— 11
(1) I
N GENERAL.—The Secretary shall develop 12
a process for systematically assessing the quality of 13
care delivered by Department and non-Department 14
providers treating covered veterans under this sec-15
tion, which shall include assessments of— 16
(A) the extent to which the provider is de-17
livering evidence-based treatments to covered 18
veterans; 19
(B) clinical outcomes for covered veterans; 20
(C) the ratio of licensed independent prac-21
titioners per resident; 22
(D) the rate of completion of training on 23
military cultural competence by licensed inde-24
pendent practitioners; and 25
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(E) potentially wasteful, fraudulent, or in-1
appropriate referral or billing practices. 2
(c) P
LACEMENT; TRANSPORTATION.— 3
(1) L
OCATIONS.—If the Secretary determines 4
that a covered veteran is in need of residential care 5
under a covered treatment program, the Secretary 6
shall provide to the covered veteran a list of loca-7
tions at which such covered veteran can receive such 8
residential care that meets— 9
(A) the standards for screening under sec-10
tion 202; and 11
(B) the care needs of the covered veteran, 12
including applicable treatment tracks. 13
(2) T
RANSPORTATION COVERAGE .—The Sec-14
retary shall provide transportation or pay for or re-15
imburse the costs of transportation for any covered 16
veteran who is admitted into a covered treatment 17
program and needs transportation assistance— 18
(A) from the residence of the covered vet-19
eran or a facility of the Department or author-20
ized non-Department facility that does not pro-21
vide such care to another such facility that pro-22
vides residential care covered under a covered 23
treatment program; and 24
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(B) back to the residence of the covered 1
veteran after the conclusion of a covered treat-2
ment program, if applicable. 3
(d) A
PPEALS.— 4
(1) I
N GENERAL.—The Secretary shall develop 5
a national policy and associated procedures under 6
which a covered veteran, a representative of a cov-7
ered veteran, or a provider who requests a covered 8
veteran be admitted to a covered treatment program, 9
including a provider of the Department or a non-De-10
partment provider, may file a clinical appeal pursu-11
ant to this subsection if the covered veteran is— 12
(A) denied admission into a covered treat-13
ment program; or 14
(B) accepted into a covered treatment pro-15
gram but is not offered bed placement in a 16
timely manner. 17
(2) T
IMELINESS STANDARDS FOR REVIEW .— 18
(A) I
N GENERAL.—The national policy and 19
procedures developed under paragraph (1) for 20
appeals described in such paragraph shall in-21
clude timeliness standards for the Department 22
to review and make a decision on such an ap-23
peal. 24
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(B) DECISION.—The Secretary shall re-1
view and respond to any appeal under para-2
graph (1) not later than 72 hours after the Sec-3
retary receives such appeal. 4
(3) P
UBLIC GUIDANCE.—The Secretary shall 5
develop, and make available to the public, guidance 6
on how a covered veteran, a representative of the 7
covered veteran, or a provider of the covered veteran 8
can file a clinical appeal pursuant to this sub-9
section— 10
(A) if the covered veteran is denied admis-11
sion into a covered treatment program; 12
(B) if the first date on which the covered 13
veteran may enter a covered treatment program 14
does not comply with the standards established 15
by the Department under section 1703B of title 16
38, United States Code, for purposes of deter-17
mining eligibility for mental health care under 18
subsections (d) and (e) of section 1703 of such 19
title; or 20
(C) with respect to such other factors as 21
the Secretary may specify. 22
(4) R
ULE OF CONSTRUCTION .—Nothing in this 23
subsection may be construed as granting a covered 24
veteran the right to appeal a decision of the Sec-25
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retary with respect to admission to a covered treat-1
ment program to the Board of Veterans’ Appeals 2
under chapter 71 of title 38, United States Code. 3
(e) T
RACKING OFAVAILABILITY ANDWAITTIMES.— 4
(1) I
N GENERAL.—The Secretary shall, to the 5
extent practicable, create a method for tracking 6
availability and wait times under a covered treat-7
ment program across all facilities of the Depart-8
ment, Veterans Integrated Service Networks of the 9
Department, and non-Department providers 10
throughout the United States. 11
(2) A
VAILABILITY OF INFORMATION .—The Sec-12
retary shall, to the extent practicable, make the in-13
formation tracked under paragraph (1) available in 14
real time to— 15
(A) the mental health treatment coordina-16
tors at each facility of the Department; 17
(B) the leadership of each medical center 18
of the Department; 19
(C) the leadership of each Veterans Inte-20
grated Service Network; and 21
(D) the Office of the Under Secretary for 22
Health of the Department. 23
(f) T
RAINING ANDOVERSIGHT.— 24
(1) T
RAINING.— 25
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(A) IN GENERAL.—The Secretary shall up-1
date and implement training for staff of the 2
Department directly involved in a covered treat-3
ment program regarding referrals, screening, 4
admission, placement decisions, and appeals for 5
such program, including all changes to proc-6
esses and guidance under such program re-7
quired by this section and section 202. 8
(B) C
OVERED VETERANS AWAITING ADMIS -9
SION.—The training under subparagraph (A) 10
shall include procedures for the care of covered 11
veterans awaiting admission into a covered 12
treatment program and communication with 13
such covered veterans and the providers of such 14
covered veterans. 15
(C) T
IMING OF TRAINING.— 16
(i) I
N GENERAL.—The Secretary shall 17
require the training under subparagraph 18
(A) to be completed by staff required to 19
complete such training— 20
(I) not later than 60 days after 21
beginning employment at the Depart-22
ment in a position that includes work 23
directly involving a covered treatment 24
program; and 25
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(II) not less frequently than an-1
nually. 2
(ii) T
RACKING.—The Secretary shall 3
track completion of training required 4
under clause (i) by staff required to com-5
plete such training. 6
(2) O
VERSIGHT STANDARDS .—The Secretary 7
shall review and revise oversight standards for the 8
leadership of the Veterans Integrated Service Net-9
works and the Veterans Health Administration to 10
ensure that facilities and staff of the Department 11
are adhering to the policy on access to care of each 12
covered treatment program. 13
(g) C
ARECOORDINATION AND FOLLOW-UPCARE.— 14
(1) C
ONTINUITY OF CARE.—The Secretary shall 15
ensure each covered veteran who is screened for ad-16
mission to a covered treatment program is offered, 17
and provided if agreed upon, care options during the 18
period between screening of the covered veteran and 19
admission of the covered veteran to such program to 20
ensure the covered veteran does not experience any 21
lapse in care. 22
(2) C
ARE COORDINATION FOR SUBSTANCE USE 23
DISORDER.—For a covered veteran being treated for 24
substance use disorder, the Secretary shall— 25
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(A) ensure there is a care plan in place 1
during the period between any detoxification 2
services or inpatient care received by the cov-3
ered veteran and admission of the covered vet-4
eran to a covered treatment program; and 5
(B) communicate that care plan to the cov-6
ered veteran, the primary care provider of the 7
covered veteran, and the facility where the cov-8
ered veteran is or will be residing under such 9
program. 10
(3) C
ARE PLANNING PRIOR TO DISCHARGE .— 11
(A) I
N GENERAL.—The Secretary, in con-12
sultation with the covered veteran and the 13
treating providers of the covered veteran in a 14
covered treatment program, shall ensure the 15
completion of a care plan prior to the covered 16
veteran being discharged from such program. 17
(B) M
ATTERS TO BE INCLUDED .—The 18
care plan required under subparagraph (A) for 19
a covered veteran shall include details on the 20
course of treatment for the covered veteran fol-21
lowing completion of treatment under the cov-22
ered treatment program, including any nec-23
essary follow-up care. 24
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(C) SHARING OF CARE PLAN .—The care 1
plan required under subparagraph (A) shall be 2
shared with the covered veteran, the primary 3
care provider of the covered veteran, and any 4
other providers with which the covered veteran 5
consents to sharing the plan. 6
(D) D
ISCHARGE FROM NON -DEPARTMENT 7
FACILITY.—Upon discharge of a covered vet-8
eran under a covered treatment program from 9
a non-Department facility, the facility shall 10
share with the Department all care records 11
maintained by the facility with respect to the 12
covered veteran and shall work in consultation 13
with the Department on the care plan of the 14
covered veteran required under subparagraph 15
(A). 16
(h) R
EPORTS TOCONGRESS.— 17
(1) R
EPORT ON MODIFICATIONS TO PRO -18
GRAMS.— 19
(A) I
N GENERAL.—Not later than two 20
years after the date of the enactment of this 21
Act, the Secretary shall submit to the Com-22
mittee on Veterans’ Affairs of the Senate and 23
the Committee on Veterans’ Affairs of the 24
House of Representatives a report on modifica-25
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tions made to the guidance, operation, and 1
oversight of covered treatment programs to ful-2
fill the requirements of this section. 3
(B) E
LEMENTS.—The report required by 4
subparagraph (A) shall include— 5
(i) an assessment of whether costs of 6
covered treatment programs, including for 7
residential care provided through facilities 8
of the Department and non-Department 9
facilities, serve as a disincentive to place-10
ment in the such a program; 11
(ii) a description of actions taken by 12
the Department to address the findings 13
and recommendations by the Secretary 14
contained in the report under section 15
503(c) of the STRONG Veterans Act of 16
2022 (division V of Public Law 117–328; 17
136 Stat. 5515), including— 18
(I) such actions with respect to— 19
(aa) any new locations 20
added for covered treatment pro-21
grams; 22
(bb) any beds added at ex-23
isting facilities of such programs; 24
and 25
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(cc) any additional treat-1
ment tracks or sex-specific pro-2
grams created or added at facili-3
ties of the Department; and 4
(II) a breakdown of the number 5
and percentage of covered veterans 6
who are determined eligible for pri-7
ority placement into a covered treat-8
ment program and the number and 9
percentage of covered veterans who 10
are determined eligible for routine 11
placement into a covered treatment 12
program; and 13
(iii) such recommendations as the 14
Secretary may have for legislative or ad-15
ministrative action to address any funding 16
constraints or disincentives for use of a 17
covered treatment program. 18
(2) A
NNUAL REPORT ON OPERATION OF PRO -19
GRAMS.— 20
(A) I
N GENERAL.—Not later than one year 21
after the submission of the report under para-22
graph (1), and not less frequently than annu-23
ally thereafter during the period in which a cov-24
ered treatment program is carried out, the Sec-25
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retary shall submit to the Committee on Vet-1
erans’ Affairs of the Senate and the Committee 2
on Veterans’ Affairs of the House of Represent-3
atives a report on the operation of such pro-4
grams. 5
(B) E
LEMENTS.—Subject to subparagraph 6
(C), each report required by subparagraph (A) 7
shall include the following: 8
(i) The number of covered veterans 9
served by a covered treatment program, 10
disaggregated by— 11
(I) Veterans Integrated Service 12
Network in which the covered veteran 13
receives care; 14
(II) facility, including facilities of 15
the Department and non-Department 16
facilities, at which the covered veteran 17
receives care; 18
(III) type of residential rehabili-19
tation treatment care received by the 20
covered veteran under such program; 21
(IV) sex of the covered veteran; 22
and 23
(V) race or ethnicity of the cov-24
ered veteran. 25
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(ii) Wait times under a covered treat-1
ment program for the most recent year 2
data is available, disaggregated by— 3
(I) treatment track or specificity 4
of residential rehabilitation treatment 5
care sought by the covered veteran; 6
(II) sex of the covered veteran; 7
(III) State or territory in which 8
the covered veteran is located; 9
(IV) Veterans Integrated Service 10
Network in which the covered veteran 11
is located; and 12
(V) facility of the Department at 13
which the covered veteran seeks care. 14
(iii) A list of all locations of a covered 15
treatment program and number of bed 16
spaces at each such location, disaggregated 17
by residential rehabilitation treatment care 18
or treatment track provided under such 19
program at such location. 20
(iv) A list of any new locations of cov-21
ered treatment programs added or removed 22
and any bed spaces added or removed dur-23
ing the one-year period preceding the date 24
of the report. 25
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(v) Average cost of a stay under a 1
covered treatment program, including total 2
stay average and daily average, at facilities 3
of the Department compared to non-De-4
partment facilities. 5
(vi) A review of staffing needs and 6
gaps with respect to covered treatment 7
programs. 8
(vii) Any recommendations for 9
changes to the operation of covered treat-10
ment programs, including any policy 11
changes, guidance changes, training 12
changes, or other changes. 13
(C) A
NONYMITY.—To ensure that the data 14
provided under this paragraph, or some portion 15
of that data, will not undermine the anonymity 16
of a veteran, the Secretary shall provide such 17
data pursuant to applicable Federal law and in 18
a manner that is wholly consistent with applica-19
ble Federal privacy and confidentiality laws, in-20
cluding— 21
(i) section 552a of title 5, United 22
States Code (commonly known as the ‘‘Pri-23
vacy Act of 1974’’); 24
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(ii) the Health Insurance Portability 1
and Accountability Act of 1996 (Public 2
Law 104–191); 3
(iii) parts 160 and 164 of title 45, 4
Code of Federal Regulations, or successor 5
regulations; and 6
(iv) sections 5701, 5705, and 7332 of 7
title 38, United States Code. 8
(i) R
EVISION OFGUIDANCE.—The Secretary shall 9
update the guidance of the Department on the operation 10
of covered treatment programs to reflect each of the re-11
quirements under subsections (b) through (h). 12
(j) D
EADLINE.—The Secretary shall carry out each 13
requirement under this section by not later than one year 14
after the date of the enactment of this Act, unless other-15
wise specified. 16
(k) C
OMPTROLLERGENERALREVIEW.— 17
(1) I
N GENERAL.—Not later than two years 18
after the date of the enactment of this Act, the 19
Comptroller General of the United States shall re-20
view access to care under a covered treatment pro-21
gram for covered veterans in need of residential 22
mental health care and substance use disorder care. 23
(2) E
LEMENTS.—The review required by para-24
graph (1) shall include the following: 25
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(A) A review of wait times under a covered 1
treatment program, disaggregated by— 2
(i) treatment track or specificity of 3
residential rehabilitation treatment care 4
needed; 5
(ii) sex of the covered veteran; 6
(iii) home State of the covered vet-7
eran; 8
(iv) home Veterans Integrated Service 9
Network of the covered veteran; and 10
(v) wait times for— 11
(I) facilities of the Department; 12
and 13
(II) non-Department facilities. 14
(B) A review of policy and training of the 15
Department on screening, admission, and place-16
ment under a covered treatment program. 17
(C) A review of the rights of covered vet-18
erans and providers to appeal admission deci-19
sions under a covered treatment program and 20
how the Department adjudicates appeals. 21
(D) When determining the facility at which 22
a covered veteran admitted to a covered treat-23
ment program will be placed in such program, 24
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a review of how the input of the covered veteran 1
is taken into consideration with respect to— 2
(i) program specialty, subtype, or 3
treatment track offered to the covered vet-4
eran; and 5
(ii) the geographic placement of the 6
covered veteran, including family- or occu-7
pation-related preferences or cir-8
cumstances. 9
(E) A review of staffing and staffing needs 10
and gaps of covered treatment programs, in-11
cluding with respect to— 12
(i) mental health providers and coor-13
dinators at the facility level; 14
(ii) staff of facilities of such pro-15
grams; 16
(iii) staff of Veterans Integrated Serv-17
ice Networks; and 18
(iv) overall administration of such 19
programs at the national level. 20
(F) Recommendations for improvement of 21
access by covered veterans to care under a cov-22
ered treatment program, including with respect 23
to— 24
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(i) any new sites or types of programs 1
needed or in development; 2
(ii) changes in training or policy; 3
(iii) changes in communications with 4
covered veterans; and 5
(iv) oversight of covered treatment 6
programs by the Department. 7
TITLE III—OTHER HEALTH CARE 8
MATTERS 9
SEC. 301. PLAN ON ESTABLISHMENT OF INTERACTIVE, ON-10
LINE SELF-SERVICE MODULE FOR CARE. 11
(a) I
NGENERAL.—The Secretary of Veterans Af-12
fairs, working with Third Party Administrators and acting 13
through the Center for Innovation for Care and Payment 14
of the Department of Veterans Affairs under section 15
1703E of title 38, United States Code, shall develop and 16
implement a plan to establish an interactive, online self- 17
service module— 18
(1) to allow veterans to request appointments, 19
track referrals for health care under the laws admin-20
istered by the Secretary, whether at a facility of the 21
Department or through a non-Department provider, 22
and receive appointment reminders; 23
(2) to allow veterans to appeal and track deci-24
sions relating to— 25
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(A) denials of requests for care or services 1
under section 1703 of title 38, United States 2
Code; or 3
(B) denials of requests for care or services 4
at facilities of the Department, including under 5
section 1710 of such title; and 6
(3) to implement such other matters as deter-7
mined appropriate by the Secretary in consultation 8
with Third Party Administrators. 9
(b) S
UBMITTAL OFPLAN.— 10
(1) I
NITIAL PLAN.—Not later than 180 days 11
after the date of the enactment of this Act, the Sec-12
retary shall submit to the Committee on Veterans’ 13
Affairs of the Senate and the Committee on Vet-14
erans’ Affairs of the House of Representatives the 15
plan developed under subsection (a). 16
(2) Q
UARTERLY UPDATE .—Not less frequently 17
than quarterly following the submittal of the plan 18
under paragraph (1) and for two years thereafter, 19
the Secretary shall submit to the Committee on Vet-20
erans’ Affairs of the Senate and the Committee on 21
Veterans’ Affairs of the House of Representatives a 22
report containing any updates on the implementa-23
tion of such plan. 24
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(c) RULE OFCONSTRUCTION.—This section shall not 1
be construed to be a pilot program subject to the require-2
ments of section 1703E of title 38, United States Code. 3
(d) T
HIRDPARTYADMINISTRATORDEFINED.—In 4
this section, the term ‘‘Third Party Administrator’’ means 5
an entity that manages a provider network and performs 6
administrative services related to such network under sec-7
tion 1703 of title 38, United States Code. 8
SEC. 302. MODIFICATION OF REQUIREMENTS FOR CENTER 9
FOR INNOVATION FOR CARE AND PAYMENT 10
OF THE DEPARTMENT OF VETERANS AF-11
FAIRS AND REQUIREMENT FOR PILOT PRO-12
GRAM. 13
(a) I
NGENERAL.—Section 1703E of title 38, United 14
States Code, is amended— 15
(1) in subsection (a)— 16
(A) in paragraph (1), by striking ‘‘within 17
the Department’’ and inserting ‘‘within the Of-18
fice of the Secretary’’; 19
(B) in paragraph (2), by striking ‘‘may’’ 20
and inserting ‘‘shall’’; and 21
(C) in paragraph (3)— 22
(i) in subparagraph (A), by striking ‘‘; 23
and’’ and inserting a semicolon; 24
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(ii) in subparagraph (B), by striking 1
the period at the end and inserting ‘‘; or’’; 2
and 3
(iii) by adding at the end the fol-4
lowing new subparagraph: 5
‘‘(C) increase productivity, efficiency, and mod-6
ernization throughout the Department.’’; 7
(2) by striking subsection (d) and inserting the 8
following new subsection (d): 9
‘‘(d) B
UDGETARYLINEITEM.—The Secretary shall 10
include in the budget justification materials submitted to 11
Congress in support of the budget of the Department of 12
Veterans Affairs for a fiscal year (as submitted with the 13
budget of the President under section 1105(a) of title 31) 14
specific identification, as a budgetary line item, of the 15
amounts required to carry out this section.’’; 16
(3) in subsection (f)— 17
(A) in paragraph (1), by striking ‘‘in sub-18
chapters I, II, and III of this chapter’’ and in-19
serting ‘‘of this title, of title 38, Code of Fed-20
eral Regulations, and of any handbooks, direc-21
tives, or policy documents of the Department’’; 22
and 23
(B) in paragraph (2), in the matter pre-24
ceding subparagraph (A), by striking ‘‘waiving 25
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any authority’’ and inserting ‘‘waiving any pro-1
vision of this title’’; 2
(4) in subsection (g)(1), by inserting ‘‘fewer 3
than three or’’ before ‘‘more than 10’’; 4
(5) in subsection (i)— 5
(A) in paragraph (1), by striking ‘‘the 6
Under Secretary for Health and the Special 7
Medical Advisory Group established pursuant to 8
section 7312 of this title’’ and inserting ‘‘the 9
Under Secretary for Health, the Special Med-10
ical Advisory Group established pursuant to 11
section 7312 of this title, the Office of Inte-12
grated Veteran Care (or successor office), the 13
Office of Finance (or successor office), the Vet-14
eran Experience Office (or successor office), the 15
Office of Enterprise Integration (or successor 16
office), and the Office of Information and Tech-17
nology (or successor office)’’; and 18
(B) in paragraph (2), by striking ‘‘rep-19
resentatives of relevant Federal agencies, and 20
clinical and analytical experts with expertise in 21
medicine and health care management’’ and in-22
serting ‘‘representatives of relevant Federal 23
agencies, nonprofit organizations, and other 24
public and private sector entities, including 25
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those with clinical and analytical experts with 1
expertise in medicine and health care manage-2
ment’’; and 3
(6) by adding at the end the following new sub-4
section: 5
‘‘(k) R
EPORT ONACTIVITIES OFCENTER FORINNO-6
VATION FORCARE ANDPAYMENT.—Not less frequently 7
than annually, the Secretary shall submit to Congress a 8
report that contains, for the one-year period preceding the 9
date of the report— 10
‘‘(1) a full accounting of the activities, staff, 11
budget, and other resources and efforts of the Cen-12
ter; and 13
‘‘(2) an assessment of the outcomes of the ef-14
forts of the Center.’’. 15
(b) C
OMPTROLLER GENERALREPORT.—Not later 16
than 18 months after the date of the enactment of this 17
Act, the Comptroller General of the United States shall 18
submit to Congress a report— 19
(1) on the efforts of the Center for Innovation 20
for Care and Payment of the Department of Vet-21
erans Affairs in fulfilling the objectives and require-22
ments under section 1703E of title 38, United 23
States Code, as amended by subsection (a); and 24
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(2) containing such recommendations as the 1
Comptroller General considers appropriate. 2
(c) P
ILOTPROGRAM.— 3
(1) I
N GENERAL.—Not later than one year 4
after the date of the enactment of this Act, the Cen-5
ter for Innovation for Care and Payment of the De-6
partment of Veterans Affairs under section 1703E 7
of title 38, United States Code, shall establish a 8
three-year pilot program in not fewer than five loca-9
tions to allow veterans enrolled in the system of an-10
nual patient enrollment of the Department estab-11
lished and operated under section 1705(a) of such 12
title to access outpatient mental health and sub-13
stance use services through health care providers 14
specified under section 1703(c) of such title without 15
referral or pre-authorization. 16
(2) P
RIORITY.—In selecting sites for the pilot 17
program under paragraph (1), the Secretary shall 18
prioritize sites in the following areas: 19
(A) Areas with varying degrees of urban-20
ization, including urban, rural, and highly rural 21
areas. 22
(B) Areas with high rates of suicide among 23
veterans. 24
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(C) Areas with high rates of overdose 1
deaths among veterans. 2
(D) Areas with high rates of calls to the 3
Veterans Crisis Line. 4
(E) Areas with long wait times for mental 5
health and substance use services at facilities of 6
the Department. 7
(F) Areas with outpatient mental health 8
and substance use programs that utilize a 9
value-based care model, to the extent prac-10
ticable. 11
(3) E
LEMENTS.—The Secretary, in imple-12
menting the pilot program under paragraph (1), 13
shall ensure the Department has a care coordination 14
system in place that includes— 15
(A) knowledge sharing, including the time-16
ly exchange of medical documentation; 17
(B) assistance with transitions of care, in-18
cluding the potential need for inpatient or resi-19
dential psychiatric services, substance use de-20
toxification services, post-detoxification step- 21
down services, and residential rehabilitation 22
programs; 23
(C) continuous assessment of patient needs 24
and goals; and 25
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(D) creating personalized, proactive care 1
plans. 2
(4) O
VERSIGHT AND OUTCOMES .—The Sec-3
retary shall develop appropriate metrics and meas-4
ures— 5
(A) to track and oversee sites at which the 6
pilot program under paragraph (1) is carried 7
out; 8
(B) to monitor patient safety and out-9
comes under the pilot program; and 10
(C) to assess and mitigate any barriers to 11
extending the pilot program across the entire 12
Veterans Health Administration. 13
(5) A
NNUAL REPORT.— 14
(A) I
N GENERAL.—Not later than one year 15
after the commencement of the pilot program 16
under paragraph (1), and not less frequently 17
than annually thereafter during the duration of 18
the pilot program, the Secretary shall submit to 19
the Committee on Veterans’ Affairs of the Sen-20
ate and Committee on Veterans’ Affairs of the 21
House of Representatives a report on the pilot 22
program, which shall include the following: 23
(i) The number of unique veterans 24
who participated in the pilot program. 25
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(ii) The number of health care pro-1
viders who participated in the pilot pro-2
gram. 3
(iii) An assessment of the effective-4
ness of the pilot program in increasing ac-5
cess to, and improving outcomes for, men-6
tal health and substance use treatment 7
services. 8
(iv) The cost of the pilot program. 9
(v) Such other matters as the Sec-10
retary considers appropriate. 11
(B) F
INAL REPORT.—The Secretary shall 12
include in the final report submitted under sub-13
paragraph (A), in addition to the requirements 14
under such subparagraph, the assessment by 15
the Secretary of the feasibility and advisability 16
of extending the pilot program across the entire 17
Veterans Health Administration, including a 18
plan, timeline, and required resources for such 19
an extension. 20
(6) V
ETERANS CRISIS LINE DEFINED .—In this 21
subsection, the term ‘‘Veterans Crisis Line’’ means 22
the toll-free hotline for veterans established under 23
section 1720F(h) of title 38, United States Code. 24
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SEC. 303. REPORTS. 1
(a) R
EPORT ONIMPROVEMENTS TO CLINICALAP-2
PEALSPROCESS.—Not later than one year after the date 3
of the enactment of this Act, and not less frequently than 4
once every three years thereafter, the Secretary of Vet-5
erans Affairs, in consultation with veterans service organi-6
zations, veterans, caregivers of veterans, employees of the 7
Department of Veterans Affairs, and other stakeholders 8
as determined by the Secretary, shall submit to the Com-9
mittee on Veterans’ Affairs of the Senate and Committee 10
on Veterans’ Affairs of the House of Representatives a 11
report containing recommendations for legislative or ad-12
ministrative action to improve the clinical appeals process 13
of the Department with respect to timeliness, trans-14
parency, objectivity, consistency, and fairness. 15
(b) R
EPORT ONREQUIREDCARE ANDSERVICES 16
U
NDERCOMMUNITYCAREPROGRAM.—Not later than 17
one year after the date of the enactment of this Act, and 18
not less frequently than annually thereafter, the Secretary 19
shall submit to the Committee on Veterans’ Affairs of the 20
Senate and Committee on Veterans’ Affairs of the House 21
of Representatives a report that contains, for the one-year 22
period preceding the date of the report, the following: 23
(1) The number of veterans eligible for care or 24
services under section 1703 of title 38, United 25
States Code, and the reasons for such eligibility, in-26
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cluding multiple such reasons for veterans eligible 1
under more than one eligibility criteria. 2
(2) The number of veterans who opt to seek 3
care or services under such section. 4
(3) The number of veterans who do not opt to 5
seek care or services under such section. 6
(4) An assessment of the timeliness of referrals 7
for care or services under such section. 8
(5) The number of times a veteran did not 9
show for an appointment for care or services under 10
such section. 11
(6) The number of requests for an appeal of a 12
denial of care or services under such section using 13
the clinical appeals process of the Veterans Health 14
Administration. 15
(7) The timeliness of each such appeal. 16
(8) The outcome of each such appeal. 17
(c) V
ETERANSSERVICEORGANIZATIONDEFINED.— 18
In this section, the term ‘‘veterans service organization’’ 19
means any organization recognized by the Secretary under 20
section 5902 of title 38, United States Code. 21
Æ
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